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International Journal of Clinical Oncology

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Open Access 01-10-2019 | Prostate Cancer | Original Article

Ten-year outcomes of high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer with unfavorable risk: early initiation of salvage therapy may replace long-term adjuvant androgen deprivation

Authors: Rihito Aizawa, Kenji Takayama, Kiyonao Nakamura, Takahiro Inoue, Toshinari Yamasaki, Takashi Kobayashi, Shusuke Akamatsu, Osamu Ogawa, Takashi Mizowaki

Published in: International Journal of Clinical Oncology | Issue 10/2019

Abstract

Background

The optimal timing of salvage androgen deprivation therapy (ADT) following definitive radiation therapy for prostate cancer (PCa) is unknown. This study evaluated the efficacy of early initiation of salvage-ADT (S-ADT) based on predetermined timing among patients with unfavorable PCa treated with high-dose intensity-modulated radiation therapy (IMRT).

Materials and methods

High-risk (HR) and very-high-risk (VHR) PCa patients treated with IMRT at our institution between September 2000 and December 2010 were analyzed retrospectively. Treatment consisted of high-dose IMRT (78 Gy/39 fractions) combined with 6 months of neoadjuvant-ADT (NA-ADT). S-ADT was initiated when prostate-specific antigen levels exceeded 4.0 ng/mL.

Results

In total, 268 (184 HR and 84 VHR) patients were analyzed. The median follow-up period was 114.4 months. The 10-year overall survival (OS), PCa-specific survival (PCSS), biochemical failure (BF), and clinical failure (CF) rates were 82.8%, 97.1%, 27.3%, and 12.8% among the HR PCa patients and 79.4%, 87.9%, 56.2%, and 26.7% among the VHR PCa patients (p = 0.839, = 0.0377, < 0.001, and < 0.001), respectively. The 10-year cumulative incidence rates of urinary and rectal (grades 2–3) toxicities were 22.6% and 5.8%, respectively. No grade 4 or higher toxicities were observed.

Conclusion

High-dose IMRT combined with short-term NA-ADT resulted in long-term disease-free status, with acceptable morbidity among approximately three-fourths of the HR PCa patients and nearly half of the VHR PCa patients. Moreover, excellent survival outcomes were achieved by the early S-ADT initiation. This approach may be a promising alternative to uniform provision of long-term ADT.

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Title: Ten-year outcomes of high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer with unfavorable risk: early initiation of salvage therapy may replace long-term adjuvant androgen deprivation
Authors: Rihito Aizawa
Kenji Takayama
Kiyonao Nakamura
Takahiro Inoue
Toshinari Yamasaki
Takashi Kobayashi
Shusuke Akamatsu
Osamu Ogawa
Takashi Mizowaki
Publication date: 01-10-2019
Publisher: Springer Singapore
Keywords: Prostate Cancer
Prostate Cancer
Androgens
Published in: International Journal of Clinical Oncology / Issue 10/2019
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01478-y

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