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A multiinstitutional, concurrent chemoradiation trial of strontium‐89, estramustine, and vinblastine for hormone refractory prostate carcinoma involving bone
Author(s) -
Akerley Wallace,
Butera James,
Wehbe Terek,
Noto Richard,
Stein Barry,
Safran Howard,
Cummings Frank,
Sambandam Sundaresan,
Maynard John,
Di Rienzo Gregory,
Leone Louis
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10437
Subject(s) - medicine , vinblastine , estramustine , radiation therapy , urology , regimen , surgery , refractory (planetary science) , oncology , gastroenterology , prostate , chemotherapy , cancer , prostate disease , physics , astrobiology
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/m 2 daily on Weeks 1–4 and 7–10, vinblastine 4 mg/m 2 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. Cancer 2002;94:1654–60. © 2002 American Cancer Society. DOI 10.1002/cncr.10437