Wang Mao Qiang, Zhang Jin Long, Yuan Kai, Yuan Bing, Duan Feng, Yan Jie Yu, Wang Yan, Fu Jin Xin
Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing 100853, P.R. China.
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China.
Ther Adv Med Oncol. 2020 May 18;12:1758835920917573. doi: 10.1177/1758835920917573. eCollection 2020.
Prostatic leiomyosarcoma (LMS) has a poor prognosis with a median overall survival (OS) of 15-18 months. For patients with metastatic disease, radical surgical resection, with or without adjuvant systemic chemotherapy and radiation therapy, unfortunately provides limited therapeutic benefit. Novel approaches for this lethal disease are urgently needed.
To evaluate the feasibility and efficacy of transarterial chemoembolization (TACE) with doxorubicin-eluting HepaSpheres (HS) for inoperable LMS of the prostate.
This case series included 12 patients (median age 57 years, range 32-74) with inoperable LMS of the prostate who were treated with TACE using doxorubicin-eluting HS. All patients were pathologically proved by fine-needle biopsy. Symptomatic relief, complications, OS, and local disease control based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria were evaluated.
Symptomatic relief, including control of the gross hematuria, removal of indwelling catheters, improvement of constipation and perineal pain, were obtained in 100%, 75%, 100%, and 86%, respectively after TACE, without any major complications. At the last follow-up after TACE, the percentage of the tumor necrosis and volume reduction were present with a median value of 90% and 84%, respectively. TACE after two to four sessions allowed subsequent surgical resection in five (41.7%) patients. The median follow-up time was 29 months; the survival rate at 1, 2, and 3 years was 91.7%, 83.3%, and 41.7%, respectively, and the median OS was 29 months (range 9-49 months).
TACE of inoperable LMS of the prostate appears to be safe and effective in providing tumor necrosis, shrinkage, and symptom relief; that could improve the quality of life and the survival rate of these patients.
前列腺平滑肌肉瘤（LMS）预后较差，中位总生存期（OS）为15 - 18个月。对于转移性疾病患者，无论是否进行辅助全身化疗和放疗，根治性手术切除带来的治疗益处都很有限。迫切需要针对这种致命疾病的新方法。
评估使用载有多柔比星的 HepaSpheres（HS）进行经动脉化疗栓塞术（TACE）治疗无法手术切除的前列腺LMS的可行性和疗效。
本病例系列纳入了12例（中位年龄57岁，范围32 - 74岁）无法手术切除的前列腺LMS患者，他们接受了使用载有多柔比星的HS的TACE治疗。所有患者均经细针穿刺活检病理证实。根据实体瘤改良疗效评价标准（mRECIST）评估症状缓解情况、并发症、OS以及局部疾病控制情况。
TACE术后，分别有100%、75%、100%和86%的患者出现了症状缓解，包括肉眼血尿得到控制、拔除留置导管、便秘和会阴部疼痛改善，且无任何严重并发症。在TACE后的最后一次随访时，肿瘤坏死百分比和体积缩小百分比的中位值分别为90%和84%。两到四次TACE治疗后，5例（41.7%）患者得以进行后续手术切除。中位随访时间为29个月；1年、2年和3年的生存率分别为91.7%、83.3%和41.7%，中位OS为29个月（范围9 - 49个月）。
对于无法手术切除的前列腺LMS，TACE在实现肿瘤坏死、缩小以及缓解症状方面似乎是安全有效的；这可以提高这些患者的生活质量和生存率。
