磷酸雌二醇氮芥联合足叶乙甙治疗激素抵抗性前列腺癌  

Combined use of oral estramustine phosphate and oral etoposide in patients with hormone refractory prostate carcinoma

作　　者：孙忠全[1] 钱伟庆[1] 宋建达[1] 

机构地区：[1]华东医院泌尿外科,上海200040

出　　处：《中华泌尿外科杂志》2006年第1期46-48,共3页Chinese Journal of Urology

摘　　要：目的观察磷酸雌二醇氮芥（EMP）联合足叶乙甙（Vp16）治疗激素抵抗性前别腺癌的疗效。方法2000年1月至2004年6月对12例全雄激素阻断治疗失败、排除氟他胺撤药综合征的激素抵抗性前列腺癌患者行EMP加Vp16联合化疗。患者年龄61～82岁，平均70岁。病理分级：G23例，G39例。其中骨转移10例，软组织转移4例（肺转移2例，淋巴结转移2例）。化疗方案：EMP560mg／d，Vp16 50mg·m^-2·d^-1，连续口服21d，28d为1个周期。直至病情进展或毒副反应无法耐受。疗效判断标准：血PSA下降〉50％且维持〉1个月为有效；软组织转移灶疗效分为完全缓解、部分缓解、稳定和进展。结果12例随访6～24个月，平均12个月。PSA有效率50％（6／12），有效患者PSA从治疗前（63．9±47．3）ng／ml下降至（14．4±8．8）ng／ml，平均有效时间7．5个月。软组织转移灶部分缓解者2例，转移灶分别从治疗前的4．0cm×5．0cm，3．0cm×3．5cm缩小为2．0cm×2．0cm，1．0cm×1．5cm，有效时间分别为3、8个月。毒副反应包括Ⅰ度血白细胞减少1例，Ⅰ度贫血1例，Ⅰ度脱发1例，Ⅰ度恶心2例，Ⅱ度肝功能损害1例。结论EMP加Vp16治疗激素抵抗性前列腺癌有一定疗效，毒副反应轻。Objective To evaluate the efficacy of oral estramustine phosphate combined with oral etoposide for the treatment of hormone refractory prostate cancer （ HRPC）. Methods Between January 2000 and June 2004,12 patients （ mean age, 70 years; age range, 61 - 82 years ） with HRPC were treated with oral estramustine phosphate （560 mg/d） and oral etoposide （50 mg · m^-2· d^-1 ） for 21 d with 28 d as a circle. Inclusion criteria were previous complete androgen blockade, anti-androgen （flutamide） withdrawal evaluation,clinical or biochemical disease progression assessment. The pathologic grading was as follows：3 cases of G： and 9 of G3;among them 10 cases had bone metastasis,4 had soft tissue metastasis （2 in the lungs and 2 in the lymph nodes）. The therapy continued until there was evidence of disease progression or side effects that patients could not bear. The outcome measure included PSA level decrease 〉 50% for more than 1 month as effective,and the efficacy for soft tissue metastases were classified as complete,partial remission,stabilization and progression. Results All patients were followed up for 6 -24 months （mean, 12 months） with the evaluation of efficacy and toxicity. PSA levels decreased by at least 50% in 6 of 12 cases （50%） ;it decreased from （63.9± 47.3 ） ng/ml before treatment to （ 14.4 ± 8.8 ） ng/ml after treatment, with a mean duration of response being 7.5 months （ range,5 - 12 months）. Partial remission of soft tissue metastases was obtained in 2 cases ;the metastatic lesions were reduced from 4.0 cm × 5.0 cm ,3.0 cm × 3.5 cm to 2.0 cm × 2.0 cm, 1.0 cm ×1.5 cm, respectively, by the treatment, with response duration being 3 and 8 months,respectively. Toxicities were minimal with leukopenia at grade Ⅰ in 1 case,anemia at grade Ⅰ in 1 ,baldness at grade Ⅰ in 1 ,nausea at grade Ⅰ in 2 and impaired liver function at grade Ⅱ in 1. Conclusions The combination of oral estramustine phosphate and oral etoposide may be an effective and well-tole

关 键 词：前列腺肿瘤 癌 激素抵抗性 磷酸雌二醇氮芥 足叶乙甙 

分 类 号：R737.25[医药卫生—肿瘤] R737.250.5[医药卫生—临床医学]