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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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Published on: February 6, 2019

Pride or prejudice: does Phoenix flatter radiation therapy?

W James Morris¹, Tom Pickles¹, Mira Keyes¹

¹Division of Surgery, Department of Radiation Oncology, Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Radiation Oncology, Vancouver Cancer Centre, 600 West 10 Avenue, Vancouver, British Columbia, Canada V5Z 4E6.

|August 20, 2013

Summary

The Phoenix definition (nadir+2 ng/mL) for biochemical failure after low-dose-rate prostate brachytherapy (LDR-PB) shows higher disease-free survival (DFS) rates than a >0.4 ng/mL threshold. This study compared DFS in 1006 patients treated with LDR-PB.

Keywords:

Biochemical failure Biologic equivalent dose Nadir PSA values Phoenix threshold Prostate brachytherapy

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Area of Science:

Oncology
Urology
Radiation Oncology

Background:

Prostate cancer treatment often involves low-dose-rate brachytherapy (LDR-PB).
Accurate assessment of treatment outcomes, such as disease-free survival (DFS), is crucial.
Biochemical failure definitions, like the Phoenix criteria (nadir+2 ng/mL) and a >0.4 ng/mL threshold, are used to evaluate treatment success.

Purpose of the Study:

To compare disease-free survival (DFS) rates between the Phoenix definition and a >0.4 ng/mL threshold in patients treated with LDR-PB monotherapy.
To analyze biochemical failure rates in a cohort of 1006 patients undergoing LDR-PB.

Main Methods:

Retrospective analysis of a prospective database of 1006 consecutive LDR-PB implants (1998-2003).
Patients had low- or intermediate-risk prostate cancer, with 65% receiving neoadjuvant and concomitant androgen deprivation therapy.
The Phoenix definition was modified to exclude benign prostate-specific antigen (PSA) bounces.

Main Results:

Median follow-up was 7.5 years, with a median PSA of 0.04 ng/mL in disease-free patients.
The Phoenix definition yielded 5- and 10-year DFS estimates of 96.5% and 93.7%, respectively.
The >0.4 ng/mL threshold resulted in lower DFS estimates (94.4% at 5 years, 88.8% at 10 years; log rank, p=0.015).

Conclusions:

A >0.4 ng/mL failure definition increased biochemical failure rates by approximately 2% at 5 years and 5% at 10 years compared to the Phoenix definition.
The Phoenix definition did not significantly overestimate DFS in this LDR-PB cohort due to exceptionally low residual PSA values.
These findings specific to LDR-PB should not be generalized to other radiation therapy modalities.