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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3973_Библиотеки_им_академика_М_И_Перельмана.pdf
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10.2.7 Comments
Management of PS is a challenge.
Multidisciplinary comprehensive therapies,
including surgery, radiotherapy, and chemo-
therapy are recommended, however, no consen-
sus has been achieved on the best treatment.
Overall prognosis is poor and 50%–75% of
patients die of the malignant tumor within
2–5 years; median survival is about
15–18months [27–30]. Thus, there is a need to
nd new treatment protocols to increase sur-
vival rates and improve their quality of life.
Benets of PACE in authors’ case series
appear to be extensive tumor necrosis with a
median value of 90% and signicant volume
reduction with a median value 84% at the last
follow-up after PACE and rapid resolution of
gross hematuria, urinary retention, constipation,
and perineal pain, apparently attributed to bulky
tumors and rapid tumor progression. In addition,
the median OS in the authors’ study was much
longer (29 months, mean 30 months) than the
median OS of 15–18months (mean 24months)
in patients with nonresectable nonmetastatic PS
reported by others [27–33]. The actuarial survival
rate at 1-, 2-, and 3-year were 91.7%, 83.3%, and
41.7%, respectively, and longer than the reported
by Vandoros et al. [37] with the 1- and 3-year
survival rates of 68% and 34%, respectively; and
also longer than the reported by Wang etal. [32]
with the 1-, −2, 3-year survival rates of 80.0%,
47.4%, and 22.6%, respectively.
For patients with giant prostate sarcoma with
surrounding tissue invasion, in order to achieve a
radical resection and minimize the extent of
resection, thereby retaining optimal function out-
comes, neoadjuvant radiation therapy (with or
without chemotherapy) can be performed before
resection. However, only a few patients could be
converted from an unresectable tumor to a resect-
able one after these treatments. Wang et al.
reported the outcomes of 25 patients with
unresectable prostate sarcoma. They concluded
that neither chemotherapy nor radiation therapy
could improve the survival rate of these patients
[32]. Musser and colleagues updated the
Memorial Sloan Kettering experience of treat-
ment of prostate sarcoma in 38 patients. The
authors concluded that neoadjuvant systemic
therapy along with radiotherapy occasionally
lead to downsizing of the primary tumor, thereby
achieve complete resection [33]. In the authors’
series, PACE allowed surgical resection in 5
(41.7%) patients after 2–4 sessions; negative sur-
gical margin was presented in 4 of the ve
patients. Therefore, PACE can be the initial treat-
ment before resection substitute for systemic
chemotherapy, especially for patients without
distant metastases, and can be repeated until the
tumor can be completely resectable. In the
authors’ case series, PACE for the treatment of
the PA has been shown to be safe and well toler-
ated. There was no marked chemotherapeutic
agent-induced toxicity noted.
In patients with large aggressive PS, complete
local control of the lesion was difcult to achieve
with a single session of PACE, repeat PACE thus
usually needed. Although most prostate tumors
are supplied by prostatic arteries, some lesions,
especially in giant tumors with adjacent organs
invasion, have multiple feeding arteries. It is crit-
ical to identify these arteries accurately prior to
PACE, so as to achieve better outcomes and avoid
nontarget embolization.
10.2.8 Conclusions
Prostate sarcoma is a rare tumor that is usually
very large at the initial presentation. Regardless
of the initial tumor size, grade, and histological
subtype, the overall survival rate remains very
low. Complete surgical resection, especially,
microscopically negative margins, is critical for
cure and is essential for long-term survival. It is
necessary to perform long-term surveillance to
detect relapses. Salvage surgery can prolong sur-
vival in patients with isolated local recurrence.
The role of PACE seems promising in controlling
locally advanced lesions, and warrants further
study in this particular setting.
10 PAE intheTreatment ofProstate Malignant Tumor
100
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