Zagars G K, Johnson D E, von Eschenbach A C, Hussey D H
Department of Clinical Radiotherapy, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston 77030.
Int J Radiat Oncol Biol Phys. 1988 Jun;14(6):1085-91. doi: 10.1016/0360-3016(88)90383-5.
Seventy-eight patients with clinical Stage C adenocarcinoma of the prostate were prospectively randomized to receive either radiation alone or radiation and adjuvant estrogen (diethylstilbestrol). No patient had received any prior definitive treatment for cancer. Forty patients were randomized to receive radiotherapy only and 38 patients to receive radiotherapy and estrogen. The median follow-up for all surviving patients was 14.5 years. Whether analyzed according to the original randomization or according to the treatment actually received, disease-free survival in the adjuvant estrogen group was strikingly and significantly higher than in the radiation-only group. At 5, 10, and 15 years patients receiving adjuvant estrogen had respective disease-free survival rates of 71%, 63%, and 63% compared with 49%, 43%, and 35% in patients having radiation only (p = 0.008). However, because of greater intercurrent disease-related mortality in patients receiving estrogen, there was no improvement in survival. This study suggests that a prospective randomized evaluation of early androgen deprivation with orchiectomy or with one of the nonestrogenic agents should be undertaken and that patients receiving early androgen deprivation should not be included in series reporting on the curative potential of radiation as a single modality.
78例临床C期前列腺腺癌患者被前瞻性随机分组，分别接受单纯放疗或放疗联合辅助雌激素（己烯雌酚）治疗。所有患者此前均未接受过任何确定性的癌症治疗。40例患者被随机分配接受单纯放疗，38例患者接受放疗加雌激素治疗。所有存活患者的中位随访时间为14.5年。无论根据最初的随机分组情况还是实际接受的治疗情况进行分析，辅助雌激素组的无病生存率均显著高于单纯放疗组。在5年、10年和15年时，接受辅助雌激素治疗的患者无病生存率分别为71%、63%和63%，而单纯接受放疗的患者分别为49%、43%和35%（p = 0.008）。然而，由于接受雌激素治疗的患者并发疾病相关死亡率更高，生存率并未得到改善。本研究表明，应进行一项关于睾丸切除术或非雌激素类药物之一进行早期雄激素剥夺的前瞻性随机评估，并且接受早期雄激素剥夺治疗的患者不应纳入关于放疗作为单一治疗手段的治愈潜力的系列报告中。
