Solhjem Matthew C, Davis Brian J, Pisansky Thomas M, Wilson Torrence M, Mynderse Lance A, Hillman David W, Herman Michael G, King Bernard F
Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Cancer J. 2004 Nov-Dec;10(6):343-8. doi: 10.1097/00130404-200411000-00003.
Limited duration neoadjuvant cytoreductive hormonal therapy (NHT) is used before the definitive radiotherapeutic management of prostate cancer to decrease target volume size and/or to decrease urinary obstructive symptoms. The purpose of this study is to examine the effect of NHT on prostate volume before permanent prostate brachytherapy (PPB) and on prostatic edema after PPB.
Between May 1998 and February 2004, 408 patients underwent PPB at our institution and provided research authorization for the use of their records. Of these, 122 (30%) underwent NHT. Of the 122, 78 (64%) underwent transrectal ultrasound before the start of NHT. Patients undergoing PPB who received NHT were compared with a similar non-NHT group (N = 286). Detailed measurements of prostate volume were performed by transrectal ultrasound before and after NHT, if applicable. In addition, intraoperative preimplantation transrectal ultrasound and post-implantation transrectal ultrasound were also performed. Post-implantation computed tomography was per formed within 1 day of PPB.
The mean duration of NHT was 4.0 +/- 1.1 months (range, 1-8 months). The mean prostate volume before NHT was 63.3 +/- 22.8 cc (range, 19-138 cc), and after NHT (before PPB), it was 41.6 +/- 16.4 cc (18-98 cc). The median prostate volume decrease after NHT was 22.7 cc or 34.9%. There was no significant difference in the degree of postimplantation prostate edema, as measured by the postimplantation to preimplantation ratio (1.18 +/- 0.05 [range, 0.8-1.9]) for the NHT group and 1.21 +/- 0.03 (range, 0.8-1.9) for the non-NHT group (P = 0.5).
Prostate volume decreased by approximately one third after 4 months of NHT. NHT did not affect the degree of post-PPB prostatic edema.
在前列腺癌的确定性放射治疗前，采用有限疗程的新辅助细胞减灭激素疗法（NHT）以减小靶区体积和/或减轻尿路梗阻症状。本研究的目的是探讨NHT对永久性前列腺近距离放疗（PPB）前前列腺体积以及PPB后前列腺水肿的影响。
1998年5月至2004年2月期间，408例患者在本机构接受了PPB，并提供了使用其记录的研究授权。其中，122例（30%）接受了NHT。在这122例患者中，78例（64%）在NHT开始前接受了经直肠超声检查。将接受NHT的PPB患者与类似的非NHT组（N = 286）进行比较。如有必要，在NHT前后通过经直肠超声对前列腺体积进行详细测量。此外，还进行了术中植入前经直肠超声和植入后经直肠超声检查。在PPB后1天内进行植入后计算机断层扫描。
NHT的平均疗程为4.0±1.1个月（范围1 - 8个月）。NHT前前列腺平均体积为63.3±22.8立方厘米（范围19 - 138立方厘米），NHT后（PPB前）为41.6±16.4立方厘米（18 - 98立方厘米）。NHT后前列腺体积中位数减少22.7立方厘米或34.9%。通过植入后与植入前的比值测量，NHT组植入后前列腺水肿程度为1.18±0.05（范围0.8 - 1.9），非NHT组为1.21±0.03（范围0.8 - 1.9），两组之间无显著差异（P = 0.5）。
NHT治疗4个月后前列腺体积减少约三分之一。NHT不影响PPB后前列腺水肿程度。
