International Journal of Clinical Oncology

, Volume 15, Issue 6, pp 571–577 | Cite as

Long-term outcomes of three-dimensional conformal radiation therapy combined with neoadjuvant hormonal therapy in Japanese patients with locally advanced prostate cancer

  • Masato Sakamoto
  • Takashi Mizowaki
  • Michihide Mitsumori
  • Kenji Takayama
  • Keisuke Sasai
  • Yoshiki Norihisa
  • Toshiyuki Kamoto
  • Eijiro Nakamura
  • Osamu Ogawa
  • Masahiro Hiraoka
Original Article

Abstract

Background

The outcomes of three-dimensional conformal radiation therapy (3D-CRT) combined with neoadjuvant hormonal therapy (NAHT) in Japanese patients with locally advanced prostate cancer who initiated salvage hormonal therapy (SHT) at a relatively early phase were evaluated.

Methods

Between April 1998 and April 2003, 70 Japanese patients with T3N0M0 prostate cancer who received radical 3D-CRT treatment were evaluated. The median age, initial prostate-specific antigen (PSA) level, and duration of NAHT were 73 years old, 26.3 ng/ml, and 4 months, respectively. Seventy grays were given in 35 fractions that were confined to the prostate and seminal vesicles. Adjuvant hormonal therapy was not administered after 3D-CRT in any of the cases.

Results

The median follow-up period was 64.9 months. The median PSA value at the time of initiation of SHT was 5.0 ng/ml (range 0.1–21.6 ng/ml). Overall, disease-specific, PSA failure-free (based on the Phoenix definition) and SHT-free survival rates at 5 years were 90.3% (95% CI 86.5–94.0), 96.5% (94.0–98.9), 60.5% (48.2–72.7), and 63.5% (57.2–69.8), respectively. Therefore, two-thirds of the patients were still hormone-free at 5 years.

Conclusions

PSA control rates in our series of Japanese patients with stage T3N0M0 prostate cancer treated with the standard dose of 3D-CRT combined with NAHT seemed higher than expected. This approach involving 3D-CRT combined with NAHT with the initiation of SHT at PSA values of around 5 ng/ml may be one option for Japanese patients with locally advanced prostate cancer, although further prospective study is required to confirm the validity.

Keywords

Prostate cancer Neoadjuvant hormonal therapy Three-dimensional conformal radiation therapy PSA failure Salvage hormonal therapy 

Notes

Acknowledgments

This work was partially supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (20229009).

Conflict of interest statement

Authors have no conflicts of interest.

