Top

International Journal of Clinical Oncology

Published in:

01-04-2020 | Prostate Cancer | Original Article

Low incidence of late recurrence in patients with intermediate-risk prostate cancer treated by intensity-modulated radiation therapy plus short-term androgen deprivation therapy

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 4/2020

Abstract

Objectives

This study evaluated the long-term outcomes of intensity-modulated radiation therapy (IMRT) combined with short-term neoadjuvant androgen deprivation therapy (ADT) in patients with intermediate-risk (IR) prostate cancer (PCa).

Materials and methods

Patients with IR PCa treated with IMRT at our institution between September 2000 and November 2010 were analyzed retrospectively. The treatment consisted of IMRT (70–78 Gy in 35–39 fractions) combined with 6 months of neoadjuvant ADT. Salvage ADT was initiated when the prostate-specific antigen level was > 4.0 ng/mL

Results

In total, 106 consecutive patients with IR PCa (median age: 70 years old) were analyzed. The median follow-up period was 8.0 years. The overall survival, PCa-specific survival, biochemical failure, and clinical failure rates were 99.0%, 100.0%, 6.8%, and 1.9% at 5 years and 89.1%, 100.0%, 11.3%, and 2.9% at 10 years, respectively. Late recurrence (> 5 years) was observed in three cases (2.8%). The cumulative incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicities (grade 2/3) were 10.5% and 5.8% at 5 years, and 14.7% and 5.8% at 10 years, respectively. No patient developed grade 4/5 GU toxicities or grade 3–5 GI toxicities.

Conclusion

IMRT at a dose up to 78 Gy combined with short-term neoadjuvant ADT resulted in excellent long-term disease-free outcomes with acceptable morbidities among patients with IR PCa. In addition, the incidence of late recurrence was very low. Further investigation is warranted to confirm our findings.

Alicikus ZA, Yamada Y, Zhang Z et al (2011) Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. Cancer 117(7):1429–1437. https://doi.org/10.1002/cncr.25467 CrossRefPubMed

National Comprehensive Cancer network (2019) NCCN Guidelines; prostate cancer version 2.2019. In: The category of prostate cancer. https://www.nccn.org/professionals/physician_gls/pdf/prostatepdf. Accessed 17 Apr 2019

Zaorsky NG, Palmer JD, Hurwitz MD et al (2015) What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiother Oncol 115(3):295–300. https://doi.org/10.1016/j.radonc.2015.05.011 CrossRefPubMed

Pasalic D, Kuban DA, Allen PK et al (2019) Dose escalation for prostate adenocarcinoma: a long-term update on the outcomes of a phase 3, single institution randomized clinical trial. Int J Radiat Oncol Biol Phys 104(4):790–797. https://doi.org/10.1016/j.ijrobp.2019.02.045 CrossRefPubMedPubMedCentral

Dearnaley DP, Jovic G, Syndikus I et al (2014) Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol 15(4):464–473. https://doi.org/10.1016/S1470-2045(14)70040-3 CrossRefPubMed

Heemsbergen WD, Al-Mamgani A, Slot A et al (2014) Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol 110(1):104–109. https://doi.org/10.1016/j.radonc.2013.09.026 CrossRefPubMed

Bolla M, Maingon P, Carrie C et al (2016) Short androgen suppression and radiation dose escalation for intermediate- and high-risk localized prostate cancer: results of EORTC trial 22991. J Clin Oncol 34(15):1748–1756. https://doi.org/10.1200/JCO.2015.64.8055 CrossRefPubMed

Michalski JM, Moughan J, Purdy J et al (2018) Effect of standard vs dose-escalated radiation therapy for patients with intermediate-risk prostate cancer: the NRG oncology RTOG 0126 randomized clinical trial. JAMA Oncol 4(6):e180039. https://doi.org/10.1001/jamaoncol.2018.0039 CrossRefPubMedPubMedCentral

Abu-Gheida I, Reddy CA, Kotecha R et al (2019) Ten-year outcomes of moderately hypofractionated (70 Gy in 28 fractions) intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 104(2):325–333. https://doi.org/10.1016/j.ijrobp.2019.01.091 CrossRefPubMed

10.

