Hormonal therapy and 3D conformal radiotherapy in prostate cancer: early toxicity of combined treatment

Abstract

Purpose

To evaluate acute toxicity of combined treatment (androgen ablation and high-dose 3D conformal radiotherapy [3D-CRT]) in patients with a localized cancer of prostate.

Materials and methods

Between April 1999 and March 2000, at the Greatpoland Cancer Centre in Poznań, 22 patients with prostate cancer (T1–T3 N0 M0) were treated with 3 D conformal radiation therapy and hormonal therapy. Patients represented a localized disease (T1 = 4 patients, T2 = 11 patients), and locally disease (T3 = 7 patients). No patients had clinically detectable distant metastases. Neoadjuvant androgen ablation therapy (bilateral orchiectomy or LH-RH agonists and flutamide) was administered to all patients. Radiotherapy was performed using 15 MV photons in the daily fraction of 1.8 Gy to the total median dose of 70.2 Gy (range, 67.8 to 72 Gy). Acute toxicities were evaluated according to the Radiation Therapy Oncology Group morbidity scoring scale.

Results

All patients completed the entire course of radiotherapy and were assessable for evaluation of acute toxicities. The most common side effects of androgen ablation were “hot flushes” and gynecomastia, although these were mild. The main problems during irradiation and a few weeks after the completion of radiotherapy were related to:

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  the genitourinary tract (urgency, nocturia, dysuria) with toxicities of grade 0 and 1 (80% of patients) and grade 2 (20% of patients)

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  the gastrointestinal tract (rectal discomfort and mild diarrhea) with toxicities grade 0 and 1 (75% of patients) and grade 2 (25% of patients).

Conclusions

Preliminary results of combined treatment (androgen ablation and 3 D-CRT) have suggested that such modality is well tolerated with only modest acute toxicities of the gastrointestinal and genitourinary tracts.