单纯内分泌与内分泌加内照射治疗晚期前列腺癌的疗效对比分析

Clinical analysis of the effect of systemic radionuclide therapy combined with the endocrine therapy for advanced prostate cancer, comparing with the only endocrine therapy

目的 :研究核素内照射改善前列腺癌骨转移引起的疼痛及对骨转移治疗的疗效 ,并与内分泌治疗进行比较。方法 :对 5 2例前列腺癌骨转移患者均采用双侧睾丸切除加氟他胺 (2 5 0mg ,3次 /d)治疗。所有患者均于术前不同时间出现明显的疼痛症状 ,其中 15例接受89锶内照射治疗 (14 8MBq静脉注射 ) ,8例接受153 Sm EDTMP内照射治疗 (37MBq/kg静脉注射 ,1次 /月 ) ;2 9例未接受内照射治疗者作为对照组。 结果 :89锶治疗组有 14例患者疼痛明显缓解 ,占 93.3% (14 / 15 ) ;153 Sm EDTMP治疗组有 6例疼痛明显缓解 ,占 75 .0 % (6 / 8) ;单纯内分泌治疗组经调整药物剂量或结构后 ,疼痛明显缓解者仅 9例 ,占 31.0 % (9/ 2 9)。99Tcm MDP全身骨显像示骨转移病灶出现不同程度的好转 ,其中89锶治疗组有 11例 ,占 73.3% (11/ 15 ) ;153 Sm EDTMP治疗组有 5例 ,占6 2 .5 % (5 / 8) ,而单纯内分泌组有 7例 ,占 2 4 .1% (7/ 2 9)。89锶治疗组 3例、153 Sm EDTMP治疗组有 2例出现血白细胞和血小板明显下降 ,经对症治疗后恢复。结论 :核素内照射治疗能改善前列腺癌骨转移引起的疼痛 ,并可不同程度地抑制肿瘤骨转移灶的生长 ,但必须密切观察血红蛋白。

Purpose:To investigate the effect of the systemic radionuclide therapy for the pain of bone metastasis of advanced prostate cancer, comparing with the only endocrine therapy. Methods:From March 1998 to March 2001, 52 patients of advanced prostate cancer with bone metastasis accepted the treatment of bilateral orchidectomy and Flutaminde (250 mg every 8 hours) in this hospital. 15 of the 52 patients also accepted intravenously infusion of 89 Srcl 2 (148 MBq); 8 of the 52 patients accepted intravenously infusion of 153 Sm EDTMP (37MBq/kg once a month); the others accepted the only endocrine therapy.Results:14 of 15 patients who accepted 89 Srcl 2 infusion had obvious pain relief, and 6 patients in the 153 Sm EDTMP group had the same result. However, even changed the dose and type of the drugs, lessening of pain was observed in only 9 patients of the endocrine therapy group. By the way of the systemic bone screen of 99 Tcm MDP the bone metastasis lesions were controlled and recovered in 73% of the 89 Srcl 2 group, 62% of the 153 Sm EDTMP group and 24% of the only endocrine therapy group. The leukothrombopenia was observed in 3 patients of the 89 Srcl 2 group and 2 patients of the 153 Sm EDTMP group. Then all of them had recovered after the expectant treatment.Conclusions:The systemic radionuclide therapy can obviously relief the pain caused by the bone metastasis of advanced prostate cancer and inhibit the development of bone metastasis lesions effectively. But during the treatment the blood cell counts shall be followed up carefully.