Treatment outcomes in high-risk prostate cancer: a single-centre experience

Yıl 2022, Cilt: 5 Sayı: 4, 1062 - 1067, 20.07.2022

Esra Kekilli , Yasemin Güzle Adaş

https://doi.org/10.32322/jhsm.1118861

Öz

Aim: The aim of that study was to evaluate the treatment results of patients with high-risk prostate cancer who received image-guided intensity-modulated radiotherapy with curative intent.
Material and Method: Patients who underwent curative radiotherapy (RT) for high-risk prostate cancer were evaluated retrospectively in our clinic from April 2010 to April 2021. Demographics, prostate specific antigen (PSA) levels, gleason score (GS), the TNM stage of the tumor, and the success of treatment and complications were noted.
Results: Eighty-two patients were evaluated. The mean follow-up time was 39.1 months. The mean age was 71.2±6.2 (range 50-84 years) years. The mean PSA levels of the patients was 41.1±33.8, and the median was 27 ng/ml (range 8-129 ng/ml). The mean GS of the patients was 8.3±0.6, and the median was 8 (range 7-10). The mean overall survival (OS) rate was 75.6%; survival rates for 24 months and 36 months were 91.1% and 80.4% respectively. The progression-free survival (PFS) was found to be 62.8%. Moreover, the PFS time was found to be 66,6 months. Twenty-four months and 36 months PFS rates were 83.6% and 65.4%, respectively.
Conclusion: Intensity-modulated radiotherapy (IMRT) combined with androgen deprivation therapy is a safe and effective treatment modality for elderly patients with high-risk prostate cancer.

Anahtar Kelimeler

prostate cancer, IMRT, high risk, treatment

Kaynakça

• Global Cancer Observatory: Cancer Today. Available from: https://gco.iarc.fr/today.
• Mohler JL, Antonarakis ES. NCCN guidelines updates: management of prostate cancer. J Natl Compr Canc Netw 2019; 17: 583-6.
• Moris L, Cumberbatch MG, Van den Broeck T, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review. Eur Urol 2020; 77: 614-27.
• Becker-Schiebe M, Abaci A, Ahmad T, Hoffmann W. Reducing radiation-associated toxicity using online image guidance (IGRT) in prostate cancer patients undergoing dose-escalated radiation therapy. Rep Pract Oncol Radiother 2016; 21: 188-94.
• Wang Z, Ni Y, Chen J, et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 2020; 18: 42.
• Pasalic D, Kuban DA, Allen PK, et al. Dose escalation for prostate adenocarcinoma: a long-term update on the outcomes of a phase 3, single institution randomized clinical trial. Int J Radiat Oncol Biol Phys 2019; 104: 790-7.
• Yamazaki H, Suzuki G, Masui K, et al. Radiotherapy for clinically localized T3b or T4 very-high-risk prostate cancer-role of dose escalation using high-dose-rate brachytherapy boost or high dose intensity modulated radiotherapy. Cancers (Basel) 2021; 13. doi:10.3390/cancers13081856
• Roach III M, Marquez C, You HS, et al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer. Int. J. Radiation Oncology Biol. Phys 1994; 28: 33-7.
• Croke J, Maclean J, Nyiri B, et al. Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines. Radiation Oncology 2014; 9: 303.
• Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341-6.
• Bolla M, Van Tienhoven G, Warde P, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. The Lancet Oncology 2010; 11: 1066-73.
• Terlizzi M, Bossi A. High-risk locally advanced prostate cancer: multimodal treatment is the key. Eur Urol Open Sci 2022; 38: 14-6.
• Horwitz EM, Bae K, Hanks GE, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol 2008; 26: 2497-504.
• Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 2009; 360: 2516-27.
• Nabid A, Carrier N, Martin AG, et al. Duration of androgen deprivation therapy in high-risk prostate cancer: A randomized phase III trial. Eur Urol 2018; 74: 432-41.
• Murthy V, Maitre P, Kannan S, et al. Prostate-only versus whole-pelvic radiation therapy in high-risk and very high-risk prostate cancer (POP-RT): outcomes from phase III randomized controlled trial. J Clin Oncol 2021; 39: 1234-42.
• Pommier P, Chabaud S, Lagrange JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 2007; 25: 5366-73.
• Abu-Gheida I, Reddy CA, Kotecha R, et al. Ten-year outcomes of moderately hypofractionated (70 Gy in 28 fractions) intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2019; 104: 325-33.
• Yossepowitch O, Eggener SE, Bianco FJ, et al. Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol 2007; 178: 493-9; discussion 9.
• Petrelli F, Vavassori I, Coinu A, Borgonovo K, Sarti E, Barni S. Radical prostatectomy or radiotherapy in high-risk prostate cancer: a systematic review and metaanalysis. Clin Genitourin Cancer 2014; 12: 215-24.
• Incrocci L, Wortel RC, Alemayehu WG, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2016; 17: 1061-9.
• Sabolch A, Feng FY, Daignault-Newton S, et al. Gleason pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose-escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys 2011; 81: e351-60.
• Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-60.
• Ang M, Rajcic B, Foreman D, Moretti K, O'Callaghan ME. Men presenting with prostate-specific antigen (PSA) values of over 100 ng/mL. BJU Int 2016; 117: 68-75.
• Detti B, Baki M, Becherini C, et al. High-dose intensity-modulated radiation therapy as primary treatment of prostate cancer: genitourinary/gastrointestinal toxicity and outcomes, a single-institution experience. Radiol Med 2019; 124: 422-31.