- 作者：Daniel Krauss M.D. ; a ; dkrauss@beaumont.edu"" rel=""nofollow ; Larry Kestin M.D.a ; Hong Ye M.S.a ; Donald Brabbins M.D.a ; Michel Ghilezan M.D.a ; Gary Gustafson M.D.a ; Frank Vicini M.D.a ; Alvaro Martinez M.D. ; F.A.C.R.a
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2011
- 出版时间：15 July 2011
- 年：2011
- 卷：80
- 期：4
- 页码：1064-1071
- 全文大小：450 K
Purpose
Assessment of androgen deprivation therapy (ADT) benefits for prostate cancer treated with dose-escalated radiotherapy (RT).Methods and Materials
From 1991 to 2004, 1,044 patients with intermediate- (n = 782) or high-risk (n = 262) prostate cancer were treated with dose-escalated RT at William Beaumont Hospital. Patients received external-beam RT (EBRT) alone, brachytherapy (high or low dose rate), or high dose rate brachytherapy plus pelvic EBRT. Intermediate-risk patients had Gleason score 7, prostate-specific antigen (PSA) 10.0–19.9 ng/mL, or Stage T2b–T2c. High-risk patients had Gleason score 8–10, PSA ≥20, or Stage T3. Patients were additionally divided specifically by Gleason score, presence of palpable disease, and PSA level to further define subgroups benefitting from ADT.
Results
Median follow-up was 5 years; 420 patients received ADT + dose-escalated RT, and 624 received dose-escalated RT alone. For all patients, no advantages in any clinical endpoints at 8 years were associated with ADT administration. No differences in any endpoints were associated with ADT administration based on intermediate- vs. high-risk group or RT modality when analyzed separately. Patients with palpable disease plus Gleason ≥8 demonstrated improved clinical failure rates and a trend toward improved survival with ADT. Intermediate-risk patients treated with brachytherapy alone had improved biochemical control when ADT was given.
Conclusion
Benefits of ADT in the setting of dose-escalated RT remain poorly defined. This question must continue to be addressed in prospective study.