Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer

Laverdière, Jacques; Gómez, José L.; Cusan, Leonelo; Suburu, Elbio Raul; Diamond, P.; Lemay, Martin; Candas, Bernard; Fortin, A.; Labrie, Fernand

doi:10.1016/s0360-3016(96)00513-5

Cited by 286 publications

(105 citation statements)

References 23 publications

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“…In fact, we collect patients from three different urology departments and several private practices; they refer us patients after neoadjuvant AD has been already started. This along with the fact that data about the efficacy of neoadjuvant AD changed during years (Pilepich et al, 1995;Laverdiere et al, 1997), resulted in a wide spectrum of indications and duration of neoadjuvant AD. As result, all but 65 patients (117 patients, 64%) underwent neoadjuvant AD for a median duration of 4.2 months (0.4 -67.2 months) before 3DCRT.…”

Section: Treatment Strategymentioning

confidence: 99%

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Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma

Sanguineti¹,

Agostinelli²,

Foppiano³

et al. 2002

Br J Cancer

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To evaluate whether androgen deprivation impacts late rectal toxicity in patients with localised prostate carcinoma treated with three-dimensional conformal radiotherapy. One hundred and eighty-two consecutive patients treated with 3DCRT between 1995 and 1999 at our Institution and with at least 12 months follow-up were analysed. three-dimensional conformal radiotherapy consisted in 70 -76 Gy delivered with a conformal 3-field arrangement to the prostate+seminal vesicles. As part of treatment, 117 patients (64%) received neo-adjuvant and concomitant androgen deprivation while 88 (48.4%) patients were continued on androgen deprivation at the end of three-dimensional conformal radiotherapy as well. Late rectal toxicity was graded according to the RTOG morbidity scoring scale. Median follow up is 25.8 (range: 12 -70.2 months). The 2-year actuarial likelihood of grade 2 -4 rectal toxicity was 21.8+3.2%. A multivariate analysis identified the use of adjuvant androgen deprivation (P=0.0196) along with the dose to the posterior wall of the rectum on the central axis (P=0.0055) and the grade of acute rectal toxicity (P=0.0172) as independent predictors of grade 2 -4 late rectal toxicity. The 2-year estimates of grade 2 -4 late rectal toxicity for patients receiving or not adjuvant hormonal treatment were 30.3+5.2% and 14.1+3.8%, respectively. Rectal tolerance is reduced in presence of adjuvant androgen deprivation.

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Section: Treatment Strategymentioning

confidence: 99%

“…While some quoted studies did not even mention late toxicity (Pollack et al, 1995;Zagars et al, 1999;Laverdiere et al, 1997), some other reports may suggest a reduced tolerance of both genitourinary and gastrointestinal systems in presence of AAD (Bolla et al, 1997;Fiorino et al, 2001;Sanguineti et al, 2000).…”

mentioning

confidence: 99%

Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma

Sanguineti¹,

Agostinelli²,

Foppiano³

et al. 2002

Br J Cancer

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“…The optimal duration of ADT in men undergoing RT has been addressed in at least four trials, all of which suggest benefit from prolonged therapy [47,[53][54][55][56]. For example, in the largest trial, RTOG 92-02, 1,554 men with T2c-T4 disease received 4 months of goserelin and flutamide (2 months before and during EBRT) and were then randomly assigned to no further therapy or 24 months of additional goserelin.…”

Section: How Long Should Abiraterone Acetate Be Continued After Progrmentioning

confidence: 99%

Beyond Castration—Defining Future Directions in the Hormonal Treatment of Prostate Cancer

Niraula¹,

N.²,

Joshua³

2011

HORM CANC

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It is now almost 70 years since Charles Huggins described the relationship between testosterone and the prostate gland. Arguably defining one of the first targeted therapies, the reduction of testosterone to castrate levels remains unaltered as the standard of care for men with metastatic prostate cancer. The failure of castration to permanently control the growth of prostate cancer leads to a state called castration-resistant prostate cancer (CRPC).

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“…RTOG 9202 demonstrated that the duration of testosterone suppression can influence outcome, not just in terms of biochemical control, but also in terms of cause-specific survival (Hanks et al, 2000). Although the benefits of neoadjuvant androgen deprivation have been well established in phase III trials (Pilepich et al, 1995(Pilepich et al, , 2001Laverdiere et al, 1997;Porter et al, 1997), the possibility that the magnitude of this benefit is agedependent should be tested by subgroup analysis of these studies.…”

Section: Clinicalmentioning

confidence: 99%

“…NAD can also cause additional (or even synergistic) tumour cell kill (Joon et al, 1997;Zietman et al, 1997). Three randomised trials have shown that the addition of NAD to radical external beam radiotherapy does indeed confer a benefit, in terms of local control, progression-free survival (Pilepich et al, 1995;Laverdiere et al, 1997;Porter et al, 1997), and in the case of RTOG 8610, overall survival (Pilepich et al, 2001). These studies include a combined total of just over 400 men treated with NAD and radical radiotherapy.…”

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confidence: 99%

Pre-treatment nomogram for biochemical control after neoadjuvant androgen deprivation and radical radiotherapy for clinically localised prostate cancer

et al. 2002

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Phase III studies have demonstrated the clinical benefit of adding neo-adjuvant androgen deprivation to radical radiotherapy for clinically localised prostate cancer. We have developed a nomogram to describe the probability of PSA control for patients treated in this way. Five hundred and seventeen men with clinically localised prostate cancer were treated with 3 -6 months of neo-adjuvant androgen deprivation and radical radiotherapy (64 Gy in 32#) between 1988 and 1998. Median presenting PSA was 20 ng ml 71 , and 56% of patients had T3/4 disease. Multivariate analysis of pre-treatment factors was performed, and a nomogram developed to describe PSA-failure-free survival probability. At a median follow-up of 44 months, 233 men had developed PSA failure. Presenting PSA, histological grade and clinical T stage were all highly predictive of PSA failure on multivariate analysis. The nomogram score for an individual patient is given by the summation of PSA (510=0, 10 -19=16, 20 -49=44, 550=100), grade (Gleason 2 -4=0, 5 -7=44, 8 -10=81) and T stage (T1/2=0, T3/4=35). For a nomogram score of 0, 50, 100 and 150 points the 2 year PSA control rate was 93, 87, 75 and 54%, and the 5 year PSA control rate was 82, 67, 44 and 18%. These results are comparable to those using surgery or higher doses of radical radiotherapy alone. The nomogram illustrates the results of multivariate analysis in a visually-striking way, and facilitates comparisons with other treatment methods.

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Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer

Cited by 286 publications

References 23 publications

Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma

Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma

Beyond Castration—Defining Future Directions in the Hormonal Treatment of Prostate Cancer

Pre-treatment nomogram for biochemical control after neoadjuvant androgen deprivation and radical radiotherapy for clinically localised prostate cancer

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