Abstract
Simple SummarySeveral randomized controlled trials have shown that concurrent use of deep regional hyperthermia and radiotherapy results in a significant increase in local control of cervical and rectal cancer. Intensity-modulated radiotherapy (IMRT) plus androgen deprivation therapy (ADT) has recently become standard treatment for high-risk localized prostate carcinoma; however, as there is room for improvement in outcomes, we have been using hyperthermia to improve the effect of IMRT. This retrospective analysis shows that addition of regional hyperthermia to IMRT plus ADT is a promising approach as it improves clinical outcomes with acceptable toxicity. Importantly, a higher thermal dose was significantly correlated with better biochemical disease-free survival. Further investigations, including prospective trials with detailed treatment protocols, are needed.Background: The purpose of this study was to evaluate the efficacy and toxicity of adding regional hyperthermia to intensity-modulated radiotherapy (IMRT) plus neoadjuvant androgen deprivation therapy (ADT) for high-risk localized prostate carcinoma. Methods: Data from 121 consecutive patients with high-risk prostate carcinoma who were treated with IMRT were retrospectively analyzed. The total planned dose of IMRT was 76 Gy in 38 fractions for all patients; hyperthermia was used in 70 of 121 patients. Intra-rectal temperatures at the prostate level were measured to evaluate thermal dose. Results: Median number of heating sessions was five and the median total thermal dose of CEM43T90 was 7.5 min. Median follow-up duration was 64 months. Addition of hyperthermia to IMRT predicted better clinical relapse-free survival. Higher thermal dose with CEM43T90 (>7 min) predicted improved biochemical disease-free survival. The occurrence of acute and delayed toxicity ≥Grade 2 was not significantly different between patients with or without hyperthermia. Conclusions: IMRT plus regional hyperthermia represents a promising approach with acceptable toxicity for high-risk localized prostate carcinoma. Further studies are needed to verify the efficacy of this combined treatment.
Highlights
Radiation therapy with androgen deprivation therapy (ADT) is the main treatment modality for patients with high-risk localized prostate cancer [1]
A recent study with intensity-modulated radiotherapy (IMRT) at a dose of 76–80 Gy plus ADT, which was administrated in 78.5% of the patients with National Comprehensive Carcinoma Network (NCCN) high-risk localized prostate carcinoma, reported 5-year Biochemical disease-free survival (bDFS) and metastasis-free survival rates of 80.6% and 92.5%, respectively [25]
We report higher and more promising 5-year bDFS and clinical relapse-free survival (RFS) rates of 89.8% and 98.0%, respectively, after IMRT with 76Gy in 38 fractions plus regional hyperthermia and ADT (Figure 3a,c)
Summary
Radiation therapy with androgen deprivation therapy (ADT) is the main treatment modality for patients with high-risk localized prostate cancer [1]. External radiation, such as intensity-modulated radiotherapy (IMRT), stereotactic body radiation therapy, and proton therapy, has been increasingly used in recent years to optimize dose concentration in tumors and reduce exposure to at-risk organs. In patients with prostate cancer, previous phase I/II clinical trials and retrospective studies have described the use of three-dimensional conformal radiation therapy in combination with regional hyperthermia to be both promising and feasible. The purpose of this study was to evaluate the efficacy and toxicity of adding regional hyperthermia to intensity-modulated radiotherapy (IMRT) plus neoadjuvant androgen deprivation therapy (ADT) for high-risk localized prostate carcinoma.
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