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Intensity-modulated Radiotherapy Combined with Endocrine Therapy for Intermediate and Advanced Prostate Cancer: Long-term Outcome of Chinese Patients

  • Luo, Hua-Chun (Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA) ;
  • Cheng, Hui-Hua (Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA) ;
  • Lin, Gui-Shan (Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA) ;
  • Fu, Zhi-Chao (Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA) ;
  • Li, Dong-Shi (Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA)
  • Published : 2013.08.30

Abstract

Aim: The aim of this study was to evaluate acute adverse events and efficacy of three-dimensional intensitymodulated radiotherapy (IMRT) combined with endocrine therapy for intermediate and advanced prostate cancer. Methods: Sixty-seven patients were treated with three-dimensional IMRT combined with maximum androgen blockade. The correlation between radiation-induced rectal injury and clinical factors was further analyzed. Results: After treatment, 21 patients had complete remission (CR), 37 had partial remission (PR), and nine had stable disease (SD), with an overall response rate of 86.5%. The follow-up period ranged from 12.5 to 99.6 months. Thirty-nine patients had a follow-up time of ${\geq}$ five years. In this group, three-year and five-year overall survival rates were 89% and 89.5%, respectively; three-year and five-year progression-free survival rates were 72% and 63%. In univariate analyses, gross tumor volume was found to be prognostic for survival ($X^2$ = 5.70, P = 0.037). Rates of leucopenia and anemia were 91.1% and 89.5%, respectively. Two patients developed acute liver injury, and a majority of patients developed acute radiation proctitis and cystitis, mainly grade 1/2. Tumor volume before treatment was the only prognostic factor influencing the severity of acute radiation proctitis (P < 0.05). Conclusions: IMRT combined with endocrine therapy demonstrated promising efficacy and was well tolerated in patients with intermediate and advanced prostate cancer.

