Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Anticancer Res. 2023 Aug;43(8):3589-3596. doi: 10.21873/anticanres.16538.
BACKGROUND/AIM: The aim of this study was to evaluate the benefit of adding long-term adjuvant hormonal therapy to high-dose intensity-modulated radiation therapy for locally advanced prostate cancer patients with multiple unfavorable risks.
All cT3-4N0M0 prostate cancer patients with Gleason score 8-10 and prostate-specific antigen ≥30 ng/ml who received intensity-modulated radiation therapy to the prostate and seminal vesicle alone (78 Gy in 39 fractions) between September 2000 and June 2017 at our institution were analyzed retrospectively. All patients received short-term neoadjuvant hormonal therapy. Before May 2011, salvage hormonal therapy was initiated when prostate-specific antigen levels exceeded 4.0 ng/ml (early salvage hormonal therapy cohort). In June 2011, 2-year adjuvant hormonal therapy was added (adjuvant hormonal therapy cohort). Clinical outcomes were retrospectively compared using the log-rank test.
In total, 88 patients (44 in both cohorts) were analyzed. Median follow-up periods were 10.9 and 6.1 years in early salvage hormonal therapy and adjuvant hormonal therapy cohorts, respectively. No significant difference in overall survival rates was observed (p=0.58). Disease controls were significantly better in the adjuvant hormonal therapy cohort: 95.5 versus 73.6% for castration-resistant prostate cancer-free rate (p=0.04), and 73.6 versus 34.1% for biochemical failure-free rate (p<0.001), both at 8 years, respectively.
Among locally advanced prostate cancer patients with multiple unfavorable risks, adding long-term adjuvant hormonal therapy to high-dose intensity-modulated radiation therapy resulted in significantly better disease control than short-term hormonal therapy, even when salvaged early after biochemical failure.
背景/目的：本研究旨在评估对伴有多种不良风险的局部晚期前列腺癌患者，在高强度调强放疗基础上增加长期辅助性激素治疗的获益。
回顾性分析了 2000 年 9 月至 2017 年 6 月期间在本机构接受单纯前列腺和精囊高强度调强放疗（78Gy 分 39 次）的所有 cT3-4N0M0 前列腺癌患者，Gleason 评分 8-10 分，前列腺特异抗原（PSA）≥30ng/ml。所有患者均接受短期新辅助性激素治疗。在 2011 年 5 月之前，当 PSA 水平超过 4.0ng/ml 时开始挽救性激素治疗（早期挽救性激素治疗队列）。2011 年 6 月，开始进行为期 2 年的辅助性激素治疗（辅助性激素治疗队列）。采用对数秩检验比较临床转归。
共分析了 88 例患者（早期挽救性激素治疗和辅助性激素治疗队列各 44 例）。早期挽救性激素治疗和辅助性激素治疗队列的中位随访时间分别为 10.9 年和 6.1 年。两组的总生存率无显著差异（p=0.58）。辅助性激素治疗队列的疾病控制情况明显更好：无去势抵抗性前列腺癌生存率分别为 95.5%和 73.6%（p=0.04），生化失败无复发生存率分别为 73.6%和 34.1%（p<0.001），均在 8 年时。
在伴有多种不良风险的局部晚期前列腺癌患者中，与短期激素治疗相比，在高强度调强放疗基础上增加长期辅助性激素治疗可显著改善疾病控制，即使在生化失败后早期进行挽救性治疗也是如此。
