1. A multiinstitutional, concurrent chemoradiation trial of strontium-89, estramustine, and vinblastine for hormone refractory prostate carcinoma involving bone.
- Author
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Akerley W, Butera J, Wehbe T, Noto R, Stein B, Safran H, Cummings F, Sambandam S, Maynard J, Di Rienzo G, and Leone L
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Antineoplastic Agents, Hormonal administration & dosage, Antineoplastic Agents, Phytogenic administration & dosage, Carcinoma pathology, Combined Modality Therapy, Estramustine administration & dosage, Humans, Infusions, Intravenous, Male, Middle Aged, Palliative Care, Prostate-Specific Antigen blood, Prostatic Neoplasms pathology, Strontium Radioisotopes therapeutic use, Treatment Outcome, Vinblastine administration & dosage, Antineoplastic Agents, Hormonal pharmacology, Antineoplastic Agents, Phytogenic pharmacology, Carcinoma drug therapy, Carcinoma radiotherapy, Estramustine pharmacology, Prostatic Neoplasms drug therapy, Prostatic Neoplasms radiotherapy, Vinblastine pharmacology
- Abstract
Background: Estramustine phosphate (EMP) and vinblastine have radiosensitizing properties and significant activity against hormone refractory prostate carcinoma. Strontium-89 is a palliative agent that acts as a selective radiation source for bone metastasis. The combination of EMP, vinblastine, and strontium-89 was developed to exploit the potential for radiosynergy. PATIENTS AND METHODS Forty-four patients at the Brown Oncology Group affiliated hospitals were treated with oral EMP 600 mg/m2 daily on Weeks 1-4 and 7-10, vinblastine 4 mg/m2 intravenously once each week on Weeks 1-4 and 7-10, and strontium-89 2.2 MBq/kg on Day 1. Courses were repeated every 12 weeks. Response assessment was based on a change in the serum prostate specific antigen (PSA) levels, correlated with change in measurable disease and bone scan appearance., Results: A greater than or equal to 50% decline in PSA for at least 6 weeks was observed in 21 patients (48%, 95% confidence interval, 33-62%). Median duration of response was 23 weeks (range, 6-70.8 weeks). The median survival was 13 months with 1- and 2-year survival rates of 55% and 25%, respectively. After completion of protocol therapy, a retrospective review showed that only nine patients received subsequent palliative external beam radiation after progression., Conclusions: The addition of strontium-89 to the regimen of EMP and vinblastine can be delivered safely and in repeated doses, provides effective palliation, and may decrease the need for future radiation therapy. A randomized trial is necessary to quantify these effects., (Copyright 2002 American Cancer Society.)
- Published
- 2002
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