Azria D, Lemanski C, Zouhair A, Gutowski M, Belkacémi Y, Dubois J B, Romieu G, Ozsahin M
Département d'oncologie-radiothérapie, CRLC Val-d'-Aurelle, rue croix-verte, 34298 Montpellier cedex 5, France.
Cancer Radiother. 2004 Jun;8(3):188-96. doi: 10.1016/j.canrad.2004.01.003.
Combining radiation and hormone therapy has become common clinical practice in recent years for locally advanced prostate cancer. The use of such concomitant therapy in the treatment of breast disease has been very infrequently reported in the literature, but such an application seems justified given the common hormonal dependence of breast cancer and the potential synergetic effect of these two treatment modalities. As adjuvant therapy, tamoxifen is the key drug in the hormonal treatment arsenal, providing a significant improvement in both local control and global survival rates. Aromatase inhibitors are currently being evaluated in this setting, and initial results are promising. In vitro, tamoxifen does not seem to offer a protective effect against radiation. In clinical use, the few available published studies confirm the superiority of the association of radiation with tamoxifen as opposed to radiation therapy alone in decreasing local recurrences of surgically removed breast tumors. Toxicity associated with such concomitant therapy includes mainly subcutaneous and pulmonary fibroses. However, subcutaneous fibrosis and its cosmetic impact on the treated breast are frequently described side effects of radiation therapy, and their incidence may actually be reduced when tamoxifen is associated. The evidence is less controversial for pulmonary fibrosis, which is more common with the concomitant therapy. The association of radiation and aromatase inhibitors has as of yet rarely been reported. Letrozole (Femara) has a radiosensitizing effect on breast-cancer cell lines transfected with the aromatase gene. Clinical data assessing this effect in vivo are not available. The FEMTABIG study (letrozole vs. tamoxifen vs. sequential treatment) did not specify the sequence of radiation and hormonal therapy. The ATAC study comparing the adjuvant use of anastrozole (Arimidex) and tamoxifen does not provide any information on the number of patients receiving radiation concomitant with the hormonal treatment, and in addition also does not specify the sequence of radiation and hormonal treatment. The TEAM study compared exemestane (Aromasine) and tamoxifen, but specified that hormonal treatment follow the completion of radiation therapy.
近年来，联合放疗与激素疗法已成为局部晚期前列腺癌的常见临床治疗方法。在文献中，这种联合疗法用于治疗乳腺疾病的报道非常少见，但鉴于乳腺癌常见的激素依赖性以及这两种治疗方式可能存在的协同效应，这种应用似乎是合理的。作为辅助治疗，他莫昔芬是激素治疗药物库中的关键药物，在局部控制和总体生存率方面均有显著改善。目前正在对芳香化酶抑制剂在这种情况下进行评估，初步结果很有前景。在体外，他莫昔芬似乎对放疗没有保护作用。在临床应用中，为数不多的已发表研究证实，与单纯放疗相比，放疗联合他莫昔芬在降低手术切除乳腺肿瘤的局部复发率方面具有优势。这种联合疗法相关的毒性主要包括皮下和肺部纤维化。然而，皮下纤维化及其对治疗乳房的美容影响是放疗常见的副作用，当联合使用他莫昔芬时，其发生率实际上可能会降低。对于肺部纤维化，证据的争议较小，这种情况在联合疗法中更常见。放疗与芳香化酶抑制剂联合使用的报道至今仍很少见。来曲唑（弗隆）对转染了芳香化酶基因的乳腺癌细胞系具有放射增敏作用。目前尚无评估这种体内效应的临床数据。FEMTABIG研究（来曲唑与他莫昔芬对比及序贯治疗）未明确放疗与激素治疗的顺序。比较阿那曲唑（瑞宁得）和他莫昔芬辅助使用的ATAC研究未提供任何关于接受激素治疗时同步放疗患者数量的信息，此外也未明确放疗与激素治疗的顺序。TEAM研究比较了依西美坦（阿诺新）和他莫昔芬，但明确激素治疗在放疗结束后进行。
