| Background:At present, the incidence of prostate cancer in China is much lower than that of Europe and the United States, but the trend is rising in recent years. The data from Shanghai Municipal disease control and prevention shows that male prostate cancer incidence is11.81/100000, ranking the fifth of male cancer.Partical the newly diagnosed patients with prostate cancer may recive curative effect after radical prostatectomy or radical external beam radiotherapy, but mostly patients with prostate cancer are not suitable for radical treatment because of elderly, poor health, complications and so on. For these patients, hormonal therapy, brachytherapy, cryotherapy, high tension focused ultrasound and chemotherapy are still optional and hormonal therapy or radiation therapy are the most common.Hormonal therapy of prostate cancer refers to the removal of androgen and the mechanism of prostate cancer is on the basis of androgen-dependent prostate cancer cells.By lowering androgen concentration in the body, synthesis of androgen is inhibited. Because of blocking the androgen receptors combined with receptors and testosterone can not translate into dihydrotestosterone, the prostate cancer cell proliferation is inhibited or controled.Hormonal therapy are divided into continuous hormonal therapy and intermittent hormonal therapy. Continuous hormonal therapy can obviously inhibite prostate cancer cell, achieving the objective of anti-tumor. But there are still several disadvantages during the application process, such as drug resistance, decreasing in quality of life as a result of complications and high medical costs.Through the intermitten blocking androgen, tumor cells regain their ability to grow and the process of development to androgen-independent prostate cancer can be delayed. IHT has the advantage of extending the time of tumor dependenting on androgen, improving patients’ quality of life and good economic benefits.IHT applies to each stage of prostate cancer, particularly localized lesions or recurrent after curative treatment. Cancer cell proliferation during off-treament period and a single course of treatment might also accelerate progress. Whether it can be combine with other treatments such as radiotherapy and reduce the risk of disease progression and have a higher quality of life is one of the hot spots in the present study.The radiation therapy for prostate cancer included brachytherapy and external radiotherapy.Radiation damages structure of DNA in tumor cells and external environment of tumor growth, apoptosis in tumor cells is triggered. At this stage, brachytherapy technology for prostate cancer generally refers to permanent radioactive125I seeds interstitial planted persistent low dose rate brachytherapy(brachytherapy,LDR-BT).The indication of brachytherapy is not yet fully consolidated,which mainly refers to the standard of American brachytherapy Society:①low-risk prostate cancer(clinical stage T1-2aN0M0; Gleason sorce<7; PSA <10ng/ml) and the prostate volume was no more than60ml, monotherapy with brachytherapy is effective.②Combining with external radiotherapy, hormonal therapy and other method can be achieved quite good results for patients with high-risk prostate cancer whose multi or bilateral biopsy positive and which breakthroughs the prostate capsule and violations the peripheral nerve.In recent years,most researches confirm that effective of125I seeds implantation brachytherapy for low-risk prostate cancer with external radiation therapy is equal to that of external radiation therapy.125I seeds implantation is minimally invasive, safe,effective and low complication rates,which have been domestic application. Foreign studies have shown that estrogen combining with radiotherapy can reduce the volume of advanced prostate cancer and the rate of local progress.The aim of brachytherapy combining with endocrine therapy is to reduce the complications of radiotherapy and side effects of hormone therapy, destruct cancer cells and reduce the risk of early micrometastases. Finally, event-free survival rate and overall survival can improve.Merrick’s research indicates that125I,103Pd seeds implantation in425patients with prostate cancer T1～3,5-yr biochemical progression-free survival rate was94%.5-yr biochemical progression-free survival rate of low, intermediate and high risk group were97.1%、97.5%、84.4%, respectively. Median PSA was no more than0.2ng/ml. Among seeds implantation brachytherapy, external radiotherapy and radical prostatectomy, seeds implantation brachytherapy has the advantage of improving quality of life. At present, many studies have shown that hormonal therapy combining with125I seed implantation for prostate cancer has a good effect, but enroll criteria for cases, hormonal therapy and effective evaluation criteria had not been reached a consensus. Therefore, we compare two group of patients with prostate cancer who receive intermittent hormonal therapy or intermittent hormonal therapy combining with125I seed implantation in our retrospective analysis.Objective:To compare the clinical efficacy of intermittent hormonal therapy and intermittent hormonal therapy combining with125I seed implantation for patients with prostate cancer. To investigate the important factor for intermittent hormonal therapy in the treatment of patients with prostate cancer. To compare the clinical efficacy of transrectal