1015 poster EVALUATION OF ROTATIONAL IMRT FOR THE TREATMENT OF PROSTATE CANCER PATIENTS WITH PROSTHETIC HIP

Abstract

Purpose: Diethylstilbestrol (DES), a synthetic ethynyl estrogen, and intermediate dose ketoconazole (IDK) and hydrocortisone, a combination of antimycotic and corticosteroid, are often used as salvage therapy after several hormone manipulations. We investigated their efficacy in patients with hormone refractory prostate cancer (HRPC). Materials: A retrospective review of medical records of 32 HRPC pts receiving IDK and 19 pts receiving DES from Jan 2005 to Dec 2009. Results: Prior to IDK, patients received four lines of hormonal therapy. The median baseline serum PSA level was 75.8 ng/ml (range 1.75-563.3). A PSA response (defined by ≥ 50% decline in baseline PSA) or any PSA decline were observed in 5 (17.9%) and 11 (39.3%) pts, respectively.For the entire study group, the median time to progression (TTP) was 2.25 months (interquartile range (IQR) 2.0-5.75 mths), and the median survival was 11 months (IQR 5-21 mths). In PSA responders, TTP was significantly longer (7 mths) than in PSA non-responders (2.0 mths) (p=0.014). TTP was also significantly longer (6 mths) in patients with any PSA decline than in the group without decline (2.0 mths)(p 50% decline were observed in 11 (68.7%) and 6 (37.5%) pts, respectively. The median TTP was 7.25 months (IQR 4.0-9.25 mths) and the median overall survival was 12 months (IQR 7.4-17.5 mths). Using the >50% response criteria, the median TTP for responders was 8.25 mths compared to 4.5 mths for non-responders (p=0.093). DES toxicity was reported in only one patient. Conclusions: Diethylstilbestrol and ketoconazole are a valuable option for HRPC patients. DES can induce prolonged responses and is well tolerated. Early identified PSA responders to IDK will benefit from this therapy. A substantial proportion of patients discontinue therapy due to intolerable side effects. Long responses are more likely to occur in men initiating IDK or DES early in the course of their disease.