Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and
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RESEARCH
Open Access
Favorable outcomes in locally advanced and node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy Wolfgang Lilleby1*†, Amol Narrang2†, Gunnar Tafjord1, Ljiljana Vlatkovic3, Kjell Magne Russnes1, Andreas Stensvold4, Knut Håkon Hole5, Phuoc Tran2 and Karsten Eilertsen6
Abstract Background: 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). Material and methods: Of 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 cancerspecific 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. Results: Patients 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, 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. Conclusion: Pelvic IMRT in combination with long-term ADT can achieve long-lasting disease control in men with N+ disease and unfavorable prognostic factors. Keywords: Intensity modulated radiotherapy, Prostate cancer, Pelvic lymph node
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 * Correspondence: [email protected] † Equal contributors 1 Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, 0424 Oslo, Norway Full list of author information is available at the end of the article
(PCa) derive a survival benefit from the combination of radiation and hormonal therapy [1–4]. Randomized trials of elective nodal irradiation of the pelvic lymph nodes in N0 men have not been shown to confer a survival benefit in similar patients [5, 6]. Therefore, the most appro
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