Technical and tumor-related factors affecting outcome of definitive irradiation for localized carcinoma of the prostate

Pérez, Carlos A.; Lee, Henry K.; Georgiou, Anastasios; Logsdon, Mark D.; Lai, Peter P.; Lockett, Mary Ann

doi:10.1016/0360-3016(93)90273-x

Cited by 74 publications

(19 citation statements)

References 33 publications

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“…13 The results in these series consistently demonstrate the probabilities for survival of advanced stage T3 prostate cancer to be approximately 35% to 45% at 10 years (Table 3). 16,19,35,36 Few long-term data are available that define control of advanced-stage prostate cancers with respect to PSA control. The Massachusetts General Hospital reported results for 10-year biochemical disease-free survival rates of 10%-33% for T3 and T4 tumors, depending on substage and grade.…”

Section: Results Of Conventional Ebrt Treatmentmentioning

confidence: 99%

“…Local recurrence rates at 10-15 years following treatment have ranged between 20% and 60%, depending on the method of detection and reporting. 17,19,34 Several approaches have been investigated in attempts to improve results in this challenging patient population. The first approach focused on dose escalation techniques to selectively increase the irradiation dose to the prostate gland while not exceeding the normal tissue tolerance limits of critical adjacent structures.…”

Section: Rationale and Treatment Techniques For Ebrt For Stage T3 Or mentioning

confidence: 99%

“…Table 1 presents results from several institutions with published experiences in EBRT of prostate cancer in terms of local control and actuarial survival. [17][18][19][20][21] The prostate tumor grade or Gleason score and the PSA value at diagnosis significantly influence clinical outcomes, particularly survival. In the pre-PSA era, histologic grade was considered the most significant prognostic factor, responsible for an estimated 20% inferior survival for patients with poorly differentiated T2 prostate cancers compared to patients with moderately to well-differentiated adenocarcinoma.…”

Section: Treatment Planning/deliverymentioning

confidence: 99%

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External-Beam Radiotherapy in the Management of Carcinoma of the Prostate

Zlotecki

2001

Cancer Control

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Section: Results Of Conventional Ebrt Treatmentmentioning

confidence: 99%

Section: Rationale and Treatment Techniques For Ebrt For Stage T3 Or mentioning

confidence: 99%

Section: Treatment Planning/deliverymentioning

confidence: 99%

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External-Beam Radiotherapy in the Management of Carcinoma of the Prostate

Zlotecki

2001

Cancer Control

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“…External-beam radiation therapy alone requires delivery of very high doses to achieve local control [3][4][5], thus leading to an increased frequency of radiotherapyrelated morbidity [6][7][8], Interstitial brachythcrapy has resulted in comparable local control rates with better spar ing of surrounding tissues, but is a major surgical proce dure which requires great technical skill [9].…”

Section: Discussionmentioning

confidence: 99%

“…For intracapsular tumors, external-beam radia tion therapy at high doses has produced a 10-year control rate equivalent to radical prostatectomy [4,5] at the expense of an overall incidence of 3% severe and 7-10% moderate urinary and rectosigmoid sequelae [6][7][8], Bra chytherapy allows application of a higher radiation dose to the tumor with better sparing of surrounding tissues [9].…”

Section: Introductionmentioning

confidence: 99%

High Dose Rate Transurethral Brachytherapy as a Boost Dose for Localized Adenocarcinoma of the Prostate

Serin

Erkal²,

Sak³

et al. 1997

Urol Int

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From September 1989 to February 1993, 11 patients with localized adenocarcinoma of the prostate were treated with pelvic external-beam radiation therapy followed by high dose rate (HDR) transurethral brachytherapy as a boost dose. External-beam radiation therapy was administered through opposed pelvic fields using a 60Co teletherapy unit to a tumor dose of 46–50 Gy in 23–25 fractions and followed by three fractions of transurethral brachytherapy, delivered using a ⁶⁰Co HDR remote afterloading equipment. The treatment time was calculated using the prostatic capsule as the reference point. The dose calculated to be delivered to the capsule was 5 Gy/fraction, making a total of 15 Gy. The follow-up period ranged from 11 to 65 months, with a median follow-up time of 30 months. Local control was achieved in all patients. The prostate-specific antigen levels were normalized within 3 months of radiotherapy in 9 patients and within 3–6 months in the remaining 2. Transurethral brachytherapy appears to be a simple and feasible form of brachytherapy. Preliminary local control and radiotherapy-related morbidity rates are comparable to those of other forms of brachytherapy. Further follow-up is required for assessment of long-term local control and delayed radiotherapy-related morbidity.

