Five-year outcomes after neoadjuvant chemotherapy and conformal radiotherapy in patients with high-risk localized prostate cancer Journal Article

Authors: Ryan, C. J.; Zelefsky, M. J.; Heller, G.; Regan, K.; Leibel, S. A.; Scher, H. I.; Kelly, W. K.
Article Title: Five-year outcomes after neoadjuvant chemotherapy and conformal radiotherapy in patients with high-risk localized prostate cancer
Abstract: Objectives To describe the 5-year outcomes of patients with high-risk localized prostate cancer treated with neoadjuvant estramustine and vinblastine followed by concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT). Methods A total of 23 patients completed therapy consisting of two 8-week cycles of vinblastine, weekly as 4 mg/m2, followed by 8 weeks of concomitant chemotherapy and 3D-CRT. Estramustine was given daily at 10 mg/kg in three divided doses. 3D-CRT consisted of a total dose of 7560 cGy. Results Assessable patients include 9 with Stage T3 or greater tumors and 5 with lymph node metastasis at diagnosis. All patients had a Gleason score 7 or greater. The median follow-up was 60 months. Of the 23 assessable patients, 15 (65%) experienced biochemical relapse by American Society for Therapeutic Radiology Oncology criteria. The median time to prostate-specific antigen relapse was 12 months (range 7 to 16). Five patients (22%) developed metastases. The median time to metastasis had not been reached by last follow-up. Of the 23 assessable patients, 11 (48%) received no additional therapy and had noncastrate testosterone levels. Six patients had no evidence of disease and 9 patients were receiving androgen blockade. Three patients died (one of prostate cancer and two of other diseases). Conclusions A substantial proportion of patients with unfavorable-risk localized prostate cancer achieved long-term disease control with estramustine and vinblastine and concurrent 3D-CRT, no significant long-term toxicities were seen and 48% underwent no further therapy after RT. These long-term findings support the continued study of chemotherapy combined with RT as a potential alternative to prolonged androgen deprivation. © 2004 Elsevier Inc.
Keywords: adult; cancer chemotherapy; clinical article; controlled study; treatment outcome; aged; disease-free survival; middle aged; survival analysis; clinical trial; cancer localization; side effect; cancer radiotherapy; combined modality therapy; neoadjuvant therapy; cancer staging; follow up; follow-up studies; adenocarcinoma; controlled clinical trial; antineoplastic combined chemotherapy protocols; tumor markers, biological; vinblastine; risk; prostate-specific antigen; prostatic neoplasms; feasibility studies; acetylsalicylic acid; thromboembolism; androgen antagonists; neoplasm metastasis; radiotherapy, conformal; antineoplastic agents, hormonal; testosterone; prostate carcinoma; estramustine; brain artery aneurysm; humans; prognosis; human; male; priority journal; article
Journal Title: Urology
Volume: 64
Issue: 1
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2004-07-01
Start Page: 90
End Page: 94
Language: English
DOI: 10.1016/j.urology.2004.03.006
PROVIDER: scopus
PUBMED: 15245942
Notes: Urology -- Cited By (since 1996):20 -- Export Date: 16 June 2014 -- CODEN: URGYA -- Source: Scopus
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MSK Authors
  1. Michael J Zelefsky
    624 Zelefsky
  2. Glenn Heller
    303 Heller
  3. William K Kelly
    110 Kelly
  4. Charles Ryan
    9 Ryan
  5. Steven A Leibel
    220 Leibel
  6. Howard Scher
    834 Scher
  7. Kevin P Regan
    9 Regan