The Efficacy and Sequencing of a Short Course of Androgen Suppression on Freedom From Biochemical Failure When Administered With Radiation Therapy for T2-T3 Prostate Cancer

Laverdière, Jacques; Nabid, Abdenour; Bedoya, L Diaz de; Ébacher, Annie; Fortin, A.; Wang, Chang Shu; Harel, François

doi:10.1097/01.ju.0000112979.97941.7f

Cited by 120 publications

(72 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Potential advantages of combined modality treatment include an additive or synergistic effect on tumour cell kill and also a reduction in radiation target volume (Dearnaley, 2001). Four phase III randomised trials have reported benefits in tumour control compared to radiation alone (Laverdiere et al, 1997(Laverdiere et al, , 2004Porter et al, 1998;Pilepich et al, 2001), and an overview of the Radiation Treatment and Oncology Groups (RTOG), experience suggested an overall improvement in survival using neoadjuvant androgen suppression in addition to radiotherapy . Several groups have measured the reduction in prostate and prostate target volume after initial hormone treatment, which varied between 25 and 41% and showed a complimentary increase in the sparing of rectum and bladder when initial hormone treatment was combined with CFRT (Zelefsky et al, 1994;Forman et al, 1995;Dearnaley, 2000).…”

mentioning

confidence: 99%

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

et al. 2005

View full text Add to dashboard Cite

Radical radiotherapy is a standard form of management of localised prostate cancer. Conformal treatment planning spares adjacent normal tissues reducing treatment-related side effects and may permit safe dose escalation. We have tested the effects on tumour control and side effects of escalating radiotherapy dose and investigated the appropriate target volume margin. After an initial 3 -6 month period of androgen suppression, 126 men were randomised and treated with radiotherapy using a 2 by 2 factorial trial design. The initial radiotherapy tumour target volume included the prostate and base of seminal vesicles (SV) or complete SV depending on SV involvement risk. Treatments were randomised to deliver a dose of 64 Gy with either a 1.0 or 1.5 cm margin around the tumour volume (1.0 and 1.5 cm margin groups) and also to treat either with or without a 10 Gy boost to the prostate alone with no additional margin (64 and 74 Gy groups). Tumour control was monitored by prostate-specific antigen (PSA) testing and clinical examination with additional tests as appropriate. Acute and late side effects of treatment were measured using the Radiation Treatment and Oncology Groups (RTOG) and LENT SOM systems. The results showed that freedom from PSA failure was higher in the 74 Gy group compared to the 64 Gy group, but this did not reach conventional levels of statistical significance with 5-year actuarial control rates of 71% (95% CI 58 -81%) in the 74 Gy group vs 59% (95% CI 45 -70%) in the 64 Gy group. There were 23 failures in the 74Gy group and 33 in the 64 Gy group (Hazard ratio 0.64, 95% CI 0.38 -1.10, P ¼ 0.10). No difference in disease control was seen between the 1.0 and 1.5 cm margin groups (5-year actuarial control rates 67%, 95% CI 53 -77% vs 63%, 95% CI 50 -74%) with 28 events in each group (Hazard ratio 0.97, 95% CI 0.50 -1.86, P ¼ 0.94). Acute side effects were generally mild and 18 weeks after treatment, only four and five of the 126 men had persistent XGrade 1 bowel or bladder side effects, respectively. Statistically significant increases in acute bladder side effects were seen after treatment in the men receiving 74 Gy (P ¼ 0.006), and increases in both acute bowel side effects during treatment (P ¼ 0.05) and acute bladder sequelae (P ¼ 0.002) were recorded for men in the 1.5 cm margin group. While statistically significant, these differences were of short duration and of doubtful clinical importance. Late bowel side effects (RTOGX2) were seen more commonly in the 74 Gy and 1.5 cm margin groups (P ¼ 0.02 and P ¼ 0.05, respectively) in the first 2 years after randomisation. Similar results were found using the LENT SOM assessments. No significant differences in late bladder side effects were seen between the randomised groups using the RTOG scoring system. Using the LENT SOM instrument, a higher proportion of men treated in the 74 Gy group had Grade X3 urinary frequency at 6 and 12 months. Compared to baseline scores, bladder symptoms improved after 6 months or more follow-up in all groups. Sexual function d...

