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

TROD 09-001 multi-institutional study

Behandlungsergebnisse von mit definitiver Strahlentherapie behandelten Prostatakrebspatienten mit einem Gleason-Score von 8–10

TROD 09-001 Multizenterstudie

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Zusammenfassung

Ziel

Beurteilung der klinischen Ergebnisse und prognostischen Faktoren bei Patienten mit Prostatakrebs (PCa) mit Gleason-Score (GS) 8–10, die mit externer Strahlentherapie (EBRT) und einer Androgendeprivationstherapie (ADT) behandelt wurden.

Methoden

Zwischen 2000 und 2015 wurden insgesamt 641 mittels Biopsie diagnostizierte PCa-Patienten mit GS 8–10 von 11 Instituten in die Studie einbezogen. In dieser multizentrischen Studie der Turkish Radiation Oncology Group wurde ein Standard-Datenbankformular zur Patientenaufnahme an jedes Zentrum geschickt. Die Einschlusskriterien waren: keine vorherige Diagnose von Malignitäten, T1–T3 N0 M0 gemäß der TNM-Klassifikation des AJCC (American Joint Committee on Cancer) von 2010 und eine RT von Prostata und Samenblasen mindestens bis 70 Gy entweder mit dreidimensionaler oder mit intensitätsmodulierter RT zusammen mit einer ADT.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 5,9 Jahre (Spanne 0,4–18,2 Jahre). Das 5‑Jahres-Gesamtüberleben (OS), die biochemische Rezidivrate (BCR) und das fernmetastasenfreie Überleben (FÜ) der Patienten mit einer Nachbeobachtungszeit von 5 Jahren betrug jeweils 88%, 78% und 79%. Höhere Dosis der RT (≥78 Gy) und langfristige ADT waren signifikante Prädiktoren für ein verbessertes FÜ. Fortgeschrittenes Stadium bei Patienten mit GS 9–10 wurde als negativer Prognosefaktor für das FÜ identifiziert.

Schlussfolgerung

Unsere Ergebnisse zeigen, dass sich die onkologischen Ergebnisse zwischen GS 8 und GS 9–10 bei Patienten mit PCa, die mit EBRT behandelt wurden, unterscheiden. Die EBRT-Dosis erwies sich als wichtiger prädiktiver Faktor unabhängig von ADT. Patienten, die keine optimale Behandlung erhielten (RT mit Dosen <78 Gy und ADT-Zeit <2 Jahre), hatten die schlechtesten Behandlungsergebnisse.

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Correspondence to Gokhan Ozyigit M.D..

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Conflict of interest

G. Ozyigit, C. Onal, S. Igdem, Z.A. Alicikus, A. Iribas, M. Akin, D. Yalman, I. Cetin, M.G. Aksu, B. Atalar, F. Dincbas, P. Hurmuz, O.C. Guler, B. Aydin, F. Sert, C. Yildirim, I.B. Gorken, F.Y. Agaoglu, A.F. Korcum, D. Yuce, S. Ozkok, E. Darendeliler and F. Akyol declare that they have no competing interests.

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Ozyigit, G., Onal, C., Igdem, S. et al. Treatment outcomes of prostate cancer patients with Gleason score 8–10 treated with definitive radiotherapy. Strahlenther Onkol 195, 882–893 (2019). https://doi.org/10.1007/s00066-019-01476-z

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Keywords

  • Pelvic radiotherapy
  • Grading system
  • Intensity modulated radiation therapy
  • Hormonal treatment
  • Androgen deprivation therapy

Schlüsselwörter

  • Beckenstrahlentherapie
  • Bewertungssystem
  • Intensitätsmodulierte Strahlentherapie
  • Hormonelle Behandlung
  • Androgendeprivationstherapie