ORIGINAL ARTICLE
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Impact of androgen-deprivation therapy on the outcome of dose-escalation prostate cancer radiotherapy without elective pelvic irradiation


1 Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China
2 Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, China
3 Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, China

Correspondence Address:
Jason Chia-Hsien Cheng,
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
China
Yeong-Shau Pu,
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
China
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Source of Support: None, Conflict of Interest: None

The benefit of androgen-deprivation therapy (ADT) in combination with dose-escalated radiotherapy (DERT) for localized prostate cancer has not been determined in randomized studies. In this study, the benefit of ADT was assessed in patients uniformly treated with dose-escalated intensity-modulated radiation therapy (IMRT) to the prostate and seminal vesicles but not pelvis. In all, 419 patients with localized prostate adenocarcinoma underwent definitive IMRT (cumulative dose 78 Gy), with 32.6%, 33.1%, 32.1%, and 2.1% having T1 through T4 disease, respectively, and 51.2% having high-risk disease. ADT was given to 76.1% of patients. With a median follow-up of 60 months, 5-year biochemical failure-free, disease-free, and overall survival rates were 87%, 86%, and 87%, respectively. T stage was an independent predictor of all three rates. Five-year pelvic nodal recurrence rate was 2.9%. ADT improved biochemical failure-free and disease-free survival but not overall survival. ADT showed benefit in high-risk disease but not intermediate-risk disease. Late gastrointestinal and genitourinary toxicities ≥ grade 2 occurred in 11.0% and 6.7%, respectively. In conclusion, DERT with 78 Gy yields good disease control and low rate of pelvic nodal recurrence. ADT improves disease-free survival in patients with high-risk but not intermediate-risk disease.


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    -  Huang CY
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