Results of 3D conformal radiotherapy in the treatment of localized prostate cancer
| Autor: | P. William McLaughlin, Kathleen E. Kish, Myla Strawderman, Howard M. Sandler, Nina Fukunaga-Johnson, Allen S. Lichter, Katherine H. Grijalva |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Urology urologic and male genital diseases Disease-Free Survival Prostate cancer Prostate 3d conformal radiotherapy Humans Medicine Radiology Nuclear Medicine and imaging Radiation treatment planning Survival analysis Aged Neoplasm Staging Aged 80 and over Radiation business.industry Prostatic Neoplasms Middle Aged Prostate-Specific Antigen medicine.disease Radiotherapy Computer-Assisted Surgery Radiation therapy Prostate-specific antigen Treatment Outcome medicine.anatomical_structure Oncology Multivariate Analysis Hormonal therapy business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 38:311-317 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/s0360-3016(97)82499-6 |
| Popis: | 3D conformal radiotherapy (3D CRT) has been shown to decrease acute morbidity in the treatment of prostate cancer. Therapeutic outcome and late morbidity data have been accumulating. To evaluate the results of 3D CRT for the treatment of prostate cancer, we analyzed the outcome of a large series of patients treated with conformal techniques.From January 1987 through June 1994, 707 patients with localized prostate cancer were treated with 3D CRT. Patients with pathologically-confirmed pelvic lymph node metastasis, treated with pre-irradiation (preRT) androgen ablation, or treated post-prostatectomy were excluded. All had CT obtained specifically for treatment planning, multiple structures contoured on the axial images, and beam's-eye view conformal beams edited to provide 3D dose coverage. Median follow-up is 36 mos; 70 patients have been followed longer than 5.5 years. Six hundred three had T1-T2 tumors. PreRT prostate specific antigen (PSA) was available for 649 patients: median preRT PSA was 12.9 ng/ml, 209 patients had preRT PSA20 ng/ml. The median dose of radiation was 69 Gy; 102 patients receivedor = 69 Gy. Biochemical failure was defined as: 1) two consecutive PSA rises over 2.0 ng/ml if nadir PSAor = 2.0 ng/ml, 2) two consecutive PSA rises over nadir if nadir PSA2.0 ng/ml, or 3) initiation of hormonal therapy after RT. Complications were graded using the RTOG system.PreRT PSA and Gleason score emerged as independent indicators of biochemical control (bNED). Patients with preRT PSA10 had a significantly worse bNED at 5 years than patients with preRT PSAor = 10. Five-year bNED was determined according to preRT PSA: PSAor = 4, 88%; PSA4or = 10, 72%; PSA10or = 20, 43%; and PSA20, 30%. Patients with Gleason scoreor = 7 also had a significantly worse bNED than patients with Gleason score7. Patients were divided into two prognostic groups: a favorable group with PSAor = 10, Gleason score7, and T1-T2 tumors, and an unfavorable group with PSA10, Gleason scoreor = 7 or T3-T4 tumors and studied for the effect of dose on bNED status. The bNED at 5 years was 75% for the favorable group and 37% for the unfavorable group. In addition, a group that might be considered a surgical subset was reviewed: patients with PSAor = 10, Gleason scoreor = 7, and T1-T2 tumors who were70 years old. This subset had an 84% 5-year bNED rate and 98% 5-year overall survival. Complications with the techniques used here are very low: 3% risk at 7 years of Grade 3-4 complications and 1% risk at 7 years of Grade 3 bladder complications (no Grade 4).3D CRT allows for treatment of prostate cancers with a very low risk of complications. Patients with relatively early disease as defined by preRT PSA, Gleason score7, and T1-2 tumors and patients who are candidates for radical prostatectomy have excellent 5-year bNED rates. Patients with adverse prognostic factors have a high risk of biochemical recurrence and are candidates for innovative therapy. |
| Databáze: | OpenAIRE |
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