show abstract

mentioning

confidence: 99%

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

et al. 2005

View full text Add to dashboard Cite

show abstract

“…30 Two earlier RCTs that included patients with localized PCa who were treated either with RT alone or variable durations of short-term NHT plus RT indicated no advantages to NHT administered for a duration of > 5 months. 7 Finally, 2 more recent trials compared 4 months versus 8 months and 4 months versus 9 months of ADT and RT and found no differences in outcome (Fig. 2).…”

Section: Long-term Adjuvant Adt Plus Rt Versus Adt Alonementioning

confidence: 99%

“…The evidence for short-term NHT plus RT compared with RT alone is supported by several studies. [4][5][6][7][8] In the RTOG 86-10 trial, the combination of goserelin plus flutamide for 2 months before RT and concurrent with RT was evaluated in patients with locally advanced PCa (bulky T2-4 tumors with or without pelvic lymph node involvement). 29 NHT significantly improved diseasespecific survival versus the use of RT alone.…”

Section: Long-term Adjuvant Adt Plus Rt Versus Adt Alonementioning

confidence: 99%

“…Neoadjuvant hormonal therapy (NHT), defined as ADT administered before definitive RT, decreases micrometastatic and macroscopic disease, [4][5][6][7][8] and reduces prostate volumes by an average of 25% to 30% .9,10 In the setting of wholepelvic RT, there appears to be a sequence-dependent favorable interaction between ADT and RT favoring NHT over adjuvant hormonal therapy (AHT)…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Current trends for the use of androgen deprivation therapy in conjunction with radiotherapy for patients with unfavorable intermediate‐risk, high‐risk, localized, and locally advanced prostate cancer

Roach

2014

Cancer

View full text Add to dashboard Cite

Androgen deprivation therapy (ADT) is now a well‐established standard of care in combination with definitive radiotherapy for patients with unfavorable intermediate‐risk to high‐risk locally advanced prostate cancer. It is also well established that combination modality treatment with ADT and radiotherapy is superior to either of these modalities alone for the treatment of patients with high‐risk locally advanced disease. Current treatment guidelines for prostate cancer in the United States are based on the estimated risk of recurrence and death. This review examines the clinical evidence underpinning the use of ADT and radiotherapy among patients with high‐risk localized and locally advanced disease in the United States. This review also considers the rationale for moving from traditional luteinizing hormone‐releasing hormone agonists to more recently developed gonadotrophin‐releasing hormone antagonists. Cancer 2014;120:1620–1629. © 2014 American Cancer Society.

show abstract

“…Three dimensional conformal radiotherapy (3DCRT) techniques provide the delivery of higher doses to the target while sparing the adjacent normal structures. Additionally, RT and ADT have been shown to improve overall survival (OS), PSA relapse free survival (PSA-RFS) and distant metastasis free survival (DMFS) [1][2][3] compared to RT alone. Thus RT with ADT is the standard of care for localized prostate cancer in intermediate and high risk patients.…”

Section: Introductionmentioning

confidence: 99%

Three Dimensional Conformal Radiotherapy and Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer; Hacettepe University Experience

