Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review.
Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review.
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DOI：
10.1186/1471-2407-12-54
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发表时间：
2012-02-02
期刊：
影响因子：
3.8
通讯作者：
Macedo LT
中科院分区：
文献类型：
--
作者：
Sasse AD;Sasse E;Carvalho AM;Macedo LT
局部晚期前列腺癌通常与复发率升高相关。尽管观察到的反应有限，但外束放射治疗一直是这种疾病的首选治疗方法。最近的随机试验证据表明，在这种情况下，联合使用雄激素抑制剂具有临床获益。本荟萃分析的目的是比较不同激素治疗方式的组合与单独放疗的总生存率，无病生存率和毒性。对数据库（MEDLINE、EMBASE、LILACS、科克伦数据库和ClinicalTrials.gov）进行扫描，以查找涉及局部前列腺癌放疗伴或不伴雄激素抑制的随机临床试验。检索策略包括截至2011年10月发表的文章。对这些研究进行了检查，并将感兴趣的数据绘制成图进行荟萃分析。生存结局报告为风险比和相应的95%置信区间。纳入了1988年至2011年发表的10项试验的数据，包括6555例患者。与单纯放疗相比，在总生存期和无病生存期方面，使用雄激素抑制有统计学显著优势。长期使用戈舍瑞林（长达三年）是提供更高程度临床获益的策略。与戈舍瑞林相反，没有试验评估使用其他促黄体生成激素释放激素（LHRH）类似物作为单药治疗。未显示完全激素阻断剂上级优于戈舍瑞林单药治疗。基于该系统性综述的结果，证据支持使用雄激素抑制联合戈舍瑞林单药治疗作为接受放疗的前列腺癌患者的标准治疗，这些患者具有复发或转移的高风险。
Locally advanced prostate cancer is often associated with elevated recurrence rates. Despite the modest response observed, external-beam radiotherapy has been the preferred treatment for this condition. More recent evidence from randomised trials has demonstrated clinical benefit with the combined use of androgen suppression in such cases. The aim of this meta-analysis is to compare the combination of distinct hormone therapy modalities versus radiotherapy alone for overall survival, disease-free survival and toxicity. Databases (MEDLINE, EMBASE, LILACS, Cochrane databases and ClinicalTrials.gov) were scanned for randomised clinical trials involving radiotherapy with or without androgen suppression in local prostate cancer. The search strategy included articles published until October 2011. The studies were examined and the data of interest were plotted for meta-analysis. Survival outcomes were reported as a hazard ratio with corresponding 95% confidence intervals. Data from ten trials published from 1988 to 2011 were included, comprising 6555 patients. There was a statistically significant advantage to the use of androgen suppression, in terms of both overall survival and disease free survival, when compared to radiotherapy alone. The use of long-term goserelin (up to three years) was the strategy providing the higher magnitude of clinical benefit. In contrast to goserelin, there were no trials evaluating the use of other luteinizing hormone-releasing hormone (LHRH) analogues as monotherapy. Complete hormonal blockade was not shown to be superior to goserelin monotherapy. Based on the findings of this systematic review, the evidence supports the use of androgen suppression with goserelin monotherapy as the standard treatment for patients with prostate cancer treated with radiotherapy, which are at high risk of recurrence or metastases.
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