Center for Evidences in Oncology, Clinical Oncology Service, Internal Medicine Department Faculty of Medical Sciences, University of Campinas--UNICAMP, 6111, 13083-970 Campinas, SP, Brazil.
BMC Cancer. 2012 Feb 2;12:54. doi: 10.1186/1471-2407-12-54.
Locally advanced prostate cancer is often associated with elevated recurrence rates. Despite the modest response observed, external-beam radiotherapy has been the preferred treatment for this condition. More recent evidence from randomised trials has demonstrated clinical benefit with the combined use of androgen suppression in such cases. The aim of this meta-analysis is to compare the combination of distinct hormone therapy modalities versus radiotherapy alone for overall survival, disease-free survival and toxicity.
Databases (MEDLINE, EMBASE, LILACS, Cochrane databases and ClinicalTrials.gov) were scanned for randomised clinical trials involving radiotherapy with or without androgen suppression in local prostate cancer. The search strategy included articles published until October 2011. The studies were examined and the data of interest were plotted for meta-analysis. Survival outcomes were reported as a hazard ratio with corresponding 95% confidence intervals.
Data from ten trials published from 1988 to 2011 were included, comprising 6555 patients. There was a statistically significant advantage to the use of androgen suppression, in terms of both overall survival and disease free survival, when compared to radiotherapy alone. The use of long-term goserelin (up to three years) was the strategy providing the higher magnitude of clinical benefit. In contrast to goserelin, there were no trials evaluating the use of other luteinizing hormone-releasing hormone (LHRH) analogues as monotherapy. Complete hormonal blockade was not shown to be superior to goserelin monotherapy.
Based on the findings of this systematic review, the evidence supports the use of androgen suppression with goserelin monotherapy as the standard treatment for patients with prostate cancer treated with radiotherapy, which are at high risk of recurrence or metastases.
局部晚期前列腺癌常伴有较高的复发率。尽管观察到适度的反应，外照射放射治疗一直是这种情况的首选治疗方法。来自随机试验的最新证据表明，在这种情况下联合使用雄激素抑制具有临床益处。本荟萃分析的目的是比较不同激素治疗方式与单纯放射治疗在总生存、无病生存和毒性方面的疗效。
检索 MEDLINE、EMBASE、LILACS、 Cochrane 数据库和 ClinicalTrials.gov 数据库，寻找涉及局部前列腺癌放射治疗联合或不联合雄激素抑制的随机临床试验。搜索策略包括截至 2011 年 10 月发表的文章。检查这些研究并绘制感兴趣的数据进行荟萃分析。生存结果以风险比和相应的 95%置信区间报告。
纳入了 1988 年至 2011 年发表的十项试验的数据，共纳入 6555 例患者。与单纯放射治疗相比，雄激素抑制在总生存和无病生存方面均具有统计学优势。与放射治疗相比，使用长期戈舍瑞林（长达三年）可获得更高的临床获益。与戈舍瑞林不同，没有试验评估其他黄体生成素释放激素（LHRH）类似物作为单一疗法的应用。完全激素阻断并未显示优于戈舍瑞林单药治疗。
基于这项系统评价的结果，证据支持使用戈舍瑞林单药联合雄激素抑制作为高危复发或转移的前列腺癌患者接受放射治疗的标准治疗方法。