Spratt DE, Zumsteg ZS, Ghadjar P et al (2014) Comparison of high-dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate-risk prostate cancer. BJU Int 114(3):360–367. https://doi.org/10.1111/bju.12514 CrossRefPubMed

11.

Mizowaki T, Norihisa Y, Takayama K et al (2016) Ten-year outcomes of intensity-modulated radiation therapy combined with neoadjuvant hormonal therapy for intermediate- and high-risk patients with T1c–T2N0M0 prostate cancer. Int J Clin Oncol 21(4):783–790. https://doi.org/10.1007/s10147-016-0954-4 CrossRefPubMed

12.

Zhu S, Mizowaki T, Nagata Y et al (2005) Comparison of three radiotherapy treatment planning protocols of definitive external-beam radiation for localized prostate cancer. Int J Clin Oncol 10(6):398–404. https://doi.org/10.1007/s10147-005-0519-4 CrossRefPubMed

13.

Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65(4):965–974. https://doi.org/10.1016/j.ijrobp.2006.04.029 CrossRefPubMed

14.

Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458. https://doi.org/10.1038/bmt.2012.244 CrossRefPubMed

15.

Wilcox SW, Aherne NJ, McLachlan CS et al (2015) Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: a comparison of Australian series. J Med Imaging Radiat Oncol 59(1):125–133. https://doi.org/10.1111/1754-9485.12275 CrossRefPubMed

16.

Zelefsky MJ, Kollmeier M, Cox B et al (2012) Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 84(1):125–129. https://doi.org/10.1016/j.ijrobp.2011.11.047 CrossRefPubMed

17.

Engels B, Soete G, Gevaert T et al (2014) Impact of planning target volume margins and rectal distention on biochemical failure in image-guided radiotherapy of prostate cancer. Radiother Oncol 111(1):106–109. https://doi.org/10.1016/j.radonc.2014.02.009 CrossRefPubMed

18.

Pisansky TM, Hunt D, Gomella LG et al (2015) Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. J Clin Oncol 33(4):332–339CrossRefPubMed

19.

Aizawa R, Takayama K, Nakamura K et al (2019) 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. Int J Clin Oncol 24(10):1247–1255. https://doi.org/10.1007/s10147-019-01478-y CrossRefPubMedPubMedCentral

20.

Cooperberg MR, Hinotsu S, Namiki M et al (2016) Trans-Pacific variation in outcomes for men treated with primary androgen-deprivation therapy (ADT) for prostate cancer. BJU Int 117(1):102–109. https://doi.org/10.1111/bju.12937 CrossRefPubMed

Title: Low incidence of late recurrence in patients with intermediate-risk prostate cancer treated by intensity-modulated radiation therapy plus short-term androgen deprivation therapy
Authors: Rihito Aizawa
Kenji Takayama
Kiyonao Nakamura
Takahiro Inoue
Toshinari Yamasaki
Takashi Kobayashi
Shusuke Akamatsu
Osamu Ogawa
Takashi Mizowaki
Publication date: 01-04-2020
Publisher: Springer Singapore
Keywords: Prostate Cancer
Prostate Cancer
Androgens
Published in: International Journal of Clinical Oncology / Issue 4/2020
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01596-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2020

LINC00163 inhibits the invasion and metastasis of gastric cancer cells as a ceRNA by sponging miR-183 to regulate the expression of AKAP12

Predictive value of 18F-FDG PET/CT for acute exacerbation of interstitial lung disease in patients with lung cancer and interstitial lung disease treated with chemotherapy

Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities

Treatment intensity and control rates in combining external-beam radiotherapy and radioactive iodine therapy for metastatic or recurrent differentiated thyroid cancer

A randomized, double-blind, comparison of radium-223 and placebo, in combination with abiraterone acetate and prednisolone, in castration-resistant metastatic prostate cancer: subgroup analysis of Japanese patients in the ERA 223 study

Significance of RAS mutations in pulmonary metastases of patients with colorectal cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer