新一期英国医学刊物《柳叶刀》刊登研究报告说，在前列腺癌的治疗中，与单独使用放射疗法相比，联合使用激素疗法和放射疗法的疗效更好，可以大幅降低患者的死亡率。
澳大利亚纽卡斯尔大学等机构的研究人员报告说，他们对800多名前列腺癌症患者进行了为期10年的跟踪。这些患者在治疗上被分为3组，第1组只用放射疗法，第2组在放射疗法的基础上加上3个月的激素疗法，第3组则是在放射疗法的基础上加上6个月的激素疗法。
结果显示，在10年跟踪期间，第2组患者的死亡率与第1组相比略有下降，但第3组患者的死亡率则大幅下降，与第1组相比要低一半。
研究人员说，这项研究提供了两个重要信息，即在前列腺癌的治疗中联合使用激素疗法和放射疗法的确效果更好，且激素疗法应持续6个月才会有较好效果。
放射疗法是一种常见的疗法，它用X射线来杀死癌变组织。而激素疗法主要用于与性别有关的疾病。男性的前列腺癌常与雄性激素有关，因此用药物控制雄性激素有助于治疗前列腺癌。（生物谷Bioon.com）
生物谷推荐原文出处：
The Lancet Oncology, doi:10.1016/S1470-2045(11)70063-8
Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial
Original TextProf James W Denham MD a , Allison Steigler BMath a, Prof David S Lamb FRANZCR b, Prof David Joseph FRANZCR c, Sandra Turner FRANZCR d, John Matthews FRANZCR e, Chris Atkinson FRANZCR f, John North FRANZCR g, David Christie FRANZCR h, Prof Nigel A Spry FRANZCR c, Keen-Hun Tai FRANZCR i, Chris Wynne FRANZCR f, Prof Catherine D'Este PhD j
Summary
Background
The TROG 96.01 trial assessed whether 3-month and 6-month short-term neoadjuvant androgen deprivation therapy (NADT) decreases clinical progression and mortality after radiotherapy for locally advanced prostate cancer. Here we report the 10-year results.
Methods
Between June, 1996, and February, 2000, 818 men with T2b, T2c, T3, and T4 N0 M0 prostate cancers were randomly assigned to receive radiotherapy alone, 3 months of NADT plus radiotherapy, or 6 months of NADT plus radiotherapy. The radiotherapy dose for all groups was 66 Gy, delivered to the prostate and seminal vesicles (excluding pelvic nodes) in 33 fractions of 2 Gy per day (excluding weekends) over 6·5—7·0 weeks. NADT consisted of 3·6 mg goserelin given subcutaneously every month and 250 mg flutamide given orally three times a day. NADT began 2 months before radiotherapy for the 3-month NADT group and 5 months before radiotherapy for the 6-month NADT group. Primary endpoints were prostate-cancer-specific mortality and all-cause mortality. Treatment allocation was open label and randomisation was done with a minimisation technique according to age, clinical stage, tumour grade, and initial prostate-specific antigen concentration (PSA). Analysis was by intention-to-treat. The trial has been closed to follow-up and all main endpoint analyses are completed. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12607000237482.
Findings
802 men were eligible for analysis (270 in the radiotherapy alone group, 265 in the 3-month NADT group, and 267 in the 6-month NADT group) after a median follow-up of 10·6 years (IQR 6·9—11·6). Compared with radiotherapy alone, 3 months of NADT decreased the cumulative incidence of PSA progression (adjusted hazard ratio 0·72, 95% CI 0·57—0·90; p=0·003) and local progression (0·49, 0·33—0·73; p=0·0005), and improved event-free survival (0·63, 0·52—0·77; p<0·0001). 6 months of NADT further reduced PSA progression (0·57, 0·46—0·72; p<0·0001) and local progression (0·45, 0·30—0·66; p=0·0001), and led to a greater improvement in event-free survival (0·51, 0·42—0·61, p<0·0001), compared with radiotherapy alone. 3-month NADT had no effect on distant progression (0·89, 0·60—1·31; p=0·550), prostate cancer-specific mortality (0·86, 0·60—1·23; p=0·398), or all-cause mortality (0·84, 0·65—1·08; p=0·180), compared with radiotherapy alone. By contrast, 6-month NADT decreased distant progression (0·49, 0·31—0·76; p=0·001), prostate cancer-specific mortality (0·49, 0·32—0·74; p=0·0008), and all-cause mortality (0·63, 0·48—0·83; p=0·0008), compared with radiotherapy alone. Treatment-related morbidity was not increased with NADT within the first 5 years after randomisation.
Interpretation
6 months of neoadjuvant androgen deprivation combined radiotherapy is an effective treatment option for locally advanced prostate cancer, particularly in men without nodal metastases or pre-existing metabolic comorbidities that could be exacerbated by prolonged androgen deprivation.
Funding
Australian Government National Health and Medical Research Council, Hunter Medical Research Institute, AstraZeneca, and Schering-Plough.
