Whittington R, Malkowicz S B, Machtay M, Van Arsdalen K, Barnes M M, Broderick G A, Wein A J
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, USA.
Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):673-80. doi: 10.1016/s0360-3016(97)00369-6.
To determine the rate of tumor response and patterns of relapse following combined hormonal-radiation therapy of adenocarcinoma of the prostate and to measure the survival in a group of men with tumor metastatic to pelvic lymph nodes.
66 patients with adenocarcinoma of the prostate with pathologically confirmed pelvic lymph node involvement were treated with combined radiation therapy and hormonal therapy. An additional five patients declined hormonal therapy. The patients treated with combined therapy represented a group with locally advanced disease including 44 patients (67%) with T3 or T4 tumors and 51 patients (80%) had N2 or N3 lymph node metastases. The pelvic lymph nodes were treated to a dose of 45 Gy and the prostate was boosted to a dose of 65 to 71 Gy. Hormonal therapy began up to 2 months before radiation and continued indefinitely. Patients were allowed to select their hormonal therapy and could choose DES (2 patients), orchiectomy (21 patients), LHRH agonist (7 patients) or combined androgen blockade (34 patients).
Median follow-up is 49 months (range 12 to 131 months) and 21 patients have been followed for longer than 5 years. There have been 15 recurrences the entire group including three local recurrences in the prostate, seven patients with distant metastases, four patients with biochemical recurrences without clinical evidence of disease, and one patient where the location was unknown. Two of the PSA recurrences occurred in patients who elected to discontinue hormones after less than 3 years of therapy. The overall survival at 5 and 8 years is 94 and 84%, the clinical disease free survival is 85 and 67%, and the biochemical disease-free survival is 78 and 47%. There was no increased toxicity of the combined modality regimen compared to the expected effects of radiation and hormonal therapy.
Combined hormonal and radiation therapy represents an effective treatment option for patients with adenocarcinoma of the prostate metastatic to pelvic lymph nodes. Combined modality therapy appears to extend the disease-free survival and allow patients to maintain their independent function.
确定前列腺腺癌联合激素 - 放射治疗后的肿瘤反应率和复发模式，并测量一组盆腔淋巴结转移肿瘤男性患者的生存率。
66例经病理证实盆腔淋巴结受累的前列腺腺癌患者接受了放射治疗和激素治疗联合方案。另外5例患者拒绝接受激素治疗。接受联合治疗的患者代表一组局部晚期疾病患者，其中包括44例（67%）T3或T4期肿瘤患者，51例（80%）有N2或N3淋巴结转移。盆腔淋巴结接受45 Gy的剂量照射，前列腺接受追加剂量至65至71 Gy。激素治疗在放疗前2个月内开始并无限期持续。患者可自行选择激素治疗方式，可选择己烯雌酚（2例患者）、睾丸切除术（21例患者）、促性腺激素释放激素（LHRH）激动剂（7例患者）或联合雄激素阻断（34例患者）。
中位随访时间为49个月（范围12至131个月），21例患者随访时间超过5年。整个组中有15例复发，包括前列腺局部复发3例、远处转移7例、无疾病临床证据的生化复发4例以及1例复发部位不明的患者。2例前列腺特异性抗原（PSA）复发发生在治疗不到3年就选择停用激素的患者中。5年和8年的总生存率分别为94%和84%，临床无病生存率分别为85%和67%，生化无病生存率分别为78%和47%。与单纯放疗和激素治疗的预期效果相比，联合治疗方案并未增加毒性。
联合激素和放射治疗是前列腺腺癌盆腔淋巴结转移患者的一种有效治疗选择。联合治疗似乎可延长无病生存期，并使患者维持其独立功能。