and transperineal puncure125I seed implantation in patients with prostate cancer.Methods:A retrospective analysis was carried on for the patients with prostate cancer in our hospital from December2004to December2012. Clinical stage of82patients with prostate cancer was T2b-3aN0M0, all of them recivied intermittent hormonal therapy(IHT), while42case recivied IHT combining with125I seed implantation(IHT+125I).The follow-up time was38～50months, median was45months.Patients were randomized divided into two group:IHT group and IHT+125I group. IHT use maximum androgen blockade treatment which includes goserelin sustained-release implant and bicalutamide tablets. Hormonal therapy should be stopped when the PSA≤0.2ng/ml maintaining over3～6months.When the PSA>4ng/ml, we started for the next cycle of IHT+125I. Hormonal therapy of IHT was the same as before.125I seed was put into prostate in3nd month at1th cycle, whose prescription dose was145Gy. IHT+125I group included twenty-four cases with transperineal punctures and sixteen cases with transrectal punctures.Clinical information of patients were gathered, including age, TNM stage, Gleason score, the values of PSA, PV, Qmax and IPSS in pre-treatment and post-treatment of6,12,24,36months.The duration time including on-treatment and off-treament period in the first cycle of intermittent hormonal therapy,2-yr biochemical progression-free survival, biochemical progression-free survival time, the number of patients whose nadir PSA≤0.1ng/ml after treament and quality of life and complications were compared between the two group.Biochemical progression was defined as three consecutive rises in nadir PSA levels every two weeks after hormonal therapy.According to ABS and RTOG recommended standards, clinical classification of urinary and rectal complications were assessed.Statistical method:All measuring information were used for statistical analysis by SPSS13.0and were expressed as mean±standard deviation(x±s). Paired-t tests were used to compare with the data of pre-treatment and post-treatment and two independent samples-t tests were used to compare the data of two groups. Repeated measures analysis of variance was used for the comparison of values in diffrencent time. Chi-square test was used for the percentage of number. Survival analysis applied for Kaplan-Meier method and Cox proportional hazard models for multivariate analysis. In all analyses, P<0.05was considered statistically significant.Results:1. Compared with pre-treatment, notable decline in PSA (IHT group:F=239.121, P<0.001; IHT+125I group:F=199.896, P<0.001), obvious narrowing in PV (IHT+125I group:F=278.635, P<0.001; IHT group:F=391.526, P<0.001), IPSS improvement (IHT+125I group:F=639.230, P<0.001; IHT group: F=516.685, P<0.001),Qmax improvement (IHT+125I group:F=783.875, P <0.001; IHT group:F=559.471, P<0.001) were observed post-treatment6months,12months,24months and36months later.2. The duration time of treatment period of the first cycle in intermittent hormonal therapy are no significant difference between two group.(P>0.05),but the duration time of intermittent period of the first cycle in the IHT+125I group is superior to that of IHT group (P<0.001).3.2-year biochemical progression-free survival rate of IHT group and IHT+125I group are38.1%(16/42) and87.1%(35/40) respectively.Therefore,2-year biochemical progression-free survival rate of IHT+125I group is superior to that of IHT group (χ2=21.268, v=1, P<0.001).4.The biochemical progression-free survival time of IHT group and IHT+125I group are21.21±4.57months and32.95±5.85months respectively.Therefore,combined treatment can improve biochemical progression-free survival time in patients with localized prostate cancer(P<0.001).5. There are28.6%(12/42) and80%(32/40) of the patients in IHT group and IHT+125I group respectively,whose post-treament nadir PSA is less than or equal to0.1ng/ml (χ2=21.792, v=1, P<0.001). So IHT+125I group is superior to IHT group.6. Univariate analysis shows that age and PSA are independent of2-year biochemical progression-free survival rate (P>0.05).Gleason score, TNM staging, combined treatment and post-treament nadir PSA relates to2-year biochemical progression-free survival rate (P<0.001)7. Multivariate analysis use Cox regression analysis model, post-treament nadir PSA and combining with125I implantation brachytherapy are key factors for biochemical progression-free survival time of intermittent hormonal therapy.7. Clinical efficacy and complications of the two puncturing methods for125I implantation brachytherapy are no different(P>0.05), But transrectal puncture procedure is simple, short, perineal pain-free, stay short after implantation (P<0.01).Conclusions:1. IHT and IHT+125I for prostate cancer is effective, but IHT+125I can improve2-year biochemical progression-free survival rate and the duration time in the first cycle of intermittent hormonal therapy.2. Post-treatment nadir PSA, combining with brachytherapy are two important factors of biochemical progression-free survival time with intermittent hormonal therapy for prostate cancer.3.Clinical efficacy and complications of the transrectal and transperineal puncture methods for seed implantation brachytherapy are no different, but transrectal puncture procedure is simple, short, perineal pain-free, stay short after implantation... |
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