Favorable 10-year outcomes of image-guided intensity-modulated radiotherapy combined with long-term androgen deprivation for Japanese patients with nonmetastatic prostate cancer.

AIM: To investigate 10-year outcomes of high-dose image-guided intensity-modulated radiation therapy (IG-IMRT) combined with long-term androgen deprivation therapy (ADT) for Japanese patients with nonmetastatic prostate cancer. METHODS: A retrospective analysis was performed on 208 Japanese patients with T1-4N0M0 prostate cancer, who underwent definitive IG-IMRT from 2006 to 2010 at our single institution. The median dose was 78 Gy (74-78) and median ADT time was 32 months (6-151). The risk stratification followed the National Comprehensive Cancer Network criteria. A biochemical relapse was defined as nadir plus 2.0 ng/mL. Toxicity was scored with the Radiation Therapy Oncology Group morbidity scale. RESULTS: The median follow-up time was 102 months. For low-, intermediate-, high-, and very-high-risk groups, the 10-year biochemical disease-free survival rates were 100%, 84%, 90%, and 72%, respectively (P = 0.008); clinical relapse-free survival rates were 100%, 100%, 100%, and 81%, respectively (P < 0.001); and cancer-specific survival rates were 100%, 100%, 100%, and 89%, respectively (P = 0.13). The independent prognostic factors influencing biochemical relapse were younger age, Gleason score ≥ 8, and radiation dose < 78 Gy in the multivariate analysis (P = 0.006, 0.014, and 0.013). The 10-year cumulative incidence of late grade 2 or higher gastrointestinal and genitourinary toxicities were 12% and 13%, respectively. No events of grade 4 or 5 were observed. CONCLUSIONS: This study suggest that high-dose IG-IMRT combined with long-term ADT is effective and implementable, leading to excellent 10-year outcomes for Japanese patients with nonmetastatic prostate cancer.

Effects of dose-escalated radiotherapy in combination with long-term androgen deprivation on prostate cancer.

OBJECTIVE: We aimed to examine the effects of a dose escalation for prostate cancer patients receiving long-term androgen deprivation therapy (ADT). METHODS: A retrospective analysis of 605 patients treated with radiotherapy (RT) and long-term ADT (National Comprehensive Cancer Network criteria-defined intermediate-risk, minimum 10 months; high-risk and very-high-risk, minimum 20 months) was performed. The median ADT time was 31 months. Cox's proportional hazards models were used to compare biochemical disease-free survival (bDFS), clinical relapse-free survival (cRFS) and overall survival (OS) between the ≥70, <78 Gy group and 78 Gy group in a univariate analysis and to assess the effects of the dose escalation on bDFS in a multivariate analysis. RESULTS: After a median follow-up of 70 months, 5-year bDFS was significantly better in the 78 Gy group than in the ≥70, <78 Gy group [96 vs 83%; hazard ratio 3.6 (95% confidence interval 2.2-6.1); p < 0.001]. 5-year cRFS and OS were similar between the two groups. The multivariate analysis showed that RT dose was still an independent prognostic factor of bDFS (p = 0.005). CONCLUSION: The results of the present study suggest that dose escalations result in significant improvements in bDFS, even when used in combination with long-term ADT. A longer follow-up is needed to clarify the effects of dose escalations on cRFS and OS. Advances in knowledge: It remains unclear whether high-dose RT is necessary for improving the outcomes of patients receiving long-term ADT. The results suggest that dose escalations result in significant improvements in biochemical control.

High-dose radiotherapy with helical tomotherapy and long-term androgen deprivation therapy for prostate cancer: 5-year outcomes.

PURPOSE: We aimed to examine outcomes of high-dose radiotherapy with helical tomotherapy (HT) and long-term androgen deprivation therapy (ADT) for T1-4N0M0 prostate cancer. METHODS: A total of 391 patients treated with HT between June 2006 and December 2013 were included in this retrospective study. All patients received neoadjuvant ADT for a median duration of 10 months followed by HT at a median dose of 78 Gy [interquartile range (IQR) 78-78]. The times of median adjuvant and total ADT were 19 and 27 months (IQR 20-31), respectively. The risk stratification followed the 2015 National Comprehensive Cancer Network criteria. Biochemical disease-free survival (bDFS) followed the Phoenix definition. Toxicity was scored according to the Radiation Therapy Oncology Group morbidity grading scale. RESULTS: Median follow-up from HT start was 60 months (IQR 42-81). Five-year bDFS rates for low-, intermediate-, high-, and very-high-risk groups were 100, 98.2, 97.7, and 87.9 %, respectively. We observed clinical relapse in nine very-high-risk patients and one high-risk patient, resulting in a 5-year clinical relapse-free survival of 100, 100, 99.4, and 91.7 %, respectively, for each risk group. Three patients died of prostate cancer, resulting in a 5-year prostate cancer-specific survival of 99.6 %. The late grade 2 or higher gastrointestinal and genitourinary toxicities were 9.7 and 10.7 %. No cardiovascular fatal events were observed. CONCLUSIONS: This report confirmed the excellent outcomes with acceptable late toxicities with the combination of HT and long-term ADT. Longer follow-up is crucial to further determine the treatment effect and toxicity.

A case of local advanced penile cancer treated with multimodality therapy.

A 61-year-old man presented to our institution complaining of a putrescent left inguinal ulcerated tumor. Our diagnosis was penile cancer with bilateral inguinal lymph node metastasis and clinical staging T4N3M0. Here we report a case of local advanced penile cancer experimentally treated with a multimodal approach.