Abstract
PurposeTo report the toxicity and long-term outcomes of dose-escalated intensity-modulated radiation therapy (IMRT) for patients with localised prostate cancer.Methods and MaterialsFrom 2001 to 2005, a total of 125 patients with histologically confirmed T1-3N0M0 prostate cancer were treated with IMRT to 74Gy at the Austin Health Radiation Oncology Centre. The median follow-up was 5.5 years (range 0.5–8.9 years). Biochemical prostate specific antigen (bPSA) failure was defined according to the Phoenix consensus definition (absolute nadir + 2ng/mL). Toxicity was scored according to the RTOG/EORTC criteria. Kaplan-Meier analysis was used to calculate toxicity rates, as well as the risks of bPSA failure, distant metastases, disease-specific and overall survival, at 5 and 8-years post treatment.ResultsAll patients completed radiotherapy without any treatment breaks. The 8-year risks of ≥ Grade 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 6.4% and 5.8% respectively, and the 8-year risks of ≥ Grade 3 GU and GI toxicity were both < 0.05%. The 5 and 8-year freedom from bPSA failure were 76% and 58% respectively. Disease-specific survival at 5 and 8 years were 95% and 91%, respectively, and overall survival at 5 and 8 years were 90% and 71%, respectively.ConclusionsThese results confirm existing international data regarding the safety and efficacy of dose-escalated intensity-modulated radiation therapy for localised prostate cancer within an Australian setting.
Highlights
There has been significant attention over the past decade on dose escalation of radiotherapy for localised prostate cancer on the premise of a dose response relationship
A recent meta-analysis of randomised controlled trials evaluating dose escalation for prostate radiotherapy confirmed a positive relationship between radiation dose and biochemical prostate specific antigen (bPSA) control across all risk categories of prostate cancer [8]
We have evaluated our cohort of 125 patients treated prospectively to 74 Gy with intensity-modulated radiation therapy (IMRT)
Summary
There has been significant attention over the past decade on dose escalation of radiotherapy for localised prostate cancer on the premise of a dose response relationship. These randomised trials demonstrate that the delivery of higher doses (74–78 Gy) than conventionally prescribed (64–68 Gy) has been associated with improved biochemical prostate specific antigen (bPSA). A recent meta-analysis of randomised controlled trials evaluating dose escalation for prostate radiotherapy confirmed a positive relationship between radiation dose and bPSA control across all risk categories of prostate cancer [8]. This meta-analysis estimated a reduction in bPSA failure risk of approximately 1.8% for each 1 Gy increase in dose
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