去势抵抗性前列腺癌冷冻消融联合多西紫杉醇治疗临床观察

Cryoablation combined with docetaxel chemotherapy in the treatment of castration-resistant prostate cancer

目的:评价氩氦刀冷冻消融联合多西紫杉醇化疗治疗去势抵抗性前列腺癌的安全性、有效性及临床价值。方法:2007-06-01-2011-12-30南京大学医学院附属鼓楼医院采用冷冻消融联合多西紫杉醇+泼尼松3周标准方案化疗治疗去势抵抗性前列腺癌17例。以PSA缓解,前列腺MR及ECT骨扫描作为评定指标,疗效评价包括完全缓解(CR)、部分缓解(PR)、病情稳定(SD)和病情恶化(PD)。不良反应选择髓抑制、肝功能损害及呕吐作为评估。结果:17例患者经过18～66个月随访,平均随访时间31个月。冷冻手术时间(102±43)min,均未输血及术中并发症。其中29.4%(5/17)CR,47.1%(8/17)PR,17.6%(3/17)SD,5.9%(1/17)PD。CR+PR患者的PSA进展时间为18～112周,中位进展时间为54.2周。中位生存期>14个月。PSA无进展生存率为94.1%。合并骨痛患者11例,经治疗后72.7%(8/11)骨痛缓解,27.3%(3/11)骨痛稳定。骨髓抑制、肝功能损害和胃肠道反应等不良反应可耐受。结论:冷冻消融联合标准多西紫杉醇+泼尼松标准方案化疗治疗CRPC安全可行,近期疗效明显,远期疗效有待进一步观察。

OBJECTIVE： To evaluate the safety,efficacy and clinical value of cryoablation combined with docetaxel and prednisone chemotherapy in the treatment of castration-resistant prostate cancer（CRPC）. METHODS：From June 2007 to December 2011,17 cases of CRPC were treated with cryoablation combined with docetaxel and prednisone chemothera- py （every 3 week）. Depended on PSA,MR and ECT bone scan, the efficacy was divided into four grades： complete response （CR）, partial response （PR）, stabilization of disease （SD） and progression of disease（PD）. The subjective symptoms were evaluated depending on bone ache,Dysuria and changes of clinical symptoms. Adverse reactions were assesed. RESULTS： The follow-up time ranged from 18 to 66 months （mean time of 31 months）. The operative time was （ 102 ± 43） min,no blood transfusion and intraoperative complications. 29. 4 % （5/17） of them got complete response, 47. 1% （8/17） partial response, 17.6% （3/17） stable disease and 5.9% （1/17） progressed. The average time to PSA relapse in CR＋PR patients was 54.2 weeks （18--112 weeks）. The median survival time was more than 14 months. PSA progres- sion-free survival was 94.1%. 72.7%（8/11） patients with bone pain had pain relief and 27.3% （3/11） pain stable after treatment. Adverse reactions included bone marrow suppression, liver damage and gastrointestinal side effects and which could be tolerated. CONCLUSIONS：Cryoablation combined docetaxel＋ prednisone chemotherapy in the treatment of CRPC is effective,feasible and safe option. The short-term efficacy is obvious and long-term observation is needed.