THE USE OF COMBINED RADIATION-THERAPY AND HORMONAL-THERAPY IN THE MANAGEMENT OF LYMPH NODE-POSITIVE PROSTATE-CANCER

Purpose: To determine the rate of tumor response and patterns of relap se following combined hormonal-radiation therapy of adenocarcinoma of the prostate and to measure the survival in a group of men with tumor metastatic to pelvic lymph nodes, Methods and Materials: 66 patients w ith adenocarcinoma of the prostate with pathologically confirmed pelvi c lymph node involvement were treated with combined radiation therapy and hormonal therapy, An additional five patients dec:lined hormonal t herapy. The patients treated with combined therapy represented a group with locally advanced disease including 44 patients (67%) with T3 or T4 tumors and 51 patients (80%) had N2 or N3 lymph node metastases. Th e pelvic lymph nodes were treated to a dose of 45 Gy and the prostate was boosted to a dose of 65 to 71 Gy, Hormonal therapy began up to 2 m onths before radiation and continued indefinitely, Patients were allow ed to select their hormonal therapy and could choose DES (2 patients), orchiectomy (21 patients), LHRH agonist (7 patients) or combined andr ogen blockade (34 patients), Results: Median follow-up is 49 months (r ange 12 to 131 months) and 21 patients have been followed for longer t han 5 years, There have been 15 recurrences the entire group including three local recurrences in the prostate, seven patients with distant metastases, four patients with biochemical recurrences without clinica l evidence of disease, and one patient where the location was unknown, Two of the PSA recurrences occurred in patients who elected to discon tinue hormones after less than 3 years of therapy, The overall surviva l at 5 and 8 years is 94 and 84%, the clinical disease free survival i s 85 and 67%, and the biochemical disease-free survival is 78 and 47%, There was no increased toxicity of the combined modality regimen comp ared to the expected effects of radiation and hormonal therapy, Conclu sion: Combined hormonal and radiation therapy represents an effective treatment option for patients with adenocarcinoma of the prostate meta static to pelvic lymph nodes, Combined modality therapy appears to ext end the disease-free survival and allow patients to maintain their ind ependent function. (C) 1997 Elsevier Science Inc.