Multicenter Analysis of Effect of High Biologic Effective Dose on Biochemical Failure and Survival Outcomes in Patients with Gleason Score 7-10 Prostate Cancer Treated with Permanent Prostate Brachytherapy. International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] Journal article | | Title | Multicenter Analysis of Effect of High Biologic Effective Dose on Biochemical Failure and Survival Outcomes in Patients with Gleason Score 7-10 Prostate Cancer Treated with Permanent Prostate Brachytherapy. | | Author(s) | Stone NN, Potters L, Davis BJ, Ciezki JP, Zelefsky MJ, Roach M, Shinohara K, Fearn PA, Kattan MW, Stock RG | | Institution | Mount Sinai School of Medicine, New York, NY. | | Source | Int J Radiat Oncol Biol Phys 2008 Jun 30. | | Abstract | PURPOSE: To investigate the biochemical control rates and survival for Gleason score 7-10 prostate cancer patients undergoing permanent prostate brachytherapy as a function of the biologic effective dose (BED).
METHODS AND MATERIALS: Six centers provided data on 5,889 permanent prostate brachytherapy patients, of whom 1,078 had Gleason score 7 (n = 845) or Gleason score 8-10 (n = 233) prostate cancer and postimplant dosimetry results available. The median prostate-specific antigen level was 7.5 ng/mL (range, 0.4-300). The median follow-up for censored patients was 46 months (range, 5-130). Short-term hormonal therapy (median duration, 3.9 months) was used in 666 patients (61.8%) and supplemental external beam radiotherapy (EBRT) in 620 (57.5%). The patients were stratified into three BED groups: <200 Gy (n = 645), 200-220 Gy (n = 199), and >220 Gy (n = 234). Biochemical freedom from failure (bFFF) was determined using the Phoenix definition.
RESULTS: The 5-year bFFF rate was 80%. The bFFF rate stratified by the three BED groups was 76.4%, 83.5%, and 88.3% (p < 0.001), respectively. Cox regression analysis revealed Gleason score, prostate-specific antigen level, use of hormonal therapy, EBRT, and BED were associated with bFFF (p < 0.001). Freedom from metastasis improved from 92% to 99% with the greatest doses. The overall survival rate at 5 years for the three BED groups for Gleason score 8-10 cancer was 86.6%, 89.4%, and 94.6%, respectively (p = 0.048).
CONCLUSION: These data suggest that permanent prostate brachytherapy combined with EBRT and hormonal therapy yields excellent bFFF and survival results in Gleason score 7-10 patients when the delivered BEDs are >220 Gy. These doses can be achieved by a combination of 45-Gy EBRT with a minimal dose received by 90% of the target volume of 120 Gy of (103)Pd or 130 Gy of (125)I. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 18597953 |
|
|
| |
Advertise on this site.
| | |
|
