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Whole Pelvis Versus Prostate-Only Radiotherapy With or Without Short-Course Androgen Deprivation Therapy and

Lior Z Braunstein1, Ming-Hui Chen2, Daniel E Dosoretz3

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Clinical Genitourinary Cancer
|May 25, 2015
PubMed
Summary
This summary is machine-generated.

Whole-pelvic radiotherapy (WPRT) and androgen deprivation therapy (ADT) both reduce prostate cancer mortality. Combining WPRT and ADT does not offer additional survival benefits, suggesting a shared mechanism targeting micrometastatic disease.

Keywords:
Hormonal therapyLymph nodesNodal irradiationPelvic radiationProstate cancerRadiation therapy

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Prostate cancer treatment involves radiotherapy and androgen deprivation therapy (ADT).
  • The extent of radiation field (whole-pelvic vs. prostate/seminal vesicle) and ADT use may impact survival.
  • Understanding these factors is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the association between prostate radiotherapy extent (WPRT vs. PSVRT) and all-cause mortality (ACM).
  • To determine if ADT use influences the relationship between radiotherapy extent and ACM.
  • To evaluate the combined effect of WPRT and ADT on ACM in prostate cancer patients.

Main Methods:

  • A cohort of 3709 prostate cancer patients treated between 1991-2006 was analyzed.
  • Patients received either WPRT or PSVRT with a brachytherapy boost, with or without neoadjuvant ADT.
  • Cox regression models assessed the impact of radiation volume and ADT on ACM, including interaction effects.

Main Results:

  • WPRT was associated with a decreased risk of ACM compared to PSVRT (AHR=0.58, P=.01).
  • ADT use was also linked to reduced ACM (AHR=0.71, P=.004).
  • A significant interaction between radiation volume and ADT was observed (AHR=1.61, P=.048), with no added benefit from combining WPRT and ADT.

Conclusions:

  • Both WPRT and short-course ADT are associated with decreased ACM in prostate cancer patients.
  • Combining WPRT and ADT does not provide a greater reduction in ACM compared to either treatment alone.
  • A shared mechanism, potentially targeting micrometastatic disease in pelvic lymph nodes, may explain the observed risk reduction.