目的 比较125Ⅰ粒子植入近距离放疗与间歇性内分泌治疗在前列腺癌治疗中的效果.方法 2001年1月至2006年2月期间,未能接受根治性前列腺切除的前列腺癌患者74例,分为2组,43例采用单纯间歇性内分泌治疗；31例单纯采用近距离125Ⅰ粒子植入,比较2组患者的临床症状、PSA变化情况、局部进展率、无事件生存率.结果 5年生存率和无事件生存率在两组之间比较差异无统计学意义.对于危险分级低危的病例,近距放疗组无事件生存率为77.78％ (7/9),内分泌治疗组的无事件生存率为26.67％ (4/15),两者之间存在差异(P=0.015)；治疗一年后PSA及PSA的变化两组比较,差异均无统计学意义.治疗一年后PSA比较,两组间差异存在统计学意义(P=0.003)；治疗前后的PSA的变化差异亦存在统计学意义(P=0.038).结论 对于早期、低危的前列腺痛的治疗首选近距放疗,对于晚期、中高危患者,内分泌治疗与近距放疗效果相近,是否需要联合治疗,需要进一步实践研究.%Objective To study the effects of 125I seed implantation brachytherapy and intermittent hormonal therapy for patients with prostate cancer. Methods From January 2001 to February 2006, a total of 74 patients with prostate cancer, who couldn't undergo radical prostatectomy, were divided into two groups. Forty-three of them received the intermittent endocrine therapy alone, while 31 cases received the close125I seed implantation. Their symptoms, PSA changes, local progression rate and event-free survival in the two groups were comparatively analyzed. Results The total of 74 patients, 5-year survival rate, event-free survival was no significant difference between two groups. However, for the low-risk grade patients, the event-free survival of the brachytherapy group was 77.78% (7/9), the event-free survival rate of endocrine treatment group was 26.67% (4/15). There was a significant differences between the two groups (P=0.015); By the patients of low risk classification , the serum PSA one year after treatment showed significant differences between the two groups(P=0.003); significant difference was also found in PSA (P=0.038) before and after treatment. For the intermediate to high risk grade patients, there was not significant differences between the two groups. Conclusion For patients with early low-risk prostate cancer, brachytherapy is the first choice. For patients with advanced, intermediate-risk and high-risk prostate cancer, the endocrine therapy and brachytherapy show the same effect. Suggestions of the integral therapy needs further study.
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