Kasahara K, Inoue K, Karashima T, Inoue Y, Kariya S, Inomata T, Yoshida S, Shuin T
Department of Urology, Kochi Medical School.
Nihon Hinyokika Gakkai Zasshi. 2001 Jul;92(5):572-8. doi: 10.5980/jpnjurol1989.92.572.
We report our technique and also preliminary results in the cases with localized prostate cancer treated by the combination of high-dose rate Iridium-192 (HDR-Ir192) brachytherapy and external irradiation.
From June 1999 to August 2000, 17 patients were treated by the combination of HDR-Ir 192 and external beam. The mean age of patients was 72 years (range, 48-81 years). The clinical stage was B1 in 5, B2 in 7 and C (no cancer with seminal vesicle) in 5 cases. Of 10 patients without neoadjuvant hormonal therapy, the median initial pretreatment PSA was 15.3 ng/ml (6.93-222.32 ng/ml). The treatment was given by HDR-Ir 192 brachytherapy (6 Gy x 3 times/2 days) and external beam irradiation (40 or 45 Gy). The brachytherapy was given using TRUS guided percutaneously inserted temporary needles with a high dose rate remote afterloading control. Local control was evaluated by digital rectal examination. TRUS-guided biopsies and serum PSA evaluations. Follow-up ranged from 2 to 14 months, with a median of 8 months.
In 4 (40.0%) of 10 patients without neoadjuvant hormonal therapy the level of serum PSA was decreased to less than 4.0 ng/ml within 3 months after the therapy. The effective grade in the biopsy specimens of 8 patients without neoadjuvant hormonal therapy was Grade Ob in 4, Grade 1 in 1, Grade 3 in 3 cases at 3 months after the therapy. No severe intra- or peri-operative complications occurred.
The combined radiotherapy treatment is safe and effective for use in the patients with localized prostate cancer. However, more comprehensive studies involving long-term follow-up and great numbers of the cases with localized prostate cancer treated by the combination of HDR-Ir 192 brachytherapy and external irradiation will be necessary to determine whether this therapy contributes to better prognosis.
我们报告高剂量率铱 - 192（HDR - Ir192）近距离放疗与外照射联合治疗局限性前列腺癌的技术及初步结果。
1999年6月至2000年8月，17例患者接受了HDR - Ir192与外照射联合治疗。患者平均年龄72岁（范围48 - 81岁）。临床分期为B1期5例，B2期7例，C期（无精囊侵犯）5例。10例未接受新辅助激素治疗的患者，治疗前初始前列腺特异抗原（PSA）中位数为15.3 ng/ml（范围6.93 - 222.32 ng/ml）。治疗采用HDR - Ir192近距离放疗（6 Gy×3次/2天）和外照射（40或45 Gy）。近距离放疗通过经直肠超声（TRUS）引导经皮插入临时针并采用高剂量率远程后装控制。通过直肠指检、TRUS引导活检和血清PSA评估进行局部控制评估。随访时间为2至14个月，中位数为8个月。
10例未接受新辅助激素治疗的患者中，4例（40.0%）在治疗后3个月内血清PSA水平降至4.0 ng/ml以下。8例未接受新辅助激素治疗患者的活检标本在治疗后3个月时，有效分级为0b级4例，1级1例，3级3例。未发生严重的术中或围手术期并发症。
联合放疗治疗局限性前列腺癌患者安全有效。然而，需要进行更全面的研究，包括长期随访以及大量采用HDR - Ir192近距离放疗与外照射联合治疗的局限性前列腺癌病例，以确定该疗法是否有助于改善预后。
