The potential for normal tissue dose reduction with neoadjuvant hormonal therapy in conformal treatment planning for stage C prostate cancer

Yang, Feng; Chen, George T.Y.; Ray, Paul S.; Vaida, Florin; Chiru, P.; Hamilton, Russell J.; Spelbring, D.; Abellera, Milagros; Vijayakumar, Srinivasan

doi:10.1016/0360-3016(95)02064-0

Cited by 49 publications

(22 citation statements)

References 20 publications

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“…The finding that most of the toxicity reduction appeared to be in the grade I category suggests that the effect may be more related to reduction in integral dose to the bladder than to a decrease in the volume of the bladder receiving high-dose. Several prior investigations 29,30,32,34 have documented the role of HT in ). Thus, it is our opinion that the potential for increasing RT toxicity should not be a concern for the clinician when making the decision regarding the addition of neoadjuvant HT to RT.…”

Section: Discussionmentioning

confidence: 99%

“…The influence of HT on acute and late RT toxicity has been the subject of several prior investigations. [28][29][30][31][32][33][34][35] One major theoretical advantage of neoadjuvant HT is the potential for cytoreduction of the prostate to reduce the overlap of the treatment volume with the surrounding bladder and rectum-indeed, several investigators have documented the potential role of cytoreduction in improving rectal and bladder dose volume histograms for EBRT 29,30,32,34 and in reducing the number of needles/ seeds for interstitial brachytherapy. 33 This potential for reducing toxicity is countered, however, by (a) the potential for reducing normal tissue tolerance and (b) if RT planning is done while the HT is still causing continued cytoreduction, the possibility of the RT treatment fields being overly generous for the still-shrinking prostate.…”

Section: Introductionmentioning

confidence: 99%

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Impact of hormone therapy on acute radiotherapy toxicity in the treatment of prostate cancer

Jani

Gratzle

Myers

2005

Prostate Cancer Prostatic Dis

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Purpose: To analyze the impact of neoadjuvant hormone therapy (HT) on acute gastrointestinal (GI) and genitourinary (GU) toxicity from radiotherapy (RT). Scope: The toxicity rates of 480 consecutive prostate cancer patients were reviewed and compared using the v 2 test. Ordered logit regression analyses were performed including the major demographic, disease, and treatment factors. Although no reduction in acute GI toxicity from HT use was observed (P ¼ 0.067), a lower rate of acute GU toxicity was observed (P ¼ 0.002). No factor reached statistical significance on regression analysis. Conclusions: Observed toxicity rates were similar or lower in patients receiving HT. Thus, increased RT toxicity should not be a concern when deciding to add neoadjuvant HT to RT for prostate cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of hormone therapy on acute radiotherapy toxicity in the treatment of prostate cancer

Jani

Gratzle

Myers

2005

Prostate Cancer Prostatic Dis

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“…The authors are aware of reports documenting that hormone therapy may surrogate radiation dose 47 and that downsizing of the prostate may reduce the complications of external beam therapy. 48,49 Nonetheless, these effects are likely to be very small in absolute magnitude and were not considered in the current investigation.…”

Section: Discussionmentioning

confidence: 99%

Hormone therapy adjuvant to external beam radiotherapy for locally advanced prostate carcinoma

Jani

Kao

Hellman

2003

Cancer

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BACKGROUNDHormone therapy commonly is used to treat metastatic, locally advanced, and localized prostate carcinoma. The objective of the current investigation was to determine, using the number‐needed‐to‐treat (NNT) method, the effect of using hormone therapy to treat locally advanced disease, with consideration given to both the complications and the known advantages associated with hormone therapy.METHODSA literature review was performed to determine 1) the absolute benefit, based on available clinical endpoints, associated with the addition of hormone therapy to external beam radiotherapy for locally advanced prostate carcinoma; 2) the incidence of side effects of short‐term and long‐term hormone therapy; and 3) the stepwise progression from biochemical failure to death. A model was constructed to estimate the complication/utility‐adjusted survival detriment resulting from the side effects of short‐term (≤ 6 months) and long‐term (> 6 months) hormone therapy, and the absolute/unadjusted and complication‐adjusted NNTs for the addition of short‐term and long‐term hormone therapy were computed. In all cases, the magnitudes and signs of the NNTs obtained were used to gauge the effect of hormone therapy.RESULTSThe unadjusted NNTs were positive and in most cases had relatively small magnitudes (the greater the NNT, the smaller the benefit) for both short‐term and long‐term hormone therapy; these results were expected, and they suggested that there is a strong benefit associated with the use of hormones adjuvant to radiotherapy for locally advanced disease. Adjusted NNTs remained positive and had relatively small magnitudes even after the introduction into the analysis of complications of short‐term and long‐term hormone therapy. This finding, although weak with respect to the effect of short‐term hormone therapy on cause‐specific survival, remained robust over the range of values for utility impairment expected from short‐term and long‐term hormone therapy.CONCLUSIONSThe benefits of short‐term and long‐term hormone therapy for locally advanced prostate carcinoma appear to be significant and to outweigh the associated side effects. Long‐term therapy appears to be better than short‐term therapy in terms of virtually all endpoints studied, even when the increased incidence of side effects is considered. The current investigation was successful in the use of the complication‐adjusted NNT method for oncologic and radiotherapeutic scenarios in which the results of randomized trials could be summarized, adjusted for treatment toxicity, and individualized to a given patient. Cancer 2003. © 2003 American Cancer Society.

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“…Other reports have suggested a significant decrease in the bladder and rectal volume in the high dose region with the use of neoadjuvant hormonal therapy. 12 Given other biological advantages of neoadjuvant hormonal therapy 13,14 is a reasonable approach in the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Evolution of toxicity after conformal radiotherapy for prostate cancer

Abdalla

Ignacio

Vaida

et al. 2002

Prostate Cancer Prostatic Dis

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The limiting factor for radiation (RT) dose-escalation is normal tissue toxicity. In dose-escalation studies, it is important to determine the factors associated with toxicity and the length of follow-up period after which a particular RT dose is considered safe.We analyzed 449 prostate cancer patients treated with RT at our institution and followed for a median of 27 months. Genitourinary (GU) and gastrointerological (GI) complications were graded and analyzed using three different statistical models. Univariate and multivariate analyses were conducted for factors associated with toxicity.There was no RTOG grade 4 or 5 toxicity. Only 23 patients (5%) experienced grade 3 toxicity. After treatment, there was an initial rapid decline in the risk of toxicity following treatment, followed by an increase or stabilization of the toxicity with time of follow-up. The breakpoints between the two periods were 2 y (any toxicity) and 1 y (high toxicity) for GU and 9 months (any toxicity, high toxicity) for GI. Age, dose, fraction size, duration of treatment and hospital of treatment emerge as important factors in the probability of developing toxicity.Our study shows that delivering conventional doses using conformal techniques is associated with minimal high-grade toxicity. However, even within a narrow dose range and fraction size used, differences do emerge which should lead one to be cautious in extending the results of dose escalation study to the community practice without a sufficient follow-up.

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The potential for normal tissue dose reduction with neoadjuvant hormonal therapy in conformal treatment planning for stage C prostate cancer

Cited by 49 publications

References 20 publications

Impact of hormone therapy on acute radiotherapy toxicity in the treatment of prostate cancer

Impact of hormone therapy on acute radiotherapy toxicity in the treatment of prostate cancer

Hormone therapy adjuvant to external beam radiotherapy for locally advanced prostate carcinoma

Evolution of toxicity after conformal radiotherapy for prostate cancer

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