title: Impact of androgen-deprivation therapy on the outcome of dose-escalation prostate cancer radiotherapy without elective pelvic irradiation.
abstract: The benefit of androgen-deprivation therapy (ADT) in combination with dose-escalated radiotherapy (DERT) for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy (IMRT) to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT (cumulative dose 78 Gy), with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities ≥ grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease.
authors: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Wei-Hsien
authors: WH
authors: Hou
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Chao-Yuan
authors: CY
authors: Huang
authors: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Chia-Chun
authors: CC
authors: Wang
authors: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Keng-Hsueh
authors: KH
authors: Lan
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Chung-Hsin
authors: CH
authors: Chen
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Hong-Jen
authors: HJ
authors: Yu
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Shih-Ping
authors: SP
authors: Liu
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Ming-Kuen
authors: MK
authors: Lai
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China.
authors: Yeong-Shau
authors: YS
authors: Pu
authors: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China.|Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China.|Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan, China.|Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, China.
authors: Jason Chia-Hsien
authors: JC
authors: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010388:Pelvis / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists