Ruff P, Derman D P, Weaving A, Bezwoda W R
Department of Medicine, Hillbrow Hospital, Johannesburg, South Africa.
Oncology. 1989;46(5):288-92. doi: 10.1159/000226734.
Ninety-two patients with D2 prostatic cancer were studied. Initial treatment was with either diethylstilboestrol (DES) or orchidectomy. Response to DES (5/63, 81%) was significantly higher than for orchidectomy (18/29, 62%; p less than 0.01). However, duration of response and duration of survival were not significantly different for the 2 forms of hormonal therapy. Fifty-seven patients were randomised to receive second-line treatment with either medroxyprogesterone acetate (MPA), oral chlorambucil or combination chemotherapy (adriamycin + cyclophosphamide + 5-fluoro-uracil). Response to second-line treatment was similar for all 3 regimens (46% overall response). Most of the responses were disease stabilisation and, although there was symptomatic benefit, response to second-line therapy did not significantly improve survival compared to the survival experience of the group as a whole. It is concluded that palliative second-line treatment for advanced prostatic cancer should consist of the least toxic form of treatment which in this study was second-line hormone administration (MPA).
对92例D2期前列腺癌患者进行了研究。初始治疗采用己烯雌酚（DES）或睾丸切除术。DES治疗的有效率（5/63，81%）显著高于睾丸切除术（18/29，62%；p<0.01）。然而，两种激素治疗方式的反应持续时间和生存时间并无显著差异。57例患者被随机分配接受二线治疗，治疗方案为醋酸甲羟孕酮（MPA）、口服苯丁酸氮芥或联合化疗（阿霉素+环磷酰胺+5-氟尿嘧啶）。三种治疗方案的二线治疗有效率相似（总体有效率46%）。大多数反应为病情稳定，尽管有症状改善，但与整个组的生存经验相比，二线治疗并未显著提高生存率。结论是，晚期前列腺癌的姑息性二线治疗应采用毒性最小的治疗方式，在本研究中为二线激素给药（MPA）。
