Dose escalation of external beam radiotherapy for high-risk prostate cancer—Impact of multiple high-risk factor

doi:10.1016/j.ajur.2017.07.002

Asian Journal of Urology, 2019, 6 (2): 192-199 doi: 10.1016/j.ajur.2017.07.002

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Dose escalation of external beam radiotherapy for high-risk prostate cancer—Impact of multiple high-risk factor

Rei Umezawa^a,b,*(

),Koji Inaba^a,Satoshi Nakamura^a,Akihisa Wakita^a,Hiroyuki Okamoto^a,Keisuke Tsuchida^a,Tairo Kashihara^a,Kazuma Kobayashi^a,Ken Harada^a,Kana Takahashi^a,Naoya Murakami^a,Yoshinori Ito^a,Hiroshi Igaki^a,Keiichi Jingu^b,Jun Itami^a

a.Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan;
b.Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan

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Abstract

Objective To retrospectively investigate the treatment outcomes of external beam radiotherapy with androgen deprivation therapy (ADT) in high-risk prostate cancer in three radiotherapy dose groups.Methods Between 1998 and 2013, patients with high-risk prostate cancer underwent three-dimensional conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy, 72 Gy, or 78 Gy with ADT. Prostate-specific antigen (PSA) relapse was defined using the Phoenix definition. PSA relapse-free survival (PRFS) was evaluated in each radiotherapy dose group. Moreover, high-risk patients were divided into H-1 (patients with multiple high-risk factors) and H-2 (patients with a single high-risk factor) as risk subgroups.Results Two hundred and eighty-nine patients with a median follow-up period of 77.3 months were analyzed in this study. The median duration of ADT was 10.1 months. Age, Gleason score, T stage, and radiotherapy dose influenced PRFS with statistical significance both in univariate and multivariate analyses. The 4-year PRFS rates in Group-66 Gy, Group-72 Gy and Group-78 Gy were 72.7%, 81.6% and 90.3%, respectively. PRFS rates in the H-1 subgroup differed with statistical significance with an increasing radiotherapy dose having a more favorable PRFS, while PRFS rates in H-2 subgroup did not differ with increase in radiotherapy dose.Conclusion Dose escalation for high-risk prostate cancer in combination with ADT improved PRFS. PRFS for patients in the H-1 subgroup was poor, but dose escalation in those patients was beneficial, while dose escalation in the H-2 subgroup was not proven to be effective for improving PRFS.

Key words： Prostate cancer External beam radiotherapy Dose escalation Biochemical control

Received: 16 February 2017 Available online: 19 October 2017

Corresponding Authors: Rei Umezawa E-mail: reirei513@hotmail.com

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	Rei Umezawa
	Koji Inaba
	Satoshi Nakamura
	Akihisa Wakita
	Hiroyuki Okamoto
	Keisuke Tsuchida
	Tairo Kashihara
	Kazuma Kobayashi
	Ken Harada
	Kana Takahashi
	Naoya Murakami
	Yoshinori Ito
	Hiroshi Igaki
	Keiichi Jingu
	Jun Itami

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Cite this article:

Rei Umezawa,Koji Inaba,Satoshi Nakamura, et al. Dose escalation of external beam radiotherapy for high-risk prostate cancer—Impact of multiple high-risk factor[J]. Asian Journal of Urology, 2019, 6(2): 192-199.

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http://www.ajurology.com/EN/10.1016/j.ajur.2017.07.002 OR http://www.ajurology.com/EN/Y2019/V6/I2/192

Patients' characteristics of each radiotherapy dose group.

Prostate-specific antigen relapse-free survival (PRFS), distant metastases-free survival (DMFS), cause-specific survival (CSS) and overall survival (OS) of each subgroup.

Prostate-specific antigen relapse-free survival (PRFS) in all patients (A) and in each radiotherapy dose group (B).

Results of univariate and multivariate analyses of prostate-specific antigen relapse-free survival.

PRFS, DMFS, CSS, and OS of risk subgroups according to radiotherapy dose group.

Prostate-specific antigen relapse-free survival (PRFS) in each radiotherapy dose group for H-1 patients (patients with multiple high-risk factors) (A) and H-2 patients (patients with a single high-risk factor) (B).

Incidence of late toxicities (n [%]) according to the common terminology criteria for adverse events ver. 4.

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