Whittington R, Malkowicz B, Barnes M M, Broderick G A, Van Arsdalen K, Dougherty M J, Wein A J
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Urology. 1995 Aug;46(2):213-9. doi: 10.1016/s0090-4295(99)80196-4.
To evaluate the efficacy of combined radiation and hormonal therapy in patients with prostate cancer metastatic to the pelvic lymph nodes.
Fifty consecutive patients with node-positive prostate cancer were evaluated by the Departments of Urology and Radiation Oncology at the University of Pennsylvania and offered combined hormonal and radiation therapy. All patients received pelvic radiation to 45 Gy, with a boost dose to the prostate to 65 to 71 gy. Forty-five of the patients were treated with concurrent hormonal therapy consisting of diethylstilbestrol (2 patients), orchiectomy (18 patients), leuprolide (5 patients), or combined androgen blockade (20 patients); the other 5 patients declined hormonal therapy. Patients represented a group with locally advanced disease with a high incidence of T3 tumors (66%), high grade (74%; Gleason score more than 7), high prostate-specific antigen (PSA) (40%; more than 30.0 ng/mL), and a high incidence of gross (36%) or bilateral (30%) adenopathy and a high incidence of multiply involved lymph nodes (62%).
Median follow-up of patients is 42 months (range, 10 to 102). All 5 patients declining hormonal therapy relapsed within 18 months and only 1 patient survived longer than 3 years. Among patients treated with combined hormonal and radiation therapy, the 6-year survival rate is 82%, the clinical disease-free survival at 6 years is 71%, and the probability of survival free of recurrence, with a PSA less than 0.2 ng/mL, is 62%. Only two PSA recurrences occurred, both in patients who elected to discontinue hormone therapy. There was no synergistic toxicity observed as a result of combined therapy.
Combined hormonal and radiation therapy offers the potential for extended disease-free survival and may represent an effective treatment option for patients with locally advanced prostate cancer.
评估放疗联合激素疗法对前列腺癌盆腔淋巴结转移患者的疗效。
宾夕法尼亚大学泌尿外科和放射肿瘤学系对50例连续性淋巴结阳性前列腺癌患者进行评估，并为其提供激素与放疗联合治疗。所有患者均接受盆腔放疗，剂量为45 Gy，前列腺追加剂量至65至71 Gy。45例患者接受同步激素治疗，其中2例使用己烯雌酚，18例行睾丸切除术，5例使用亮丙瑞林，20例采用联合雄激素阻断疗法；另外5例患者拒绝激素治疗。患者均为局部晚期疾病，T3肿瘤发生率高（66%），肿瘤分级高（74%；Gleason评分大于7），前列腺特异性抗原（PSA）水平高（40%；大于30.0 ng/mL），大体（36%）或双侧（30%）腺病发生率高，多组淋巴结受累发生率高（62%）。
患者的中位随访时间为42个月（范围10至102个月）。所有5例拒绝激素治疗的患者在18个月内复发，只有1例患者存活超过3年。在接受激素与放疗联合治疗的患者中，6年生存率为82%，6年临床无病生存率为71%，PSA小于0.2 ng/mL的无复发生存概率为62%。仅发生2例PSA复发，均出现在选择停止激素治疗的患者中。联合治疗未观察到协同毒性。
激素与放疗联合治疗有可能延长无病生存期，可能是局部晚期前列腺癌患者的一种有效治疗选择。
