Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy

Objective： To analyze the correlations among comorbidity and overall survival （OS）, biochemical progression-free survival （b-PFS） and toxicity in elderly patients with localized prostate cancer treated with 125I brachytherapy. Methods： Elderly men, aged ≥65 years, with low-intermediate risk prostate cancer, were treated with permanent 125I brachytherapy as monotherapy. Comorbidity data were obtained from medical reports using age-adjusted Charlson comorbidity index （a-CCI）. The patients were categorized into two age groups （〈75 and 〉75 years old）, and two comorbidity score groups （a-CCI ≤3 and 〉3）. Toxicity was scored with Radiation Therapy Oncology Group （RTOG） scale. Results： From June 2003 to October 2009, a total of 92 elderly patients underwent prostate brachytherapy, including 57 men （62%） with low-risk prostate cancer, and 35 men （38%） with intermediate-risk prostate cancer. The median age of patients was 75 years （range, 65-87 years）. Forty-seven patients （51%） bad a-CCI _〈3 and 45 patients （49%） a-CCI 〉3. With a median follow-up period of 56 months （range, 24-103 months）, the 5-year actuarial OS and b-PFS were 91.3% and 92.4% respectively, without statistical significance between two Charlson score groups. Toxicity was mild. None of the patients experienced gastrointestinal （GI） toxicity, and only 4 patiens （4%） experienced late genitourinary （GU） grade-3 （G3） toxicity. No correlation between acute GU and GI toxicity and eomorbidity was showed （P=0.50 and P=0.70, respectively）. Conclusions： Our data suggest that elderly men with low-intermediate risk prostate cancer and comorbidity can be considered for a radical treatment as 12Sl low-dose rate brachytherapy.

Dose escalation of external beam radiotherapy for high-risk prostate cancerdImpact of multiple high-risk factor

Objective:To retrospectively investigate the treatment outcomes of external beam radiotherapy with androgen deprivation therapy(ADT)in high-risk prostate cancer in three radiotherapy dose groups.Methods:Between 1998 and 2013,patients with high-risk prostate cancer underwent threedimensional conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy,72 Gy,or 78 Gy with ADT.Prostate-specific antigen(PSA)relapse was defined using the Phoenix definition.PSA relapse-free survival(PRFS)was evaluated in each radiotherapy dose group.Moreover,high-risk patients were divided into H-1(patients with multiple high-risk factors)and H-2(patients with a single high-risk factor)as risk subgroups.Results:Two hundred and eighty-nine patients with a median follow-up period of 77.3 months were analyzed in this study.The median duration of ADT was 10.1 months.Age,Gleason score,T stage,and radiotherapy dose influenced PRFS with statistical significance both in univariate and multivariate analyses.The 4-year PRFS rates in Group-66 Gy,Group-72 Gy and Group-78 Gy were 72.7%,81.6%and 90.3%,respectively.PRFS rates in the H-1 subgroup differed with statistical significance with an increasing radiotherapy dose having a more favorable PRFS,while PRFS rates in H-2 subgroup did not differ with increase in radiotherapy dose.Conclusion:Dose escalation for high-risk prostate cancer in combination with ADT improved PRFS.PRFS for patients in the H-1 subgroup was poor,but dose escalation in those patients was beneficial,while dose escalation in the H-2 subgroup was not proven to be effective for improving PRFS.