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Titolo:
Higher than standard radiation doses (>= 72 Gy) with or without androgen deprivation in the treatment of localized prostate cancer
Autore:
Kupelian, PA; Mohan, DS; Lyons, J; Klein, EA; Reddy, CA;
Indirizzi:
Cleveland Clin Fdn, Dept Radiat Oncol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 Oncol, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Urol, Cleveland, OH 44195 USA Cleveland Clin FdnCleveland OH USA 44195 t Urol, Cleveland, OH 44195 USA
Titolo Testata:
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
fascicolo: 3, volume: 46, anno: 2000,
pagine: 567 - 574
SICI:
0360-3016(20000201)46:3<567:HTSRD(>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
EXTERNAL-BEAM RADIOTHERAPY; CONFORMAL RADIOTHERAPY; ESCALATION; TOXICITY; THERAPY;
Keywords:
localized prostate cancer; radiotherapy; hormonal therapy; treatment; radiation dose;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
14
Recensione:
Indirizzi per estratti:
Indirizzo: Kupelian, PA Cleveland Clin Fdn, Dept Radiat Oncol, Desk T28,9500 Euclid Ave, Cleveland, OH 44195 USA Cleveland Clin Fdn Desk T28,9500 Euclid Ave Cleveland OH USA 44195
Citazione:
P.A. Kupelian et al., "Higher than standard radiation doses (>= 72 Gy) with or without androgen deprivation in the treatment of localized prostate cancer", INT J RAD O, 46(3), 2000, pp. 567-574

Abstract

Purpose: To study the effect on biochemical relapse-free survival (bRFS) and clinical disease-free survival of radiation doses delivered to the prostate and periprostatic tissues for localized prostate cancer. Methods and Materials: A total of 1041 consecutive localized prostate cancer cases treated with external beam radiotherapy (RT) at our institution between 7/86 and 2/99 were reviewed. All cases had available pretreatment parameters including pretreatment prostate-specific antigen (iPSA), biopsy Gleason score (bGS), and clinical T stage. The median age was 69 years. Twenty-three percent of cases (n = 238) were African-American. The distribution by clinical T stage was as follows: T1 in 365 cases (35%), T2 in 562 cases (54%), and T3 in 114 cases (11%). The median iPSA level was 10.1 ng/ml (range: 0.4-692.9). The distribution by biopsy Gleason score (bGS) was as follows: less than or equal to 6 in 580 cases (56%) and greater than or equal to 7 in 461 cases (44%). Androgen deprivation (AD) in the adjuvant or neoadjuvant setting was given in 303 cases (29%). The mean RT dose was 71.9 Gy (range: 57.6-78.0 Gy). The median RT dose was 70.2 GS, with 458 cases (44%) receiving at least 72.0 Gy. The average dose in patients receiving <72 Gy was 68.3 Gy (median 68.4) versus 765 Gy (median 78.0) for patients receiving greater than or equal to 72 Gy. The mean follow-up was 38 months (median 33 months). The number of follow-up prostate-specific antigen (PSA) levels available was 5998. Results: The 5- and 8-gear bRFS rates were 61% (95% CI55-65%) and 58% (95%CI51-650/0), respectively. The 5-year bRFS rates for patients receiving radiation doses greater than or equal to 72 Gy versus <72 Gy were 87% (95% CI82-92%) and 55% (95 % CI 49-60%), respectively. The 8-year bRFS rates for patients receiving radiation doses greater than or equal to 72 Gy versus <72 Gy were 87% (95% CI 82-92%) and 51% (95% CI 44-58%), respectively (p < 0.001). A multivariate analysis of factors affecting bRFS was performed usingthe following parameters: age (continuous variable), race, T-stage (T1-T2 vs. T3), iPSA (continuous variable), bGS (less than or equal to 6 vs. greater than or equal to 7), use of AD (yes vs. no), radiation technique (conformal versus standard), and radiation dose (continuous variable). T-stage (p < 0.001), iPSA (p < 0.001),bGS (p < 0.001), and RT dose (p < 0.001) were independent predictors of outcome. Age (p = 0.74), race (p = = 0.96), radiation technique (p = 0.15), and use of AD (p = 0.31) were not. We observed 11%clinical failures (local, distant, or both) at 5 years and 15% at 8 years for the entire cohort. There was a statistically significant improvement with higher radiation doses (p = 0.032). The 5-year clinical relapse rates for patients receiving greater than or equal to 72 Gy versus <72 Gy were 5% and 12%, respectively. The 8-year clinical relapse rates for patients receiving radiation doses greater than or equal to 72 Gy versus <72 Gy were 5% and 17%, respectively (p = 0.026). Conclusion: Patients receiving radiation doses exceeding 72 Gy had significantly better bRFS and clinical disease-free survival rates. Although results need to be confirmed with longer follow-up, these preliminary results are extremely encouraging. If these results are confirmed by other institutions and by longer follow-up, RT doses exceeding 72 Gy should be considered as standard of care. (C) 2000 Elsevier Science Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/04/20 alle ore 11:30:34