Prostate Cancer in comparison to Radiotherapy alone:
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- Stella York
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2 Prostate Cancer in comparison to Radiotherapy alone: 1 RTOG (2001) 456 patients with > a-goserelin 2 month before RTand during RT + Cyproterone acetate (1 month) vs b-pelvic irradiation (50 gy) + Boost to the prostate (20 Gy) 3 RTOG (2008) 1554 patients with T2c T4 and PSA < 150ng/ml a-goserelin + Flutamide 2 month before RT and during RT (Short Antiandrogen Deprivation) vs b-goserelin + Flutamide 2 month before RT and 24 additional months (Long Antiandrogen Deprivation)
3 Randomized trials to test the use of Androgen Deprivation (AD) in Prostate Cancer in comparison to Radiotherapy alone: RTOG In GS 2-6 patients a short course of androgen ablation has been associated with a highly significant improvement of local control, reduction in disease progression and overall survival. Gleason 2 6: Local progression Gleason 2 6: bned (PSA < 1.5) Gleason 2 6: Disease spec. mortality
4 Randomized trials to test the use of Androgen Deprivation (AD) in Prostate Cancer in comparison to Radiotherapy alone: 1 RTOG (2001) 456 patients with > T2 prostate cancer a-goserelin + Flutamide 2 month before RT and during RT vs b-pelvic irradiation (45 Gy) + Boost to the prostate (20-25 Gy) 2 EORTC Bolla M. and Genitourinary Group (2002) 415 patients with T1 2 Grade III or T3-4 a-goserelin 2 month before RTand during RT + Cyproterone acetate (1 month) vs b-pelvic irradiation (50 gy) + Boost to the prostate (20 Gy) 3 RTOG (2008) 1554 patients with T2c T4 and PSA < 150ng/ml a-goserelin + Flutamide 2 month before RT and during RT (Short Antiandrogen Deprivation) vs b-goserelin + Flutamide 2 month before RT and 24 additional months (Long Antiandrogen Deprivation)
5 Bolla et al. EORTC Radiotherapy Cooperative Group Overall Survival: 79% vs 62% Disease free interval: 85% vs 48% N Engl J Med 1997;337:
6 T2 prostate cancer a-goserelin vs + Flutamide 2 month before RT and during RT Cyproterone acetate (1 month) (2002) vs b-pelvic irradiation (50 gy) + Boost to the prostate (20 Gy) Cyproterone acetate (1 month) 3 vs RTOG b-pelvic (2008) irradiation (50 gy) + Boost to the prostate (20 Gy) 1554 patients with T2c T4 and PSA < 150ng/ml 3 RTOG a-goserelin (Short(2008) Antiandrogen + Flutamide Deprivation) 2 month before RT and during RT 1554 patients vs with T2c T4 and PSA < 150ng/ml b-goserelin a-goserelin + Flutamide 2 month before RT and during 24 additional RT months (Short Antiandrogen (Long Antiandrogen Deprivation) Deprivation) vs b-goserelin + Flutamide 2 month before RT and 24 additional months (Long Antiandrogen Deprivation)
7 Goserelin: 2 months, Flutamide Goserelin: 2 months, Flutamide Flutamide + Goserelin 24 months Flutamide after the end + Goserelin of RT 24 months
8 OS - Gleason Score 8-10 Gleason Score 8 10 Distant met failure Gleason Score 8 10 Biochemical failure OS -Gleason Score 2-7
9 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: 1 RTOG Stage A2, Stage B (1988) 445 analyzable patients Gy to the prostate gy to the pelvis + 20 Gy boost to the prostate 2 RTOG Elevated PSA < 100 ng/ml ( ) Estimated risk of nodal involvement > 15% 1323 randomized patients 1. Whole pelvic irradiation + Neoadjuvant Hormonal therapy 2. Prostate only RT + Neoadjuvant Hormonal therapy 3. Whole pelvic irradiation + Adjuvant Hormonal therapy 4. Prostate only RT + Adjuvant Hormonal therapy 3 GETUG-01 (2007) 444 T1b T3, N0 pnx, M0 patients 1. Pelvis + prostate RT (225 pts) 2. Prostate RT only (221 pts)
10 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: 1 RTOG Stage A2, Stage B Method of nodal evaluation: Surgical 25% Lymphangiogram 75% Treatment details Prostate and a portion of seminal vesicles 65 Gy Maximum dose 72 Gy Rectal and bladder dose not to exceed 65 Gy Pelvic nodal terget volume Gy 5 year survival with local control Prostate arm 88% Pelvic arm 90% 5 year survival NED Prostate arm 67% Pelvic arm 64% 5 year survival without metastases Prostate arm 84% Pelvic arm 83% Randomization was carried out with equal hormonal manipulation in both arms. It is conceivable that the hormonal therapy may have masked evidence of distant metastases Int J Radiat oncol Biol Phys 15; ,1988
11 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: 1 RTOG Stage A2, Stage B (1988) 445 analyzable patients Gy to the prostate gy to the pelvis + 20 Gy boost to the prostate 2 RTOG Elevated PSA < 100 ng/ml ( ) Estimated risk of nodal involvement > 15% 1323 randomized patients 1. Whole pelvic irradiation + Neoadjuvant Hormonal therapy 2. Prostate only RT + Neoadjuvant Hormonal therapy 3. Whole pelvic irradiation + Adjuvant Hormonal therapy 4. Prostate only RT + Adjuvant Hormonal therapy 3 GETUG-01 (2007) 444 T1b T3, N0 pnx, M0 patients 1. Pelvis + prostate RT (225 pts) 2. Prostate RT only (221 pts)
12 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG PFS by treatment arm
13 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG Primary endpoint for this study is PFS
14 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG 94-13
15 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG 94-13
16 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG Whole-Pelvis, Mini-Pelvis or Prostate-Only: better results with a large volume in comparison to Prostate-Only RT? These patients were originally included in the same group (Prostate-Only and NHT) without a difference significant in terms of PFS and OS
17 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: RTOG Whole-Pelvis, Mini-Pelvis or Prostate-Only: better results with a large volume in comparison to Prostate-Only RT? Prostate Only Group Lower Toxicity
18 Randomized trials to test the use of Pelvic Irradiation in Prostate Cancer: 1 RTOG Stage A2, Stage B (1988) 445 analyzable patients Gy to the prostate gy to the pelvis + 20 Gy boost to the prostate 2 RTOG Elevated PSA < 100 ng/ml ( ) Estimated risk of nodal involvement > 15% 1323 randomized patients 1. Whole pelvic irradiation + Neoadjuvant Hormonal therapy 2. Prostate only RT + Neoadjuvant Hormonal therapy 3. Whole pelvic irradiation + Adjuvant Hormonal therapy 4. Prostate only RT + Adjuvant Hormonal therapy 3 GETUG-01 (2007) 444 T1b T3, N0 pnx, M0 patients 1. Pelvis + prostate RT (225 pts) 2. Prostate RT only (221 pts)
19 Is there a role for Pelvic Irradiation in localized prostete adenocarcinoma? Is there a role for Pelvic Irradiation in localized prostete adenocarcinoma? Preliminary results of GETUG-01 PFS Low risk group PFS High risk group PFS Low risk High risk Rt only Rt + AD 60% - 63% 75% - 84%
20 Is there a role for Pelvic Irradiation in localized prostete adenocarcinoma? Preliminary results of GETUG-01
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