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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
[Dose escalation with three dimensional conformal radiotherapy for prostate cancer: more is better?]
A Zapatero1, A Marín, A Cruz-Conde
1Servicios de Oncologia Radioterápica, Hospital Universitario de la Princesa, Madrid. hlpr@salud.madrid.org
Purpose:
The present study was undertaken to determine the effect of radiation dose on biochemical control and morbidity in prostate cancer patients.
Materials And Methods:
Between 1995 and 2003, 360 patients with T1-T3b prostate cancer were treated in a sequential radiation dose escalation trial from 66.0 to 82.6 Gy. These patients were prospectively assigned to 1 of 3 prognostic groups according to risk factors: a) low risk patients were treated with 3DCRT alone; b) intermediate risk patients were allocated to receive neoadjuvant AD (NAD) 4-6 months prior and during 3DCRT; and c) high-risk received NAD and adjuvant AD (AAD) 2 years after 3DCRT. RTOG/EORTC toxicity score was used to analyze late complications
Results:
Median follow-up was 48 months (12-138). The actuarial biochemical disease free survival (bDFS) at 4 years for low risk, intermediate risk and high risk patients was 88%, 68% and 79% respectively. Stratified and multivariate analysis showed that higher radiation dose (>76 Gy) (p=0.0053) and the use of AAD for high risk patients (p=0.0046) correlated significantly with an improvement of bDFS for all patients. The incidence of late grade 2 rectal and urinary bleeding were 7% and 11% respectively.
Conclusion:
The present study confirms an independent benefit of high-dose (> 76 Gy) radiation therapy and long-term AAD in high-risk prostate cancerpatients.
