Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT Journal Article
| Authors: | Deutsch, I.; Zelefsky, M. J.; Zhang, Z.; Mo, Q.; Zaider, M.; Cohen, G.; Cahlon, O.; Yamada, Y. |
| Article Title: | Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT |
| Abstract: | Purpose: We report on a retrospective comparison of biochemical outcomes using an ultra-high dose of conventionally fractionated intensity-modulated radiation therapy (IMRT) vs. a lower dose of IMRT combined with high-dose-rate (HDR) brachytherapy to increase the biologically effective dose of IMRT. Methods: Patients received IMRT of 86.4. Gy (n= 470) or HDR brachytherapy (21. Gy in three fractions) followed by IMRT of 50.4. Gy (n= 160). Prostate-specific antigen (PSA) relapse was defined as PSA nadir. +. 2. Median followup was 53 months for IMRT alone and 47 months for HDR. Results: The 5-year actuarial PSA relapse-free survival (PRFS) for HDR plus IMRT vs. ultra-high-dose IMRT were 100% vs. 98%, 98% vs. 84%, and 93% vs. 71%, for National Comprehensive Cancer Network low- (p= 0.71), intermediate- (p< 0.001), and high-risk (p= 0.23) groups, respectively. Treatment (p= 0.0006), T stage (p< 0.0001), Gleason score (p< 0.0001), pretreatment PSA (p= 0.0037), risk group (p< 0.0001), and lack of androgen-deprivation therapy (p= 0.0005) were significantly associated with improved PRFS on univariate analysis. HDR plus IMRT vs. ultra-high-dose IMRT (p= 0.0012, hazard ratio [HR]. = 0.184); age (p= 0.0222, HR. = 0.965); and risk group (p< 0.0001, HR. = 2.683) were associated with improved PRFS on multivariate analysis. Conclusion: Dose escalation of IMRT by adding HDR brachytherapy provided improved PRFS in the treatment of prostate cancer compared with ultra-high-dose IMRT, independent of risk group on multivariate analysis, with the most significant benefit for intermediate-risk patients. © 2010 American Brachytherapy Society. |
| Keywords: | adult; cancer survival; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; retrospective studies; major clinical study; intensity modulated radiation therapy; risk benefit analysis; disease free survival; radiation dose; cancer staging; outcome assessment; follow up; prostate specific antigen; neoplasm recurrence, local; radiotherapy dosage; risk factors; retrospective study; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; radiotherapy, intensity-modulated; brachytherapy; intermethod comparison; external beam radiotherapy; high risk population; cancer control; biochemistry; androgen deprivation therapy; high dose rate; psa relapse-free survival; high dose rate brachytherapy |
| Journal Title: | Brachytherapy |
| Volume: | 9 |
| Issue: | 4 |
| ISSN: | 1538-4721 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-10-01 |
| Start Page: | 313 |
| End Page: | 318 |
| Language: | English |
| DOI: | 10.1016/j.brachy.2010.02.196 |
| PUBMED: | 20685176 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 20 April 2011" - "CODEN: BRACC" - "Source: Scopus" |
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