Is there a role for short-term hormone use in the treatment of nonmetastatic prostate cancer?

E M Horwitz, A L Hanlon, W H Pinover, G E Hanks
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引用次数: 7

Abstract

We reviewed our institution's experience treating patients with prostate cancer with 3-dimensional conformal radiation therapy (3DCRT) and short-term adjuvant hormonal therapy to determine biochemical no evidence of disease (bNED) and clinical outcome compared with patients treated with 3DCRT alone. Between 4/1/89 and 11/30/94, 558 patients with clinically localized prostate cancer received treatment at Fox Chase Cancer Center (Philadelphia, Pa.); 484 patients were treated with 3DCRT alone (Group I); 74 patients were treated with 3DCRT and hormones (Group II). Five-year actuarial rates of bNED control, distant metastasis-free survival (DMFS), cause-specific survival (CSS), and overall survival (OS) were calculated for pretreatment PSA, Gleason score, T stage, use of hormones, treatment field size, age, and dose. A matched case/control analysis was performed to further evaluate the effect of hormones on treatment with 3DCRT. Median follow-up was 47 months (range: 2-97 months). The 5-year actuarial rates of bNED control, DMFS, CSS, and OS were 66%, 93%, 98%, and 86%, respectively, for Group I patients and 68%, 93%, 98%, and 89%, respectively, for Group II patients. Multivariate analysis demonstrated that hormone use was an independent predictor of bNED control only. A significant difference in bNED control was observed between Group I and II (43% vs. 71%) using the matched case/control analysis (P = 0.02). A trend towards significance was observed for different rates of DMFS between Group I and II (79% vs. 94%, P = 0.09). Patients with clinically localized prostate cancer with poor prognostic features (pretreatment PSA > or = 10 ng/ml, Gleason score > or = 7, and/or T2c or greater palpation stage) show improved rates of bNED control and a trend towards improved DMFS when treated with 3DCRT and short-term adjuvant hormones compared with 3DCRT alone. Long-term observation will be necessary to see if improvements in bNED control will translate into improvements in overall survival.

短期使用激素在非转移性前列腺癌的治疗中是否有作用?
我们回顾我院采用三维适形放射治疗(3DCRT)和短期辅助激素治疗前列腺癌的经验,比较单独3DCRT治疗患者的生化无病证据(bNED)和临床转归。1989年1月4日至1994年11月30日期间,558名临床局限性前列腺癌患者在Fox Chase癌症中心(Philadelphia, Pa)接受了治疗;单纯3DCRT治疗484例(第一组);74例患者接受3DCRT和激素治疗(II组)。计算预处理PSA、Gleason评分、T分期、激素使用、治疗范围大小、年龄和剂量的5年精算率,bNED控制率、远端无转移生存(DMFS)、病因特异性生存(CSS)和总生存(OS)。通过配对病例/对照分析,进一步评价激素对3DCRT治疗的影响。中位随访为47个月(范围:2-97个月)。1组患者bNED控制、DMFS、CSS和OS的5年精算率分别为66%、93%、98%和86%,2组患者的5年精算率分别为68%、93%、98%和89%。多变量分析表明,激素使用仅是bNED控制的独立预测因子。通过配对病例/对照分析,观察到I组和II组bNED控制率有显著差异(43%对71%)(P = 0.02)。第一组和第二组DMFS的发生率有显著性差异(79% vs. 94%, P = 0.09)。临床局限性前列腺癌预后较差的患者(预处理PSA >或= 10 ng/ml, Gleason评分>或= 7,和/或T2c或更高的触诊期),与单独3DCRT相比,3DCRT联合短期辅助激素治疗bNED控制率提高,DMFS有改善的趋势。长期观察是必要的,以确定bNED控制的改善是否会转化为总体生存的改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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