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3.3. Results of treatment of patients of group II

General characteristic.

49 men have been included in group II localised RPZH, 5 patients have been excluded from research for following reasons:

- 4 (80,0 %) - non-observance of procedures of research and-or loss of contact,

- 1 (20,0 %) - growth of the DOG after BT, regarded by us as biochemical relapse RPZH.

As a result, the analysis of results of treatment of 44 prostates sick by a localised cancer by which as a method of radical treatment it is executed BT is carried out.

The characteristic of patients of group II.

Table 26.

Parametre Average value

Age (years) 67,70±6,50 (from 54 to 75)

DOG (ng/ml) 8,17±3,23 (from 2,7 to 14,4)

Volume PZH (sm3) 45,24±10,55 (from 23 to 66)

Vv (ml) 267,43±65,64 (from 154 to 380)

Qm (ml/c) 9,34±2,64 (from 5 to 13)

Qmax (ml/c) 17,56±6,51 (from 15 to 36)

OOM (sm3) 20,68±16,53 (from 0 to 51)

IPSS (points) 6,14±3,63 (from 2 to 14)

QoL 1,86±1,34 (from 0 to 4)

At the moment of the beginning of research at one patient of group II it has not been taped development risk factors infravezikalnoj obstructions (tab. 26). Despite it, the analysis of questionnaire IPSS has shown presence at patients of some complaints. Most often in group II the symptoms bound to a boring of a bladder became perceptible: nokturija (on the average 1,5 points), a strangury (on the average 1,14 points) and a pollakiuria (on the average 1,0 point). The symptoms caused infravezikalnoj by obstruction, met seldom (fig. 33).

The incomplete

oporozhnenie

2

' Speeded up

Nokturija g IT

And msche

0,5

I

It is complicated. • intermittent

The beginning / to urine my

Vv/aja a stream the Imperative.

Desires

Drawing 33. Expression of symptoms of the bottom urinary ways (IPSS) in group II at the moment of the research beginning.

On a question on that, as though the patient felt, if available symptoms remained till the end of a life (QoL), an uncooperative altitude have stated 6 (13,6 %) patients, 29 (66,0 %) have chosen positive variants, 9 (20,4 %) the interrogated were at a loss with the answer. The variant was chosen "very badly" by any patient, thus an estimation have "perfectly put at once 9 (20,4 %) patients (fig. 34).

prekrasno "Well" it is good 1 I Am at a loss "Badly More likely

Drawing 34. Quality of a life (QoL) patients of group II at the moment of the beginning of research (%).

Brahiterapija.

In group 2 brahiterapija it has been executed to 44 patients. Features of implantation it has not been noted, average time of operation has made 29,54 ±3,02 (from 25 to 35) minute

At all patients SOD was not less than 145 Gr, having averaged 162,95 ±7,0 (from 152,0 to 174,7) Gr. The average quantity of the needles used at implantation, has made 26,09 ±3,19 (from 18 to 32), and quantity of sources - 70,45 ±6,26 (from 54 to 80).

To all patients implantation of sources was spent under spinal anaesthesia, complications has not been fixed.

The gross hematuria became perceptible at 7 (15,9 %) patients, at one patient it has demanded to enlarge time of a drainage of a bladder till 3 days, at other patients catheters have been removed next day after operation.

At 4 (9,1 %) patients of group II after excision of an urethral catheter it is diagnosed OZM which was resolved after a repeated short-term drainage of a bladder.

Other significant complications of the early postoperative period in group II it has not been fixed. At the moment of an extract at all patients the independent emiction was restored.

postimplantatsionnoe observation.

All patients passed control inspection in 3, 6, 9 and 12 months after brahiterapii. On these visits the control of risk factors of development infravezikalnoj obstructions was carried out: prostate and residual urine volume, indicators urofloumetrii, an estimation of quality of a life and IPSS. Level of the DOG was besides defined. In 1 month after brahiterapii it was spent postimplantatsionnoe dosimetric planning. In 3 and 12 months after implantation of sources the analysis of early and late radial damages on classification RTOG was carried out.

Dynamics of volume of a prostate is presented in a drawing 35. Before carrying out BT average volume PZH made 45,24 ±10,55 sm, by third month after implantation of sources it authentically has not changed, the tendency to its reduction however is noted. The least volume is fixed in 9 months after BT and has made 34,80 ±9,69 sm that has appeared authentically below a reference value (р=0,000003).

Drawing 35. Dynamics of average value of volume of a prostate in

3

To group in II (sm).

The volume of a residual urine at patients of group II statistically was not significantly enlarged by third month after BT, and further decreased at each control measurement, having reached the least value (16,25 ±21,84 ml) by 9 month after implantation (р=0,004) (fig. 36).

Drawing 36. Dynamics of average value of volume of a residual urine (OOM) in

To group in II (sm).

