Author(s): Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH,
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Abstract PURPOSE: To report the long-term results of a randomized radiotherapy dose escalation trial for prostate cancer. METHODS AND MATERIALS: From 1993 to 1998, a total of 301 patients with stage T1b to T3 prostate cancer were accrued to a randomized external beam dose escalation trial using 70 Gy versus 78 Gy. The median follow-up is now 8.7 years. Kaplan-Meier analysis was used to compute rates of prostate-specific antigen (PSA) failure (nadir + 2), clinical failure, distant metastasis, disease-specific, and overall survival as well as complication rates at 8 years post-treatment. RESULTS: For all patients, freedom from biochemical or clinical failure (FFF) was superior for the 78-Gy arm, 78\%, as compared with 59\% for the 70-Gy arm (p = 0.004, and an even greater benefit was seen in patients with initial PSA >10 ng/ml (78\% vs. 39\%, p = 0.001). The clinical failure rate was significantly reduced in the 78-Gy arm as well (7\% vs. 15\%, p = 0.014). Twice as many patients either died of prostate cancer or are currently alive with cancer in the 70-Gy arm. Gastrointestinal toxicity of grade 2 or greater occurred twice as often in the high dose patients (26\% vs. 13\%), although genitourinary toxicity of grade 2 or greater was less (13\% vs. 8\%) and not statistically significantly different. Dose-volume histogram analysis showed that the complication rate could be significantly decreased by reducing the amount of treated rectum. CONCLUSIONS: Modest escalation in radiotherapy dose improved freedom from biochemical and clinical progression with the largest benefit in prostate cancer patients with PSA >10 ng/ml.
This article was published in Int J Radiat Oncol Biol Phys
and referenced in Journal of Clinical & Experimental Pathology