Five-Year Results of IMRT for Prostate Cancer – Tumor Control

Czech version

Authors: Odrážka K.- ^{1 4}; M. Doležel ^1,2,5; J. Vaňásek ¹; M. Vaculíková ⁶; M. Zouhar ⁷; J. Šefrová ^8,9; P. Paluska ⁷; M. Vošmik ⁷; T. Kohlová ¹⁰; I. Kolářová ¹; M. Broďák ¹¹; P. Navrátil ¹¹; P. Prošvic ¹²; P. Hoffmann ¹³; A. Hafuda ¹²
Authors‘ workplace: Oddělení klinické a radiační onkologie, Multiscan, Pardubická krajská nemocnice, Pardubice ¹; 1. LF UK v Praze ²; 3. LF UK v Praze ³; Katedra radiační onkologie IPVZ, Praha ⁴; LF UP v Olomouci ⁵; Onkologické oddělení, Oblastní nemocnice Trutnov ⁶; Klinika onkologie a radioterapie, FN Hradec Králové ⁷; Onkologická ambulance, Nemocnice Prachatice, a. s. ⁸; Hospic sv. Jana N. Neumanna, Prachatice ⁹; Oddělení nukleární medicíny, FN Hradec Králové ¹⁰; Urologická klinika, FN Hradec Králové ¹¹; Urologické oddělení, Oblastní nemocnice Náchod ¹²; Radiologická klinika, FN Hradec Králové ¹³
Published in: Klin Onkol 2013; 26(6): 415-420
Category: Original Articles

Overview

Background:
Intensity-modulated radiation therapy (IMRT) is the method of choice in external-beam radiotherapy tolocalized prostate cancer. This work analyses five year results of IMRT with a dose of 78/82 Gy.

Patients and Methods:
From June 2003 to December 2007, the IMRT technique was employed to treat 233 patients with T1-3 N0 M0 prostate cancer. It was supplemented by hormone therapy especially in high-risk patients. Two IMRT techniques were applied – IMRT with a dose of 78 Gy in 39 fractions to prostate and seminal vesicles (SV) (IMRT 78) and IMRT with simultaneous integrated 82 Gy boost to prostate concurrently with 73,8 Gy in 41 fractions to SV (IMRT SIB 82). The IMRT 78 technique was used in 160 patients (69%). Seventy-three (31%) patients with intermediate (IR) or high-risk (HR) prostate cancer without SV involvement were treated with IMRT SIB 82 technique. The PSA relapse was defined as an increase in PSA of at least 2.0 ng/mL above the nadir or in comparison to the value at the initiation of hormone therapy. Clinical relapse was defined as an occurence of distant metastases and/or local recurrence.

Results:
The median follow-up of our patients´ population was 4.3 years (range 0.6–8.9 years). The estimated 5-year PSA relapse-free survival in low-risk (LR), IR and HR patients was 86%, 89% and 83%, respectively (p = NS). In a multivariate analysis, Gleason score (GS) 8–10 was associated with significantly higher risk of PSA relapse (RR 2.76), while higher age at the time of diagnosis significantly decreased the PSA relapse risk (RR 0.94). The estimated 5-year clinical relapse-free survival in LR, IR and HR patients was 100%, 99% and 95%, respectively (p = NS). In a univariate analysis, both GS and PSA had a significant impact on the 5-year clinical relapse-free survival – GS 2–7 97 % vs GS 8–10 88 % (p = 0.03), PSA ≤ 20 98 % vs PSA > 20 85 % (p < 0.01).

Conclusion:
Treatment of localized prostate cancer using IMRT with a dose 78/82 Gy yielded an excellent 5-year tumour control with a risk of clinical relapse being less than 5%.

Key words:
prostate cancer – radiation therapy – IMRT

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
3. 6. 2013

Accepted:
12. 6. 2013

Sources

1. Dearnaley DP, Sydes MR, Grahan JD et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 2007; 8(6): 475–487.

2. Al-Mamgani A, van Putten WL, Heemsbergen WD et al. Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 72(4): 980–988.

3. Kuban DA, Tucker SL, Dong L et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70(1): 67–74.

4. Staffurth J, Radiotherapy Development Board. A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol 2010; 22(8): 643–657.

5. Elliott SP, Adejoro OO, Konety BR et al. Intensity modulated radiation therapy replaces 3-dimensional conformal radiotherapy as prostate cancer treatment. J Urol 2012; 187(4): 1253–1258.

6. Zelefsky MJ, Levin EJ, Hunt M et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70(4): 1124–1129.

7. Zelefsky MJ, Yamada Y, Fuks Z et al. Long-term results of conformal radiotherapy for prostate cancer: impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008; 71(4): 1028–1033.

8. Fonteyne V, Villeirs G, Speleers B et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys 2008; 72(3): 799–807.

9. Dolezel M, Odrazka K, Vaculikova M et al. Dose escalation in prostate radiotherapy up to 82 Gy using simultaneous integrated boost: direct comparison of acute and late toxicity with 3D-CRT 74 Gy and IMRT 78 Gy. Strahlenther Onkol 2010; 186(4): 197–202.

10. Odrazka K, Zouhar M, Petera J et al. Comparison of rectal dose-volume constraints for IMRT prostate treatment planning. Phys Med 2005; 21(4): 129–135.

11. Thames HD, Kuban D, Levy LB et al. The role of overall treatment time in the outcome of radiotherapy of prostate cancer: an analysis of biochemical failure in 4839 men treated between 1987 and 1995. Radiother Oncol 2010; 96(1): 6–12.

12. Zelefsky MJ, Reuter VE, Fuks Z et al. Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. J Urol 2008; 179(4): 1368–1373.

13. Zelefsky MJ, Pei X, Chou JF et al. Dose escalation for prostate cancer radiotherapy: predictors of long-term biochemical tumor control and distant metastases-free survival outcomes. Eur Urol 2011; 60(6): 1133–1139.

14. Kuban DA, Levy LB, Cheung MR et al. Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? Int J Radiat Oncol Biol Phys 2011; 79(5): 1310–1317.

15. Vaňásek J, Odrážka K, Doležel M et al. Adaptivní IG-IMRT karcinomu prostaty. Klin Onkol 2011; 24(5): 361–366.

16. Zelefsky MJ, Kollmeier M, Cox B et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 84(1): 125–129.