The analysis of dynamics of indicators urofloumetrii has shown, that authentically worst value Qmax and Qm are fixed in 3 months after implantation of sources (p=0,00). At the further measurements the augmentation of indicators which in 9 months authentically did not differ from reference values (р=1,00) became perceptible, however by the moment of the termination of research remained a little bit more low predimplantatsionnogo level (fig. 37).

-A-Qmax-A-Qrn

Drawing 37 Dynamics of value of average value of volume maximum and average rate of an emiction (Qmax and Qm) in group II (ml/c).

The volume of an emiction which was initially equaled 267,43 yo 65,64 ml, after BT has statistically significantly decreased, and on all extent of research remained authentically below a reference value. In time postimplantatsionnogo observations the least volume (203,82 ±37,86 the ml) is noted in 6 months after operation. The tendency to augmentation of an indicator which at the moment of the research termination was equaled 221,29 yo 35,59 ml (fig. 38) further was outlined.

Drawing 38. Dynamics of average value of volume of an emiction (Vv)

In group in II (ml).

The analysis of dynamics of data IPSS has shown, that the greatest number of the complaints bound to disorder of an emiction, patients showed in 3 months after implantation of sources. The mean score in this control point has made 11,29 ±3,57 and it has appeared authentically above level,

Fixed before brahiterapiej (p=0,00). Since 6 months after the equipment of sources, proof positive dynamics is observed. In 12 months point IPSS was equaled 6,56 ±1,75 and authentically did not differ from predimplantatsionnogo value (р=0,11). (Fig. 39).

Drawing 39. Dynamics of average value IPSS in group II (points).

Dynamics of all controllable indicators of group II is presented to tab. 27.

Table 27.

Dynamics of controllable indicators in group II.

Before BT In 3 months In 6 months In 9 months In 12 months

Volume

PZH

(Sm3) 45,24

±10,55 43,21±9,87 (r = 0,17) 36,45±9,57

(p =

0,000001) 34,80±9,69

(p=0,45) 34,93±10,39

(p=0,09)

OOM

(Sm3) 20,68

±16,53 20,79±15,36

(р=0,87) 17,27±23,49

(р=0,22) 16,25±21,84

(р=0,69) 16,82±23,13

(р=0,09)

Qmax

(Ml/c) 17,56±6,5

1 15,09±5,04

(р=0,00) 15,38±4,42

(р=0,005) 17,20±5,23

(р=0,00) 17,41±5,02

(р=1,0)

Qm

(Ml/c) 9,34±2,64 8,98±3,28

(р=0,28) 8,54±2,81

(р=0,005) 8,54±2,48

(р=1,0) 8,73±2,71

(р=0,11)

Vv

(Sm3) 267,43

±65,64 218,38±46,1

0

(р=0,00005) 203,82±37,86

(р=0,05) 207,86±37,4

4

(р=0,88) 221,29±35,59

(р=0,004)

IPSS

(Points) 6,14±3,63 11,29±3,57

(p=0,00) 9,14±3,25

(p = 0,00001) 6,29±3,20

(р=0,00) 6,56±1,75

(p=0,22)

At all investigation phases at patients of group II symptoms of a boring of the bottom urinary ways prevailed over the symptoms caused infravezikalnoj by obstruction. Patients tested the greatest discomfort in connection with nokturiej, the speeded up emiction and, rather less often, with imperative desires. Symptoms oporozhnenija became perceptible seldom (fig. 40).

The incomplete

The incomplete

oporozhnenie

Noiturija

It is complicated.

The beginning

Flaccid stream

The incomplete

oporozhnenie

Speeded up І to urine my

The intermittent

To urine my

Імператив.

Noiturija

It is complicated

The beginning

Flaccid stream

\ Speeded up

To urine my

The intermittent

mpermtie

V NMK

3 mes

The incomplete

Noiturija

Speeded up і to urine my

Noiturija

Speeded up

To urine my

It is complicated. The beginning \

The intermittent

To urine my

It is complicated.

The beginning

The intermittent

To urine my

Flaccid stream

Imperative.

Desires

6 M=S.

Flaccid stream

Імператив.

Desires

9 months

The incomplete

Noiturija

It is complicated.

The beginning

Flaccid stream

4V. Speeded up

To urine

The intermittent

Imperative.

P DBb BM

12 M=S

Drawing 40. Dynamics of average value of symptoms of the bottom urinary ways

(IPSS) in group II.

Changes of quality of a life (QoL) correlated with dynamics IPSS. The worst indicator - 2,6 ±1,5 - is fixed in 3 months after brahiterapii. Since 6 months after implantation distinct positive dynamics of value QoL which by this moment authentically did not differ from predimplantatsionnogo level (fig. 41) is noted.

Drawing 41. Dynamics of average value of quality of a life (QoL) in group II

(Points).

Early and late radial damages.

