Phase II trial of radiation dose escalation with conformal external beam radiotherapy and high-dose-rate brachytherapy combined with long-term androgen suppression in unfavorable prostate cancer: feasibility report.

Autori:	Jeanette Valero, Mauricio Cambeiro, Carlos Galán, Mercedes Teijeira, Pilar Romero, Javier Zudaire, Marta Moreno, Raquel Ciérvide, José Javier Aristu, Rafael Martínez-Monge
Lingua:	Eng.
Data:	2010-02-01
Giornale:	(1879-355X)
Release:	Int J Radiat Oncol Biol Phys. 2010 Feb;76(2):386-92
Abstract:	PURPOSE: To determine the feasibility of combined long-term luteinizing hormone-releasing hormone agonist-based androgen suppressive therapy (AST) and dose escalation with high-dose-rate (HDR) brachytherapy for high-risk (HRPC) or very-high-risk prostate cancer (VHRPC). METHODS AND MATERIALS: Between January 2001 and October 2006, 134 patients (median age, 70 years) with either National Comprehensive Cancer Network criteria-defined HRPC (n = 47, 35.1%) or VHRPC (n = 87, 64.9%) were prospectively enrolled in this Phase II trial. Tumor characteristics included a median pretreatment prostate-specific antigen level of 14.6 ng/mL, a median clinical stage of T2c, and a median Gleason score of 7. Three-dimensional conformal radiotherapy (54 Gy in 30 fractions) was followed by HDR brachytherapy (19 Gy in 4 b.i.d. treatments). Androgen suppressive therapy started 0-3 months before three-dimensional conformal radiotherapy and continued for 2 years. RESULTS: One implant was repositioned with a new procedure (0.7%). Five patients (3.7%) discontinued AST at a median of 13 months (range, 6-18 months) because of disease progression (n = 1), hot flashes (n = 2), fatigue (n = 1), and impotence (n = 1). After a median follow-up of 37.4 months (range, 24-90 months), the highest Radiation Therapy Oncology Group-defined late urinary toxicities were Grade 0 in 47.8%, Grade 1 in 38.1%, Grade 2 in 7.5%, and Grade 3 in 6.7% of patients. Maximal late gastrointestinal toxicities were Grade 0 in 73.1%, Grade 1 in 16.4%, Grade 2 in 7.5%, and Grade 3 in 2.9% of patients. There were no Grade 4 or 5 events. CONCLUSIONS: Intermediate-term results show that dose escalation with HDR brachytherapy combined with long-term AST is feasible and has a toxicity profile similar to that reported by previous HDR brachytherapy studies.
Copyright:	Department of Oncology, Clínica Universitaria de Navarra, University of Navarre, Navarre, Spain.
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Oggetto:	Aged, Aged, 80 and over, Androgen Antagonists, Brachytherapy, Combined Modality Therapy, Dose Fractionation, Feasibility Studies, Gastrointestinal Tract, Gonadotropin-Releasing Hormone, Humans, Male, Middle Aged, Prospective Studies, Prostate-Specific Antigen, Prostatic Neoplasms, Radiotherapy, Conformal, Urogenital System