Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes Journal Article
| Authors: | Zelefsky, M. J.; Yamada, Y.; Fuks, Z.; Zhang, Z.; Hunt, M.; Cahlon, O.; Park, J.; Shippy, A. |
| Article Title: | Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes |
| Abstract: | Purpose: To report prostate-specific antigen (PSA) relapse-free survival and distant metastases-free survival (DMFS) outcomes for patients with clinically localized prostate cancer treated with high-dose conformal radiotherapy. Methods and Materials: Between 1988 and 2004, a total of 2,047 patients with clinically localized prostate cancer were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Prescribed dose levels ranged from 66-86.4 Gy. Median follow-up was 6.6 years (range, 3-18 years). Results: Although no differences were noted among low-risk patients for the various dose groups, significant improvements were observed with higher doses for patients with intermediate- and high-risk features. In patients with intermediate-risk features, multivariate analysis showed that radiation dose was an important predictor for improved PSA relapse-free survival (p < 0.0001) and improved DMFS (p = 0.04). In patients with high-risk features, multivariate analysis showed that the following variables predict for improved PSA relapse-free survival: dose (p < 0.0001); age (p = 0.0005), and neoadjuvant-concurrent androgen deprivation therapy (ADT; p = 0.01). In this risk group, only higher radiation dose was an important predictor for improved DMFS (p = 0.04). Conclusions: High radiation dose levels were associated with improved biochemical tumor control and decreased risk of distant metastases. For high-risk patients, despite the delivery of high radiation dose levels, the use of ADT conferred an additional benefit for improved tumor control outcomes. We observed a benefit for ADT in high-risk patients who received higher doses. © 2008 Elsevier Inc. All rights reserved. |
| Keywords: | adult; cancer survival; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; major clinical study; cancer localization; intensity modulated radiation therapy; cancer risk; adjuvant therapy; cancer adjuvant therapy; radiation dose; follow up; follow-up studies; cohort studies; neoplasm recurrence, local; radiotherapy; prevalence; risk factors; high risk patient; risk assessment; prostate cancer; prostate-specific antigen; prostatic neoplasms; long term care; antiandrogen; cancer control; dose fractionation; new york; computer assisted radiotherapy; androgen therapy; distant metastases; localized prostate cancer; conformal radiotherapy; high dose; intensity-modulated radiotherapy (imrt); dose levels; tumor control; dose escalation; prostate cancer (cap); multivariate analysis (mva); prostate specific antigen (psa); three dimensional conformal radiotherapy (3d crt) |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 71 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-07-15 |
| Start Page: | 1028 |
| End Page: | 1033 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2007.11.066 |
| PUBMED: | 18280056 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 65" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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