[Radiotherapy combined with hormonal therapy as treatment method in patients with prostate cancer: still more questions than answers].
Treatment of prostate cancer is a challenge for both urologists and radiation oncologists. Currently two radical methods of treatment are recommended i.e. radical prostatectomy and radiotherapy. Hormonal therapy is mainly indicated for treatment of patients with metastases, but lately has become popular in combination with radical radiotherapy. Outcome of radiotherapy in more advanced stage of disease due to high risk of distant metastases and local failure is unsatisfactory. In the last years the introduction of combined treatment consisted of radiotherapy and hormonal therapy may lead to improvement of results of treatment. The general rationales for combining radiotherapy and hormonal therapy are fourfold: decreasing prostate volume, diminishing of amount of cancer cells, improving tumor oxygenation, and elimination of micro metastasis. One of the first trials, which indicated that combined treatment might improve results of treatment, was RTOG 8307. In this trial two strategies of hormonal therapy were compared: megestrol acetate versus diethylostilbestrol. The comparison of results from this trial to historical study control group indicated that combined treatment gave benefit. Another trial, which indicated that combined treatment might produce better results, was RTOG 8531. Results from this trial indicated that better local control is achieved by combined treatment. Another trial, which indicated benefit due to implementation of hormonal therapy to radiotherapy, was trial RTOG 8610 The EORTC 22863 reported an improvement in the estimated 5-year overall survival (79% vs. 63%). In investigational trial hormonal therapy after radiotherapy ending was continued for three years. The RTOG 9202 was the latest study, which indicated benefits obtained by long lasting adjuvant hormonal treatment. This study showed that 2 years of adjuvant hormonal therapy produced significant prolongation of the 5-year overall survival by 80% in comparison to 69% for patients treated without adjuvant hormonal therapy. Despite these few trials, lacking is still data and the following crucial questions are waiting for answers in the near future: What is the optimal timing of hormonal therapy? Which patients will obtain the greatest benefits due to combined strategy? How does long lasting hormonal therapy influence on patient's quality of life? Future trials (RTOG 9413 and RTOG 9901) will give some answers to the mentioned above questions. Currently we can conclude that in the group of patients with high risk of relapse, hormonal therapy with radiotherapy improve results of treatment.
Milecki
Piotr
P
Zakład Radioterapii Wielkopolskiego, Centrum Onkologii. piotr.milecki@wco.pl
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant
D018931:Antineoplastic Agents, Hormonal