- 作者：Felix Y. Feng ; MD&lowast ; ; &dagger ; ; ffeng@med.umich.edu ; Kevin Blas ; MD&lowast ; ; Karin Olson ; PhD&lowast ; ; Matthew Stenmark ; MD&lowast ; ; Howard Sandler ; MD&Dagger ; ; Daniel A. Hamstra ; MD ; PhD&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2013
- 出版时间：1 May, 2013
- 年：2013
- 卷：86
- 期：1
- 页码：64-71
- 全文大小：663 K
Purpose
To evaluate the role of androgen deprivation therapy (ADT) and duration for high-risk prostate cancer patients treated with dose-escalated radiation therapy (RT).Methods and Materials
A retrospective analysis of high-risk prostate cancer patients treated with dose-escalated RT (minimum 75 Gy) with or without ADT was performed. The relationship between ADT use and duration with biochemical failure (BF), metastatic failure (MF), prostate cancer-specific mortality (PCSM), non-prostate cancer death (NPCD), and overall survival (OS) was assessed as a function of pretreatment characteristics, comorbid medical illness, and treatment using Fine and Gray's cumulative incidence methodology.
Results
The median follow-up time was 64 months. In men with National Comprehensive Cancer Network defined high-risk prostate cancer treated with dose-escalated RT, on univariate analysis, both metastasis (P<.0001; hazard ratio 0.34; 95 % confidence interval 0.18-0.67; cumulative incidence at 60 months 13 % vs 35 % ) and PCSM (P=.015; hazard ratio 0.41; 95 % confidence interval 0.2-1.0; cumulative incidence at 60 months 6 % vs 11 % ) were improved with the use of ADT. On multivariate analysis for all high-risk patients, Gleason score was the strongest negative prognostic factor, and long-term ADT (LTAD) improved MF (P=.002), PCSM (P=.034), and OS (P=.001). In men with prostate cancer and Gleason scores 8 to 10, on multivariate analysis after adjustment for other risk features, there was a duration-dependent improvement in BF, metastasis, PCSM, and OS, all favoring LTAD in comparison with STAD or RT alone.
Conclusion
For men with high-risk prostate cancer treated with dose-escalated EBRT, this retrospective study suggests that the combination of LTAD and RT provided a significant improvement in clinical outcome, which was especially true for those with Gleason scores of 8 to?10.