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Regimen Almost Doubles Five-Year Prostate Cancer Survival
Lancet
07/11/2002
By Harvey McConnell
Disease free survival can be almost doubled among men with advanced prostate cancer if hormone-suppression therapy is used during and for three years after radiotherapy.
This has been found in a follow-up of 415 patients with advanced prostate cancer taking part in a Phase III European Organization for
Research and Treatment of Cancer (EORTC) trial.
Patients were randomly assigned radiotherapy or external irradiation combined with an analogue of luteinising-hormone releasing hormone (LHRH) and immediate androgen suppression.
The long-term outcome after external irradiation alone in locally advanced prostate cancer is poor, especially for biochemically defined disease-free survival, points out Dr. Michel Bolla and colleagues from University Hospital, Grenoble, France.
Patients in the trial ranged in age from 51 to 80, with a median of 71 years. Both groups of patients received 50 Gy radiation delivered to the pelvis over five weeks, and 20 Gy over two weeks as a prostatic boost. Goserelin, at 3.6 mg. subcutaneously every four weeks, was started on the first day of irradiation and continued for three years. Cyproterone acetate, at 150 mg. orally, was given for one month starting one week before the first goserelin injection.
Patients given combined radiotherapy and hormone-suppression therapy had a substantially higher five-year disease-free survival rate (74 percent) than patients given radiotherapy alone (40 percent). Overall, the survival rates were 78 percent for combined therapy and 62 percent
for radiotherapy alone.
Dr. Bolla and colleagues said: "Androgen suppression provides a means of improving the outcome of external irradiation alone, by possibly eliminating occult disease. Moreover, androgen suppression and external irradiation appear to have an additive effect on local disease control
by inducing apoptosis."
Clinicians predicted that in the future, management of locally advanced prostate cancer will be tailored according to prognostic factors, with a possible escalation of the dose and the addition of chemotherapy to hormonal treatment for high-risk categories.
Lancet 2002; 360: 103-08.
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