title: Analysis of prognostic factors in localized high-risk prostate cancer patients treated with HDR brachytherapy, hypofractionated 3D-CRT and neoadjuvant/adjuvant androgen deprivation therapy (trimodality therapy).
abstract: Trimodality therapy consisting of high dose rate (HDR) brachytherapy combined with external beam radiation therapy (EBRT), neoadjuvant hormonal therapy (NHT) and adjuvant hormonal therapy (AHT) has been used to treat localized high-risk prostate cancer. In this study, an analysis of patients receiving the trimodality therapy was performed to identify prognostic factors of biochemical relapse-free survival (bRFS). Between May 2005 and November 2008, 123 high-risk prostate cancer patients (D'Amico classification) were treated with NHT prior to HDR brachytherapy combined with hypofractionated EBRT. Among these patients, 121 had completed AHT. The patients were assigned by time to be treated with a low-dose or high-dose arm of HDR brachytherapy with subsequent hypofractionated 3D conformal radiation therapy (3D-CRT). Multivariate analysis was used to determine prognostic factors for bRFS. With a median follow-up of 60 months, the 5-year bRFS for all patients was 84.3% (high-dose arm, 92.9%; low-dose arm, 72.4%, P = 0.047). bRFS in the pre-HDR PSA ≤ 0.1 ng/ml subgroup was significantly improved compared with that in the pre-HDR PSA > 0.1 ng/ml subgroup (88.3% vs 68.2%, P = 0.034). On multivariate analysis, dose of HDR (P = 0.045, HR = 0.25, 95% CI = 0.038-0.97) and pre-HDR PSA level (P = 0.02 HR = 3.2, 95% CI = 1.18-10.16) were significant prognostic factors predicting bRFS. In high-risk prostate cancer patients treated with the trimodality therapy, the dose of HDR and pre-HDR PSA were significant prognostic factors. The pre-HDR PSA ≤ 0.1 subgroup had significantly improved bRFS. Further studies are needed to confirm the relevance of pre-HDR PSA in trimodality therapy.
authors.affiliation: Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Aoki
authors.forename: Kenta
authors.initials: K
authors.lastname: Miki
authors.forename: Masahito
authors.initials: M
authors.lastname: Kido
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Wataru
authors.initials: W
authors.lastname: Nakamura
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kijima
authors.forename: Masao
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Shin
authors.initials: S
authors.lastname: Egawa
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kanehira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000401:mortality*; D059248:Chemoradiotherapy / Q000401:mortality*; D019583:Dose Fractionation, Radiation; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists
keywords: HDR; PSA response; high-risk prostate cancer; trimodality therapy