Roach M
Department of Radiation Oncology and Medical Oncology, University of California, San Francisco 94143-0226, USA.
Semin Urol Oncol. 1996 May;14(2 Suppl 2):32-7; discussion 38.
The combination of radiation therapy and total androgen suppression shows potential for improving the outcome in patients with locally advanced prostate cancer. Both radiation and androgen ablation induce apoptosis through different mechanisms, and a synergistic interaction has been reported between the two modalities in vitro. Studies of neoadjuvant hormonal therapy before radical prostatectomy have shown considerable tumor shrinkage, a change that would greatly facilitate subsequent radiotherapy. A recent randomized trial involving patients with bulky disease has shown that the use of androgen ablation therapy before and during radiation therapy substantially improved local control and decreased the time to biochemical failure. Still another randomized trial performed in patients with locally advanced disease has shown that the positive biopsy rate was strikingly lower in patients who received neoadjuvant hormonal therapy before radiation than in those who underwent radiotherapy alone, and was even lower in patients who were treated with both neoadjuvant and adjuvant total androgen suppression. The combination of hormonal therapy and radiation has not yet been proven to prolong survival. Nevertheless, given the limitations of conventional radiotherapy, it is recommended that patients at high risk for failure be entered into one of the ongoing Radiation Therapy Oncology Group (RTOG) trials. These trials are attempting to clarify such questions as the role of adjuvant therapy following neoadjuvant therapy and radiation, the optimal timing of hormonal therapy, and the role of whole pelvic irradiation.
放射治疗与全雄激素抑制相结合显示出改善局部晚期前列腺癌患者治疗结果的潜力。放疗和雄激素消融均通过不同机制诱导细胞凋亡，并且在体外已报道这两种治疗方式之间存在协同相互作用。前列腺癌根治术前新辅助激素治疗的研究显示肿瘤有显著缩小，这一变化将极大地促进后续放疗。一项近期针对有大块肿瘤疾病患者的随机试验表明，在放疗前及放疗期间使用雄激素消融治疗可显著改善局部控制并缩短至生化复发的时间。另一项针对局部晚期疾病患者进行的随机试验显示，放疗前接受新辅助激素治疗的患者阳性活检率显著低于单纯接受放疗的患者，而接受新辅助和辅助全雄激素抑制治疗的患者阳性活检率更低。激素治疗与放疗相结合尚未被证实可延长生存期。尽管如此，鉴于传统放疗的局限性，建议将高失败风险患者纳入正在进行的放射肿瘤学组（RTOG）试验之一。这些试验正试图阐明诸如新辅助治疗和放疗后辅助治疗的作用、激素治疗的最佳时机以及全盆腔照射的作用等问题。
