前列腺癌骨转移影像学疗效评价误区—个案报道及文献综述
发布时间：2018-09-07 15:04
【摘要】：[研究背景及目的] 前列腺癌是最易发生骨转移的恶性肿瘤之一。近年来针对转移性前列腺癌,尤其是去势抵抗性前列腺癌(Castration resistant prostate cancer CRPC),我们目睹了一系列新的有效的治疗手段,因此如何在治疗早期正确判断所选择治疗方案的疗效显得十分重要。正确评价前列腺癌骨转移患者现行治疗方案的疗效面领着巨大挑战,应用影像学检查评价治疗疗效所显示的假性进展,使影像学工作者及临床工作者的正确疗效评价陷入困境。本文结合不同影像学检查手段检测骨转移的机制,总结不同影像学检查可能出现的误区,指出如何正确识别出假阳性结果,从而能够正确判定治疗疗效。 [方法] 本文报道了一名伴骨转移的激素难治性前列腺癌(Hormone-refractory prostate cancer HRPC)患者经2周期化疗后行磁共振检查(Magnetic resonance imaging MRI)显示疾病进展,而患者骨痛症状缓解、前列腺特异性抗原(Prostate specific antigen PSA)下降超50%,继续原方案化疗随访MRI显示骨转移灶缩小,直至化疗10周期结束正电子发射计算机断层扫描／计算机断层扫描技术(Positron emission tomography/Computed tomography PET/CT)检查显示未见明显骨代谢的个案案例。回顾相关文献,讨论了前列腺癌骨转移的特点、相关影像学检查手段、影像学检查误区,并提出了正确合理疗效评价的建议。 [结论] 影像学检查误区主要包括CT及骨扫描技术(Bone scintigraphy BS)上的“闪烁”现象及MRI上的骨髓逆转现象。准确地识别此类假性进展尤为重要。对于前列腺癌骨转移患者的疗效评价单单依据影像学检查手段是不明智的,应结合PSA反应、骨痛症状等多项评估指标予以综合评价,从而避免错误评估导致临床决策的错误。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25
本文编号：2228607
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25
【参考文献】
相关期刊论文 前1条
1 韩苏军;张思维;陈万青;李长岭;;中国前列腺癌发病现状和流行趋势分析[J];临床肿瘤学杂志;2013年04期
，本文编号：2228607
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