Document Detail


Neoadjuvant androgen ablation prior to radiotherapy for prostate cancer: reducing the potential morbidity of therapy.
MedLine Citation:
PMID:  9123735     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine the impact of neoadjuvant hormonal therapy (NHT) prior to conformal radiotherapy on the reduction of volume of normal tissue structures exposed to high doses of radiation therapy and to evaluate the overall late toxicity and response to treatment among patients treated with this approach. METHODS: Among 214 patients treated with neoadjuvant leuprolide acetate and flutamide for 3 months prior to three-dimensional conformal radiotherapy (3D-CRT), 45 patients were prospectively evaluated with detailed dose-volume histogram (DVH) analyses to determine the extent of improvement of the geometry of the target volume after NHT. All patients underwent simulation and conformal treatment planning before and after NHT, and the pre- and posthormone DVH calculations for all normal tissue structures were compared for each patient. In addition, toxicity and response to therapy were evaluated in the 214 patients treated with this combined approach. RESULTS: In the 45 patients evaluated, the median reduction of the rectal and bladder volumes receiving 95% of the prescription dose (D95) were 18% and 46%, respectively, while 91% showed a reduction of small bowel volume in a range of 27% to 100% of the prehormonal values. Among the entire group of 214 patients treated with NHT and 3D-CRT, no grade 3 or 4 toxicity was observed with a median follow-up of 15 months after 3D-CRT. The 3-year actuarial grade 2 late gastrointestinal and genitourinary toxicity rates were 6% and 18%, respectively. CONCLUSIONS: Neoadjuvant hormonal therapy effectively reduces the volume of normal tissue exposed to high radiation doses in the majority of treated patients and decreases the potential morbidity of therapy.
Authors:
M J Zelefsky; A Harrison
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Urology     Volume:  49     ISSN:  0090-4295     ISO Abbreviation:  Urology     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-04-24     Completed Date:  1997-04-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  38-45     Citation Subset:  IM    
Affiliation:
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Androgen Antagonists / therapeutic use*
Antineoplastic Agents, Hormonal / therapeutic use*
Chemotherapy, Adjuvant
Drug Therapy, Combination
Flutamide / therapeutic use*
Follow-Up Studies
Humans
Leuprolide / therapeutic use*
Male
Middle Aged
Prostatic Neoplasms / drug therapy*,  pathology,  radiotherapy*
Chemical
Reg. No./Substance:
0/Androgen Antagonists; 0/Antineoplastic Agents, Hormonal; 13311-84-7/Flutamide; 53714-56-0/Leuprolide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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