Abstract

ZAPATERO, A. et al. Dose escalation with three dimensional conformal radiotherapy for prostate cancer: more is better?. Actas Urol Esp [online]. 2005, vol.29, n.9, pp.834-841. ISSN 0210-4806.

Purpose: The present study was undertaken to determine the effect of radiation dose on biochemical control and morbidity in prostate cancer patients. Materials and Methods: Between 1995 and 2003, 360 patients with T1-T3b prostate cancer were treated in a sequential radiation dose escalation trial from 66.0 to 82.6 Gy. These patients were prospectively assigned to 1 of 3 prognostic groups according to risk factors: a) low risk patients were treated with 3DCRT alone; b) intermediate risk patients were allocated to receive neoadjuvant AD (NAD) 4-6 months prior and during 3DCRT; and c) highrisk received NAD and adjuvant AD (AAD) 2 years after 3DCRT. RTOG/EORTC toxicity score was used to analyze late complications Results: Median follow-up was 48 months (12-138). The actuarial biochemical disease free survival (bDFS) at 4 years for low risk, intermediate risk and high risk patients was 88%, 68% and 79% respectively. Stratified and multivariate analysis showed that higher radiation dose (>76 Gy) (p=0.0053) and the use of AAD for high risk patients (p=0.0046) correlated significantly with an improvement of bDFS for all patients. The incidence of late grade 2 rectal and urinary bleeding were 7% and 11% respectively. Conclusion: The present study confirms an independent benefit of high-dose (> 76 Gy) radiation therapy and long-term AAD in high-risk prostate cancer patients.

Keywords : Prostate cancer; Conformal radiotherapy; Dose escalation; Androgen deprivation; Prostate-specific antigen.

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