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A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma

Shelley, M. D., Kumar, S., Wilt, T., Staffurth, John Nicholas, Coles, Bernadette Mary and Mason, Malcolm David 2009. A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma. Cancer Treatment Reviews 35 (1) , pp. 9-17. 10.1016/j.ctrv.2008.08.002

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Abstract

Background: We performed a systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy (NHT) in localised and locally advanced prostate cancer to assess the effectiveness of this therapy. Methods: We searched MEDLINE, The Cochrane Library, Science Citation Index, LILACS and SIGLE for randomised trials comparing NHT plus primary therapy (radiotherapy or prostatectomy) with primary therapy alone. Data included information on study design, participants, interventions, and outcomes. Comparable data were extracted from eligible studies and pooled for meta-analysis with intention to treat principle. Findings: NHT prior to prostatectomy did not improve overall or disease-free survival, but did significantly reduce positive margin rates (RR 0.49, 95% CI 0.42–0.56, p < 0.00001), organ confinement (RR 1.63, 95% CI 1.37–1.95, p < 0.0001) and lymph node invasion (RR 0.49, 95% CI 0.42–0.56, p < 0.02). In one study NHT before radiotherapy significantly improved overall survival for men with Gleason 2–6 (p = 0.015). In addition, there was a significant improvement in both clinical disease-free survival (RR 1.46, 95% CI 1.24–1.71, p < 0.00001) and biochemical disease-free survival (RR 1.59, 95% CI 1.00–2.55, p = 0.05). Toxicities included hot flushes, gastrointestinal, hepatic and miscellaneous adverse events. Conclusions NHT is associated with significant clinical benefit when given with radiotherapy and improves pathological outcome prior to prostatectomy but is of minimal value prior to radical prostatectomy. The decision to use hormone therapy should be discussed between the patient, the clinician and policy maker based on the benefits, toxicity and cost.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Information Services
Medicine
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RM Therapeutics. Pharmacology
Z Bibliography. Library Science. Information Resources > ZA Information resources > ZA4050 Electronic information resources
Uncontrolled Keywords: neo-adjuvant hormone therapy, prostatectomy, radiotherapy, prostate cancer, systematic review, meta-analysis
Publisher: Elsevier
ISSN: 0305-7372
Last Modified: 10 Oct 2017 14:07
URI: http://orca-mwe.cf.ac.uk/id/eprint/24504

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