Patterns of treatment failure in patients with prostate cancer treated with 76–80 Gy radiotherapy to the prostate and seminal vesicles ± hormonotherapy

• Published in: Clinical & translational oncology Vol. 23; no. 3; pp. 481 - 490
• Main Authors: López-Torrecilla, J., Pastor-Peidro, J., Vicedo-González, A., González-Sanchis, D., Hernandez-Machancoses, A., Almendros-Blanco, P., García-Miragall, E., Gordo-Partearroyo, J. C., García-Hernández, T., Brualla-González, L., Granero-Cabañero, D., Rosello-Ferrando, J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2021
• Subjects: Medicine; Medicine & Public Health; Oncology; Research Article; Treatment outcome; Radiotherapy; Prostate cancer; Patterns of failure
• ISSN: 1699-048X; 1699-3055
• DOI: 10.1007/s12094-020-02437-0

Purpose To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76–80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. Methods Retrospective study of patients with PCa ( n  = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51–87). Distribution by NCCN risk group was low ( n  = 80, 26.5%), intermediate ( n  = 86, 28.5%), high ( n  = 77, 25.5%), and very high ( n  = 49, 16.2%). Most patients ( n  = 273, 90.4%) received IMRT at a dose of 76–80 Gy. HT was administered in 237 patients (78.5%), in most cases ( n  = 167, 55.3%) for < 7 months Results Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis ( n  = 17, 5.6%), local failure ( n  = 11, 3.6%), and regional failure ( n  = 4, 1.3%). The cause of death ( n  = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS ( p  = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. Conclusions The main type of treatment failure after 76–80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS.