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Title: Radiation dose and late failures in prostate cancer

Abstract

Purpose: To quantify the impact of radiation dose escalation on the timing of biochemical failure (BF) and distant metastasis (DM) for prostate cancer treated with radiotherapy (RT) alone. Methods: The data from 667 men with clinically localized intermediate- and high-risk prostate cancer treated with three-dimensional conformal RT alone were retrospectively analyzed. The interval hazard rates of DM and BF, using the American Society for Therapeutic Radiology and Oncology (ASTRO) and Phoenix (nadir + 2) definitions, were determined. The median follow-up was 77 months. Results: Multivariate analysis showed that increasing radiation dose was independently associated with decreased ASTRO BF (p < 0.0001), nadir + 2 BF (p = 0.001), and DM (p = 0.006). The preponderance (85%) of ASTRO BF occurred at {<=}4 years after RT, and nadir + 2 BF was more evenly spread throughout Years 1-10, with 55% of BF in {<=}4 years. Radiation dose escalation caused a shift in the BF from earlier to later years. The interval hazard function for DM appeared to be biphasic (early and late peaks) overall and for the <74-Gy group. In patients receiving {>=}74 Gy, a reduction occurred in the risk of DM in the early and late waves, although the latemore » wave appeared reduced to a greater degree. Conclusion: The ASTRO definition of BF systematically underestimated late BF because of backdating. Radiation dose escalation diminished and delayed BF; the delay suggested that local persistence may still be present in some patients. For DM, a greater radiation dose reduced the early and late waves, suggesting that persistence of local disease contributed to both.« less

Authors:
 [1];  [2];  [1];  [1];  [3];  [4]
  1. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
  2. Department of Public Health, Temple University, Philadelphia, PA (United States)
  3. Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
  4. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States). E-mail: alan.pollack@fccc.edu
Publication Date:
OSTI Identifier:
20944765
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2006.10.023; PII: S0360-3016(06)03360-8; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; FAILURES; HEALTH HAZARDS; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; PROSTATE; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Morgan, Peter B., Hanlon, Alexandra L., Horwitz, Eric M., Buyyounouski, Mark K., Uzzo, Robert G., and Pollack, Alan. Radiation dose and late failures in prostate cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.10.023.
Morgan, Peter B., Hanlon, Alexandra L., Horwitz, Eric M., Buyyounouski, Mark K., Uzzo, Robert G., & Pollack, Alan. Radiation dose and late failures in prostate cancer. United States. doi:10.1016/j.ijrobp.2006.10.023.
Morgan, Peter B., Hanlon, Alexandra L., Horwitz, Eric M., Buyyounouski, Mark K., Uzzo, Robert G., and Pollack, Alan. Thu . "Radiation dose and late failures in prostate cancer". United States. doi:10.1016/j.ijrobp.2006.10.023.
@article{osti_20944765,
title = {Radiation dose and late failures in prostate cancer},
author = {Morgan, Peter B. and Hanlon, Alexandra L. and Horwitz, Eric M. and Buyyounouski, Mark K. and Uzzo, Robert G. and Pollack, Alan},
abstractNote = {Purpose: To quantify the impact of radiation dose escalation on the timing of biochemical failure (BF) and distant metastasis (DM) for prostate cancer treated with radiotherapy (RT) alone. Methods: The data from 667 men with clinically localized intermediate- and high-risk prostate cancer treated with three-dimensional conformal RT alone were retrospectively analyzed. The interval hazard rates of DM and BF, using the American Society for Therapeutic Radiology and Oncology (ASTRO) and Phoenix (nadir + 2) definitions, were determined. The median follow-up was 77 months. Results: Multivariate analysis showed that increasing radiation dose was independently associated with decreased ASTRO BF (p < 0.0001), nadir + 2 BF (p = 0.001), and DM (p = 0.006). The preponderance (85%) of ASTRO BF occurred at {<=}4 years after RT, and nadir + 2 BF was more evenly spread throughout Years 1-10, with 55% of BF in {<=}4 years. Radiation dose escalation caused a shift in the BF from earlier to later years. The interval hazard function for DM appeared to be biphasic (early and late peaks) overall and for the <74-Gy group. In patients receiving {>=}74 Gy, a reduction occurred in the risk of DM in the early and late waves, although the late wave appeared reduced to a greater degree. Conclusion: The ASTRO definition of BF systematically underestimated late BF because of backdating. Radiation dose escalation diminished and delayed BF; the delay suggested that local persistence may still be present in some patients. For DM, a greater radiation dose reduced the early and late waves, suggesting that persistence of local disease contributed to both.},
doi = {10.1016/j.ijrobp.2006.10.023},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 67,
place = {United States},
year = {Thu Mar 15 00:00:00 EDT 2007},
month = {Thu Mar 15 00:00:00 EDT 2007}
}