發(fā)布時(shí)間：2018-09-07 15:04

【摘要】：[研究背景及目的] 前列腺癌是最易發(fā)生骨轉(zhuǎn)移的惡性腫瘤之一。近年來(lái)針對(duì)轉(zhuǎn)移性前列腺癌,尤其是去勢(shì)抵抗性前列腺癌(Castration resistant prostate cancer CRPC),我們目睹了一系列新的有效的治療手段,因此如何在治療早期正確判斷所選擇治療方案的療效顯得十分重要。正確評(píng)價(jià)前列腺癌骨轉(zhuǎn)移患者現(xiàn)行治療方案的療效面領(lǐng)著巨大挑戰(zhàn),應(yīng)用影像學(xué)檢查評(píng)價(jià)治療療效所顯示的假性進(jìn)展,使影像學(xué)工作者及臨床工作者的正確療效評(píng)價(jià)陷入困境。本文結(jié)合不同影像學(xué)檢查手段檢測(cè)骨轉(zhuǎn)移的機(jī)制,總結(jié)不同影像學(xué)檢查可能出現(xiàn)的誤區(qū),指出如何正確識(shí)別出假陽(yáng)性結(jié)果,從而能夠正確判定治療療效。 [方法] 本文報(bào)道了一名伴骨轉(zhuǎn)移的激素難治性前列腺癌(Hormone-refractory prostate cancer HRPC)患者經(jīng)2周期化療后行磁共振檢查(Magnetic resonance imaging MRI)顯示疾病進(jìn)展,而患者骨痛癥狀緩解、前列腺特異性抗原(Prostate specific antigen PSA)下降超50%,繼續(xù)原方案化療隨訪MRI顯示骨轉(zhuǎn)移灶縮小,直至化療10周期結(jié)束正電子發(fā)射計(jì)算機(jī)斷層掃描／計(jì)算機(jī)斷層掃描技術(shù)(Positron emission tomography/Computed tomography PET/CT)檢查顯示未見明顯骨代謝的個(gè)案案例。回顧相關(guān)文獻(xiàn),討論了前列腺癌骨轉(zhuǎn)移的特點(diǎn)、相關(guān)影像學(xué)檢查手段、影像學(xué)檢查誤區(qū),并提出了正確合理療效評(píng)價(jià)的建議。 [結(jié)論] 影像學(xué)檢查誤區(qū)主要包括CT及骨掃描技術(shù)(Bone scintigraphy BS)上的“閃爍”現(xiàn)象及MRI上的骨髓逆轉(zhuǎn)現(xiàn)象。準(zhǔn)確地識(shí)別此類假性進(jìn)展尤為重要。對(duì)于前列腺癌骨轉(zhuǎn)移患者的療效評(píng)價(jià)單單依據(jù)影像學(xué)檢查手段是不明智的,應(yīng)結(jié)合PSA反應(yīng)、骨痛癥狀等多項(xiàng)評(píng)估指標(biāo)予以綜合評(píng)價(jià),從而避免錯(cuò)誤評(píng)估導(dǎo)致臨床決策的錯(cuò)誤。
[Abstract]:Background and objective Prostate cancer is one of the most likely malignant tumors to metastasize bone. In recent years, we have witnessed a series of new and effective treatments for metastatic prostate cancer, especially ovariectomized prostate cancer (Castration resistant prostate cancer CRPC),). Therefore, it is very important to correctly judge the therapeutic effect of the selected treatment in the early stage of treatment. It is a great challenge to evaluate the therapeutic effect of the current treatment plan for patients with bone metastasis of prostate cancer correctly. The false progress shown by the application of imaging examination in evaluating the therapeutic effect makes the correct evaluation of curative effect of imaging workers and clinical workers into a dilemma. Based on the mechanism of detecting bone metastases by different imaging methods, this paper summarizes the possible misunderstandings in different imaging examinations, and points out how to correctly identify false positive results so as to correctly judge the therapeutic effect. [methods] A steroid-refractory prostate cancer with bone metastasis (Hormone-refractory prostate cancer HRPC) was examined by (Magnetic resonance imaging MRI) after 2 cycles of chemotherapy, and the symptoms of bone pain were relieved. The prostate specific antigen (Prostate specific antigen PSA) decreased by more than 50%. The follow-up of the original chemotherapy MRI showed that the bone metastases were reduced. Up to the end of the 10th cycle of chemotherapy, positron emission computed tomography / computed tomography (Positron emission tomography/Computed tomography PET/CT) showed no significant bone metabolism. In this paper, the characteristics of bone metastases of prostate cancer, the methods of imaging examination and the misunderstandings of imaging examination were discussed, and the suggestions of correct and reasonable evaluation of curative effect were put forward. [conclusion] the misunderstandings in imaging examination mainly include "scintillation" on CT and bone scanning technique on (Bone scintigraphy BS) and bone marrow reversal on MRI. It is particularly important to identify such false advances accurately. It is unwise to evaluate the curative effect of prostate cancer patients with bone metastases only by means of imaging examination. The evaluation should be combined with PSA reaction, bone pain symptom and so on, so as to avoid the wrong evaluation of clinical decision.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.25

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 韓蘇軍;張思維;陳萬(wàn)青;李長(zhǎng)嶺;;中國(guó)前列腺癌發(fā)病現(xiàn)狀和流行趨勢(shì)分析[J];臨床腫瘤學(xué)雜志;2013年04期

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本文編號(hào)：2228607