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目的探讨超声引导放射性125I粒子治疗前列腺癌方法建立和近期疗效。方法26例前列腺癌全身或硬膜外麻醉下行经直肠超声引导粒子植入治疗。经直肠超声获取前列腺图像,将图像直接传输到计算机治疗计划系统,术中适时计算机计划,肿瘤周边匹配剂量(matched peripheral do-ses,MPD)145~160 Gy。根据治疗计划插植粒子针,利用Mick植入器植入粒子,粒子植入总数为19~90颗,粒子活度0.35~0.4 mCi。术后1个月行盆腔CT扫描,质量验证。结果26例患者成功实施会阴超声和模板引导放射性125I粒子组织间近距离治疗前列腺癌手术。手术历时1~1.5 h。术后验MPD为(137.73±36.5014)Gy。26例前列腺癌患者125I粒子治疗后生物化学控制率92.3%,2例患者术后6个月出现骨转移。125I粒子植入治疗,34.6%无尿道副反应,Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级尿道副反应分别为38.5%、11.5%、11.5%、0和0。Ⅰ级直肠副反应发生率为3.9%。1例患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺。结论经会阴超声引导放射性粒子治疗前列腺癌具有微创、精确度高和副反应发生率低等优势。
Objective To investigate the establishment and short-term efficacy of ultrasound-guided radioactive 125I particles in the treatment of prostate cancer. Methods Twenty-six cases of prostate cancer underwent transrectal ultrasound-guided particle implantation for systemic or epidural anesthesia. Prostate images were obtained by transrectal ultrasound and the images were transmitted directly to a computerized treatment planning system with a timely intraoperative computer program and matched peripheral do-ses (MPD) of 145-160 Gy. According to the treatment plan inserted needle, the use of Mick implants implanted particles, the total number of particles implanted 19 to 90, particle activity 0.35 ~ 0.4 mCi. Postoperative pelvic CT scan 1 month, quality verification. Results Twenty-six patients underwent successful perineal ultrasound and template-guided radiofrequency 125I intra-brachytherapy brachytherapy. Surgery lasted 1 ~ 1.5 h. Postoperative MPD was (137.73 ± 36.5014) Gy. The biochemical control rate was 92.3% after 125I particles treatment in 26 patients with prostate cancer, and 2 patients had bone metastasis 6 months after operation. 125I seed implantation, 34.6% no urethral side effects, and grade I, II, III, IV and V urethral side effects were 38.5%, 11.5%, 11.5%, 0 and 0 respectively. Grade Ⅰ rectal adverse reaction rate was 3.9%. One patient had one particle displaced without causing clinically relevant complications and no particle translocation to the lungs. Conclusions Transperitoneal ultrasound guided radioactive particle therapy for prostate cancer has the advantages of minimal invasion, high accuracy and low incidence of side effects.