Multicenter Analysis of Effect of High Biologic Effective Dose on Biochemical Failure and Survival Outcomes in Patients With Gleason Score 7-10 Prostate Cancer Treated With Permanent Prostate Brachytherapy Journal Article
| Authors: | Stone, N. N.; Potters, L.; Davis, B. J.; Ciezki, J. P.; Zelefsky, M. J.; Roach, M.; Shinohara, K.; Fearn, P. A.; Kattan, M. W.; Stock, R. G. |
| Article Title: | Multicenter Analysis of Effect of High Biologic Effective Dose on Biochemical Failure and Survival Outcomes in Patients With Gleason Score 7-10 Prostate Cancer Treated With Permanent Prostate Brachytherapy |
| Abstract: | Purpose: To investigate the biochemical control rates and survival for Gleason score 7-10 prostate cancer patients undergoing permanent prostate brachytherapy as a function of the biologic effective dose (BED). Methods and Materials: Six centers provided data on 5,889 permanent prostate brachytherapy patients, of whom 1,078 had Gleason score 7 (n = 845) or Gleason score 8-10 (n = 233) prostate cancer and postimplant dosimetry results available. The median prostate-specific antigen level was 7.5 ng/mL (range, 0.4-300). The median follow-up for censored patients was 46 months (range, 5-130). Short-term hormonal therapy (median duration, 3.9 months) was used in 666 patients (61.8%) and supplemental external beam radiotherapy (EBRT) in 620 (57.5%). The patients were stratified into three BED groups: <200 Gy (n = 645), 200-220 Gy (n = 199), and >220 Gy (n = 234). Biochemical freedom from failure (bFFF) was determined using the Phoenix definition. Results: The 5-year bFFF rate was 80%. The bFFF rate stratified by the three BED groups was 76.4%, 83.5%, and 88.3% (p < 0.001), respectively. Cox regression analysis revealed Gleason score, prostate-specific antigen level, use of hormonal therapy, EBRT, and BED were associated with bFFF (p < 0.001). Freedom from metastasis improved from 92% to 99% with the greatest doses. The overall survival rate at 5 years for the three BED groups for Gleason score 8-10 cancer was 86.6%, 89.4%, and 94.6%, respectively (p = 0.048). Conclusion: These data suggest that permanent prostate brachytherapy combined with EBRT and hormonal therapy yields excellent bFFF and survival results in Gleason score 7-10 patients when the delivered BEDs are >220 Gy. These doses can be achieved by a combination of 45-Gy EBRT with a minimal dose received by 90% of the target volume of 120 Gy of <sup>103</sup>Pd or 130 Gy of <sup>125</sup>I. © 2009 Elsevier Inc. All rights reserved. |
| Keywords: | cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; treatment failure; major clinical study; overall survival; clinical trial; treatment duration; cancer patient; follow up; chemical analysis; prostate specific antigen; metastasis; controlled clinical trial; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; antigens; dosimetry; quality assurance; multicenter study; brachytherapy; gleason scores; hormonal therapy; relative biological effectiveness; external beam radiotherapy; regression analysis; radiation dose distribution; palladium; biologic equivalent dose; biochemical control rates; cox regression analyses; effective doses; external beam radiotherapies; hormonal therapies; minimal doses; overall survival rates; postimplant dosimetries; prostate brachytherapy; target volumes |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 73 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-02-01 |
| Start Page: | 341 |
| End Page: | 346 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2008.04.038 |
| PUBMED: | 18597953 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 26" - "Export Date: 30 November 2010" - "CODEN: IOBPD" - "Source: Scopus" |
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