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Moderate Dose Escalation in Three-Dimensional Conformal Localized Prostate Cancer Radiotherapy

Single-Institutional Experience in 398 Patients Comparing 66 Gy versus 70 Gy versus 74 Gy

Dreidimensionale konformale Radiotherapie des lokalisierten Prostatakarzinoms. Evaluation der Ergebnisse zur Dosiseskalation von 66 Gy über 70 Gy auf 74 Gy bei 398 Patienten

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Purpose:

To evaluate the clinical outcome in prostate cancer patients treated at one single institution by the implementation of moderate dose escalation.

Patients and Methods:

A total of 398 patients with histologically verified localized prostate cancer (T1–3 Nx0 Mx0) were treated by three-dimensional conformal radiotherapy with/without additional hormonal therapy. Risk group distribution was as follows: 106 low-risk (27%), 164 intermediate-risk (41%), and 128 high-risk (32%) patients. Total local dose was increased from 66 Gy (1994–1998) to 70 Gy (1998–2003) and 74 Gy (1998–2005). Biochemical no evidence of disease (bNED: ASTRO/Phoenix definition) and late gastrointestinal/urogenital side effects (EORTC/RTOG) were assessed.

Results:

Median follow-up was 64 months. The 5-year bNED rates according to 66 Gy, 70 Gy and 74 Gy were 37%, 64% and 63% (ASTRO), and 54%, 74% and 69% (Phoenix), respectively. In multivariate analysis, age and T-stage were significant in predicting bNED. The 5-year bNED rates (ASTRO) according to 66 Gy, 70 Gy and 74 Gy were 40%, 78% and 73% in the low-risk group, 41%, 55% and 85% in the intermediate-risk group, and 30%, 53% and 52% in the high-risk group. Intermediate-risk patients showed a significant improvement of bNED by increasing the dose up to 74 Gy. The 5-year actuarial rates of gastrointestinal/urogenital side effects grade ≥ 2 were 18%/16% (66 Gy), 20%/24% (70 Gy), and 27%/28% (74 Gy).

Conclusion:

A benefit of local doses at a level of ≥ 70 Gy could be detected showing the highest increase of prostate-specific antigen control in the intermediate-risk group. The amount of patients reporting of severe late side effects is small.

Ziel:

Evaluation der klinischen Ergebnisse zur moderaten Dosiseskalation bei Patienten mit Prostatakarzinom.

Patienten und Methodik:

Bei 398 Patienten mit histologisch verifiziertem Prostatakarzinom (T1–3 Nx0 Mx0) wurde eine dreidimensionale konformale Teletherapie mit/ohne begleitende Hormontherapie durchgeführt. Es fanden sich 106 Patienten (27%) mit niedrigem Risiko, 164 (41%) mit intermediärem Risiko und 128 (32%) mit hohem Risiko (Tabelle 1). Die applizierte Dosis wurde von 66 Gy (1994–1998) auf 70 Gy (1998–2003) bzw. 74 Gy (1998–2005) gesteigert. Biochemische Kontrollraten (bNED: ASTRO/Phoenix-Definition) sowie späte gastrointestinale/urogenitale Nebenwirkungen (EORTC/RTOG) wurden ermittelt.

Ergebnisse:

Der mediane Nachbeobachtungszeitraum betrug 64 Monate. Die 5-Jahres-bNED-Raten entsprechend der 66-Gy-, 70-Gy- und 74-Gy-Dosis betrugen 37%, 64% und 63% (ASTRO, Abbildung 1) bzw. 54%, 74% und 69% (Phoenix, Abbildung 2). In der multivariaten Analyse zeigten sich das Alter und das T-Stadium als signifikant hinsichtlich der bNED-Raten (Tabelle 2). Die 5-Jahres-bNED-Raten (ASTRO) entsprechend der 66-Gy-, 70-Gy- und 74-Gy-Dosis betrugen in der Niedrigrisikogruppe 40%, 78% und 73%, in der Gruppe mit intermediärem Risiko 41%, 55% und 85% und in der Hochrisikogruppe 30%, 53% und 52%. Bei Patienten mit intermediärem Risiko zeigte sich ein signifikanter Vorteil durch die Dosissteigerung auf 74 Gy (Abbildungen 3a bis 3c). Die 5-Jahres-Raten an gastrointestinalen/urogenitalen Nebenwirkungen Grad ≥ 2 lagen bei 18%/16% (66 Gy), 20%/24% (70 Gy) und 27%/28% (74 Gy; Abbildungen 4 und 5).

Schlussfolgerung:

Die dreidimensionale konformale Bestrahlung mit einer Dosis ≥ 70 Gy zeigt verbesserte bNED-Raten vor allem für Patienten der intermediären Risikogruppe. Die Rate an schweren Spätnebenwirkungen ist dabei gering.

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Authors and Affiliations

  1. Department of Radiotherapy, University of Vienna Medical School, Vienna, Austria

    Gregor Goldner MD, Johannes Dimopoulos, Christian Kirisits & Richard Pötter

  2. Department of Radiotherapy and Radiobiology, Medical University Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Gregor Goldner MD

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  1. Gregor Goldner MD
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  2. Johannes Dimopoulos
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Correspondence to Gregor Goldner MD.

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Goldner, G., Dimopoulos, J., Kirisits, C. et al. Moderate Dose Escalation in Three-Dimensional Conformal Localized Prostate Cancer Radiotherapy. Strahlenther Onkol 185, 438–445 (2009). https://doi.org/10.1007/s00066-2009-2033-5

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  • DOI: https://doi.org/10.1007/s00066-2009-2033-5

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