(S033) Dose-Escalated Radiation Therapy With or Without Short-Course Androgen Deprivation for Intermediate-Risk Prostate Cancer

OncologyOncology Vol 28 No 4_Suppl_1
Volume 28
Issue 4_Suppl_1

To investigate outcomes in intermediate-risk prostate cancer patients receiving dose-escalated external beam radiation therapy (RT) with or without short-course androgen deprivation therapy (ADT).

Elliot Navo, MD, David Schwartz, MD, Kwang Choi, MD, Marvin Rotman, MD, David Schreiber, MD; Department of Radiation Oncology Veterans Affairs, New York Harbor Healthcare System; Department of Radiation Oncology, SUNY Downstate Medical Center

Background and Purpose: To investigate outcomes in intermediate-risk prostate cancer patients receiving dose-escalated external beam radiation therapy (RT) with or without short-course androgen deprivation therapy (ADT).

Materials and Methods: This study comprised 203 intermediate-risk prostate cancer patients who were treated at a single institution to a dose of ≥ 7,560 cGy from 2003–2010. Of these patients, 62 (30.5%) received ADT in addition to their RT. Comparisons of patient characteristics were performed using chi-square analysis. Biochemical recurrence, distant metastatic-free survival (DMPFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were analyzed using the Kaplan-Meier method. Multivariate Cox regression was used to analyze the impact of covariates on biochemical outcomes.

Results: The median follow-up was 62 months, and the median duration of ADT was 6 months. Patients with a prostate specific antigen (PSA) above 10 ng/mL were more likely to receive ADT than those with PSA values of 10 ng/mL or less (P < .001). There was a trend toward reduced ADT usage for those who were aged younger than 70 years compared with those who were older (P = .10), as well as for those who were treated with further dose escalation above 7,560 cGy (P = .06). There were no differences in ADT use based on race or the Gleason score of the biopsy. There were a total of 33 biochemical failures (16.3%), and the median time to biochemical failure was 42 months (range: 4–98 mo). Biochemical failure occurred in 4 of the 62 patients who were treated with RT and ADT (6.5%) and in 19 of the 141 patients who were treated with RT alone (13.4%). The 6-year biochemical control was 89.2% for those receiving RT plus ADT vs 76.7% in those receiving RT alone (P = .02). There were three distant failures-two in patients who received RT alone and one in a patient who received RT + ADT; the time to distant failure was 22 and 47 months for the patients who received RT alone, respectively, and was 109 months for the patient who received RT + ADT. The 6-year DMPFS, PCSS, and OS rates were 98.2%, 99.0%, and 82.3% for those receiving RT alone and 100%,100%, and 72.3% for those receiving RT + ADT, respectively (respective P values = .91, .50, and .67). On multivariate analysis, only ADT use was associated with improved biochemical outcomes (hazard ratio [HR] = 0.24; 95% confidence interval [CI], 0.08–0.70; P = .01), while perineural invasion was associated with worse biochemical outcomes (HR = 2.94; 95% CI, 1.36–6.34; P = .01).

Conclusions: Dose-escalated RT and short-course ADT result in improved biochemical outcomes for intermediate-risk prostate cancer patients. Perineural invasion appears to be an important prognostic factor that portends worse biochemical control.

Proceedings of the 96th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) Outcomes and Prognostic Factors of Stereotactic Body Radiotherapy for Soft Tissue Sarcoma Metastases
(S001) Limb-Sparing Surgery and Intraoperative Radiotherapy in the Treatment of Primary, Nonmetastatic Extremity and Limb-Girdle Soft Tissue Sarcoma
(S003) Disparities in Stage at Diagnosis and Survival in Adult Cancer Patients According to Insurance Status
(S004) Radiation Publications Underrepresented in High-Impact General Medical and Oncology Journals 
(S005) Adjuvant Radiotherapy in Stage II Endometrial Carcinoma: Is Brachytherapy Alone Sufficient for Local Control?
(S006) Extended-Field IMRT With Concomitant Boost for Node-Positive Cervical Cancer: Analysis of Regional Control Rate and Recurrence Pattern
(S007) Stereotactic Radiosurgery to the Brain With Concurrent BRAF Inhibitors for Melanoma Metastases
(S008) Use of Mobile Devices for Creation of Survivorship Care Plans
(S009) Two-Year Outcomes Following Triapine Radiochemotherapy for Cervical Cancer 
(S010) Prospective and Real-Time Data Analysis of Image-Guided Radiotherapy Across a Multinational Pediatrics Consortium: Methodology and Considerations 
(S011) Comparison of Toxicities and Outcomes for Conventional and Hypofractionated Radiation Therapy for Early Glottic Carcinoma
(S013) Adjuvant Radiation Therapy and Temozolomide for Anaplastic Gliomas: The Twelve-Year Washington University Experience
(S014) Gamma Knife Stereotactic Radiosurgery in the Treatment of Brainstem Metastases
(S015) Temporal Lobe Radionecrosis After Skull Base Radiotherapy: Dose-Volume Predictors 
(S012) Prognostic Value of Radiographic Extracapsular Extension in Locally Advanced Non-Oropharyngeal Head and Neck Squamous Cell Cancers
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