Systemic chemotherapy with high dose conformal radiotherapy in high risk prostate cancer

الملخص EN

Background The results of therapy for locally advanced prostate cancer continue to be suboptimal despite the integration of neoadjuvant and adjuvant androgen Suppression.

Aim : this study was to determine the efficacy and safety of using estramustine and docetaxel (ED) concurrently with radiotherapy in the treatment of locally advanced prostate cancer. Methods: Between September 2000 and September 2011, all eligible patients presented to the Outpatient Clinic at Mostafa Kamel Military Hospital, Alexandria, Egypt with locally advanced prostate cancer were recruited for the present study (n = 22). Two patients are not evaluable due to incompletion of protocol therapy due to development of Grade 3 and 4 toxicity.

Treatment protocols consisted of two 21day cycles of oral estramustine 280 mg three times per day on days1 through 5 with Docetaxel 40 mg /m2 on day 2 followed by Concurrent DE chemotherapy (same dose) with three-dimensional conformal radiotherapy. Results :100% of patients developed GI or GII fatigue.

80 %developed alopecia, 70%, 40% and 20% developed anaemia, leukopenia, and thrombocytopenia respectively but no patients required dose reduction.

There were no fatal toxicities.

With a median follow-up time of 24 months, 4 patients developed a relapse.

Of these, two developed local failure, one developed both local and systemic failure, and one developed biochemical failure. Actuarial 3-year overall survival (OS) and disease free survival (DFS) were 90% and 80% respectively. Conclusion: An accurate assessment of risk is critical to making an informed decision regarding treatment for clinically localized prostate cancer.

High risk patients should be considered for clinical trials.

An integrated approach combining local and systemic treatment is especially important for this group of patients.

Neoadjuvant and concomitant Docetaxel and Estramustine with high-dose 3D-CRT is well tolerated in patients with unfavorable-risk prostate cancer. Preliminary efficacy data are encouraging.

The underlying concepts of early targeting of both hormone-sensitive and insensitive micro metastatic clones, in combination with aggressive local therapy, warrant further clinical exploration