Rationale:
Hormone therapy reduces tumor volume, improves oxygenation, and sensitizes cells to radiation (less hypoxic fraction → ↑ local control).

Key clinical evidence

  • Prostate: RTOG 8610, EORTC 22961 → ADT + RT ↑ OS vs RT alone.

  • Breast: Endocrine therapy adjuvant after RT reduces recurrence risk by ~50%.

Sequencing rules

Tumor Radiotherapy Timing vs HT Comment
Prostate Start ADT 2–3 mo before RT, continue during + 18–36 mo after Improves biochemical control & survival
Breast RT usually after chemotherapy and concurrently with endocrine therapy or within 3 weeks post-RT No negative interaction with AI/SERM

Special note:
Tamoxifen slightly ↑ risk of radiation fibrosis in chest wall RT — minimize dose hotspots.

Practical workflow:

  1. Verify receptor status before simulation.

  2. Plan RT volume reduction for shrinking hormone-sensitive glands.

  3. Coordinate DEXA and metabolic follow-up every 12–24 mo.

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