title: Management of high-risk prostate cancer: radiation therapy and hormonal therapy.
abstract: The prognosis of high-risk prostate cancer is poor with a high mortality rate. The Radiation Therapy Oncology Group (RTOG) has performed dose-escalation studies of external beam radiation therapy (EBRT) and has developed high-precision radiation therapy (RT) methods such as intensity-modulated RT, carbon ion therapy, and proton beam therapy. High-dose rate brachytherapy (HDR-BT) is also studied as an option for high-risk prostate cancer treatment. Past clinical trials have suggested that the local control rate of high-risk prostate cancer improves with total EBRT dose, even for doses > 70 Gy. Several randomized controlled trials, including RTOG 94-06, have shown significantly better prognoses with higher doses (> 75 Gy) than with lower doses (< 70 Gy). A proton beam therapy trial (PROG 95-09) also showed similar results. A phase II clinical trial (National Institute for Radiological Sciences, Japan; trial 9904) showed that carbon ion therapy resulted in very good biochemical recurrence-free survival rates among high-risk prostate cancer patients, demonstrating particle therapy to be a valid treatment option. RTOG 86-10 showed that short-term neo-adjuvant hormonal therapy (HT) was inadequate for high-risk prostate cancer but effective for intermediate-risk prostate cancer, whereas RTOG 92-02 and the European Organisation for Research and Treatment of Cancer (EORTC) 22863 showed significant improvements in the prognosis of high-risk groups receiving long-term (> 2 years) HT combined with definitive RT. Further studies are warranted to elucidate optimal irradiation doses, HT treatment durations, and combination therapy schedules.
authors: National Institute for Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan. Electronic address: t_nomiya@nirs.go.jp.
authors: Takuma
authors: T
authors: Nomiya
authors: Hiroshi
authors: H
authors: Tsuji
authors: Shingo
authors: S
authors: Toyama
authors: Katsuya
authors: K
authors: Maruyama
authors: Kenji
authors: K
authors: Nemoto
authors: Hirohiko
authors: H
authors: Tsujii
authors: Tadashi
authors: T
authors: Kamada
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods; D059248:Chemoradiotherapy; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D061766:Proton Therapy / Q000379:methods
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Androgen antagonists; Clinical trial; Prostatic neoplasms; Radiotherapy; Review