%0 Journal Article
%T The Current Role of Androgen Deprivation in Patients Undergoing Dose-Escalated External Beam Radiation Therapy for Clinically Localized Prostate Cancer
%A Michael J. Smith
%A Naveed H. Akhtar
%A Scott T. Tagawa
%J Prostate Cancer
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/280278
%X Purpose. To review existing literature on the role of androgen deprivation therapy (ADT) with dose escalated radiation therapy. Methods and Materials. A PubMed search was undertaken to identify relevant articles. Results. Multiple recent studies were identified examining the role of ADT in the current era of radiation dose-escalation. Among the reviewed studies, varying radiation doses and techniques, ADT regimens, and patient selection criteria were utilized. Conflicting results were reported, with some studies demonstrating a benefit of delivering a higher radiation dose with ADT. Other studies failed to show significant benefits with the addition of ADT to dose-escalated RT. Conclusions. The benefit of adding ADT to dose-escalated RT is still uncertain. Prospective randomized trials, several of which are ongoing, are necessary to more adequately examine this issue. In the interim, physicians and patients should continue to utilize the existing data to weigh the risks and benefits of each approach to therapy. 1. Introduction Significant improvements in outcome have been achieved in the treatment of prostate cancer (PC) over the last couple of decades. Advancements in external beam technology, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) have allowed for dose escalation, with improvements in biochemical failure and rate of distant metastases (though no overall survival (OS) benefits have yet been demonstrated), without an accompanying increase in short- and intermediate-term toxicity [1¨C3]. We have also learned through multiple phase III randomized trials that the addition of ADT to external beam radiation therapy (EBRT) in unfavorable or locally-advanced cancers leads to improvements in disease-free survival (DFS), and prostate cancer-specific survival, as well as in OS (Table 1) [4¨C14]. However, in all of these studies, radiation doses ¡Ü70£¿Gy were delivered, which are below the current standard doses used. In addition, it is increasingly recognized that ADT may be associated with acute and long-term toxicity. One controversy that currently exists in the radiation community is the role of ADT with dose-escalated radiation therapy in intermediate-risk and high-risk patients. This paper is intended to summarize existing data looking at this issue. In addition, a brief review of toxicity of hormonal therapy will be discussed. Table 1 2. Materials and Methods A PubMed literature search was undertaken, and relevant articles were reviewed. Search words and phrases included ¡°dose-escalated radiation therapy
%U http://www.hindawi.com/journals/pc/2012/280278/