Prognosis in prostate cancer radiotherapy
Importance of dosage and inductive hormonetherapy
Abstract
Introduction: we aimed to analyse the effects of radiotherapy dose and the use of neoadjuvant hormone therapy on survival without biochemical relapse, on specific cause mortality and on overall mortality, in patients with prostate cancer.
Methods: we analysed 910 consecutive patients treated with radical tridimensional conformal radiotherapy between 1993 and 2005.
Results: actuarial biochemical control at 10 years for the subset of patients who received a median dose of 74 Gy was 78%, 60% and 40% for the low, medium and high-risk groups, respectively. Biochemical control of patients receiving a median dose of 78 Gy was 96%, 81% and 40% for the same risk-groups. The difference between low and medium risk groups was p=0,029 y 0,008, respectively. Mulitvariate analysis confirmed that dose escalation significantly correlated with biochemical control and cause-specific survival. Likewise, hormone therapy was a significant factor for biochemical control and cause-specific survival. The 10-year actuarial rate of Grade 2 and Grade 3 late complications (there were no Grade 4 or 5 complications) presented non-significant differences between four subsets of patients treated with doses from 64 to 80 Gy. 4.8% of patients treated with doses between 78 and 80 Gy presented late urinary complications, and 5.3% of them showed late rectal complications. In hormone therapy naïve patients a <1 ng/ml nadir and its manifestation more than12 months after finishing treatment, significantly correlated with biochemical control.
Conclusions: administration of a dose between 77 and 80 Gy with external beam 3D conformal radiotherapy, together with the use of induction hormone therapy have improved biochemical control results and cause-specific survival in all risk groups. No increase of late complications was observed.
References
(2) American Joint Committee On Cancer. Cancer Staging Manual. 6a. Ed. New York: Springer, 2002: 309-12.
(3) International Commission on Radiation Units and Measurements. Icru Report No. 50. Prescribing, Recording, snd Reporting Photon Beam Therapy. Washington, DC: International Commission on Radiation Units and Measurements, 1994.
(4) Huang EH, Pollack A, Levy L, Starkschall G, Dong L, Rosen I, et al. Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2002; 54(5): 1314-21.
(5) Cox DR. Regression models and life-tables. J R Stat Soc Ser B 1972; 34(2): 187-200.
(6) Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65(4): 965-74.
(7) Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc 1958; 53: 457-81.
(8) Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50(3): 163-70.
(9) Storey MR, Pollack A, Zagars G, Smith L, Antolak J, Rosen I. Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 2000; 48(3): 635-42.
(10) Liu M, Pickles T, Arganovich A, Berthelet E, Duncan G, Keyes M, et al. Impact of neoadjuvant androgen ablation and other factors on late toxicity after external beam prostate radiotherapy. Int J Radiat Oncol Biol Phys 2004; 58(1): 59-67.
(11) Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, et al. Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002; 53(5): 1097-105.
(12) Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, et al. Comparison of conventional-dose vs. high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 2005; 294(10): 1233-9.
(13) Peeters STH, Heemsbergen WD, Koper PCM, van Putten WLJ, Slot A, Michel FH, et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized Phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 2006; 24(13): 1990-6.
(14) Eade TN, Hanlon AL, Horwitz EM, Buyyounouski MK, Hanks GE, Pollack A. What dose of external-beam radiation is high enough for prostate cancer? Int J Radiat Oncol Biol Phys 2007; 68(3): 682-9.
(15) Michalski JM, Purdy JA, Winter K, Roach M 3rd, Vijayakumar S, Sandler HM, et al. Preliminary report of toxicity following 3D radiation therapy for prostate cancer on 3DOG/RTOG 9406. Int J Radiat Oncol Biol Phys 2000; 46(2): 391-402.
(16) De Meerleer GO, Fonteyne VH, Vakaet L, Villiers GM, Denoyette L, Verbaeys A, et al. Intensity-modulated radiation therapy for prostate cancer: late morbidity and results on biochemical control. Radiother Oncol 2007; 82(2): 160-6.
(17) American Society for Therapeutic Radiology and Oncology Consensus Panel. Consensus Statement: Guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 1997; 37(5): 1035-41.
(18) Pilepich MV, Winter K, John MJ, Mesic JB, Sause W, Rubin P, et al. Phase III radiation therapy oncology group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001; 50(5): 1243-52.
(19) Zelefsky MJ, Ben-Porat L, Chan HM, Fearn PA, Venkatraman ES. Evaluation of postradiotherapy PSA patterns and correlation with 10-year disease free survival outcomes for prostate cancer. Int J Radiat Oncol Biol Phys 2006; 66(2): 382-8.
(20) Buyyounouski MK, Hanlon AL, Eisenberg DF, Horwitz EM, Feigenberg SJ, Uzzo RG, et al. Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. Int J Radiat Oncol Biol Phys 2005; 63(5): 1455-62.
(21) Bonin SR, Hanlon AL, Lee WR, Movsas B, Al-Saleem TI, Hanks GE. Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy. Cancer 1997; 79(1): 75-80.
(22) Beard C, Schultz D, Loffredo M, Cote K, Renshaw AA, Hurwitz MD, et al. Perineural invasion associated with increased cancer-specific mortality after external beam radiation therapy for men with low- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2006; 66(2): 403-7.
(23) Thames HD, Kuban DA, DeSilvio ML, Levy LB, Horwitz EM, Kupelian PA, et al. Increasing external beam dose for T1–T2 prostate cancer: effect on risk groups. Int J Radiat Oncol Biol Phys 2006; 65(4): 975-81.
(24) Chism DB, Hanlon AL, Troncoso P, Al-Saleem T, Horwitz EM, Pollack A. The Gleason score shift: score four and seven years ago. Int J Radiat Oncol Biol Phys 2003; 56(5): 1241-7.
(25) Smith EB, Frierson HF Jr, Mills SE, Boyd JC, Theodorescu D. Gleason scores of prostate biopsy and radical prostatectomy specimens over the past 10 years: Is there evidence for systematic upgrading? Cancer 2002; 94(8): 2282-7.
(26) Coen JJ, Chung CS, Shipley WU, Zietman AL. Influence of follow-up bias on PSA failure after external beam radiotherapy for localized prostate cancer: Results from a 10-year cohort analysis. Int J Radiat Oncol Biol Phys 2003; 57(3): 621-8.
(27) Kupelian PA, Buchsbaum JC, Elshaikh MA, Reddy CA, Klein EA. Improvement in relapse-free survival throughout the PSA era in patients with localized prostate cancer treated with definitive radiotherapy: year of treatment an independent predictor of outcome. Int J Radiat Oncol Biol Phys 2003; 57(3): 629-34.
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