多模式治疗少转移性前列腺癌:来自单中心研究的结果

K. Nyushko, V. M. Perepukhov, B. Alekseev
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At the first stage, all patients underwent combined drug therapy with docetaxel (75 mg/m2 intravenously every 3 weeks for 6 courses) and degarelix. Patients who had a decrease in PSA level ≤ 2 ng/ml and registered stabilization of the disease according to radiological examination were treated surgically through RPE with extended pelvic and retroperitoneal lymph node dissection. Radiation therapy was performed only in patients with the presence of bone lesions at a dose of 50-70 Gy to the location of bone metastases in the stage 3 plan of combined multimodal therapy.Results. PCa biochemical relapse was verified in 27 (56.3%) patients during the median follow-up of 10 months. The average time to PSA increase was 9.0 ± 5.7 months (from 1 to 24 months), median — 7 months, Six-month PSA relapse-free survival (PSA-RFS) was 61.2 ± 7.5%; 1-year PSA-RFS — 38.0 ± 8.6%. The average duration before the initiation of hormonal therapy was 12 ± 6.1 months (from 3 to 27 months), median: 10 months. 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摘要

介绍。近年来,人们对根治性前列腺切除术(RPE)作为淋巴性播散性和转移性前列腺癌(PCa)患者多模式治疗方法之一的兴趣日益浓厚。与此同时,由于缺乏大型随机试验,该技术无法在临床试验之外的广泛临床实践中使用。研究目的:评价化疗、激素、手术和放疗联合治疗原发性少转移性激素敏感性前列腺癌的有效性。材料和方法。该研究包括48例原发性少转移性前列腺癌患者,他们接受了内部单一研究中心方案的联合治疗。在第一阶段,所有患者接受多西紫杉醇(75mg /m2静脉注射,每3周,共6个疗程)和degarelix联合药物治疗。经影像学检查PSA水平下降≤2 ng/ml且病情稳定的患者,通过RPE手术治疗,并扩大盆腔和腹膜后淋巴结清扫。在联合多模式治疗的第三阶段计划中,仅对存在骨病变的患者进行放射治疗,剂量为50-70 Gy至骨转移部位。在中位随访10个月期间,27例(56.3%)患者证实前列腺癌生化复发。平均PSA升高时间为9.0±5.7个月(1 ~ 24个月),中位为7个月,6个月PSA无复发生存率(PSA- rfs)为61.2±7.5%;1年PSA-RFS - 38.0±8.6%。激素治疗开始前的平均持续时间为12±6.1个月(3 ~ 27个月),中位数为10个月。给药前6个月生存率为72.6±6.8%;12个月生存率:40.9±8.7%。约40%的低转移性前列腺癌患者在完成方案治疗后的12个月内没有进展迹象,也没有接受任何其他药物治疗。对研究结果的分析表明,在新诊断的低转移性激素敏感性前列腺癌患者中,所研究的治疗方案的肿瘤学结果令人满意,并且副作用和并发症的可能性很低。然而,有必要继续进行更大规模、更结构化的随机试验,以确定在临床实践中应用这种治疗方法的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multimodal therapy for oligometastatic prostate cancer: results from a single-centre study
Introduction. In recent years, interest in the use of radical prostatectomy (RPE) as one of the components of a multimodal approach in patients with lymphogenous disseminated and metastatic prostate cancer (PCa) has grown significantly. At the same time, the dearth of large randomized trials does not make it possible to use this technique in wide clinical practice outside of clinical trials.Purpose of the study. To evaluate the effectiveness of multimodal therapy using combined chemo-hormonal, surgical and radiation therapy in patients with primary oligometastatic hormone-sensitive PCa.Material and methods. The study included 48 patients with primary oligometastatic prostate cancer who received combination treatment within the internal one-research-center protocol. At the first stage, all patients underwent combined drug therapy with docetaxel (75 mg/m2 intravenously every 3 weeks for 6 courses) and degarelix. Patients who had a decrease in PSA level ≤ 2 ng/ml and registered stabilization of the disease according to radiological examination were treated surgically through RPE with extended pelvic and retroperitoneal lymph node dissection. Radiation therapy was performed only in patients with the presence of bone lesions at a dose of 50-70 Gy to the location of bone metastases in the stage 3 plan of combined multimodal therapy.Results. PCa biochemical relapse was verified in 27 (56.3%) patients during the median follow-up of 10 months. The average time to PSA increase was 9.0 ± 5.7 months (from 1 to 24 months), median — 7 months, Six-month PSA relapse-free survival (PSA-RFS) was 61.2 ± 7.5%; 1-year PSA-RFS — 38.0 ± 8.6%. The average duration before the initiation of hormonal therapy was 12 ± 6.1 months (from 3 to 27 months), median: 10 months. Six-month survival before the drug administration was 72.6 ± 6.8%; twelve-month survival: 40.9 ± 8.7%. About 40% of patients with oligometastatic PCa had no signs of progression and did not receive any other drug therapy for 12 months after completion of protocol treatment.Conclusions. Analysis of the study results demonstrates satisfactory oncological outcomes of the studied treatment option in patients with newly diagnosed oligometastatic hormone-sensitive PCa, as well as a low likelihood of side effects and complications. Nevertheless, it is necessary to continue conducting larger and more structured randomized trials to determine the possibility of applying this therapeutic approach in clinical practice.
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