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"
Altmetric Score
MSK Authors
  1. Zhigang Zhang
    236 Zhang
  2. Zvi Fuks
    268 Fuks
  3. Michael J Zelefsky
    599 Zelefsky
  4. Yoshiya Yamada
    352 Yamada
  5. Oren Cahlon
    82 Cahlon
  6. Alison Maureen Shippy
    16 Shippy
  7. Margie A Hunt
    224 Hunt
  8. Jessica Park
    11 Park