上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (6): 797-.doi: 10.3969/j.issn.1674-8115.2017.06.015?

• 论著（临床研究） • 上一篇    下一篇

多西他赛联合全雄阻断新辅助疗法治疗高危局部进展性前列腺 癌的安全性

潘家骅，迟辰斐，董柏君，朱寅杰，邵晓光，王艳青，徐凡，沙建军，黄翼然，薛蔚   

  1. 上海交通大学 医学院附属仁济医院泌尿科，上海 200127
  • 出版日期:2017-06-28 发布日期:2017-07-05
  • 通讯作者: ?薛蔚，电子信箱：uroxuewei@163.com
  • 作者简介:潘家骅（1980—），男，主治医师，博士；电子信箱：jiahua.pan@outlook.com
  • 基金资助:

    上海市科学技术委员会项目（16411969800）；上海市教育委员会高峰高原学科建设计划（20152215）

Safety of neoadjuvant chemo-hormonal therapy by the combination of docetaxel and maximal androgen blockage for locally advanced prostate cancer

PAN Jia-hua, CHI Chen-fei, DONG Bai-jun, ZHU Yin-jie, SHAO Xiao-guang, WANG Yan-qing, XU Fan, SHA Jian-jun, HUANG Yi-ran, XUE Wei   

  1. Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-06-28 Published:2017-07-05
  • Supported by:

     Project of Shanghai Municipal Science and Technology Committee, 16411969800; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152215

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摘要：

目的 · 评估高危局部进展性前列腺癌患者行多西他赛联合全雄阻断新辅助治疗的安全性，总结其不良反应及临床处理对策。 方法 · 回顾性研究 2015 年 6 月至 2017 年 2 月 55 例行新辅助化疗联合全雄阻断内分泌治疗患者的临床资料，新辅助治疗方案为基于 多西他赛的 3 周 DP 方案联合促性腺激素释放激素类似物及雄激素阻断剂比卡鲁胺，共 4 周期。观察并记录所有治疗相关不良反应。 结果 · 55 例中 2 例因肝功能损害在 2 周期治疗后退出研究。新辅助治疗过程中，没有严重过敏反应发生。最常见的不良反应为血液系 统毒性，23.6% 的患者出现了Ⅲ～Ⅳ级中性粒细胞减少，12.7% 的患者出现贫血。由于疗程较短，皮肤黏膜损害、外周神经毒性及体 液潴留并不多见，而全雄阻断相关性潮热、男性乳房发育及勃起功能障碍发生率较高。绝大多数不良反应通过对症支持治疗可缓解。 结论 · 在经过严格选择的局部进展期高危前列腺癌患者中进行 4 周期的新辅助化疗联合全雄阻断内分泌治疗，不良反应可控，但在治 疗期间仍需严密监测并最大程度降低不良反应发生率。此外，由全雄阻断引起的低雄激素水平相关性内分泌代谢紊乱也是治疗过程中 需要关注的问题。

关键词: 高危局部进展性前列腺癌, 新辅助化疗, 全雄阻断, 多西他赛, 不良反应

Abstract:

Objective · To evaluate the safety of neoadjuvant therapy which was constituted by docetaxel based systemic chemotherapy and maximal androgen blockage for patients with locally advanced prostate cancer and to summarize the related adverse events and clinical managements.  Methods · From June 2015 to February 2017, the clinical data of 55 patients undergoing neoadjuvant chemotherapy combined with complete androgen deprivation were retrospectively reviewed. The patients were given docetaxel and prednisone as DP regimen every 3 weeks and LHRH analogues with bicalutamide as maximal androgen deprivation for a total of 4 cycles. All treatment-related adverse events were observed and then recorded.  Results · Two cases with liver function impairment after 2 cycles of treatment were withdrawn from the study. No severe allergic reactions occurred during neoadjuvant therapy. The most common adverse events were hematologic toxicity, while 23.6% of patients had grade III-IV neutropenia, and about 12.7% had anemia. Due to a relatively short course of treatment, the skin or mucous damage, peripheral neurotoxicity and fluid retention were rare. However, hot flash, male breast development as well as erectile dysfunction were very frequently observed due to maximal androgen deprivation. The majority of these adverse events were relieved by symptomatic and supportive treatment.  Conclusion · After strict selection, 4 cycles of neoadjuvant chemotherapy combined with total androgen blockade could be well tolerated by the patients with high-risk locally advanced prostate cancer. Even though the adverse events were controllable, they still need to be closely monitored during treatment in order to reduce the incidence. In addition, the very low testosterone level associated endocrinal metabolic disorders caused by complete androgen deprivation were also of great concern.

Key words: high-risk locally advanced prostate cancer, neoadjuvant chemotherapy, complete androgen deprivation, docetaxel, adverse event