title: Radiotherapy in cT3 prostatic carcinoma: retrospective comparison between neoadjuvant and adjuvant hormonotherapy.
abstract: BACKGROUND
  The aim of this study was to retrospectively compare the clinical outcomes achieved in 2 groups of patients with cT3 prostatic carcinoma undergoing neoadjuvant hormonotherapy and neoadjuvant hormonotherapy plus adjuvant hormonotherapy with external beam radiotherapy.
  
  
  METHODS
  One hundred patients with cT3N0M0 prostatic carcinoma underwent radiotherapy to pelvic lymph nodes (45 Gy, 1.8 Gy/fraction) with a booster dose (65-70 Gy) to the prostatic cavity. Forty-four patients received neoadjuvant hormonotherapy (goserelin, starting 2 months before radiotherapy and continuing until the end of irradiation); 56 patients received neoadjuvant hormonotherapy plus adjuvant goserelin until disease progression, if present.
  
  
  RESULTS
  Patients undergoing adjuvant hormonotherapy as compared to those who received exclusive neoadjuvant therapy showed a higher reduction in PSA level below 1.0 ng/ml (p = 0.0211), a lower incidence of biochemical failures (p = 0.0170), a lower incidence of hematogenous metastases (p = 0.0320) and a trend suggestive of a better disease-free survival (p = 0.0660). At univariate analysis (logrank), Gleason score did not show a significant correlation with any of the end points analyzed. To the contrary, patients with tumor <15 mm showed a better local control (p = 0.0347) and biochemical failure-free survival (p = 0.0102). Furthermore, a trend between initial PSA level and incidence of hematogenous metastases was observed (p = 0.0519). Patients with a posttreatment PSA level <1.0 ng/ml had a lower incidence of metastases (p = 0.0237) and a better survival (p = 0.0178); patients with complete clinical response showed a lower incidence of biochemical failures (p = 0.0469). Radiotherapy doses >70 Gy showed a trend with biochemical failure-free survival (p = 0.0554). At multivariate analysis, a correlation between Gleason score and incidence of metastases (p = 0.0232), and between tumor diameter and local control (p = 0.0178) and biochemical failure-free survival (p = 0.0290) was recorded.
  
  
  CONCLUSIONS
  In patients with cT3N0M0 prostate carcinoma, prolonged hormonotherapy was shown to be significantly correlated with biochemical failure-free survival and distant metastasis-free survival. Furthermore, tumor size had a significant impact on biochemical failure-free survival as well as on local control.
authors.affiliation: Istituto di Radiologia-Cattedra di Radioterapia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy.
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Stefano
authors.initials: S
authors.lastname: Luzi
authors.forename: Alessio Giuseppe
authors.initials: AG
authors.lastname: Morganti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Marco
authors.initials: M
authors.lastname: Racioppi
authors.forename: Daniela
authors.initials: D
authors.lastname: Smaniotto
authors.forename: Mariavittoria
authors.initials: M
authors.lastname: Leone
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesù
authors.forename: Mario
authors.initials: M
authors.lastname: Giustacchini
authors.forename: Antonio
authors.initials: A
authors.lastname: Destito
authors.forename: Eugenio
authors.initials: E
authors.lastname: Alcini
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin