Dose-Escalated Radiotherapy for High-Risk Prostate Cancer: Outcomes in Modern Era With Short-Term Androgen Deprivation Therapy

Purpose Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. Materials and Methods...

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Veröffentlicht in:International journal of radiation oncology, biology, physics biology, physics, 2010-05, Vol.77 (1), p.125-130
Hauptverfasser: Liauw, Stanley L., M.D, Stadler, Walter M., M.D, Correa, David, B.S, Weichselbaum, Ralph R., M.D, Jani, Ashesh B., M.D
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container_issue 1
container_start_page 125
container_title International journal of radiation oncology, biology, physics
container_volume 77
creator Liauw, Stanley L., M.D
Stadler, Walter M., M.D
Correa, David, B.S
Weichselbaum, Ralph R., M.D
Jani, Ashesh B., M.D
description Purpose Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. Materials and Methods A total of 184 men with any single risk factor of prostate-specific antigen ≥10 ng/mL, clinical Stage T2b or greater, or Gleason score ≥7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level. Results With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose
doi_str_mv 10.1016/j.ijrobp.2009.04.074
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The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. Materials and Methods A total of 184 men with any single risk factor of prostate-specific antigen ≥10 ng/mL, clinical Stage T2b or greater, or Gleason score ≥7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level. Results With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose &lt;74 Gy (4-year FFBF rate, 64% vs. 80%) had a poorer outcome on univariate analysis. However, clinical Stage T3 disease and radiation dose were not significant on multivariable analysis, although a statistical multivariable trend was seen for both ( p = .0650 and p = .0597, respectively). Conclusion Short-term ADT and RT might be acceptable for men with intermediate- and high-risk prostate cancer, especially for clinically localized disease treated with doses of ≥74 Gy.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2009.04.074</identifier><identifier>PMID: 19695789</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adenocarcinoma - blood ; Adenocarcinoma - drug therapy ; Adenocarcinoma - pathology ; Adenocarcinoma - radiotherapy ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Androgen Antagonists - therapeutic use ; ANDROGENS ; ANDROSTANES ; ANTIGENS ; Biological and medical sciences ; BODY ; CARCINOMAS ; Combined Modality Therapy - methods ; DISEASES ; Diseases of the urinary system ; Follow-Up Studies ; GLANDS ; GONADOTROPINS ; Gynecology. Andrology. Obstetrics ; Hematology, Oncology and Palliative Medicine ; hormonal therapy ; HORMONES ; Humans ; LIBERINS ; Male ; Male genital diseases ; MALE GENITALS ; Medical sciences ; MEDICINE ; Middle Aged ; Neoplasm Staging ; NEOPLASMS ; Nephrology. Urinary tract diseases ; NUCLEAR MEDICINE ; ORGANIC COMPOUNDS ; ORGANS ; PEPTIDE HORMONES ; PITUITARY HORMONES ; Prognosis ; PROSTATE ; Prostate cancer ; Prostate-Specific Antigen - blood ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - drug therapy ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - radiotherapy ; PROTEINS ; RADIOLOGY ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated - methods ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; STEROID HORMONES ; STEROIDS ; THERAPY ; Treatment Outcome ; Tumors ; Tumors of the urinary system ; Urinary tract. Prostate gland</subject><ispartof>International journal of radiation oncology, biology, physics, 2010-05, Vol.77 (1), p.125-130</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c575t-d169e2a5d3f098bacef7c9ed2cafe3677842cc3a937ddd28e7b88178a171d1243</citedby><cites>FETCH-LOGICAL-c575t-d169e2a5d3f098bacef7c9ed2cafe3677842cc3a937ddd28e7b88178a171d1243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2009.04.074$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22655731$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19695789$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/21372250$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Liauw, Stanley L., M.D</creatorcontrib><creatorcontrib>Stadler, Walter M., M.D</creatorcontrib><creatorcontrib>Correa, David, B.S</creatorcontrib><creatorcontrib>Weichselbaum, Ralph R., M.D</creatorcontrib><creatorcontrib>Jani, Ashesh B., M.D</creatorcontrib><title>Dose-Escalated Radiotherapy for High-Risk Prostate Cancer: Outcomes in Modern Era With Short-Term Androgen Deprivation Therapy</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. Materials and Methods A total of 184 men with any single risk factor of prostate-specific antigen ≥10 ng/mL, clinical Stage T2b or greater, or Gleason score ≥7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level. Results With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose &lt;74 Gy (4-year FFBF rate, 64% vs. 80%) had a poorer outcome on univariate analysis. However, clinical Stage T3 disease and radiation dose were not significant on multivariable analysis, although a statistical multivariable trend was seen for both ( p = .0650 and p = .0597, respectively). Conclusion Short-term ADT and RT might be acceptable for men with intermediate- and high-risk prostate cancer, especially for clinically localized disease treated with doses of ≥74 Gy.</description><subject>Adenocarcinoma - blood</subject><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - radiotherapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Androgen Antagonists - therapeutic use</subject><subject>ANDROGENS</subject><subject>ANDROSTANES</subject><subject>ANTIGENS</subject><subject>Biological and medical sciences</subject><subject>BODY</subject><subject>CARCINOMAS</subject><subject>Combined Modality Therapy - methods</subject><subject>DISEASES</subject><subject>Diseases of the urinary system</subject><subject>Follow-Up Studies</subject><subject>GLANDS</subject><subject>GONADOTROPINS</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>hormonal therapy</subject><subject>HORMONES</subject><subject>Humans</subject><subject>LIBERINS</subject><subject>Male</subject><subject>Male genital diseases</subject><subject>MALE GENITALS</subject><subject>Medical sciences</subject><subject>MEDICINE</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>NEOPLASMS</subject><subject>Nephrology. Urinary tract diseases</subject><subject>NUCLEAR MEDICINE</subject><subject>ORGANIC COMPOUNDS</subject><subject>ORGANS</subject><subject>PEPTIDE HORMONES</subject><subject>PITUITARY HORMONES</subject><subject>Prognosis</subject><subject>PROSTATE</subject><subject>Prostate cancer</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - drug therapy</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>PROTEINS</subject><subject>RADIOLOGY</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy, Intensity-Modulated - methods</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>STEROID HORMONES</subject><subject>STEROIDS</subject><subject>THERAPY</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Tumors of the urinary system</subject><subject>Urinary tract. Prostate gland</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk9vEzEQxVcIREvhGyBkCSFOG_xnd73mgFSlgSIVFbVBcLMcezbrdGMH24mUC58drxK1wIWTD37zZub9piheEjwhmDTvVhO7Cn6xmVCMxQRXE8yrR8UpabkoWV3_eFycYtbgkmXxSfEsxhXGmBBePS1OiGhEzVtxWvy68BHKWdRqUAkMulHG-tRDUJs96nxAl3bZlzc23qGvwceURWiqnIbwHl1vk_ZriMg69MUbCA7NgkLfberRbe9DKucQ1ujcmeCX4NAFbILdqWS9Q_NDi-fFk04NEV4c37Pi28fZfHpZXl1_-jw9vyp1zetUGtIIoKo2rMOiXSgNHdcCDNWqA9Zw3lZUa6YE48YY2gJftC3hrSKcGEIrdlZ8OPhutos1GA0uBTXIPM9ahb30ysq_f5zt5dLvJMOVEAJng9cHg5yBlVHbBLrX3jnQSVLCOKX1qHp7bBP8zy3EJNc2ahgG5cBvo-SMtYI0lGdldVDqnGoM0N3PQrAc-cqVPPCVI1-JK5n55rJXf-7xUHQEmgVvjgI1Mu1CZmXjvY7Spq45Iw-BQE59ZyGMO0HmamwYVzLe_m-Sfw30YJ3NPe9gD3Hlt8FlopLISCWWt-MtjqeIBcYNpzX7DZvO3MU</recordid><startdate>20100501</startdate><enddate>20100501</enddate><creator>Liauw, Stanley L., M.D</creator><creator>Stadler, Walter M., M.D</creator><creator>Correa, David, B.S</creator><creator>Weichselbaum, Ralph R., M.D</creator><creator>Jani, Ashesh B., M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope><scope>5PM</scope></search><sort><creationdate>20100501</creationdate><title>Dose-Escalated Radiotherapy for High-Risk Prostate Cancer: Outcomes in Modern Era With Short-Term Androgen Deprivation Therapy</title><author>Liauw, Stanley L., M.D ; Stadler, Walter M., M.D ; Correa, David, B.S ; Weichselbaum, Ralph R., M.D ; Jani, Ashesh B., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c575t-d169e2a5d3f098bacef7c9ed2cafe3677842cc3a937ddd28e7b88178a171d1243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adenocarcinoma - blood</topic><topic>Adenocarcinoma - drug therapy</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - radiotherapy</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Androgen Antagonists - therapeutic use</topic><topic>ANDROGENS</topic><topic>ANDROSTANES</topic><topic>ANTIGENS</topic><topic>Biological and medical sciences</topic><topic>BODY</topic><topic>CARCINOMAS</topic><topic>Combined Modality Therapy - methods</topic><topic>DISEASES</topic><topic>Diseases of the urinary system</topic><topic>Follow-Up Studies</topic><topic>GLANDS</topic><topic>GONADOTROPINS</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>hormonal therapy</topic><topic>HORMONES</topic><topic>Humans</topic><topic>LIBERINS</topic><topic>Male</topic><topic>Male genital diseases</topic><topic>MALE GENITALS</topic><topic>Medical sciences</topic><topic>MEDICINE</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>NEOPLASMS</topic><topic>Nephrology. Urinary tract diseases</topic><topic>NUCLEAR MEDICINE</topic><topic>ORGANIC COMPOUNDS</topic><topic>ORGANS</topic><topic>PEPTIDE HORMONES</topic><topic>PITUITARY HORMONES</topic><topic>Prognosis</topic><topic>PROSTATE</topic><topic>Prostate cancer</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - drug therapy</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>PROTEINS</topic><topic>RADIOLOGY</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy, Intensity-Modulated - methods</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>STEROID HORMONES</topic><topic>STEROIDS</topic><topic>THERAPY</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Tumors of the urinary system</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liauw, Stanley L., M.D</creatorcontrib><creatorcontrib>Stadler, Walter M., M.D</creatorcontrib><creatorcontrib>Correa, David, B.S</creatorcontrib><creatorcontrib>Weichselbaum, Ralph R., M.D</creatorcontrib><creatorcontrib>Jani, Ashesh B., M.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liauw, Stanley L., M.D</au><au>Stadler, Walter M., M.D</au><au>Correa, David, B.S</au><au>Weichselbaum, Ralph R., M.D</au><au>Jani, Ashesh B., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dose-Escalated Radiotherapy for High-Risk Prostate Cancer: Outcomes in Modern Era With Short-Term Androgen Deprivation Therapy</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2010-05-01</date><risdate>2010</risdate><volume>77</volume><issue>1</issue><spage>125</spage><epage>130</epage><pages>125-130</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>Purpose Randomized data have supported the use of long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) for men with high-risk prostate cancer. The present study reviewed the outcomes of intermediate- and high-risk men treated with RT and short-term ADT. Materials and Methods A total of 184 men with any single risk factor of prostate-specific antigen ≥10 ng/mL, clinical Stage T2b or greater, or Gleason score ≥7 were treated with primary external beam RT for nonmetastatic adenocarcinoma of the prostate. The median radiation dose was 74 Gy; 55% were treated with intensity-modulated RT. All patients received ADT for 1 to 6 months (median, 4), consisting of a gonadotropin-releasing hormone analog. Univariate and multivariable analyses were performed for risk factors, including T stage, Gleason score, radiation dose, and prostate-specific antigen level. Results With a median follow-up of 51 months, the 4-year freedom from biochemical failure (FFBF) using the nadir plus 2 ng/mL definition was 83% for all patients. Clinical Stage T3 disease was the only variable tested associated with FFBF on univariate (4-year FFBF rate, 46% vs. 87% for Stage T1-T2c disease; p = .0303) and multivariable analysis (hazard ratio, 3.9; p = .0016). On a subset analysis of high-risk patients (National Comprehensive Cancer Network criteria), those with clinical Stage T3 disease (4-year FFBF rate, 46% vs. 80%; p = .0303) and a radiation dose &lt;74 Gy (4-year FFBF rate, 64% vs. 80%) had a poorer outcome on univariate analysis. However, clinical Stage T3 disease and radiation dose were not significant on multivariable analysis, although a statistical multivariable trend was seen for both ( p = .0650 and p = .0597, respectively). Conclusion Short-term ADT and RT might be acceptable for men with intermediate- and high-risk prostate cancer, especially for clinically localized disease treated with doses of ≥74 Gy.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19695789</pmid><doi>10.1016/j.ijrobp.2009.04.074</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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1879-355X
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subjects Adenocarcinoma - blood
Adenocarcinoma - drug therapy
Adenocarcinoma - pathology
Adenocarcinoma - radiotherapy
Adult
Aged
Aged, 80 and over
Analysis of Variance
Androgen Antagonists - therapeutic use
ANDROGENS
ANDROSTANES
ANTIGENS
Biological and medical sciences
BODY
CARCINOMAS
Combined Modality Therapy - methods
DISEASES
Diseases of the urinary system
Follow-Up Studies
GLANDS
GONADOTROPINS
Gynecology. Andrology. Obstetrics
Hematology, Oncology and Palliative Medicine
hormonal therapy
HORMONES
Humans
LIBERINS
Male
Male genital diseases
MALE GENITALS
Medical sciences
MEDICINE
Middle Aged
Neoplasm Staging
NEOPLASMS
Nephrology. Urinary tract diseases
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANS
PEPTIDE HORMONES
PITUITARY HORMONES
Prognosis
PROSTATE
Prostate cancer
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood
Prostatic Neoplasms - drug therapy
Prostatic Neoplasms - pathology
Prostatic Neoplasms - radiotherapy
PROTEINS
RADIOLOGY
RADIOLOGY AND NUCLEAR MEDICINE
RADIOTHERAPY
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated - methods
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
STEROID HORMONES
STEROIDS
THERAPY
Treatment Outcome
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
title Dose-Escalated Radiotherapy for High-Risk Prostate Cancer: Outcomes in Modern Era With Short-Term Androgen Deprivation Therapy
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