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Acute toxicity in radiotherapy of prostate cancer:Results of a randomized study with and without beam's-eye view three-dimensional conformal therapy

Yang

Vaida

Ignacio

et al. 1996

Radiat. Oncol. Investig.

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Beam's‐eye view (BEV) based three‐dimensional conformal therapy (3DCRT) treatment planning is being utilized with increasing frequency in the treatment of prostate cancer. This trend has been driven, in part, by the desire to escalate radiation doses, which may require superior targeting precision. However, conformal therapy for prostate cancer has also been advocated at lower doses partly due to retrospective studies that demonstrate improvements in quality of life by reducing acute toxicities. Such benefits of 3DCRT need to be confirmed in prospective studies as well as justifications for the additional costs in patients receiving conventional doses of radiation. A randomized study of patients undergoing radiotherapy (RT) to BEV‐based treatment volumes S. hand reconstruction of treatment volumes from computer tomography (CT) images was conducted to assess acute toxicities. Patients with clinical stage B and C disease were randomized to undergo either BEV treatment planning (Group I) (n = 17) or CT‐based hand reconstruction of treatment volumes (Group II) (n = 18). Both groups underwent standard prostate irradiation with 4 fields and conventional doses (65–70 Gy). Patients were evaluated weekly during treatment for acute rectal and bladder toxicity (RTOG/EORTC grades 0‐IV). Acute bladder and rectal toxicities increased over the course of therapy in both groups of patients. No statistically significant differences in weekly mean acute bladder toxicity (based on RTOG/EORTC grades 0 to IV) was seen with patients in Group I (week 1: 0.06; week 2: 0.29; week 3: 0.62; week 4: 0.35; week 5: 0.65; week 6: 0.60) vs. Group II (week 1: 0.22; week 2: 0.32; week 3: 0.72; week 4: 0.67; week 5: 0.86; week 6: 1.08). The mean weekly acute rectal toxicity for BEV‐based planning (week 1: 0.00; week 2: 0.41; week 3: 0.75; week 4: 0.94; week 5: 0.75; week 6: 1.07) was also not statistically different from hand reconstruction (week 1: 0.11; week 2: 0.42; week 3: 0.47; week 4: 0.53; week 5: 0.62; week 6: 0.62). Comparison of the two arms of the study failed to demonstrate an advantage to BEV therapy when the distribution of toxicities were analyzed by chi‐square or Wilcoxon rank‐sum test. No difference in severity of bladder toxicity was noted by RTOG/EORTC grade (P = 0.78); one patient in each group experienced grade 3 toxicity. No patients experienced grade 3 or 4 rectal toxicity; however, BEV therapy was associated with higher maximum toxicity (P = 0.05). No statistically significant differences in the initial or boost treatment volumes or the reconstructed prostate volumes were seen between the two arms of the study. In conclusion, although the advantages provided by 3DCRT will be necessary in patients undergoing dose escalation and/or novel treatment techniques such as noncoplanar beams, oblique portals, and intensity modulation, this trial fails to demonstrate an improvement in acute toxicity with the use of BEV planning with conventional RT doses. Computed tomographic imaging of the prostate remains essential for optim...

show abstract

Technical and tumor-related factors affecting outcome of definitive irradiation for localized carcinoma of the prostate

Cited by 74 publications

References 33 publications

External-Beam Radiotherapy in the Management of Carcinoma of the Prostate

External-Beam Radiotherapy in the Management of Carcinoma of the Prostate

High Dose Rate Transurethral Brachytherapy as a Boost Dose for Localized Adenocarcinoma of the Prostate

Acute toxicity in radiotherapy of prostate cancer:Results of a randomized study with and without beam's-eye view three-dimensional conformal therapy

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