Long-Term Results of an RTOG Phase II Trial (00-19) of External-Beam Radiation Therapy Combined With Permanent Source Brachytherapy for Intermediate-Risk Clinically Localized Adenocarcinoma of the Prostate
- Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA (United States)
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States)
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
- Department of Radiation Oncology, Northeast Radiation Oncology Center, Scranton, PA (United States)
- Department of Radiation Oncology, University of British Columbia, Kelowna, BC (Canada)
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States)
- Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Center, Toronto, ON (Canada)
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA (United States)
Purpose: External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques.
- OSTI ID:
- 22056263
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 82, Issue 5; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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