Hormone Therapy and Radiotherapy for Intermediate Risk Prostate Cancer

Lee, Irwin; Sandler, Howard M.

doi:10.1016/j.semradonc.2007.09.002

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Although trials are currently underway to address the additive advantage of HT with DERT as standard treatment, such results are pending. In the meantime, selection of men with high-intermediate risk prostate cancer for a short course of HT will be empirical, with a number of suggested approaches including nomograms, Gleason 4+3 disease, PSA>15, and 2-3 intermediate risk factors [ 38 , 39 ]. What is clear is that in the absence of definitive evidence of benefit in this patient subgroup, that toxicities must be discussed with prospective patients, and their involvement is crucial in the decision making process.…”

Section: Discussionmentioning

confidence: 99%

Image guided dose escalated prostate radiotherapy: still room to improve

et al. 2009

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Background: Prostate radiotherapy (RT) dose escalation has been reported to result in improved biochemical control at the cost of greater late toxicity. We report on the application of 79.8 Gy in 42 fractions of prostate image guided RT (IGRT). The primary objective was to assess 5-year biochemical control and potential prognostic factors by the Phoenix definition. Secondary endpoints included acute and late toxicity by the Radiotherapy Oncology Group (RTOG) scoring scales.

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Section: Discussionmentioning

confidence: 99%

Image guided dose escalated prostate radiotherapy: still room to improve

et al. 2009

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“…Risk categorization based on National Comprehensive Cancer Center (NCCN) criteria [13] defined as target(s) of irradiation the prostate only for low-risk CaP, and the prostate and seminal vesicles for intermediate-or high-risk disease using three-dimensional (3D) computed tomography (CT) scans of the pelvis. Patients were provided with written instructions to empty their bowels on the morning of their CT planning pelvic scans and then to start drinking 500 ml of water slowly 1.5 hours before the time of their appointment.…”

Section: Methodsmentioning

confidence: 99%

Predictors of radiation-induced gastrointestinal morbidity: A prospective, longitudinal study following radiotherapy for carcinoma of the prostate

et al. 2016

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Background Chronic gastrointestinal (GI) morbidity occurs in ≥50% of patients after external beam radiotherapy (EBRT) for carcinoma of prostate (CaP). This prospective, longitudinal study examines which baseline measurements of: 1) homocysteine and micronutrients in plasma; 2) chromosome damage/misrepair biomarkers; and 3) anal and rectal dose volume metrics predict GI morbidity after EBRT. Patients and methods In total, 106 patients with CaP had evaluations of GI symptoms (modified LENT-SOMA questionnaires) before EBRT and at one month, one, two and three years after its completion. Other variables measured before EBRT were: 1) plasma concentrations of homocysteine and micronutrients including caroteinoids and selenium; 2) chromosome damage/DNA misrepair (micronuclei/nucleoplasmic bridge) indices; and 3) mean anal and rectal wall doses and volumes of anal and rectal walls receiving ≥40 Gy and ≥60 Gy. Univariate and multivariate analyzes examined the relationships among: 1) plasma levels of homocysteine and micronutrients; 2) indices of chromosome damage/DNA misrepair; and 3) mean anal and rectal wall doses and volumes of anal and rectal walls receiving ≥40 Gy and ≥60 Gy and total GI symptom scores from one month to three years after EBRT. Results Increased frequency and urgency of defecation, rectal mucous discharge and bleeding after EBRT resulted in sustained rises in total GI symptom scores above baseline at three years. On univariate analysis, total GI symptom scores were significantly associated with: 1) plasma selenium and α tocopherol; 2) micronuclei indices of DNA damage; 3) mean anal and rectal wall doses; and 4) volumes of anal and rectal wall receiving ≥40 Gy and ≥60 Gy (p = 0.08-<0.001). On multivariate analysis, only volume of anal wall receiving ≥40 Gy was significant for increased GI symptoms after EBRT (p < 0.001). Conclusion The volume of anal wall receiving ≥40 Gy predicts chronic GI morbidity after EBRT for CaP.

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“…32 The role of ADT has been established by randomized data from patients with intermediate-or high-risk features treated with external beam RT. [2][3][4][5] However, these studies were designed using conventional or three-dimensional conformal RT, in which dose escalation was limited by late toxicity of treatment, particularly to the rectum.…”

Section: Discussionmentioning

confidence: 99%

Dose‐escalated radiation therapy for intermediate‐risk prostate cancer

Liauw

Fricano

Correa

et al. 2009

Cancer

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BACKGROUND:Randomized trials supported the use of androgen deprivation therapy (ADT) with radiation therapy (RT) for intermediate‐risk prostate cancer. However, the value of concurrent ADT was less certain with dose‐escalated RT. Better methods of stratifying patients in this risk group may help select patients who are most likely to benefit.METHODS:A total of 238 men with intermediate‐risk (prostate specific antigen [PSA] 10‐20, Gleason 7, or stage T2b‐c) adenocarcinoma of the prostate were treated with external beam RT between 1989 and 2006. Patients had Gleason≤6 (39%) or 7 (61%) tumors; median PSA was 10.5 ng/mL. A median of 37.5% of biopsy cores were positive from a median of 9 biopsy cores sampled. The median RT dose was 74 Gy to the prostate. A total of 112 patients (47%) received neoadjuvant and concurrent ADT (median, 4 months). Median follow‐up period was 49 months.RESULTS:The freedom from biochemical failure (FFBF, nadir + 2 definition) was 93% at 3 years, 86% at 4 years, and 80% at 5 years. On univariate analysis, the only factor associated with FFBF was percentage of positive cores (PPC, P = .0340). The prognostic value of PPC≥50 was not evident in patients receiving ADT (FFBF at 4 years 90% vs 91%, P = .3015). For patients not receiving ADT, the impact of PPC≥50 (FFBF at 4 years 76% vs 93%, P = .0844) was more pronounced. On multivariate analysis, PPC (P = .0388) was significantly associated with FFBF, whereas Gleason sum, ADT, RT dose, PSA, and T‐stage were not.CONCLUSIONS:After dose‐escalated external beam RT, intermediate‐risk prostate cancer patients with PPC≥50 had the highest risk for biochemical failure and may be most likely to derive a benefit from ADT. Cancer 2009. © 2009 American Cancer Society.

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Hormone Therapy and Radiotherapy for Intermediate Risk Prostate Cancer

Cited by 13 publications

References 29 publications

Image guided dose escalated prostate radiotherapy: still room to improve

Image guided dose escalated prostate radiotherapy: still room to improve

Predictors of radiation-induced gastrointestinal morbidity: A prospective, longitudinal study following radiotherapy for carcinoma of the prostate

Dose‐escalated radiation therapy for intermediate‐risk prostate cancer

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