During observation in group of II radial damages of 4 degrees it has not been fixed. Complications of 1 and 2 degrees were most often observed: a dysuria, nokturija and the speeded up emiction which have totally made almost 90 % of complaints.

Early radial damages GASTROINTESTINAL TRACT met much less often, than damages of genitourinary system - 38 cases from which all are qualified as damage of 1 and 2 degrees are fixed only. Almost in half of cases of all complaints patients noted a diarrhoeia, painful sensations in the field of a rectum are more rare, slime and blood allocation was fixed in single instances (tab. 28).

Frequency of development of early radiative damages at patients in group II (RTOG).

Complications 0-1 degree 2 degree 3 degree 4 degree All degrees

Abs. % Abs. % Abs. % Abs. % Abs. %

Speeded up

Emiction 15 57,7 7 26,9 4 15,4 0 0 26 26,3

Dysuria 23 67.6 7 20,6 4 11,8 0 0 34 34,3

Nokturija 19 70,4 5 18,5 3 11,1 0 0 27 27,3

Pain/spasms 9 90,0 1 10,0 0 0 0 0 10 10,1

Gross hematuria 0 0 2 100,0 0 0 0 0 2 2,0

The general number of damages of Ministry of Railways 66 66,7 22 22,2 11 11,1 0 0 99 100,0

Diarrhoeia 12 75,0 4 25,0 0 0 0 0 16 42,1

The mucous

Allocation 4 50,0 4 50,0 0 0 0 0 8 21,0

Krovjanistye

Allocation 0 0 2 100,0 0 0 0 0 2 5,3

Pain/tenezmy 9 - 3 - 0 0 0 0 12 31,6

The general number of damages GASTROINTESTINAL TRACT 25 65,8 13 34,2 0 0 0 0 38 100,0

The most frequent late radial complication was the speeded up emiction and a dysuria which became perceptible in 90 % of cases of all complications. Thus, at two patients the dysuria has been regarded, as complication of 3 degrees (tab. 29).

Frequency of development of late radiative damages at patients in group II (RTOG/EORTC).

Complications 0-1 degree 2 degree 3 degree 4 degree All degrees

Abs. % Abs. % Abs. % Abs. % Abs. %

Microhematuria 3 100,0 0 0 0 0 0 0 3 9,6

Gross hematuria 0 0 0 0 0 0 0 0 0 0

Speeded up

Emiction 11 78,6 3 21,4 0 0 0 0 14 45,2

Dysuria 7 50,0 5 35,7 2 14,3 0 0 14 45,2

Reduction of capacity of MT 0 0 0 0 0 0 0 0 0 0

Shrinkage

MT 0 0 0 0 0 0 0 0 0 0

The general number of damages of Ministry of Railways 21 67,7 8 25,8 2 6,5 0 0 31 100,0

Diarrhoeia 4 100,0 0 0 0 0 0 0 4 66,6

The mucous

Allocation 0 0 0 0 0 0 0 0 0 0

Krovjanistye

Allocation 0 0 0 0 0 0 0 0 0 0

Punching/svi

shch 0 0 0 0 0 0 0 0 0 0

Pain/spasm 0 0 2 100,0 0 0 0 0 2 33,4

The general number of damages GASTROINTESTINAL TRACT 4 66,6 2 33,4 0 0 0 0 6 100,0

As well as in a case with early damages, late disorders GASTROINTESTINAL TRACT met less often, than complications from urinary system. At patients of group II 6 cases of such damages have been fixed only. Patients noted easy disorder of a chair not demanding

Medicamental correction, two patients complained of pains in the field of a rectum.

Dynamics of the DOG.

Among patients of group II at each control measurement authentic depression of level of the DOG (tab. 30) became perceptible. In 12 months after brahiterapii average value of an indicator has made 0,27 ±0,17 ng/ml, that has appeared authentically below initial level (р=0,00).

Dynamics of the DOG in postimplantatsionnom the period (group II).

Table 30.

Control point of the DOG r

Initially 8,17 yo 3,23 -

3 months after BT 1,45 yo 0,89 0,00

6 months after BT 0,73 yo 0,59 0,0001

9 months after BT 0,42 yo 0,32 0,000003

12 months after BT 0,27 yo 0,17 0,000003

The analysis of results of treatment of patients of group II has shown, that in the absence of development risk factors infravezikalnoj obstructions in postimplantatsionnom the period, brahiterapija is an effective and safe method of treatment sick of the localised cancer of a prostate.

By the moment of the termination of research level of all controllable indicators authentically did not differ from reference values, early and late radial damages of 4 degrees were not fixed, complications of 1 and 2 degrees were in rare instances observed.

3.4.

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A source: GORELOV Victor Pavlovich. PREVENTIVE MAINTENANCE INFRAVEZIKALNOI of OBSTRUCTION AT PLANNING BRAHITERAPII of the CANCER of the PROSTATE. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg. 2014

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