Remote results of treatment of patients with prostate cancer who underwent radiation therapy in a combined version

Objective. To evaluate the long-term results of combined radiation treatment of patients with prostate cancer (PC) treated in the Voronezh Regional Scientific and Clinical Oncology Center. Material and methods. From February 2013 to January 2016, 229 patients with localized form of PC (T1—2N0M0) were treated. All patients received combined radiation therapy (CRT): two fractions of HDR brachytherapy using a high-power 192Ir source in a single dose (SD) of 10 Gy to the prostate and 3D conformal radiation therapy in a SD of 2 Gy, a total dose of 46 Gy, EQD2 111.7 Gy to the prostate and regional lymphatic drainage pathways of 46 Gy. The median follow-up of patients was 112±6.7 months. The average age of patients at the time of treatment was 67±4.6 years. Of the 229 patients, 106 (46.3%) had an intermediate risk of progression, and 123 (53.7%) had a high risk. Morphologically, the tumors were represented by acinar adenocarcinomas with a Gleason score of 6 or more. The maximum urinary flow was 10 ml/s or more; prostate-specific antigen was less than 50 ng/ml; the volume of the gland did not exceed 50 cm3. Results. During the observation period (112±6.7 months), cancer-specific survival was 96.8%, relapse-free survival in patients with moderate risk was 85.3%, and in patients with high risk it was 80.3%. When analyzing the clinical material, no early and late radiation injuries of stage III–IV according to the EORTC/RTOG scale were observed after the use of CRT technologies. Complaints of frequent urination were observed in 34.1±6.5% of cases. Gastrointestinal and genitourinary complications were detected in 0.9 and 23.1% of patients, respectively. The average IPSS (International Prostate Symptom Score) was 10.2±2.6, which corresponds to moderate urination disorder. The average QoL (Quality of life) score was 2.7±0.7, which indicates a good quality of life for patients after the treatment. Conclusion. Combined radiation therapy is a highly effective method for treating intermediate- and high-risk PC. This method allows escalating maximum radiation doses directly to the tumor site while minimizing the impact on critical organs and tissues.