High-Dose Adjuvant Radiotherapy After Radical Prostatectomy With or Without Androgen Deprivation Therapy

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• 作者：Piet Ost ; M.D. ; Ph.D.^&lowast ; ; ^{piet.ost@ugent.be} ; Cesare Cozzarini ; M.D.^&dagger ; ; Gert De Meerleer ; M.D. ; Ph.D.^&lowast ; ; Claudio Fiorino ; Ph.D.^&dagger ; ; Bruno De Potter ; B.A.^&lowast ; ; Alberto Briganti ; M.D.^&Dagger ; ; Evi V.T. Nagler ; M.D.^§ ; ; Francesco Montorsi ; M.D.^&Dagger ; ; Valé ; rie Fonteyne ; M.D. ; Ph.D.^&lowast ; ; Nadia Di Muzio ; M.D.^&dagger ;
• 关键词：Adjuvant ; Androgen deprivation ; Dose ; Prostate cancer ; Radiotherapy
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：1 July, 2012
• 卷：83
• 期：3
• 页码：960-965
• 文件大小：249 K

摘要

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Purpose

To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT).

Methods and Materials

Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or without ADT to two large academic institutions. Indications for HD-ART were extracapsular extension, seminal vesicle invasion (SVI), and/or positive surgical margins at radical prostatectomy (RP). A dose of at least 69.1 Gy was prescribed to the prostate bed and seminal vesicle bed. The ADT consisted of a luteinizing hormone-releasing hormone analog. The duration and indication of ADT was left at the discretion of the treating physician. The effect of HD-ART and ADT on biochemical (bRFS) and clinical (cRFS) relapse-free survival was examined through univariate and multivariate analysis, with correction for known patient- and treatment-related variables. Interaction terms were introduced to evaluate effect modification.

Results

After a median follow-up time of 5 years, the 7-year bRFS and cRFS were 84%and 88%, respectively. On multivariate analysis, the addition of ADT was independently associated with an improved bRFS (hazard ratio [HR] 0.4, m>pm> = 0.02) and cRFS (HR 0.2, m>pm> = 0.008). Higher Gleason scores and SVI were associated with decreased bRFS and cRFS. A lymphadenectomy at the time of RP independently improved cRFS (HR 0.09, m>pm> = 0.009). The 7-year probability of late Grade 2-3 toxicity was 29%and 5%for genitourinary (GU) and gastrointestinal (GI) symptoms, respectively. The absolute incidence of Grade 3 toxicity was <1%and 10%for GI and GU symptoms, respectively. The study is limited by its retrospective design and the lack of a standardized use of ADT.

Conclusions

This retrospective study shows significantly improved bRFS and cRFS rates with the addition of ADT to HD-ART, with low Grade 3 gastrointestinal toxicity and 10%Grade 3 genitourinary toxicity.