Androgen suppression plus radiation versus radiation alone for patients with stage D1/Pathologic node-positive adenocarcinoma of the prostate:: Updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31
Androgen suppression plus radiation versus radiation alone for patients with stage D1/Pathologic node-positive adenocarcinoma of the prostate:: Updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31
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DOI：
10.1200/jco.2005.08.141
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发表时间：
2005-02-01
影响因子：
45.3
通讯作者：
Pilepich, MV
中科院分区：
文献类型：
--
作者：
Lawton, CA;Winter, K;Pilepich, MV
目的：更新即刻雄激素抑制联合标准外束照射与单独放疗对一组组织学上淋巴结阳性的前列腺癌患者的影响。材料和方法1985年开始了一项国家前瞻性随机试验（放射治疗肿瘤组85-31），对局部晚期前列腺腺癌患者进行标准外束照射加立即雄激素抑制与单独外束照射的对比。在这项试验中，173名患者有组织学上受累的淋巴结。98例患者接受放疗加立即雄激素抑制（促黄体生成素释放激素[LHRH]激动剂），而75例患者在复发时单独接受放疗并进行激素调节。结果：所有患者的中位随访时间为6.5年，存活患者的中位随访时间为9.5年，立即接受LHRH激动剂治疗的患者在5年和9年时前列腺特异性抗原（PSA）水平低于1.5 ng/mL的估计无进展生存率分别为54%和10%，而在复发时单独接受放疗并进行激素调节的患者为33%和4% （P < 0.0001）。多变量分析显示放射治疗和立即激素操作对分析的所有终点有统计学上显著的影响：绝对生存、疾病特异性失败、转移性失败和生化控制，PSA低于4 ng/mL和低于1.5 ng/mL。结论在随机试验结果公布之前，对于病理累及盆腔淋巴结（病理淋巴结阳性或临床D期）的前列腺腺癌患者，应考虑在复发时进行外束照射加立即激素处理，而不是单独放疗加激素处理。
Purpose To update the effect of immediate androgen suppression in conjunction with standard external-beam irradiation versus radiation alone on a group of histologically lymph nodepositive patients with adenocarcinoma of the prostate.Materials and Methods A national prospective randomized trial (Radiation Therapy Oncology Group 85-31) of standard external-beam irradiation plus immediate androgen suppression versus external-beam irradiation alone was initiated in 1985 for patients with locally advanced adenocarcinoma of the prostate. One hundred seventy-three patients in this trial had histologically involved lymph nodes. Ninety-eight patients received radiation plus immediate androgen suppression (luteinizing hormone-releasing hormone [LHRH] agonist), whereas 75 patients received radiation alone with hormonal manipulation instituted at the time of relapse.Results With a median follow-up of 6.5 years for all patients and 9.5 years for living patients, estimated progression-free survival with prostate-specific antigen (PSA) level less than 1.5 ng/mL at 5 and 9 years was 54% and 10%, respectively, for patients who received immediate LHRH agonist versus 33% and 4% for patients who received radiation alone with hormonal manipulation instituted at time of relapse (P < .0001). Multivariate analysis revealed radiation therapy and immediate hormonal manipulation as having a statistically significant impact on all end points analyzed: absolute survival, disease-specific failure, metastatic failure, and biochemical control with PSA less than 4 ng/mL and less than 1.5 ng/mL.Conclusion Pending the results of randomized trials, patients with adenocarcinoma of the prostate who have pathologically involved pelvic lymph nodes (pathologic node-positive or clinical stage D,) should be considered for external-beam irradiation plus immediate hormonal manipulation rather than radiation alone with hormone manipulation at the time of relapse.