Additional androgen deprivation makes the difference

Biochemical recurrence-free survival in prostate cancer patients after HDR brachytherapy and external beam radiotherapy

Zusätzlicher Androgenentzug macht den Unterschied

Biochemisches rezidivfreies Überleben bei Prostatakarzinompatienten nach HDR-Brachytherapie und perkutaner Bestrahlung

Abstract

Background

The role of additional androgen deprivation therapy (ADT) in prostate cancer (PCa) patients treated with combined HDR brachytherapy (HDR-BT) and external beam radiotherapy (EBRT) is still unknown.

Patients and methods

Consecutive PCa patients classified as D’Amico intermediate and high-risk who underwent HDR-BT and EBRT treatment ± ADT at our institution between January 1999 and February 2009 were assessed. Multivariable Cox regression models predicting biochemical recurrence (BCR) were performed. BCR-free survival was assessed with Kaplan–Meier analyses.

Results

Overall, 392 patients were assessable. Of these, 221 (56.4 %) underwent trimodality (HDR-BT and EBRT and ADT) and 171 (43.6 %) bimodality (HDR-BT and EBRT) treatment. Additional ADT administration reduced the risk of BCR (HR: 0.4, 95 % CI: 0.3–0.7, p < 0.001). D’Amico high-risk patients had superior BCR-free survival when additional ADT was administered (log-rank p < 0.001). No significant difference for BCR-free survival was recorded when additional ADT was administered to D’Amico intermediate-risk patients (log-rank p = 0.2).

Conclusions

Additional ADT administration improves biochemical control in D’Amico high-risk patients when HDR-BT and EBRT are combined. Physicians should consider the oncological benefit of ADT administration for these patients during the decision-making process.

Zusammenfassung

Hintergrund

Der Nutzen einer zusätzlichen Hormonentzugstherapie (ADT, „androgen deprivation therapy“) für Patienten mit Prostatakarzinom (PCa), welche mit einer Kombination aus HDR-Brachytherapie (HDR-BT) und perkutaner Bestrahlung (EBRT) behandelt werden, ist weiterhin ungeklärt.

Methodik

Für diese Studie wurden konsekutive, nach der D’Amico-Risikoklassifizierung in „intermediate“ und „high-risk“ eingeteilte Patienten ausgewählt, die zwischen Januar 1999 und Februar 2009 in unserem Institut eine kombinierte Therapie aus HDR-BT, EBRT ± ADT erhalten haben. Eine multivariable Cox-Regressionsanalyse zur Vorhersage eines biochemischen Rezidivs (BCR) wurde durchgeführt. Zusätzlich wurde mit einer Kaplan-Meier-Analyse das BCR-freie Überleben in Abhängigkeit vom Status der Hormonentzugstherapie untersucht.

Ergebnisse

Insgesamt wurden 221 von 392 Patienten (56,4 %) mit einer 3-fachen (HDR-BT und EBRT und ADT) und 171 (43,6 %) mit einer 2-fachen Therapie (HDR-BT und EBRT) behandelt. Die zusätzliche ADT hat das Risiko für ein BCR reduziert (HR 0,4; 95 %-KI 0,3–0,7; p < 0,001). D’Amico high-risk-Patienten zeigten ein verbessertes BCR-freies Überleben, wenn eine zusätzliche Hormonentzugstherapie durchgeführt wurde (log-rank p < 0,001). Bei D’Amico intermidiate-risk Patienten hatte die zusätzliche ADT keinen signifikanten Einfluss auf das BCR-freie Überleben (log-rank p = 0,2).

Schlussfolgerung

Die zusätzliche ADT führt bei „High-risk“-Patienten, die mit einer Kombination aus HDR-BT und EBRT behandelt werden, zu einem verbesserten BCR-freien Überleben. Der zusätzliche Nutzen einer ADT sollte in diesem Kontext bei der Therapieplanung erwogen werden.

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Correspondence to Jonas Schiffmann MD.

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Conflict of interest

J. Schiffmann, H. Lesmana, P. Tennstedt, B. Beyer, K. Boehm, V. Platz, D. Tilki, G. Salomon, C. Petersen, A. Krüll, M. Graefen, and R. Schwarz state that there are no conflicts of interest.

Additional information

Jonas Schiffmann and Hans Lesmana contributed equally to this manuscript.

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Schiffmann, J., Lesmana, H., Tennstedt, P. et al. Additional androgen deprivation makes the difference. Strahlenther Onkol 191, 330–337 (2015). https://doi.org/10.1007/s00066-014-0794-y

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Keywords

  • Androgen deprivation therapy
  • Biochemical recurrence
  • Brachytherapy
  • External beam radiotherapy
  • Prostate cancer

Schlüsselwörter

  • Androgenentzugstherapie
  • Biochemisches Rezidiv
  • Brachytherapie
  • Externe Strahlentherapie
  • Prostatakarzinom