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[摘要]
目的：探讨吉西他滨（健择）+顺铂全身化疗治疗激素非依赖性砥谇傲邢侔┑牧俅残Ч岸靖狈从Α?/SPAN>
方法：本组18例激素非依赖性晚期前列腺癌患者，全部经去势手术及不同程度的抗雄激素药物治疗，经全身骨扫描证实均有多发性骨转移灶，其中肝脏、双侧肾上腺和颅内转移各1例，血PSA呈逐渐上升趋势。用健择1 000mg/m2+NS 100 ml静脉滴注，第1、8天各一次；DDP 100 mg/m2+NS 500ml静脉滴注，第1天用，或者DDP 30 mg+NS 250 ml静脉滴注，第1～5天使用；每28天为一个疗程。
结果：12例患者的血PSA值降至正常水平（<4ng/l），4例PSA值下降超过50%，2例PSA值变化不明显。化疗前，14例骨转移灶疼痛按VRS分级Ⅰ级5例、Ⅱ级6例、Ⅲ级3例，化疗后分别为Ⅰ级3例、Ⅱ级1例、Ⅲ级0例。多发性颅内转移灶其中最大转移瘤直径由化疗前的3.0 cm缩小至0.5 cm，化疗后面瘫症状消失。肝脏转移瘤由原来的10.2 cm缩小至3.3 cm。双侧肾上腺多发性转移瘤化疗后总的肿瘤体积缩小三分之二以上。随访2～33个月，平均17.3个月，3例患者死亡，中位生存期16.2个月。疼痛缓解期平均为15.3个月。PSA值降低的稳定期平均为14.2个月。本组病例最常见的毒副反应分别是恶心、呕吐、白细胞减少、血红蛋白降低及血小板减少等，但均在可耐受的范围。
结论：健择联合顺铂全身化疗治疗激素非依赖性晚期前列腺癌的临床疗效显著，毒副反应可耐受，可作为激素非依赖性晚期前列腺癌的一种辅助治疗方法。
[关键词] 吉西他滨；顺氯铵铂；前列腺癌；化学治疗
[Abstract]
Purpose：The aim of this study was to evaluate the clinical efficacy and toxicity of treatment with gemcitabine and cisplatin for hormone independent prostate cancer.
Methods：18 cases of advanced hormone independent prostate cancers who received castration and antiandrogen medicines were confirmed to have multiple bone metastatic carcinomas by emission computed tomography(ECT), and hepatic , adrenal and intracranial metastasis were found respectively each in 1 patient, and the value of PSA(prostatic special antigen) had on ascending trend in all patients. Gemcitabine 1000 mg/m2+NS 100 ml was administered by intravenous drip on days 1,8 and cisplatin 100 mg/m2 +NS 500 ml was administered by intravenous drip on day 1 or cisplatin 30 mg/m2+NS 250 ml was administered by intravenous drip on days 1 to 5 in each 28-day cycle.
Results：Levels of PSA descent to normal titer（<4ng/l） in 12 patients, and descent more than 50% in 4 patients, and did no change in 2 patients. Before chemotherapy, the grades of pain in 14 cases suffering pain due to bone metastasis were 5 cases in grade Ⅰ, 6 cases in grade Ⅱand 3 cases in grade Ⅲ. After the chemotherapy, the grades of ache were 3 cases in grade Ⅰ, 1 case in grade Ⅱand 0 in grade Ⅲ. After chemotherapy, the maximum diameter of multiple intracranial metastatic tumor was reduced from 3.0cm to 0.5cm, and the symptoms of facial paralysis vanished. The diameter of hepatic metastatic tumors was reduced from 10.2cm to 3.3cm, and adrenal metastatic tumor was reduced more than 2/3. The patients were followed-up for 3～30 months (mean time= 17.3 months). Of 18 patients, 3 patients died from the disease. The median survival time was 16.2 months. Mean time of remission of pain was 15.3 months, and the stabilization of descent of levels of PSA was 14.2 months. The toxicity of chemotherapy was tolerable, mainly nausea/vomiting, leukopenia, decreased hemoglobin and thrombocytopenia.
Conclusions：The gemcitabine-cisplatin combination regime was effective and tolerable in the treatment for advanced hormone independent prostate cancer, it could be considered as one of the adjuvant treatments for advanced hormone independent prostate cancer.
第一作者简介：秦自科，男，副教授，博士。
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