TY - JOUR
T1 - Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy
AU - Hanks, Gerald E.
AU - Hanlon, Alexandra L.
AU - Pinover, Wayne H.
AU - Horwitz, Eric M.
AU - Schultheiss, Timothy E.
PY - 1999/5
Y1 - 1999/5
N2 - 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.
AB - 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.
KW - Aged
KW - Disease-Free Survival
KW - Humans
KW - Male
KW - Multivariate Analysis
KW - Prostatic Neoplasms/mortality
KW - Radiation Dosage
KW - Radiotherapy, Conformal
KW - Retrospective Studies
KW - Survival Rate
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=0033017133&partnerID=8YFLogxK
M3 - Article
C2 - 10367171
AN - SCOPUS:0033017133
SN - 1081-4442
VL - 5
SP - 152
EP - 158
JO - Cancer Journal from Scientific American
JF - Cancer Journal from Scientific American
IS - 3
ER -