PMID- 21195875
OWN - NLM
STAT- MEDLINE
DCOM- 20110201
LR  - 20181201
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 79
IP  - 2
DP  - 2011 Feb 1
TI  - Dose escalation improves cancer-related events at 10 years for intermediate- and 
      high-risk prostate cancer patients treated with hypofractionated high-dose-rate 
      boost and external beam radiotherapy.
PG  - 363-70
LID - 10.1016/j.ijrobp.2009.10.035 [doi]
AB  - PURPOSE: To evaluate the 10-year outcomes of intermediate- and high-risk prostate 
      cancer patients treated with a prospective dose escalation hypofractionated trial 
      of pelvic external beam radiation therapy (P-EBRT) with a high-dose-rate (HDR) 
      brachytherapy boost. METHODS AND MATERIALS: From 1992 to 2007, 472 patients were 
      treated with a HDR boost at William Beaumont Hospital. They had at least one of 
      the following: a prostate-specific antigen (PSA) level of >10 ng/ml, a Gleason 
      score of >/=7, or clinical stage >/=T2b. Patients received 46-Gy P-EBRT and an HDR 
      boost. The HDR dose fractionation was divided into two dose levels. The prostate 
      biologically equivalent dose (BED) low-dose-level group received <268 Gy, and the 
      high-dose group received >268 Gy . Phoenix biochemical failure (BF) definition 
      was used. RESULTS: Median follow-up was 8.2 years (range, 0.4-17 years). The 
      10-year biochemical failure rate of 43.1% vs. 18.9%, (p < 0.001), the clinical 
      failure rate of 23.4% vs. 7.7%, (p < 0.001), and the distant metastasis of 12.4% 
      vs. 5.7%, (p = 0.028) were all significantly better for the high-dose level 
      group. On Cox multivariate analysis, higher BED levels (p = 0.017; hazard ratio 
      [HR] = 0.586), pretreatment PSA assays (p < 0.001, HR = 1.022), and Gleason 
      scores (p = 0.004) were significant variables for reduced biochemical failure. 
      Higher dose levels (p, 0.002; HR, 0.397) and Gleason scores (p < 0.001) were 
      significant for clinical failure. Grade 3 genitourinary complications were 2% and 
      3%, respectively, and grade 3 gastrointestinal complication was <0.5%. 
      CONCLUSIONS: This prospective trial using P-EBRT with HDR boost and 
      hypofractionated dose escalation demonstrates a strong dose-response relationship 
      for intermediate- and high-risk prostate cancer patients. The improvement at 10 
      years for locoregional control with higher radiation doses (BED, > 268 Gy) has 
      significantly decreased biochemical and clinical failures as well as distant 
      metastasis.
CI  - Copyright A(c) 2011 Elsevier Inc. All rights reserved.
FAU - Martinez, Alvaro A
AU  - Martinez AA
AD  - Radiation Oncology Department, William Beaumont Hospital, Royal Oak, Michigan 
      48073, USA. amartinez@beaumont.edu
FAU - Gonzalez, Jose
AU  - Gonzalez J
FAU - Ye, Hong
AU  - Ye H
FAU - Ghilezan, Mihai
AU  - Ghilezan M
FAU - Shetty, Sugandh
AU  - Shetty S
FAU - Kernen, Kenneth
AU  - Kernen K
FAU - Gustafson, Gary
AU  - Gustafson G
FAU - Krauss, Daniel
AU  - Krauss D
FAU - Vicini, Frank
AU  - Vicini F
FAU - Kestin, Larry
AU  - Kestin L
LA  - eng
PT  - Clinical Trial, Phase II
PT  - Journal Article
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Iridium Radioisotopes)
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Alpha Particles/therapeutic use
MH  - Beta Particles/therapeutic use
MH  - Brachytherapy/*methods
MH  - Dose Fractionation, Radiation
MH  - Dose-Response Relationship, Radiation
MH  - Follow-Up Studies
MH  - Humans
MH  - Iridium Radioisotopes/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Prospective Studies
MH  - Prostate-Specific Antigen/blood
MH  - Prostatic Neoplasms/blood/drug therapy/pathology/*radiotherapy
MH  - Risk
EDAT- 2011/01/05 06:00
MHDA- 2011/02/02 06:00
CRDT- 2011/01/04 06:00
PHST- 2009/08/26 00:00 [received]
PHST- 2009/10/29 00:00 [revised]
PHST- 2009/10/30 00:00 [accepted]
PHST- 2011/01/04 06:00 [entrez]
PHST- 2011/01/05 06:00 [pubmed]
PHST- 2011/02/02 06:00 [medline]
AID - S0360-3016(09)03428-2 [pii]
AID - 10.1016/j.ijrobp.2009.10.035 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):363-70. doi: 
      10.1016/j.ijrobp.2009.10.035.