Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy.

Wolfgang Lilleby,Amol Narrang,Andreas Stensvold,Ljiljana Vlatkovic,Kjell Magne Russnes,Phuoc Tran,Karsten Eilertsen,Gunnar Tafjord,Knut Håkon Hole

doi:10.1186/s13014-015-0540-3

Abstract

BackgroundThe most appropriate treatment for men with prostate cancer and positive pelvic nodes, N+, is an area of active controversy. We report our 5-years outcomes in men with locally advanced prostate cancer (T1-T4N0-N1M0) treated with definitive radiotherapy encompassing the prostate and pelvic lymph nodes (intensity modulated radiotherapy, IMRT) and long-term androgen deprivation therapy (ADT).Material and methodsOf the 138 consecutive eligible men all living patients have been followed up to almost 5 years. Survival endpoints for 5-year biochemical failure-free survival (BFFS), relapse-free survival (RFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were assessed by Kaplan-Meier analysis. Univariate and multivariate Cox regression proportional hazards models were constructed for all survival endpoints. The RTOG morbidity grading system for physician rated toxicity was applied.ResultsPatients with locally advanced T3-T4 tumors (35 %) and N1 (51 %) have favorable outcome when long-term ADT is combined with definitive radiotherapy encompassing pelvic lymph nodes. The 5-year BFFS, RFS, PCSS and OS were 71.4, 76.2, 94.5 and 89.0 %, respectively. High Gleason sum (9–10) had a strong independent prognostic impact on BFFS, RFS and OS (p = 0.001, <0.001, and 0.005 respectively). The duration of ADT (= > 28 months) showed a significant independent association with improved PCSS (p = 0.02) and OS (p = 0.001). Lymph node involvement was not associated with survival endpoints in the multivariate analysis. The radiotherapy induced toxicity seen in our study population was moderate with rare Grade 3 GI side effects and up to 11 % for Grade 3 GU consisting mainly of urgency and frequency.ConclusionPelvic IMRT in combination with long-term ADT can achieve long-lasting disease control in men with N+ disease and unfavorable prognostic factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0540-3) contains supplementary material, which is available to authorized users.

Highlights

Optimal treatment of locally advanced and lymph nodepositive adenocarcinoma of the prostate has not yet been determined
Patients with locally advanced T3-T4 tumors (35 %) and N1 (51 %) have favorable outcome when long-term androgen deprivation therapy (ADT) is combined with definitive radiotherapy encompassing pelvic lymph nodes
In the present study we investigated the 5-year outcomes of patients with locally advanced and/or with N+ prostate cancer undergoing intensity modulated radiotherapy (IMRT) combined with long-term androgen deprivation therapy (ADT)

Summary

Introduction

Optimal treatment of locally advanced and lymph nodepositive (cN1 or pN1) adenocarcinoma of the prostate has not yet been determined. There is abundant evidence gained from phase III studies that a substantial number of patients with locally advanced prostate cancer (PCa) derive a survival benefit from the combination of radiation and hormonal therapy [1,2,3,4]. The most appropriate treatment for men with clinically positive pelvic nodes, cN1 (or cN+), is an area of active controversy. The most appropriate treatment for men with prostate cancer and positive pelvic nodes, N+, is an area of active controversy. We report our 5-years outcomes in men with locally advanced prostate cancer (T1-T4N0-N1M0) treated with definitive radiotherapy encompassing the prostate and pelvic lymph nodes (intensity modulated radiotherapy, IMRT) and long-term androgen deprivation therapy (ADT)

Methods

Results

Discussion

Conclusion