Optimizing External Beam Radiotherapy as per the Risk Group of Localized Prostate Cancer: A Nationwide...

Area of Science:

• Oncology
• Radiation Oncology
• Prostate Cancer Research

Background:

• External beam radiotherapy (EBRT) is a standard treatment for localized prostate cancer.
• Optimizing radiotherapy (RT) schemes based on risk stratification is crucial for improving patient outcomes.
• Current risk classification tools require evaluation for their predictive power in guiding RT decisions.

Purpose of the Study:

• To analyze patterns of care and outcomes for localized prostate cancer patients treated with EBRT.
• To compare the efficacy of various risk classification tools in predicting treatment failure.
• To assess the potential need for refining current RT strategies.

Main Methods:

• A nationwide, multi-institutional study of 1573 non-metastatic prostate cancer patients treated with primary EBRT (2001-2015).
• Patients were re-grouped using risk stratification tools to identify the best predictor of biochemical failure-free survival (BCFFS).
• Evaluated BCFFS, overall survival (OS), and toxicity rates.

Main Results:

• Five- and 10-year BCFFS rates were 82% and 60%, with 5- and 10-year OS rates of 95% and 83%, respectively.
• NCCN risk classification demonstrated the highest predictive power for BCFFS (AUC = 0.556).
• Dose escalation (≥179 Gy_1.5) with intensity-modulated RT (IMRT) significantly improved BCFFS and OS in high-risk patients without increased toxicity.

Conclusions:

• NCCN risk classification can guide dose escalation with modern techniques in high-risk prostate cancer patients, potentially improving survival.
• Dose escalation did not benefit low-risk prostate cancer patients.
• Further prospective studies are needed to confirm these findings and refine RT strategies.