Lee Andrew K
Department of Radiation Oncology, University of Texas- M.D. Anderson Cancer Center, Houston, 77030, USA.
Semin Radiat Oncol. 2006 Jan;16(1):20-8. doi: 10.1016/j.semradonc.2005.08.003.
Standard-dose radiation therapy has limited capacity to cure bulky and locally advanced prostate cancer. Multiple randomized trials have shown a clinical benefit to adding androgen suppression therapy to external-beam radiation therapy in several subsets of prostate cancer. These studies have made combining hormonal therapy with radiation therapy the standard of care for men with locally advanced (T3-4) and unfavorable prostate cancers (Gleason score >or=8 and/or prostate-specific antigen >20 ng/mL). The clinical impact of hormonal therapy has been seen in biochemical control, local control, distant metastases, disease-specific survival, and overall survival. If hormonal therapy is to be combined with radiation, it should be initiated before the start of radiation and continued during the radiation course rather than used only in the adjuvant setting. Typically, shorter-term hormone therapy is defined as regimens of 4 to 6 months, with longer-term hormone therapy describing durations beyond 24 months. Historically, longer-term hormone therapy was thought to have a more profound systemic effect; however, with the emerging use of hormonal therapy for less-advanced disease, the overall impact of shorter-course hormone therapy is being seen. This review will summarize trials using hormonal therapy and radiation with an emphasis on phase III studies and describe the more recent integration of hormone therapy with radiation for prostate cancer.
标准剂量放射治疗治愈体积较大和局部晚期前列腺癌的能力有限。多项随机试验表明，在前列腺癌的几个亚组中，在体外放射治疗中加入雄激素抑制治疗具有临床益处。这些研究使得激素治疗与放射治疗相结合成为局部晚期（T3-4）和预后不良前列腺癌（ Gleason评分≥8和/或前列腺特异性抗原>20 ng/mL）男性的标准治疗方法。激素治疗在生化控制、局部控制、远处转移、疾病特异性生存和总生存方面均有临床效果。如果要将激素治疗与放射治疗联合使用，应在放射治疗开始前启动，并在放射治疗过程中持续进行，而不是仅用于辅助治疗。通常，短期激素治疗定义为疗程为4至6个月的方案，长期激素治疗则指疗程超过24个月。从历史上看，长期激素治疗被认为具有更深远的全身效应；然而，随着激素治疗在病情较轻的疾病中越来越多地使用，短期激素治疗的总体影响也逐渐显现。本综述将总结使用激素治疗和放射治疗的试验，重点是III期研究，并描述激素治疗与放射治疗在前列腺癌方面的最新整合情况。
