進行前立腺癌に対するSurgical neoadjuvant chemo-hormonal therapy

Abstract

膀胱または大腸などの膀胱周辺臓器に浸潤が認められ, 強い膀胱刺激症状を呈した8例と腸閉塞症状も合併した4例の計12例のstage D2前立腺癌に, surgical neoadjuvant chemohormonal therapyを施行した。9例に社会復帰を伴う生存がえられ(CR 4例, PR 3例, NC 2例), 骨盤内臓器全摘出術例は全例生存がえられた(CR 2例, PR 2例)。癌死は3例で生存期間は平均25ヵ月であった

To improve the therapeutic results as well as the patient's quality of life (QOL) in advanced prostatic carcinoma, total cystprostatectomy or pelvic exenteration was performed in combination with chemo-hormonal therapy before and after operation on twelve patients with stage D2 prostatic carcinoma who had infiltration in the periprostatic organs including urinary bladder and large intestine and showed strong bladder irritation, gross hematuria and ileus symptoms. Eight patients with severe cystic infiltration underwent total cystprostatectomy, urinary division and lymph node dissection, and four with ileus symptoms had pelvic exenteration, urinary division, proctostomy and lymph node dissection. As a rule of dosing schedule for chemo-hormonal therapy, 30-60mg/sq m of etoposide was continuously administered for 5 days before operation in addition to 250-500 mg of diethylbestrol diphosphate given for 30 days after operation. Furthermore, 2-3 courses of 30-60 mg/sq m of etoposide was administered for successive days, at 3-week intervals and then 30-60 mg/sq m of etoposide at 6-to-8-week intervals for 2 years together with 75-100 mg of chrolmadinone acetate as maintenance treatment. Nine of the 12 patients survived, including 4 patients with complete response, 3 patients with partial response and 2 patients with no change. These findings, suggested that the combination of surgical treatment and chemo-hormonal therapy is of use not only for providing an effective therapeutic means but also for improving the QOL in patients with advanced prostatic carcinoma.