髂内动脉超选择性化疗栓塞术在激素难治性前列腺癌治疗中的应用

Ultraselective internal iliac artery chemotherapy and embolism for hormone-refractory prostate cancer

目的研究髂内动脉超选择性化疗栓塞术在激素难治性前列腺癌（HRPC）治疗中的作用。方法48例HRPC患者随机分为2组：①介入组25例，其中Ⅲ期8例，Ⅳ期17例，骨转移10例。行双侧髂内动脉超选择性化疗栓塞。灌注化疗药物：环磷酰胺100mg，吡喃阿霉素30mg，羟基喜树碱20g；栓塞剂：明胶海绵颗粒。每月介入治疗1次，共3次，以后每3～6个月进行1次。口服磷酸雌二醇氮芥280mg，2次／d。②对照组23例，其中Ⅲ期7例，Ⅳ期16例，骨转移9例。口服磷酸雌二醇氮芥280mg，2次／d。骨转移患者均加入伊斑磷酸钠6mg静脉滴注，每月1次。比较2组治疗前后前列腺体积、尿流率、PSA的变化情况及3年生存率。应用SPSS11．5软件进行统计学处理。结果介入组与对照组治疗前前列腺体积分别为（71．4±4．6）、（72．3±3．2）ml，治疗2周时为（50．2±4．1）、（64．2±4．5）ml。2组治疗前最大尿流率分别为（10．8±1．1）、（11．2±1．2）ml／s，治疗2周时为（16．7±1．8）、（13．8±1．5）ml／s。2组治疗前PSA为（64．34±5．32）、（65．02±6．16）ng／ml，治疗2周时为（23．56±4．26）、（56．43±4．76）ng／ml。以上指标治疗前后组内比较介入组差异有统计学意义（P〈0．05），对照组差异无统计学意义（P〉0．05）；2组治疗前比较差异无统计学意义（P〉0．06），治疗后比较差异有统计学意义（P〈0．05）。介入组3年生存率为32％（6／19），对照组为27％（4／15），2组比较差异无统计学意义（P〉0．05）。结论髂内动脉超选择性化疗栓塞术对HRPC患者症状的改善和生活质量的提高具有显著的意义。

Objective To assess the application of ultraselective internal iliac artery chemotherapy and embolism for hormone-refractory prostate cancer. Methods Forty-eight patients with hormone-refractory prostate cancer were randomly divided into 2 groups： treatment group （8 eases of stage Ⅲ, 17 cases of stage Ⅳ, 10 cases with bone metastases） and control group （7 cases of stage Ⅲ, 16 cases of stage Ⅳ, 9 cases with bone metastases）. Ultraselective internal iliac artery chemotherapy and embolism was performed for the treatment group with cyclophosphamidum 100 rag, pirarubicin 30mg, hydroxycamptothecin 20 mg and gelloam as embolization material. It was carried out once per month for 3 times and then once every 3 -- 6 months. Estramustine phosphate （280 mg twice per day） was administrated as well. Patients of the control group were given estramustine phosphate 280 nag twice per day alone. All the patients with bone mastatases were given 6 mg ibandronic acid per month. Results The pre-treatment prostate volume was （71.4±4. 6） ml in treatment group and （72.3±3.2）ml in control group; The prostate volume was （50. 2±4. 1）ml and （64.2 ±4. 5）ml, respectively, after two week treatment. The pre-treatment maximum uroflow rate （Qmax） in treatment group and control group was （10. 8 ± 1. 1） ml/s and （11.2 ± 1.2） ml/s, respectively; Two weeks after treatment, the Qmax was （16.7±1. 8）ml/s in treatment group and （13.8± 1.5）ml/s in control group. The pre-treatment PSA of the patients was （64. 34±5.32）ng/ml in treatment group and （65.02± 6.16） ng/ml in control group; Two weeks after treatment, PSA was （ 23. 56 ± 4. 26 ） ng/ml in treatment group and （56.43±4.76）ng/ml in control group. For above parameters, the difference in treatment group was significant （P〈0.05）, but not significant in control group （P〉0.05） ; The difference between treat ment group and control group was not significant before treatment （P〉0.05）, but was significant after treatment （P〈0.05）. The 3-year survival rate was 32%（6/19） in treatment group and 27%（4/15） in con trol group; The difference in the 2 groups was not significant （P〉0.05）. Conclusion The ultraselective internal iliac artery chemotherapy and embolism is effective for the quality of life improvement and symptom relieving in the patients with hormone-refractory prostate cancer.