title: Dose-escalated radiotherapy for high-risk prostate cancer: outcomes in modern era with short-term androgen deprivation therapy.
abstract: OBJECTIVE
  Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT.
  
  
  METHODS
  A total of 184 men with any single risk factor of prostate-specific antigen >or=10 ng/mL, clinical Stage T2b or greater, or Gleason score >or=7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level.
  
  
  RESULTS
  With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose <74 Gy (4-year FFBF rate, 64% vs. 80%) had a poorer outcome on univariate analysis. However, clinical Stage T3 disease and radiation dose were not significant on multivariable analysis, although a statistical multivariable trend was seen for both (p = .0650 and p = .0597, respectively).
  
  
  CONCLUSIONS
  Short-term ADT and RT might be acceptable for men with intermediate- and high-risk prostate cancer, especially for clinically localized disease treated with doses of >or=74 Gy.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. sliauw@radonc.uchicago.edu
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
authors.forename: Walter M
authors.initials: WM
authors.lastname: Stadler
authors.forename: David
authors.initials: D
authors.lastname: Correa
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
references.citation: J Clin Oncol. 2007 Jun 10;25(17):2420-5
references.pmid: 17557956
references.citation: J Clin Oncol. 2003 Nov 1;21(21):3972-8
references.pmid: 14581419
references.citation: Am J Clin Oncol. 2008 Aug;31(4):375-8
references.pmid: 18845997
references.citation: Lancet Oncol. 2006 Jun;7(6):472-9
references.pmid: 16750497
references.citation: Urology. 2007 May;69(5):936-40
references.pmid: 17482938
references.citation: J Clin Oncol. 2006 May 1;24(13):1990-6
references.pmid: 16648499
references.citation: JAMA. 1998 Sep 16;280(11):969-74
references.pmid: 9749478
references.citation: J Urol. 2001 Sep;166(3):876-81
references.pmid: 11490237
references.citation: N Engl J Med. 2009 Jan 15;360(3):e4
references.pmid: 19144933
references.citation: J Clin Oncol. 2003 Jun 1;21(11):2163-72
references.pmid: 12775742
references.citation: J Urol. 2008 Apr;179(4):1368-73; discussion 1373
references.pmid: 18289585
references.citation: Lancet Oncol. 2005 Nov;6(11):841-50
references.pmid: 16257791
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):67-74
references.pmid: 17765406
references.citation: Cancer. 2009 Apr 15;115(8):1784-90
references.pmid: 19208426
references.citation: Lancet. 2002 Jul 13;360(9327):103-6
references.pmid: 12126818
references.citation: J Natl Compr Canc Netw. 2007 Aug;5(7):650-83
references.pmid: 17692170
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):965-74
references.pmid: 16798415
references.citation: JAMA. 2004 Aug 18;292(7):821-7
references.pmid: 15315996
references.citation: Eur Urol. 2008 Jun;53(6):1172-9
references.pmid: 18222596
references.citation: J Clin Oncol. 2008 Feb 1;26(4):585-91
references.pmid: 18172188
references.citation: Urol Oncol. 2004 Jul-Aug;22(4):300-6
references.pmid: 15283887
references.citation: JAMA. 2005 Sep 14;294(10):1233-9
references.pmid: 16160131
references.citation: Curr Opin Endocrinol Diabetes Obes. 2007 Jun;14(3):247-54
references.pmid: 17940447
references.citation: J Clin Oncol. 2006 Sep 20;24(27):4448-56
references.pmid: 16983113