Bolla M
Service de Radiothérapie, Centre Hospitalier Régional et Universitaire, Grenoble, France.
Eur Urol. 1999;35 Suppl 1:23-5; discussion 26.
Long-term results of radiotherapy in locally advanced prostate cancer are poor due to local and distant failures. Since prostate cancer is hormone dependent, tumor androgen deprivation may enhance tumor eradication.
Three randomized phase III trials, RTOG and EORTC are reported: they assess androgen suppression by using a luteinizing hormone-releasing hormone analogue (LH-RHa) with or without androgen blockade before and during, or during and after external irradiation.
A gain in disease-free, local relapse-free and metastasis-free survival has been obtained (p < 0.001). Only the EORTC 22863 trial has reported a significant improvement in overall survival (p = 0.001) with an LH-RHa started the first day of radiotherapy and administered every 4 weeks over 3 years. In the RTOG 85-10 trial, and LH-RHa, initiated in the last week of radiation therapy and continued until relapse, increased overall survival only in patients with poorly differentiated tumor with a Gleason score of 8-10 (p = 0.03).
Androgen suppression prior to and during radiation improves disease-free survival; adjuvant hormonal therapy with an LH-RHa during and after radiation improves overall survival.
局部晚期前列腺癌放疗的长期效果因局部和远处复发而较差。由于前列腺癌依赖激素，肿瘤雄激素剥夺可能增强肿瘤根除效果。
报告了三项随机III期试验，即RTOG和EORTC试验：它们评估在体外照射前、照射期间或照射期间及照射后使用促黄体生成素释放激素类似物（LH-RHa）联合或不联合雄激素阻断进行雄激素抑制的情况。
已实现无病生存期、局部无复发生存期和无转移生存期的延长（p < 0.001）。只有EORTC 22863试验报告了总体生存期的显著改善（p = 0.001），该试验在放疗第一天开始使用LH-RHa，并在3年内每4周给药一次。在RTOG 85-10试验中，在放射治疗最后一周开始并持续至复发的LH-RHa仅在Gleason评分为8-10的低分化肿瘤患者中提高了总体生存期（p = 0.03）。
放疗前及放疗期间的雄激素抑制可改善无病生存期；放疗期间及放疗后的LH-RHa辅助激素治疗可改善总体生存期。
