Long-term androgen deprivation increases Grade 2 and higher late morbidity in prostate cancer patients treated with three-dimensional conformal radiation therapy

Steven J. Feigenberg, Alexandra L. Hanlon, Eric M. Horwitz, Robert G. Uzzo, Debra Eisenberg, Alan Pollack

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: To determine whether the use of androgen deprivation (AD) increases late morbidity when combined with high-dose three-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: Between May 1989 and November 1998, 1,204 patients were treated for prostate cancer with 3D-CRT to a median dose of 74 Gy. Patients were evaluated every 3-6 months. No AD was given to 945 patients, whereas 140 and 119 patients, respectively, received short-term AD (STAD; ≤6 months) and long-term AD (LTAD; > 6 months). Radiation morbidity was graded according to the Fox Chase modification of the Late Effects Normal Tissue Task Force late morbidity scale. Covariates in the multivariate analysis (MVA) included age, history of diabetes mellitus, prostate-specific antigen (PSA) level, Gleason score, T category, RT field size, total RT dose, use of rectal shielding, and AD status (no AD vs. STAD vs. LTAD). Results: The only independent predictor for Grade 2 or higher genitourinary (GU) morbidity in the MVA was the use of AD (p = 0.0065). The 5-year risk of Grade 2 or higher GU morbidity was 8% for no AD, 8% for STAD, and 14% for LTAD (p = 0.02). Independent predictors of Grade 2 or higher gastrointestinal (GI) morbidity in the MVA were the use of AD (p = 0.0079), higher total radiation dose (p < 0.0001), the lack of a rectal shield (p = 0.0003), and older age (p = 0.0009). The 5-year actuarial risk of Grade 2 or higher GI morbidity was 17% for no AD vs. 18% for STAD and 26% for LTAD (p = 0.017). Conclusions: The use of LTAD seems to significantly increase the risk of both GU and GI morbidity for patients treated with 3D-CRT.

Original languageEnglish
Pages (from-to)397-405
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume62
Issue number2
DOIs
StatePublished - Jun 1 2005
Externally publishedYes

Fingerprint

deprivation
Androgens
radiation therapy
grade
Prostatic Neoplasms
Radiotherapy
cancer
Morbidity
dosage
Multivariate Analysis
diabetes mellitus
Radiation
Neoplasm Grading
antigens
Advisory Committees
radiation
Prostate-Specific Antigen
predictions
shielding
Diabetes Mellitus

Keywords

  • 3D-CRT
  • Gastrointestinal/genitourinary morbidity
  • Hormones
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Long-term androgen deprivation increases Grade 2 and higher late morbidity in prostate cancer patients treated with three-dimensional conformal radiation therapy. / Feigenberg, Steven J.; Hanlon, Alexandra L.; Horwitz, Eric M.; Uzzo, Robert G.; Eisenberg, Debra; Pollack, Alan.

In: International Journal of Radiation Oncology Biology Physics, Vol. 62, No. 2, 01.06.2005, p. 397-405.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine whether the use of androgen deprivation (AD) increases late morbidity when combined with high-dose three-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: Between May 1989 and November 1998, 1,204 patients were treated for prostate cancer with 3D-CRT to a median dose of 74 Gy. Patients were evaluated every 3-6 months. No AD was given to 945 patients, whereas 140 and 119 patients, respectively, received short-term AD (STAD; ≤6 months) and long-term AD (LTAD; > 6 months). Radiation morbidity was graded according to the Fox Chase modification of the Late Effects Normal Tissue Task Force late morbidity scale. Covariates in the multivariate analysis (MVA) included age, history of diabetes mellitus, prostate-specific antigen (PSA) level, Gleason score, T category, RT field size, total RT dose, use of rectal shielding, and AD status (no AD vs. STAD vs. LTAD). Results: The only independent predictor for Grade 2 or higher genitourinary (GU) morbidity in the MVA was the use of AD (p = 0.0065). The 5-year risk of Grade 2 or higher GU morbidity was 8{\%} for no AD, 8{\%} for STAD, and 14{\%} for LTAD (p = 0.02). Independent predictors of Grade 2 or higher gastrointestinal (GI) morbidity in the MVA were the use of AD (p = 0.0079), higher total radiation dose (p < 0.0001), the lack of a rectal shield (p = 0.0003), and older age (p = 0.0009). The 5-year actuarial risk of Grade 2 or higher GI morbidity was 17{\%} for no AD vs. 18{\%} for STAD and 26{\%} for LTAD (p = 0.017). Conclusions: The use of LTAD seems to significantly increase the risk of both GU and GI morbidity for patients treated with 3D-CRT.",
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T1 - Long-term androgen deprivation increases Grade 2 and higher late morbidity in prostate cancer patients treated with three-dimensional conformal radiation therapy

AU - Feigenberg, Steven J.

AU - Hanlon, Alexandra L.

AU - Horwitz, Eric M.

AU - Uzzo, Robert G.

AU - Eisenberg, Debra

AU - Pollack, Alan

PY - 2005/6/1

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