Özdemir¹,

Akyol²,

Özyiğit³

et al. 2015

UHOD

View full text Add to dashboard Cite

The aim of this study is to evaluate the treatment results of three dimensional conformal radiotherapy (3DCRT) and androgen deprivation therapy (ADT) in patients with clinically localized prostate cancer (CLPC). Between June 1998 and December 2011, 577 patients with the diagnosis of CLPC were treated. ADT was started 3 months prior to radiotherapy (RT). 3DCRT was delivered to prostate and the seminal vesicles (SV) to a total dose of 70Gy. Additionally, patients with lymph node (LN) positivity received 50.4Gy RT to pelvic LN's. Median follow up time was 65 months. Five-ten years overall survival (OS), cause specific survival (CSS), PSA relapse-free survival (PSA-RFS) and distant metastasis-free survival (DMFS) rates were 92-74%, 97-91%, 77-55% and 94-88%, respectively. OS was negatively affected from LN positivity (p< 0.001). In the subgroup of patients with GS≥ 8, there was no significant difference between < 1 years and ≥ 1 years of ADT in terms of CSS, PSA-RFS and DMFS. OS was better in patients with < 1 years of ADT (p= 0.01). Five year OS (p= 0.02), CSS (p= 0.05), PSA-RFS (p= 0.01) and DMFS (p= 0.07) rates were inferior in the high risk group patients that used ADT ≥ 1 year. Acute and late RTOG grade III/IV gastrointestinal system toxicity rates were 1.7% and 5% and acute and chronic RTOG grade III/IV genitourinary system toxicity rates were 1.4% and 5%, respectively. 3DCRT and ADT combination is an effective treatment modality with acceptable toxicities in patients with clinically localized prostate cancer. Keywords: Prostate cancer, Conformal radiotherapy, Androgen deprivation therapy ÖZET Lokalize Prostat Kanserli Olgularda Üç Boyutlu Konformal Radyoterapi ve Total Androjen Blokajı; Hacettepe Üniversi-tesi DeneyimiBu çalışmanın amacı, üç boyutlu konformal radyoterapi (3BKRT) ve total androjen blokajı (TAB) Lokalize prostat kanserli olgularımızdaki tedavi sonuçlarımızı değerlendirmek. Haziran 1998 ve Aralık 2011 tarihleri arasında lokalize prostat kanseri tanısıyla 577 olgu tedavi edildi. TAB tedavisine radyoterapiden (RT) 3 ay sonar başlandı. 3BKRT olarak prostat ve seminal veziküllere toplam 70 Gy uygulandı. Ek olarak lenf nodu (LN) tutulumu olan olgularda pelvic LN'larına 50.4 Gy uygulandı. Ortanca izlem süresi 65 aydır. Beş-on yıllık genel sağkalım (GS), hastalığa özgü sağkalım (HSS), PSA-relapssız sağkalım (PSA-RFS) ve uzak metastazsız sağkalım (DMFS) oranları sırasıyla %92-74, %97-91, %77-55 ve %94-88 bulundu. LN tutulumu GS'ı olumsuz etkilemiştir (p< 0.001). Gleason skoru ≥ 8 olan olgularda <1 yıl ile ≥ 1yıl TAB kullanımı arasında HSS, PSA-RFS ve DMFS açısından fark yoktu. Ancak <1 yıl TAB kullananlarda GS daha iyiydi (p= 0.01). Yüksek riskli grupta olup ≥ 1yıl TAB kullanan hastalarda 5 yıllık GS (p= 0.02), HSS (p= 0.05), PSA-RFS (p= 0.01) ve DMFS (p= 0.07) daha düşük bulundu. Erken ve geç dönem RTOG grad III/IV gastrointestinal sistem toksisite oranları %1.7 ve %5 bulundu. Erken ve geç dönem RTOG grad III/IV genitoüriner sistem toksisite oranları %1.4 ve %5 bulundu. Lokalize prostat kanseri...

show abstract

The Efficacy and Sequencing of a Short Course of Androgen Suppression on Freedom From Biochemical Failure When Administered With Radiation Therapy for T2-T3 Prostate Cancer

Abstract: The analysis of study 1 shows a benefit of using a short course of neoadjuvant AS with EBRT vs EBRT alone for localized T2-T3 prostate cancers. Moreover, in each study adding a short course of adjuvant AS after neoadjuvant 1 provided no more advantage in these patients.

Cited by 120 publications

References 15 publications

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

Current trends for the use of androgen deprivation therapy in conjunction with radiotherapy for patients with unfavorable intermediate‐risk, high‐risk, localized, and locally advanced prostate cancer

Three Dimensional Conformal Radiotherapy and Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer; Hacettepe University Experience

Contact Info

Product

Resources

About