Treatment outcomes of prostate cancer patients with Gleason score 8–10 treated with definitive radiotherapy

Springer Science and Business Media LLC - 2019
Gokhan Ozyigit1, Cem Onal2, Sefik Igdem3, Zumre Arican Alicikus4, Ayca Iribas5, Mustafa Akin6, Deniz Yalman7, Ilknur Cetin8, Melek Gamze Aksu9, Banu Atalar10, Fazilet Dincbas11, Pervin Hurmuz1, Ozan Cem Guler2, Barbaros Aydin4, Fatma Sert7, Cumhur Yildirim11, Ilknur Birkay Gorken4, Fulya Yaman Agaoglu5, Aylin Fidan Korcum9, Deniz Yuce12, Serdar Ozkok7, Emin Darendeliler5, Fadil Akyol1
1Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
2Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
3Department of Radiation Oncology, İstanbul Bilim University, Faculty of Medicine, Istanbul, Turkey
4Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
5Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
6Balikesir State Hospital, Balikesir, Turkey
7Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
8Department of Radiation Oncology, Marmara University, Faculty of Medicine, Istanbul, Turkey
9Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
10Department of Radiation Oncology, Acibadem University, Faculty of Medicine, Istanbul, Turkey
11Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
12Department of Prevantive Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey

Tóm tắt

To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8–10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era. Institutional databases of biopsy proven 641 patients with GS 8–10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1–T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. The median follow-up time was 5.9 years (range 0.4–18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9–10. Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9–10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving ‘non-optimal treatment’ (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.

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