PTU - Polskie Towarzystwo Urologiczne
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The analysis of risk factors in prostate cancer patients treated with neoadjuvant hormonal therapy and conformal hypofractionated radiotherapy
Article published in Urologia Polska 2008/61/Supl. 1.


Piotr Pęczkowski, Małgorzata Pilichowska, Wojciech Michalski, Tomasz Demkow
Centrum Onkologii – Instytut, Klinika Nowotworów Układu Moczowego w Warszawie
Centrum Onkologii – Instytut, Biuro Badań Klinicznych i Biostatystyki w Warszawie



The application of high dose fractions is presently more often used in radiotherapy of locally advanced prostate cancer. The recent radiobiological data have indicated that prostate cancer may be highly sensitive to fraction size. This study presents the analysis of the risk factors influencing on the biochemical free survival (BFS) in prostate cancer patients treated with neoadjuvant hormonotherapy and conformal hypofractionated radiotherapy.


The evaluation of the meaning of the risk factors influencing on the biochemical failure in prostate cancer patients treated with hormonotherapy and radiotherapy.

Materials and methods.

From January of 1988 to July of 2003, 602 patients (pts) T1-T3N0/X were irradiated. 36 pts were lost from observation. 18 pts were excluded because of adjuvant hormonal therapy (AH). Analyzed group determines 548 pts in the stages: T1-8, T2a-229, T2b-119, T3a-163, T3b-29. At 57 pts with PSA >20 the laparoscopic lymph nodes verification was applied (N0). The median follow-up was 52.2 months (range: 8-98). Median age was 68 years (range:42-79). 547 pts received at least 3 month neoadjuvant hormonal deprivation (range: 3-60 months, median 5). Median pretreatment PSA was 12.8 ng/ml (range: 0.9-74). All pts were treated with
megavoltage radiation therapy with photons 4 or 15 MV. The 3DRT was used to deliver 52-54.6 Gy (302 pts) or 63.4-65 Gy (246pts) in 2.6 Gy fractions. Biochemical free survival (BFS) was defined as the treatment failure according to ASTRO consensus definition. For the analysis of risk factors the Cox proportional hazards model was applied. The first step of analysis included factors: T stage, Gleason score, pretreatment PSA. The model was fitted by the step forward method of variable elimination on the level
p=0.1. Then to the model included: duration of hormonotherapy, status of lymph nodes, the level of total dose in the selected group.


Our results in the majority confirm data from literature regarding the influence of independent risk factors on the BFS in the prostate cancer patients subjected to conformal radiotherapy. The Gleason score is worth mentioning. In our study the prognosis was decisively worse in the Gleason 6 and higher. Necessity of delivering the high total dose to the prostate was also confirmed.