Locally advanced disease refers to prostate cancer that is no longer confined to the prostate and has started to invade nearby organs such as the seminal vesicles, but where there is no evidence of spread to distant sites such as the bone (T3–T4). This may also include those patients with biochemical failure following curative treatment, patients with N+ disease and those who are surgical margin positive after radical prostatectomy.
The aim of treatment for locally advanced disease is to reduce the risk of metastatic spread and tissue invasion and thereby prolong survival (Table 3.3). There are several possible treatment alternatives for patients with this early stage of prostate cancer. Some patients may be cured.
Radiotherapy + Hormonal Therapy
Neoadjuvant hormonal treatment prior to radiation therapy
Neoadjuvant hormonal therapy, used in combination with radiotherapy, is generally administered to reduce prostatic size/symptoms. The term neoadjuvant is used to describe a treatment is given before the primary treatment. Examples of neoadjuvant therapy may include hormone therapy commenced prior to radiation therapy.
EBRT (External beam radiotherapy) is often sufficient to suppress PSA levels to within normal ranges and delay disease progression. However, EBRT following neo-adjuvant hormonal therapy has been shown to produce better local control of disease and effect greater reductions in the risk of clinical or PSA relapse than EBRT alone.
The RTOG 86-10 trial investigated the use of MAB (goserelin – ZOLADEX plus flutamide) given for 4 months, starting 2 months before and continuing for 2 months during radiation therapy in T2–T4 disease. Disease free survival at 8 years was significantly improved (33%) in patients receiving neoadjuvant therapy compared to 21% in patients receiving radiation therapy alone.
The aim of treatment for locally advanced disease is to reduce the risk of metastatic spread and tissue invasion and thereby prolong survival (Table 3.3). There are several possible treatment alternatives for patients with this early stage of prostate cancer. Some patients may be cured.
Radiotherapy + Hormonal Therapy
Neoadjuvant hormonal treatment prior to radiation therapy
Neoadjuvant hormonal therapy, used in combination with radiotherapy, is generally administered to reduce prostatic size/symptoms. The term neoadjuvant is used to describe a treatment is given before the primary treatment. Examples of neoadjuvant therapy may include hormone therapy commenced prior to radiation therapy.
EBRT (External beam radiotherapy) is often sufficient to suppress PSA levels to within normal ranges and delay disease progression. However, EBRT following neo-adjuvant hormonal therapy has been shown to produce better local control of disease and effect greater reductions in the risk of clinical or PSA relapse than EBRT alone.
The RTOG 86-10 trial investigated the use of MAB (goserelin – ZOLADEX plus flutamide) given for 4 months, starting 2 months before and continuing for 2 months during radiation therapy in T2–T4 disease. Disease free survival at 8 years was significantly improved (33%) in patients receiving neoadjuvant therapy compared to 21% in patients receiving radiation therapy alone.
Overall survival was improved in patients with a Gleason score of 2-6, although survival in all patients was not improved. In addition such neoadjuvant therapy reduces the number of patients requiring salvage therapy (Pilepich MV et al. Int J Radiat Oncol Biol Phys 2001; 50: 1243–52).
Figure 3.10. RTOG – 86-10 - Disease-free survival, all patients
No comments:
Post a Comment