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. 2015 Nov 17:10:232.
doi: 10.1186/s13014-015-0540-3.

Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy

Wolfgang Lilleby  1 , Amol Narrang  2 , Gunnar Tafjord  3 , Ljiljana Vlatkovic  4 , Kjell Magne Russnes  5 , Andreas Stensvold  6 , Knut Håkon Hole  7 , Phuoc Tran  8 , Karsten Eilertsen  9
Affiliations

Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy

Wolfgang Lilleby et al. Radiat Oncol. .

Abstract

Background: The most appropriate treatment for men with prostate cancer and positive pelvic nodes, N+, is an area of active controversy. We report our 5-years outcomes in men with locally advanced prostate cancer (T1-T4N0-N1M0) treated with definitive radiotherapy encompassing the prostate and pelvic lymph nodes (intensity modulated radiotherapy, IMRT) and long-term androgen deprivation therapy (ADT).

Material and methods: Of the 138 consecutive eligible men all living patients have been followed up to almost 5 years. Survival endpoints for 5-year biochemical failure-free survival (BFFS), relapse-free survival (RFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were assessed by Kaplan-Meier analysis. Univariate and multivariate Cox regression proportional hazards models were constructed for all survival endpoints. The RTOG morbidity grading system for physician rated toxicity was applied.

Results: Patients with locally advanced T3-T4 tumors (35 %) and N1 (51 %) have favorable outcome when long-term ADT is combined with definitive radiotherapy encompassing pelvic lymph nodes. The 5-year BFFS, RFS, PCSS and OS were 71.4, 76.2, 94.5 and 89.0 %, respectively. High Gleason sum (9-10) had a strong independent prognostic impact on BFFS, RFS and OS (p = 0.001, <0.001, and 0.005 respectively). The duration of ADT (= > 28 months) showed a significant independent association with improved PCSS (p = 0.02) and OS (p = 0.001). Lymph node involvement was not associated with survival endpoints in the multivariate analysis. The radiotherapy induced toxicity seen in our study population was moderate with rare Grade 3 GI side effects and up to 11 % for Grade 3 GU consisting mainly of urgency and frequency.

Conclusion: Pelvic IMRT in combination with long-term ADT can achieve long-lasting disease control in men with N+ disease and unfavorable prognostic factors.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier survival estimates for a biochemical failure-free survival, b relapse-free survival, c prostate cancer-specific survival, and d overall survival for overall cohort
Fig. 2
Fig. 2
Kaplan-Meier survival estimates for a biochemical failure-free survival, b relapse-free survival, c prostate cancer-specific survival, and d overall survival, stratified by lymph node status. Red curves represent men with radiologic and/or pathologic lymph node involvement. Blue curves represent men without lymph node involvement
See this image and copyright information in PMC

References

    1. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. NEnglJMed. 1997;337:295–300. doi: 10.1056/NEJM199707313370502. - DOI - PubMed
    1. Denham JW, Joseph D, Lamb DS, Spry NA, Duchesne G, Matthews J, et al. Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3 factorial trial. Lancet Oncol. 2014;15:1076–1089. doi: 10.1016/S1470-2045(14)70328-6. - DOI - PubMed
    1. Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet. 2011;378:2104–2111. doi: 10.1016/S0140-6736(11)61095-7. - DOI - PMC - PubMed
    1. Widmark A, Klepp O, Solberg A, Damber JE, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373:301–308. doi: 10.1016/S0140-6736(08)61815-2. - DOI - PubMed
    1. Pommier P, Chabaud S, Lagrange JL, Richaud P, Lesaunier F, Le PE, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol. 2007;25:5366–5373. doi: 10.1200/JCO.2006.10.5171. - DOI - PubMed

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