Androgen Ablation Following Radiotherapy in Patients with Localized Prostatic Carcinoma
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- Category: Vol. 81, March 2013
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Androgen Ablation Following Radiotherapy in Patients with Localized Prostatic Carcinoma,EL SAYED M. EL HINDAWY, IBRAHIM A. AWAD and EL-HOUSSEINY EL ZALLOUEY
Abstract
Background: Approximately 25% of patients treated with adjuvant radiotherapy (RT) will develop a biochemical failure within 5 yr after RT when doses of 60-64 Gray (GY) are used.
Androgen deprivation therapy (ADT) is increasingly used for the treatment of prostate cancer (PCa), even in clinical settings in which there's no evidence-based proof of prolonged overall survival (OS). ADT, however, may be associated with numerous side effects, including an increased therapy-related cardiovascular mortality.
Abstract: This study was performed on forty cases of and locally advanced prostate cancer, with mean follow-up period of 19 months, range (6-42 months). All patients were referred Clinical Oncology and Nuclear Medicine Department Outpa-tient Clinic, from Urology and Nephrology centre, Mansoura University Hospital, during the period from September 2001 to July 2005. And patients were blindly randomized into two groups.
Group 1: Included twenty patients, who received combined external beam irradiation and androgen ablation therapy.
Group II: Included twenty patients, who received external beam irradiation alone.
Radiation therapy was delivered as a conventional frac-tionation schedule with a dose of 5000cGy over 5.5 weeks in 27 fractions to the whole pelvis followed by 2000cGy boost to the prostate over 2 weeks in 10 fractions.
Concurrent and adjuvant hormonal therapy was given in the form of cyproterone acetate (androcur) which is steroidal antiandrogen in a dose of 200-300mg daily.
Results: The overall response rate was 90% in group I versus 60% in group II, this difference was statistically significant (p=0.048).
Complete remission occurs in 35% of group I versus 10% in group II. Partial remission occur in 55% of group I versus 50% in group II. No response occurred in 5% in both groups.
The mean overall survival & progression free survival was 20.25 & 18.20 for group I versus 18.60 & 11.40 for group II. This difference was statistically significant as regard PFs (p=0.013).
Two year overall survival was 84.6% for group I versus 71.4% for group II.
As regard the complication there is significant increased rate of complication in group I than group II including Gil complication (proctatits & bleeding per rectum), hormonal related complication (easy fatigue) elevated liver enzymes and decreased lipido.
Conclusion: The wide spread use of serum (PSA) as a case finding tool has patently increased the proportion of asymptomatic patients who present with non-palpable, clini-cally localized tumors. With the diagnosis of prostate cancer being made earlier, the emphasis of treatment has shifted from palliation of symptoms to altering disease related morbidity & morality & thus improving overall survival.
It is highly apparent that a substantial proportion of men with clinically localized (Intermediate & high risk) or locally advanced prostate cancer not cured by radical radiotherapy for curative intent, and we have therefore explored the benefit of hormone therapy as adjuvant to radical radiotherapy which was feasible, tolerable & resulted in increase in overall survival, which did not reach statistical significance. Never-theless, resulted in statistically significant improvement in both overall response rate & progression-free survival.