Moderate Dose Escalation in Three-Dimensional Conformal Localized Prostate Cancer Radiotherapy

Goldner, Gregor; Dimopoulos, J.; Kirisits, Christian; Pötter, Richard

doi:10.1007/s00066-2009-2033-5

Cited by 26 publications

(4 citation statements)

References 31 publications

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“…In elderly men with localized PCa, RT is an established primary treatment method [23]. The published rates of 5‐year BFSR (Phoenix definition) with escalated‐dose RT (74–75.6 Gy) are 85–91% in patients with low‐risk disease, 79–88% in patients with intermediate‐risk disease, and 57–74% in patients with high‐risk disease [24–26]. Compared with single‐session HIFU, results from these studies indicate equivalent efficacy rates in low‐risk disease, even if the strict PSA failure criteria of the present study are considered.…”

Section: Discussionmentioning

confidence: 99%

Single application of high‐intensity focused ultrasound as a first‐line therapy for clinically localized prostate cancer: 5‐year outcomes

2012

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? High‐intensity focused ultrasound (HIFU) therapy has been proposed for the treatment of localized prostate cancer (PCa) for all risk levels of tumour recurrence. The study adds data on the efficacy of a single HIFU application in the treatment of PCa with different risks of recurrence. Durable cancer control was achieved in 81.7% of patients with low‐risk disease, with rates of efficacy declining in intermediate‐ and high‐risk tumours. The data suggest that the principal domain for minimal invasive HIFU should be low‐risk disease. OBJECTIVE To report cancer control results after a single application of high‐intensity focused ultrasonography (HIFU) in patients with localized prostate cancer (PCa), stratified by tumour recurrence risk according to D'Amico risk classification. PATIENTS AND METHODS In a retrospective single‐centre study, we analysed the outcomes of patients with localized PCa who were treated with curative intent between December 2002 and October 2006 using an Ablatherm HIFU device (EDAP‐TMS, France). Transurethral resection of the prostate or adenomectomy were performed before HIFU to downsize large prostate glands. Oncological failure was determined by the occurrence of biochemical relapse, positive biopsy and/or metastasis. Biochemical relapse was defined as a PSA nadir +1.2 ng/mL (Stuttgart definition), or as a rise in PSA level to ≥0.5 ng/mL if PSA doubling time was ≤6 months. Kaplan–Meier analysis was performed for survival estimates. RESULTS A total of 191 consecutive patients were included in the study. The median (range) patient age was 69.7 (51–82) years, and 38, 34 and 28% of these patients were in the low‐, intermediate‐ and high‐risk groups, respectively. The median (range) follow‐up was 52.8 (0.2–79.8) months. At 5 years, overall and cancer‐specific survival rates were 86.3% and 98.4%, respectively. Stratified by risk group, negative biopsy rates were 84.2%, 63.6%, and 67.5% (P = 0.032), 5‐year biochemical‐free survival rates were 84.8%, 64.9% and 54.9% (P < 0.01), and 5‐year disease‐free survival rates were 81.7%, 53.2% and 51.2% (P < 0.01), respectively. CONCLUSION Single‐session HIFU is recommended as a curative approach in elderly patients with low‐risk PCa. Patients at higher risk of tumour progression should be counselled regarding the likely need for salvage therapy, including repeat HIFU.

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Section: Discussionmentioning

confidence: 99%

Single application of high‐intensity focused ultrasound as a first‐line therapy for clinically localized prostate cancer: 5‐year outcomes

2012

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“…The biochemical control rate (PSA recurrence free survival) of prostate cancer after definitive radiotherapy could be significantly improved by escalating the total dose above 72 Gy [5,11,15,22,24,29], especially in patients with intermediate (stage T2b, Gleason score 7, or PSA level 10.1-20 ng/mL) and high (stage T2c, Gleason score 8-10, or PSA level > 20 ng/mL) [3] risk disease. However, the treatment toxicity can be increased with the use of higher radiation doses, particularly regarding the rectum and bladder, unless high precision radiotherapy techniques are used to limit exposure of normal tissues [8,9,13,30].…”

Section: Introductionmentioning

confidence: 99%

Respiratory-Induced Prostate Motion

et al. 2011

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“…Significantly increased gastrointestinal (GI) toxicity was the major drawback of three-dimensional conformal radiotherapy (3D-CRT)-based dose-escalation in the treatment of prostate cancer (PCA) [1,4,9,15,22,31]. The development of intensity-modulated radiation therapy (IMRT) allowed better preservation of the organs at risk and significantly decreased GI toxicity compared to 3D-CRT [6,18,30].…”

Section: Introductionmentioning

confidence: 99%

High-Dose (80 Gy) Intensity-Modulated Radiation Therapy with Daily Image-Guidance as Primary treatment for Localized Prostate Cancer

et al. 2010

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Moderate Dose Escalation in Three-Dimensional Conformal Localized Prostate Cancer Radiotherapy

Abstract: A benefit of local doses at a level of > or = 70 Gy could be detected showing the highest increase of prostate-specific antigen control in the intermediate-risk group. The amount of patients reporting of severe late side effects is small.

Cited by 26 publications

References 31 publications

Single application of high‐intensity focused ultrasound as a first‐line therapy for clinically localized prostate cancer: 5‐year outcomes

Single application of high‐intensity focused ultrasound as a first‐line therapy for clinically localized prostate cancer: 5‐year outcomes

Respiratory-Induced Prostate Motion

High-Dose (80 Gy) Intensity-Modulated Radiation Therapy with Daily Image-Guidance as Primary treatment for Localized Prostate Cancer

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