Faculty Collaboration Database

Long-term treatment sequelae after external beam irradiation with or without hormonal manipulation for adenocarcinoma of the prostate: analysis of radiation therapy oncology group studies 85-31, 86-10, and 92-02. Int J Radiat Oncol Biol Phys 2008 Feb 01;70(2):437-41

Date

09/21/2007

Pubmed ID

17881145

Pubmed Central ID

PMC2917176

DOI

10.1016/j.ijrobp.2007.06.050

Scopus ID

2-s2.0-38149087621 (requires institutional sign-in at Scopus site)   64 Citations

Abstract

PURPOSE: Late gastrointestinal (GI) and genitourinary (GU) morbidity from external beam irradiation used to treat adenocarcinoma of the prostate continue to be a concern of physicians and patients alike. In addition, for locally advanced/high-risk cancer, the appropriate use of hormonal manipulation in addition to radiation therapy (RT) may increase toxicity. We analyzed three large Radiation Therapy Oncology Group (RTOG) studies (85-31, 86-10, and 92-02) to try to address these issues.

METHODS AND MATERIALS: A total of 2,922 patients were accrued with a median follow-up of 10.3 years for surviving patients. The RTOG scoring scheme was used to assess GI, GU, and other toxicities. Toxicity reported was Grade 3 or higher late toxicity. Patient toxicity level was assessed by study and by treatment type combining RT only vs. RT + short-course hormone therapy (STH) vs. RT + long-term hormone therapy (LTH).

RESULTS: Multivariate analysis reveals that age >70 was statistically significantly associated with a decrease in late any Grade 3+ toxicity (hazard ratio [HR] = 0.78, p = 0.0476) adjusted for treatment type. Comparing treatment type, patients treated with RT+STH had a statistically significant lower probability of Grade 3+ GI, GU, and other toxicity compared with RT alone (p = .00006; p = 0.0037; p = 0.0127, respectively). Patients treated with RT+LTH had a statistically significant lower probability of Grade 3+ GU toxicity compared with RT alone (p = 0.023).

CONCLUSIONS: These data show that external beam radiation therapy remains a safe option for locally advanced/high-risk prostate cancer, and the use of hormonal manipulation does appear to be protective for GU and GI toxicity depending upon length of treatment.

Author List

Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Aged
Androgen Antagonists
Combined Modality Therapy
Flutamide
Follow-Up Studies
Gastrointestinal Tract
Goserelin
Humans
Male
Prostate-Specific Antigen
Prostatic Neoplasms
Radiation Injuries
Urogenital System