Three Dimensional Conformal Radiotherapy and Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer; Hacettepe University Experience

Abstract

The aim of this study is to evaluate the treatment results of three dimensional conformal radiotherapy (3DCRT) and androgen deprivation therapy (ADT) in patients with clinically localized prostate cancer (CLPC). Between June 1998 and December 2011, 577 patients with the diagnosis of CLPC were treated. ADT was started 3 months prior to radiotherapy (RT). 3DCRT was delivered to prostate and the seminal vesicles (SV) to a total dose of 70Gy. Additionally, patients with lymph node (LN) positivity received 50.4Gy RT to pelvic LN's. Median follow up time was 65 months. Five-ten years overall survival (OS), cause specific survival (CSS), PSA relapse-free survival (PSA-RFS) and distant metastasis-free survival (DMFS) rates were 92-74%, 97-91%, 77-55% and 94-88%, respectively. OS was negatively affected from LN positivity (p< 0.001). In the subgroup of patients with GS≥ 8, there was no significant difference between < 1 years and ≥ 1 years of ADT in terms of CSS, PSA-RFS and DMFS. OS was better in patients with < 1 years of ADT (p= 0.01). Five year OS (p= 0.02), CSS (p= 0.05), PSA-RFS (p= 0.01) and DMFS (p= 0.07) rates were inferior in the high risk group patients that used ADT ≥ 1 year. Acute and late RTOG grade III/IV gastrointestinal system toxicity rates were 1.7% and 5% and acute and chronic RTOG grade III/IV genitourinary system toxicity rates were 1.4% and 5%, respectively. 3DCRT and ADT combination is an effective treatment modality with acceptable toxicities in patients with clinically localized prostate cancer. Keywords: Prostate cancer, Conformal radiotherapy, Androgen deprivation therapy ÖZET Lokalize Prostat Kanserli Olgularda Üç Boyutlu Konformal Radyoterapi ve Total Androjen Blokajı; Hacettepe Üniversi-tesi DeneyimiBu çalışmanın amacı, üç boyutlu konformal radyoterapi (3BKRT) ve total androjen blokajı (TAB) Lokalize prostat kanserli olgularımızdaki tedavi sonuçlarımızı değerlendirmek. Haziran 1998 ve Aralık 2011 tarihleri arasında lokalize prostat kanseri tanısıyla 577 olgu tedavi edildi. TAB tedavisine radyoterapiden (RT) 3 ay sonar başlandı. 3BKRT olarak prostat ve seminal veziküllere toplam 70 Gy uygulandı. Ek olarak lenf nodu (LN) tutulumu olan olgularda pelvic LN'larına 50.4 Gy uygulandı. Ortanca izlem süresi 65 aydır. Beş-on yıllık genel sağkalım (GS), hastalığa özgü sağkalım (HSS), PSA-relapssız sağkalım (PSA-RFS) ve uzak metastazsız sağkalım (DMFS) oranları sırasıyla %92-74, %97-91, %77-55 ve %94-88 bulundu. LN tutulumu GS'ı olumsuz etkilemiştir (p< 0.001). Gleason skoru ≥ 8 olan olgularda <1 yıl ile ≥ 1yıl TAB kullanımı arasında HSS, PSA-RFS ve DMFS açısından fark yoktu. Ancak <1 yıl TAB kullananlarda GS daha iyiydi (p= 0.01). Yüksek riskli grupta olup ≥ 1yıl TAB kullanan hastalarda 5 yıllık GS (p= 0.02), HSS (p= 0.05), PSA-RFS (p= 0.01) ve DMFS (p= 0.07) daha düşük bulundu. Erken ve geç dönem RTOG grad III/IV gastrointestinal sistem toksisite oranları %1.7 ve %5 bulundu. Erken ve geç dönem RTOG grad III/IV genitoüriner sistem toksisite oranları %1.4 ve %5 bulundu. Lokalize prostat kanseri...