Impact of androgen-deprivation therapy on the outcome of dose-escalation prostate cancer radiotherapy without elective pelvic irradiation
Journal
Asian Journal of Andrology
Journal Volume
18
Date Issued
2016
Author(s)
Abstract
The benefit of androgen-deprivation therapy (ADT) in combination with dose-escalated radiotherapy (DERT) for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy (IMRT) to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT (cumulative dose 78 Gy), with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities > grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease. ? 2016 AJA, SIMM & SJTU. All rights reserved.
SDGs
Other Subjects
prostate specific antigen; antiandrogen; adult; aged; androgen deprivation therapy; Article; biochemical recurrence free survival; computer assisted tomography; digital rectal examination; disease free survival; gastrointestinal toxicity; hematuria; human; human tissue; intensity modulated radiation therapy; major clinical study; male; neoadjuvant therapy; nuclear magnetic resonance imaging; overall survival; pelvis lymph node; prostate adenocarcinoma; radiation dose; radiation dose escalation; recurrence risk; retrospective study; tomotherapy; urogenital tract disease; volumetric modulated arc therapy; follow up; intensity modulated radiation therapy; Kaplan Meier method; middle aged; pelvis; procedures; prostate tumor; radiation response; survival analysis; treatment failure; treatment outcome; tumor recurrence; very elderly; Aged; Aged, 80 and over; Androgen Antagonists; Disease-Free Survival; Dose-Response Relationship, Radiation; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvis; Prostatic Neoplasms; Radiotherapy, Intensity-Modulated; Retrospective Studies; Survival Analysis; Treatment Failure; Treatment Outcome
Publisher
Medknow Publications
Type
journal article