Pettaway C A, Pisters L L, Troncoso P, Slaton J, Finn L, Kamoi K, Logothetis C J
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
J Clin Oncol. 2000 Mar;18(5):1050-7. doi: 10.1200/JCO.2000.18.5.1050.
We assessed the feasibility and efficacy of integrating chemotherapy and androgen ablation with radical prostatectomy in patients with locally advanced prostate cancer. The neoadjuvant approach was adopted because it allows an in situ assessment of antitumoral activity.
Thirty-three patients were enrolled who met the clinical criteria of stage T1-2, Gleason score of >/= 8 or T2b-T2c, Gleason score of 7 and prostate-specific antigen (PSA) level greater than 10 ng/mL (n = 15), or clinical stage T3 (n = 18). Therapy consisted of 12 weeks of ketoconazole and doxorubicin alternating with vinblastine, estramustine, and androgen ablation followed by prostatectomy. The ability of neoadjuvant chemotherapy and hormonal therapy to induce a 20% rate of pT0 in the prostatectomy specimen as well as surgical feasibility were assessed.
Chemotherapy complications were comparable to those reported with this regimen previously. No major intraoperative complications occurred. Postoperative complications occurred in 10 (33%) of 30 patients. One patient died at home after discharge (postoperative day 17; no autopsy was performed). Ten (33%) of the 30 patients had organ-confined disease, and 20 (70%) of 30 had extraprostatic extension; 11 (37%) of the 30 had positive lymph nodes. Only five (17%) of 30 exhibited positive surgical margins. All patients achieved an undetectable PSA level postoperatively, and 20 of the surviving 29 patients remain without disease recurrence with a median follow-up of 13 months (range, 9 to 18 months).
Chemotherapy and androgen ablation followed by radical prostatectomy was feasible in patients with locally advanced prostate cancer. Although the goal of achieving a 20% rate for pT0 status was not achieved, we believe this type of integrated therapeutic strategy should be investigated further for its ability to alter the course of regionally advanced prostate cancer.
我们评估了在局部晚期前列腺癌患者中，将化疗和雄激素剥夺与根治性前列腺切除术相结合的可行性和疗效。采用新辅助治疗方法是因为它能够对肿瘤活性进行原位评估。
纳入了33例符合临床标准的患者，这些患者的临床分期为T1-2期、Gleason评分≥8分，或T2b-T2c期、Gleason评分为7分且前列腺特异性抗原（PSA）水平大于10 ng/mL（n = 15），或临床分期为T3期（n = 18）。治疗方案包括酮康唑和阿霉素与长春碱、雌莫司汀交替使用12周，并进行雄激素剥夺，随后进行前列腺切除术。评估新辅助化疗和激素治疗在前列腺切除标本中诱导20%的pT0率的能力以及手术的可行性。
化疗并发症与先前报道的该方案的并发症相当。未发生重大术中并发症。30例患者中有10例（33%）发生术后并发症。1例患者出院后在家中死亡（术后第17天；未进行尸检）。30例患者中有10例（33%）存在器官局限性疾病，30例中有20例（70%）有前列腺外侵犯；30例中有11例（37%）有阳性淋巴结。30例中只有5例（17%）手术切缘阳性。所有患者术后PSA水平均检测不到，29例存活患者中有20例在中位随访13个月（范围9至18个月）时仍无疾病复发。
对于局部晚期前列腺癌患者，化疗和雄激素剥夺后行根治性前列腺切除术是可行的。虽然未达到实现20%的pT0状态率的目标，但我们认为这种综合治疗策略因其改变局部晚期前列腺癌病程的能力应进一步研究。
