Eom Keun-Yong, Ha Sung W, Lee Eunsik, Kwak Cheol, Lee Sang Eun
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Radiat Oncol J. 2014 Dec;32(4):247-55. doi: 10.3857/roj.2014.32.4.247. Epub 2014 Dec 30.
To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy.
We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique.
Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose ≥70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose ≥70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963).
NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.
确定新辅助雄激素剥夺疗法（NADT）是否能改善接受根治性放疗的前列腺癌患者的临床结局。
我们回顾性分析了1991年1月至2008年12月期间接受放疗的201例前列腺癌患者的病历。其中，156例随访超过3年的患者为本研究对象。中位随访时间为91.2个月。103例患者（66%）接受了NADT，中位持续时间为3.3个月（范围1.0至7.7个月）。采用调强放疗技术将放射剂量从64 Gy逐步提高至81 Gy。
所有患者的5年生化无复发生存率（BCRFS）和总生存率（OS）分别为72.6%和90.7%。NADT组的5年BCRFS和OS分别为79.5%和89.8%，单纯放疗组的5年BCRFS和OS分别为58.8%和92.3%。风险组（p = 0.010）和放射剂量≥70 Gy（p = 0.017）独立影响BCRFS。NADT在单因素分析中是一个显著的预后因素，但在多因素分析中不是（p = 0.073）。放射剂量≥70 Gy仅是OS的独立因素（p = 0.007；风险比，0.261；95%置信区间，0.071 - 0.963）。
根治性放疗前的NADT在BCRFS和OS方面未带来显著益处。在剂量递增放疗时代，不应常规进行NADT。
