Factores pronósticos en radioterapia del cáncer de próstata: Importancia de la dosis y de la hormonoterapia de inducción

Felix Leborgne; José H. Leborgne; Bettys Ortega; René Curochquin; Julieta Mezzera; Mercedes Mullin

Authors

Felix Leborgne Uruguay, Academia Nacional de Medicina, Miembro Titular
José H. Leborgne Uruguay, Academia Nacional de Medicina, Miembro Titular
Bettys Ortega Uruguay, Hospital Italiano, Departamento de Radioterapia, Radioterapeuta. Clínica Dres. Leborgne
René Curochquin Uruguay, Hospital Italiano, Departamento de Física. Clínica Dres. Leborgne: Ing. Fís.
Julieta Mezzera Uruguay, Clínica Dres. Leborgne, Departamento de Bioestadística. Bioestadística
Mercedes Mullin Uruguay, Clínica Dres. Leborgne. Tec. Rad.

Keywords:

PROSTATIC NEOPLASMS, PROGNOSIS, RADIOTHERAPY

Abstract

Introduction: we aimed to analyse the effects of radiotherapy dose and the use of neoadjuvant hormone therapy on survival without biochemical relapse, on specific cause mortality and on overall mortality, in patients with prostate cancer.
Methods: we analysed 910 consecutive patients treated with radical tridimensional conformal radiotherapy between 1993 and 2005.
Results: actuarial biochemical control at 10 years for the subset of patients who received a median dose of 74 Gy was 78%, 60% and 40% for the low, medium and high-risk groups, respectively. Biochemical control of patients receiving a median dose of 78 Gy was 96%, 81% and 40% for the same risk-groups. The difference between low and medium risk groups was p=0,029 y 0,008, respectively. Mulitvariate analysis confirmed that dose escalation significantly correlated with biochemical control and cause-specific survival. Likewise, hormone therapy was a significant factor for biochemical control and cause-specific survival. The 10-year actuarial rate of Grade 2 and Grade 3 late complications (there were no Grade 4 or 5 complications) presented non-significant differences between four subsets of patients treated with doses from 64 to 80 Gy. 4.8% of patients treated with doses between 78 and 80 Gy presented late urinary complications, and 5.3% of them showed late rectal complications. In hormone therapy naïve patients a <1 ng/ml nadir and its manifestation more than12 months after finishing treatment, significantly correlated with biochemical control.
Conclusions: administration of a dose between 77 and 80 Gy with external beam 3D conformal radiotherapy, together with the use of induction hormone therapy have improved biochemical control results and cause-specific survival in all risk groups. No increase of late complications was observed.

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