title: Effect of whole pelvic radiotherapy for patients with locally advanced prostate cancer treated with radiotherapy and long-term androgen deprivation therapy.
abstract: OBJECTIVE
  To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT).
  
  
  METHODS
  Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score≥7 and/or prostate-specific antigen level≥20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT).
  
  
  RESULTS
  A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12-38). With a median follow-up of 52 months (range, 20-150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p=NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p=.03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p=NS).
  
  
  CONCLUSIONS
  Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.
authors.affiliation: Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Luca
authors.initials: L
authors.lastname: Tagliaferri
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Frascino
authors.forename: Nicola
authors.initials: N
authors.lastname: Dinapoli
authors.forename: Cinzia
authors.initials: C
authors.lastname: Di Gesù
authors.forename: Edy
authors.initials: E
authors.lastname: Ippolito
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018572:Disease-Free Survival; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen