RADIOTHERAPY AND CONCOMITANT DOCETAXEL IN HIGH-RISK PROSTATIC CANCER

Background: High-risk prostate cancer patients (cT3, N1, PSA >20 ng/ml and/or Gleason score greater than or equal to 8) have a 5-year biochemical failure rate after surgery or radiation of 50% or greater. Neoadjuvant, concomitant and adjuvant hormonotherapy (HT) are currently the only systemic treatments with escalation dose of radiation therapy. Because of the heterogeneity of prostate cancer cells and the desire to improve the outcome with radiotherapy (RT), weekly chemotherapy during RT in localized, high-risk prostate cancer is being explored. Docetaxel has demonstrated significant antitumor effect and impact on survival in hormone-refractory prostate cancer and a strong sensitization of tumor cells to radiation injury. Patients and Methods: From 2005 to 2010, 16 very high-risk patients were treated with high dose of RT and concomitant docetaxel. All patients had clinically (10/16) or pathologically (6/10) advanced disease. The median age was 65 (range: 56-65) years. Gleason score was: 8 in six patients, 9 in nine patients and 10 in one patient. The median PSA level at diagnosis was 15.45 (range: 2.5-71.3) ng/ml, while pre-RT PSA was 0.15 (range: 1.8-0.02) ng/ml. The median RT dose for all patients was 76 (range: 70-80) Gy, while for radical RT it was 80 (range: 76-80) Gy. Docetaxel was administered at a standard weekly dose (30 mg for patients with surface area