Keywords

Prostate cancer;radiotherapy;endocrine therapy;prognosis

References

  1. Aizer AA, Anderson NS, Oh SC, et al (2011). The impact of pretreatment prostate volume on severe acute genitourinary toxicity in prostate cancer patients treated with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys, 79, 379-84. https://doi.org/10.1016/j.ijrobp.2009.11.023
  2. Al-Mamgani A, Heemsbergen WD, Peeters ST, et al (2009). Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys, 73, 685-91. https://doi.org/10.1016/j.ijrobp.2008.04.063
  3. Ashman JB, Zelefsky MJ, Hunt MS, et al (2005). Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 63, 765-71. https://doi.org/10.1016/j.ijrobp.2005.02.050
  4. Aus G, Abbou CC, Pacik D, et al (2001). EAU working group on oncological urology. EAU Guidelines on prostate cancer. Eur Urol, 40, 97-101.
  5. Bolla M, Van Poppel H, Collette L, et al (2005). Postoperative radiotherapy after radical prostatectomy, A randomised controlled trial(EORTC trial 22911). Lancet, 366, 572-78. https://doi.org/10.1016/S0140-6736(05)67101-2
  6. Cahlon O, Zelefsky MJ, Shippy A, et al (2008). Ultra-high dose(86.4Gy)IMRT for localized prostate cancer, Toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys, 71, 330-37.
  7. Chan L, Xia P, Gottschalk A, et al (2008). Proposed rectal dose constraints for patients undergoing definitive whole pelvic radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys, 72, 69-77. https://doi.org/10.1016/j.ijrobp.2007.12.045
  8. Cozzarini C, Fiorino C, Ceresoli GL, et al (2003). Significant correlation between rectal DVH and late bleeding in patients treated after radical prostatectomy with conformal or conventional radiotherapy (66.6-70.2Gy). Int J Radiat Oncol Biol Phys, 55, 688-94. https://doi.org/10.1016/S0360-3016(02)04117-2
  9. Cozzarini C, Fiorino C, Di Muzio N, et al (2007). Significant reduction of acute toxicity following pelvic irradiation with helical tomo therapy in patients with localized proatate cancer. Radiother Oncol, 84, 164-70. https://doi.org/10.1016/j.radonc.2007.07.013
  10. Dillman RO, Hafer R, Cox C, et al (2011). Overall survival benefit from postoperative radiation therapy for organ-confined, margin-positive prostate cancer. Int J Rad Oncol Biol Phys, 79, 719-23. https://doi.org/10.1016/j.ijrobp.2009.11.041
  11. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumors, revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  12. Hanks G, Coia L, Curry J. (1997). Patterns of care studies, past, present, and future. Semin Radiat Oncol, 7, 97-100. https://doi.org/10.1016/S1053-4296(97)80043-4
  13. Housri N, Ning H, Ondos J, et al (2011). Parameters favorable to intraprostatic radiation dose escalation in men with localized prostate cancer. Int J Radiat Oncol Biol Phys, 80, 614-20. https://doi.org/10.1016/j.ijrobp.2010.06.050
  14. Kumar S, Shelley M, Harrison C, et al (2006). Neo-adjuvant and adjuvant hormone therapy for localized and locally advanced paostate cancer. Cochrane Database Syst Rev, 18, CD006019.
  15. Nguyen PL, Chen RC, Hoffman KE, et al (2010). Rectal Dose-volume histogram parameters are associated with long-term patient-reported gastrointestinal quality of life after conventional and high-dose radiation for prostate cancer, A subgroup analysis of a randomized trial. Int J Radiat Oncol Biol Phys, 78, 1081-5. https://doi.org/10.1016/j.ijrobp.2009.09.015
  16. Parkin DM, Bray F, Ferla Y J, et al (2005). Global cancer statistics. Cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  17. Peeters ST, Heemsbergen WD, Van Putten WL, et al (2005). Acute and late complications after radiotherapy for prostate cancer, results of a multicenter randomized trial comparing 68Gy to 78Gy. Int J Radiat Oncol Biol Phys, 61, 1019-34. https://doi.org/10.1016/j.ijrobp.2004.07.715
  18. Sanda MG, Dunn RL, Michalski J, et al (2008). Quality of life and satisfaction with outcome among prostate-cancer survivors. N Eng J Med, 358, 1250-61. https://doi.org/10.1056/NEJMoa074311
  19. Schwartz LH, Bogaerts J, Ford R, et al (2009). Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer, 45, 2261-67.
  20. Siegel R,Naishadham D,Jemal A(2013). Cancer statistics, 2013.CA Cancer J Clin, 63, 11-30. https://doi.org/10.3322/caac.21166
  21. Storey MR, Pollack A, Zagars G, et al (2000). Complications from radiotherapy dose escalation in prostate cancer, Preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys, 48, 635-42. https://doi.org/10.1016/S0360-3016(00)00700-8
  22. Suneil Jain,D.Andrew Loblaw,Gerard C,et al (2012).The effect of radiation technique and bladder filling on the acute toxicity of pelvic radiotherapy for localized high risk prostate cancer.Radiother Oncol, 105, 193-7. https://doi.org/10.1016/j.radonc.2012.09.020
  23. Thompson IM Jr, Tangen CM, Paradelo J, et al (2006). Adjuvant radiotherapy for pathologically advanced prostate cancer, A randomized clinical trial. J Am Med Assoc, 296, 2329-35. https://doi.org/10.1001/jama.296.19.2329
  24. Vargas C, Martinez A, Kestin LL, et al (2005). Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. Int J Radiat Oncol Biol Phys, 62, 1297-308. https://doi.org/10.1016/j.ijrobp.2004.12.052
  25. Wiegel T, Bottke D, Steiner U, et al (2009). Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen, ARO 96-02/AUO AP 09/95. J Clin Oncol, 27, 2924-30. https://doi.org/10.1200/JCO.2008.18.9563
  26. Wong WW, Schild SE, Vora SA, et al (2011). Image-guided radiotherapy for prostate cancer, A prospective trial of concomitant boost wuing indium-111-capromab pendetide (prostascint). imaging. Int J Radiation Oncology Biol Phys, 81, 423-29.
  27. Zelefsky MJ, Levin EJ, Hunt M, et al (2008). Incidence of late rectaland urinary toxicities after three-dimensional conformal radio therapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys, 70, 1124-29. https://doi.org/10.1016/j.ijrobp.2007.11.044
  28. Zelefsky MJ, Kollmeier M, Cox B et al (2012). Improved clinical outcomes with high-dose imag guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate. Int J Radiat Oncol Biol Phys, 84, 125-9. https://doi.org/10.1016/j.ijrobp.2011.11.047
  29. Zelefsky M, Yamada Y, Fuks Z, et al (2008). Long-term results of conformal radiotherapy for prostate cancer, impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys, 71, 1028-33. https://doi.org/10.1016/j.ijrobp.2007.11.066

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