Antonarakis Emmanuel S, Eisenberger Mario A
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA.
Nat Clin Pract Urol. 2008 Sep;5(9):480-1. doi: 10.1038/ncpuro1175. Epub 2008 Jul 29.
This Practice Point discusses the 10-year data of the RTOG 8610 trial, published by Roach III and colleagues, which suggest that a short, 4-month course of neoadjuvant-concomitant androgen deprivation therapy (ADT) might be sufficient to improve clinically relevant long-term outcomes in men with bulky, locally advanced prostate cancer. The results show that patients randomized to receive short-term ADT before and during radiation therapy (RT), rather than RT alone, had improved long-term disease-specific mortality, freedom from distant metastases, disease-free survival, freedom from biochemical failure, and possibly even overall survival. Importantly, no increase in the risk of fatal cardiac events was seen. The study did not, however, address the issue of the optimum duration of ADT; recent data suggest that longer courses of ADT (>or=2 years), when added to RT, might further improve disease-free and even overall survival, especially in patients with high-grade disease.
本实践要点讨论了由罗奇三世及其同事发表的放射治疗肿瘤学组（RTOG）8610试验的10年数据，这些数据表明，为期4个月的短期新辅助-同步雄激素剥夺疗法（ADT）可能足以改善患有体积较大的局部晚期前列腺癌男性患者的临床相关长期预后。结果显示，随机分配在放疗前和放疗期间接受短期ADT而非单纯放疗的患者，其长期疾病特异性死亡率、无远处转移生存率、无病生存率、无生化复发率甚至总生存率均有所改善。重要的是，未观察到致命性心脏事件风险增加。然而，该研究未探讨ADT的最佳持续时间问题；近期数据表明，放疗联合更长疗程的ADT（≥2年）可能进一步改善无病生存率甚至总生存率，尤其是在高级别疾病患者中。
