Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy

Gerald E. Hanks, Alexandra L. Hanlon, Wayne H. Pinover, Eric M. Horwitz, Timothy E. Schultheiss

Research output: Contribution to journalArticlepeer-review

116 Scopus citations

Abstract

The value of treating prostate cancer has been questioned, and some insist that a survival benefit is demonstrated to justify treatment. Prospective dose-escalation studies with three-dimensional conformal radiotherapy technique have demonstrated improvement in biochemical freedom from disease and local control. We report the outcomes of high-dose treatment with three-dimensional conformal radiotherapy compared with low-dose treatment for biochemical freedom from disease, freedom from distant metastasis, cause-specific survival, and overall survival. PATIENTS AND METHODS The study design was retrospective, involving pairs matched on independent prognostic variables in which each patient treated with low-dose radiotherapy was matched with a patient treated with high-dose radiotherapy. Outcomes were compared for two groups of patients: Group I: Three-dimensional conformal radiotherapy treatment - 296 patients treated with more than 74 Gy matched on stage, grade, and prostate-specific antigen level, to 296 patients treated with less than 74 Gy. Group II: Three-dimensional conformal radiotherapy treatment - 357 patients treated with more than 74 Gy matched on stage and grade to 357 patients treated with less than 74 Gy. Univariate analysis showed that dose is a significant predictor of biochemical freedom from disease, freedom from distant metastasis, and cause-specific survival for group I and biochemical freedom from disease, freedom from distant metastasis, cause-specific survival, and overall survival for group II. Multivariate analysis showed that dose is a significant independent predictor in group I for biochemical freedom from disease and freedom from distant metastasis and for biochemical freedom from disease, freedom from distant metastasis, cause-specific survival, and overall survival in group II. DISCUSSION These data provide strong support for the definitive treatment of prostate cancer with high-dose (> 74 Gy) three-dimensional conformal radiotherapy. These doses can be safely delivered with three-dimensional conformal radiotherapy techniques. Various institutions and industry must collaborate to expand the technology allowing the use of high-dose three- dimensional conformal radiotherapy in the national practice beyond centers of technological excellence.

Original languageEnglish
Pages (from-to)152-158
Number of pages7
JournalCancer Journal from Scientific American
Volume5
Issue number3
StatePublished - May 1999

Keywords

  • Aged
  • Disease-Free Survival
  • Humans
  • Male
  • Multivariate Analysis
  • Prostatic Neoplasms/mortality
  • Radiation Dosage
  • Radiotherapy, Conformal
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome

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