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

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).

MATERIALS 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,  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.

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

Radiation oncology (London, England). 2015 Nov 17*** epublish ***

Wolfgang Lilleby, Amol Narrang, Gunnar Tafjord, Ljiljana Vlatkovic, Kjell Magne Russnes, Andreas Stensvold, Knut Håkon Hole, Phuoc Tran, Karsten Eilertsen

Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. Departments of Radiation Oncology and Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins Hospital, Baltimore, MD, USA. Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. Department of Oncology, Østfold Hospital Trust, 1603, Fredrikstad, Norway. Department of Radiology, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. Departments of Radiation Oncology and Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins Hospital, Baltimore, MD, USA.  Department of Medical Physics, Oslo University Hospital, The Norwegian Radium Hospital, 0424, Oslo, Norway. 

PubMed      Full Text Article

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