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Propensity Score Matched Analysis of External Beam Radiotherapy With or Without Focal Boost to Intraprostatic Lesions
Cem Onal1,2, Ozan Cem Guler1, Gurcan Erbay3
1Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey.
The Prostate
|March 11, 2025
Summary
Simultaneous integrated boost (SIB) radiotherapy significantly improves biochemical disease-free survival and reduces recurrence in prostate cancer patients. This advanced technique enhances outcomes without increasing toxicity, offering better long-term results.
Area of Science:
- Oncology
- Radiation Oncology
- Prostate Cancer Research
Background:
- Localized prostate cancer (PCa) requires effective treatment strategies.
- Radiotherapy (RT) is a standard treatment for intermediate- and high-risk PCa.
- Evaluating dose escalation techniques like simultaneous integrated boost (SIB) is crucial for improving outcomes.
Purpose of the Study:
- To assess the impact of SIB in addition to external beam RT on survival, recurrence, and toxicity in localized PCa.
- To identify prognostic and predictive factors influencing treatment outcomes.
- To compare outcomes between patients receiving RT with SIB versus RT alone.
Main Methods:
- Retrospective analysis of 712 intermediate- and high-risk PCa patients treated between 2010-2018.
- External beam RT with or without SIB (up to 86 Gy) was administered.
- Propensity score matching (PSM) was used for cohort comparability, analyzing biochemical disease-free survival (bDFS), prostate cancer-specific survival (PCSS), local recurrence (LR), distant metastasis (DM), and toxicity.
Main Results:
- After PSM, 417 patients (208 SIB, 209 non-SIB) were analyzed with a median follow-up of 8.6 years.
- The SIB group demonstrated significantly higher 8-year bDFS (93.8% vs. 83.5%) and lower rates of DM (6.1% vs. 13.0%) and LR (1.8% vs. 6.9%).
- No significant differences in Grade ≥2 genitourinary or gastrointestinal toxicities were observed between the groups.
Conclusions:
- SIB with external beam RT significantly enhances bDFS and reduces LR and DM in intermediate- and high-risk PCa.
- Dose escalation via SIB improves local control and long-term outcomes without increasing significant toxicities.
- Advanced T stage and absence of SIB were predictors of worse outcomes, highlighting SIB's importance.
