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Impact of androgen-deprivation therapy on the outcome of dose-escalation prostate cancer radiotherapy without elective pelvic irradiation
Wei-Hsien Hou1, Chao-Yuan Huang2, Chia-Chun Wang3, Keng-Hsueh Lan4, Chung-Hsin Chen5, Hong-Jen Yu6, Shih-Ping Liu7, Ming-Kuen Lai8, Yeong-Shau Pu9, Jason Chia-Hsien Cheng10
1 Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China
Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, China
Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, China
Correspondence Address:
Dr. Jason Chia-Hsien Cheng
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China; Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, China; Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, China
Dr. Yeong-Shau Pu
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1008-682X.183569
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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. |
