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Radiat Oncol. 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.

Author information

1
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. wolfgang.lilleby@ous-hf.no.
2
Departments of Radiation Oncology and Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins Hospital, Baltimore, MD, USA. anarang2@jhmi.edu.
3
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. guntaf@ous-hf.no.
4
Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. LVAT@ous-hf.no.
5
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. KMF@ous-hf.no.
6
Department of Oncology, Østfold Hospital Trust, 1603, Fredrikstad, Norway. andreas.stensvold@so-hf.no.
7
Department of Radiology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. KHH@ous-hf.no.
8
Departments of Radiation Oncology and Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins Hospital, Baltimore, MD, USA. tranpt21@sbcglobal.net.
9
Department of Medical Physics, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. KEI@ous-hf.no.

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.

PMID:
26577452
PMCID:
PMC4650510
DOI:
10.1186/s13014-015-0540-3
[Indexed for MEDLINE]
Free PMC Article

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