Open AccessOutcomes of combined radiotherapy in high-risk prostate cancer
Author(s) -
A.V. Potapova Potapova,
И. А. Гладилина,
А. В. Петровский,
В. А. Черняев,
В. Н. Шолохов,
Б. В. Бухаркин,
М. И. Нечушкин,
Ramiz K. Valiev,
Ю. С. Сергеев,
Л Е Ротобельская,
А. В. Назаренко
Publication year - 2020
Publication title -
zlokačestvennye opuholi
Language(s) - English
Resource type - Journals
eISSN - 2587-6813
pISSN - 2224-5057
DOI - 10.18027/2224-5057-2019-9-4-32-40
Subject(s) - medicine , radiation therapy , brachytherapy , prostate cancer , external beam radiotherapy , nuclear medicine , dose fractionation , confidence interval , prostate , randomized controlled trial , urology , cancer , surgery
Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques. Purpose . The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them. Materials and methods . 53 patients with PC received 125 I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125 I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied. Results . Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps. Conclusion . EBT using 125 I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.