References

  1. 1.
    Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Weir HK, Thun MJ, Hankey BF et al (2003) Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 95:1276–1299PubMedGoogle Scholar
  3. 3.
    Japanese Ministry of Health, Labour and Welfare (2005) The number and rate of death. http://www.dbtk.mhlw.go.jp/toukei/youran/data18k/1-27.xls
  4. 4.
    Japanese Ministry of Health, Labour and Welfare (2005) The number and rate of death by malignancy. http://www.dbtk.mhlw.go.jp/toukei/youran/data18k/1-31.xls
  5. 5.
    Ohshima A, Kuroishi T, Tashima K et al (2004) Cancer morbidity/mortality/prognosis, 2004. Shinohara, TokyoGoogle Scholar
  6. 6.
    Japanese Urological Association (2005) Clinicopathological statistics on registered prostate cancer patients in Japan: 2000 report from the Japanese Urological Association. Int J Urol 12:46–61Google Scholar
  7. 7.
    Zhang Y, Glass A, Bennett N et al (2004) Long-term outcomes after radical prostatectomy performed in a community-based health maintenance organization. Cancer 100:300–307PubMedCrossRefGoogle Scholar
  8. 8.
    Pilepich MV, Winter K, John MJ et al (2001) Phase III Radiation Therapy Oncology Group (RTOG) Trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 50:1243–1252Google Scholar
  9. 9.
    Kumar S, Shelley M, Harrison C et al (2006) Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database Syst Rev CD006019Google Scholar
  10. 10.
    Bolla M, Gonzalez D, Warde P et al (1997) Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337:295–300PubMedCrossRefGoogle Scholar
  11. 11.
    Bolla M, Collette L, Blank L et al (2002) Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 360:103–106PubMedCrossRefGoogle Scholar
  12. 12.
    Bolla M, de Reijke TM, Van Tienhoven G et al (2009) Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 360:2516–2527PubMedCrossRefGoogle Scholar
  13. 13.
    Fukagai T, Namiki TS, Carlile RG et al (2006) Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men. BJU Int 97:1190–1193PubMedCrossRefGoogle Scholar
  14. 14.
    Mitsumori M, Sasaki Y, Mizowaki T et al (2006) Results of radiation therapy combined with neoadjuvant hormonal therapy for stage III prostate cancer: comparison of two different definitions of PSA failure. Int J Clin Oncol 11:396–402PubMedCrossRefGoogle Scholar
  15. 15.
    Zhu S, Mizowaki T, Nagata Y et al (2005) Comparison of three radiotherapy treatment planning protocols of definitive external-beam radiation for localized prostate cancer. Int J Clin Oncol 10:398–404PubMedCrossRefGoogle Scholar
  16. 16.
    Kaplan EL Meier P (1958) Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  17. 17.
    Zietman AL, Christodouleas JP, Shipley WU (2005) PSA bounces after neoadjuvant androgen deprivation and external beam radiation: impact on definitions of failure. Int J Radiat Oncol Biol Phys 62:714–718PubMedCrossRefGoogle Scholar
  18. 18.
    Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974Google Scholar
  19. 19.
    Pilepich MV, Winter K, Lawton CA et al (2005) Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma—long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 61:1285–1290PubMedCrossRefGoogle Scholar
  20. 20.
    Pilepich MV, Caplan R, Byhardt RW et al (1997) Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group Protocol 85-31. J Clin Oncol 15:1013–1021Google Scholar
  21. 21.
    Hanks GE, Pajak TF, Porter A et al (2003) Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol 21:3972–3978Google Scholar
  22. 22.
    Crook J, Ludgate C, Malone S et al (2004) Report of a multicenter Canadian phase III randomized trial of 3 months vs. 8 months neoadjuvant androgen deprivation before standard-dose radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 60:15–23PubMedCrossRefGoogle Scholar
  23. 23.
    Roach M 3rd, Lu J, Pilepich MV et al (2000) Predicting long-term survival, and the need for hormonal therapy: a meta-analysis of RTOG prostate cancer trials. Int J Radiat Oncol Biol Phys 47:617–627CrossRefGoogle Scholar
  24. 24.
    Saito T, Kitamura Y, Komatsubara S et al (2006) Outcomes of locally advanced prostate cancer: a single institution study of 209 patients in Japan. Asian J Androl 8:555–561PubMedCrossRefGoogle Scholar
  25. 25.
    Akakura K, Isaka S, Akimoto S et al (1999) Long-term results of a randomized trial for the treatment of stages B2 and C prostate cancer: radical prostatectomy versus external beam radiation therapy with a common endocrine therapy in both modalities. Urology 54:313–318PubMedCrossRefGoogle Scholar
  26. 26.
    National Comprehensive Cancer Network (2010) NCCN clinical practice guidelines in oncology prostate cancer V.I.2010. http://www.nccn.org/
  27. 27.
    National Cancer Institute (2010) Prostate cancer treatment (PDQ®). http://www.cancer.gov/
  28. 28.
    Japanese Ministry of Health, Labour and Welfare (2005) The 20th life tables. http://www.mhlw.go.jp/english/database/db-hw/lifetb20th/table-m.html
  29. 29.
    Denham JW, Steigler A, Lamb DS et al (2005) Short-term androgen deprivation and radiotherapy for locally advanced prostate cancer: results from the Trans-Tasman Radiation Oncology Group 96.01 randomised controlled trial. Lancet Oncol 6:841–850Google Scholar
  30. 30.
    Laverdiere J, Nabid A, De Bedoya LD et al (2004) The efficacy and sequencing of a short course of androgen suppression on freedom from biochemical failure when administered with radiation therapy for T2-T3 prostate cancer. J Urol 171:1137–1140PubMedCrossRefGoogle Scholar
  31. 31.
    Pilepich MV, Krall JM, al-Sarraf M et al (1995) Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 45:616–623Google Scholar
  32. 32.
    Roach M 3rd, DeSilvio M, Lawton C et al (2003) Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 21:1904–1911Google Scholar
  33. 33.
    Shipley WU, Desilvio M, Pilepich MV et al (2006) Early initiation of salvage hormone therapy influences survival in patients who failed initial radiation for locally advanced prostate cancer: a secondary analysis of RTOG Protocol 86-10. Int J Radiat Oncol Biol Phys 64:1162–1167Google Scholar
  34. 34.
    Yamanaka H, Ito K, Naito S et al (2005) Effectiveness of adjuvant intermittent endocrine therapy following neoadjuvant endocrine therapy and external beam radiation therapy in men with locally advanced prostate cancer. Prostate 63:56–64PubMedCrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2010

Authors and Affiliations

  • Masato Sakamoto
    • 1
    • 2
  • Takashi Mizowaki
    • 1
  • Michihide Mitsumori
    • 1
  • Kenji Takayama
    • 1
  • Keisuke Sasai
    • 3
  • Yoshiki Norihisa
    • 1
  • Toshiyuki Kamoto
    • 4
  • Eijiro Nakamura
    • 4
  • Osamu Ogawa
    • 4
  • Masahiro Hiraoka
    • 1
  1. 1.Department of Radiation Oncology and Image-Applied TherapyKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of RadiologyJapanese Red Cross Society Wakayama Medical CenterWakayamaJapan
  3. 3.Department of RadiologyJuntendo University School of MedicineTokyoJapan
  4. 4.Department of UrologyKyoto University Graduate School of MedicineKyotoJapan

Personalised recommendations