Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer

Deborah A. Kuban, Susan L. Tucker, Lei Dong, George Starkschall, Eugene H. Huang, M. Rex Cheung, Andrew K. Lee, Alan Pollack

Research output: Contribution to journalArticle

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Abstract

Purpose: To report the long-term results of a randomized radiotherapy dose escalation trial for prostate cancer. Methods and Materials: From 1993 to 1998, a total of 301 patients with stage T1b to T3 prostate cancer were accrued to a randomized external beam dose escalation trial using 70 Gy versus 78 Gy. The median follow-up is now 8.7 years. Kaplan-Meier analysis was used to compute rates of prostate-specific antigen (PSA) failure (nadir + 2), clinical failure, distant metastasis, disease-specific, and overall survival as well as complication rates at 8 years post-treatment. Results: For all patients, freedom from biochemical or clinical failure (FFF) was superior for the 78-Gy arm, 78%, as compared with 59% for the 70-Gy arm (p = 0.004, and an even greater benefit was seen in patients with initial PSA >10 ng/ml (78% vs. 39%, p = 0.001). The clinical failure rate was significantly reduced in the 78-Gy arm as well (7% vs. 15%, p = 0.014). Twice as many patients either died of prostate cancer or are currently alive with cancer in the 70-Gy arm. Gastrointestinal toxicity of grade 2 or greater occurred twice as often in the high dose patients (26% vs. 13%), although genitourinary toxicity of grade 2 or greater was less (13% vs. 8%) and not statistically significantly different. Dose-volume histogram analysis showed that the complication rate could be significantly decreased by reducing the amount of treated rectum. Conclusions: Modest escalation in radiotherapy dose improved freedom from biochemical and clinical progression with the largest benefit in prostate cancer patients with PSA >10 ng/ml.

Original languageEnglish
Pages (from-to)67-74
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume70
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Prostatic Neoplasms
cancer
dosage
antigens
Prostate-Specific Antigen
toxicity
radiation therapy
grade
Radiotherapy
rectum
Kaplan-Meier Estimate
metastasis
Rectum
histograms
progressions
Neoplasm Metastasis
Survival
Neoplasms
Therapeutics

Keywords

  • Dose
  • External beam
  • Prostate cancer
  • Radiotherapy
  • Randomized

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer. / Kuban, Deborah A.; Tucker, Susan L.; Dong, Lei; Starkschall, George; Huang, Eugene H.; Cheung, M. Rex; Lee, Andrew K.; Pollack, Alan.

In: International Journal of Radiation Oncology Biology Physics, Vol. 70, No. 1, 01.01.2008, p. 67-74.

Research output: Contribution to journalArticle

Kuban, Deborah A. ; Tucker, Susan L. ; Dong, Lei ; Starkschall, George ; Huang, Eugene H. ; Cheung, M. Rex ; Lee, Andrew K. ; Pollack, Alan. / Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 70, No. 1. pp. 67-74.
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AB - Purpose: To report the long-term results of a randomized radiotherapy dose escalation trial for prostate cancer. Methods and Materials: From 1993 to 1998, a total of 301 patients with stage T1b to T3 prostate cancer were accrued to a randomized external beam dose escalation trial using 70 Gy versus 78 Gy. The median follow-up is now 8.7 years. Kaplan-Meier analysis was used to compute rates of prostate-specific antigen (PSA) failure (nadir + 2), clinical failure, distant metastasis, disease-specific, and overall survival as well as complication rates at 8 years post-treatment. Results: For all patients, freedom from biochemical or clinical failure (FFF) was superior for the 78-Gy arm, 78%, as compared with 59% for the 70-Gy arm (p = 0.004, and an even greater benefit was seen in patients with initial PSA >10 ng/ml (78% vs. 39%, p = 0.001). The clinical failure rate was significantly reduced in the 78-Gy arm as well (7% vs. 15%, p = 0.014). Twice as many patients either died of prostate cancer or are currently alive with cancer in the 70-Gy arm. Gastrointestinal toxicity of grade 2 or greater occurred twice as often in the high dose patients (26% vs. 13%), although genitourinary toxicity of grade 2 or greater was less (13% vs. 8%) and not statistically significantly different. Dose-volume histogram analysis showed that the complication rate could be significantly decreased by reducing the amount of treated rectum. Conclusions: Modest escalation in radiotherapy dose improved freedom from biochemical and clinical progression with the largest benefit in prostate cancer patients with PSA >10 ng/ml.

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