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External beam irradiation of prostate cancer. Conformal treatment techniques and outcomes for the 1990
Author(s) -
Hanks Gerald E.,
Corn Benjamin W.,
Lee W. Robert,
Hunt Margie,
Hanlon Alexandra,
Schultheiss Timothy E.
Publication year - 1995
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19950401)75:7+<1972::aid-cncr2820751636>3.0.co;2-p
Subject(s) - medicine , prostate cancer , prostate , cancer , oncology , irradiation , beam (structure) , medical physics , optics , physics , nuclear physics
Background . This paper presents the results of external beam treatment of prostate cancer. Long term results are represented by the U.S. national averages from the Patterns of Care study. The modern innovations of three‐dimensional‐assisted conformal treatment are also shown to demonstrate the technologic progress in external beam treatment, the effect of pretreatment prostate specific antigen (PSA), the inaccuracy of clinical end points used for 30 years, and the new early outcome standards for the 1990s. Methods . The Patterns of Care study has surveyed the national practice for processes of care and outcome of care in the United States. Ten‐ and 15‐year outcomes are reported for patients treated in 1973 and 1978 by external beam irradiation. The conformal radiation therapy program developed at Fox Chase Cancer Center since 1989 is used to illustrate the advantage of this technology, the importance of pretreatment PSA level on outcome, the inaccuracies in clinical end point evaluation, and the reduction in morbidity associated with conformal treatment. Three hundred seventy‐three consecutive patients treated with conformal therapy were compared with 129 consecutive conventionally treated patients for survival end points. The outcome of 460 consecutive patients with pretreatment PSA are presented by pretreatment PSA level. Late morbidity is presented for 208 consecutive conformal treated patients who received 68‐71 Gy to the center of the prostate. Cancer control is defined as biochemical control of cancer (bNED) and requires a nonrising PSA with a nadir of less than or equal to 1.5 ng/ml. Results . Conformal treatment was superior to conventional in 12‐month PSA response ( P = 0.00005), 4‐year bNED ( P < 0.005), and multivariate analysis ( P < 0.04). The difference between clinical absence of disease and bNED at 4 years was 8% for pretreatment PSA less than 10 ng/ml, 51% for PSA 10‐20 ng/ml, and 57% for pretreatment PSA greater than 20 ng/ml. Acute morbidity of conformal therapy was reduced ( P < 0.00001), and late morbidity was observed at 5 years in only 4.2% of 208 consecutive patients treated to 68‐71 Gy. Conclusions . The conformal treatment method is superior to conventional treatment, and this technology should be further developed and disseminated. Dose escalation beyond 68‐71 Gy is not indicated by these data, although these results are preliminary, with short term follow‐up for the conformal group and longer follow‐up for the conventional group. PSA evaluation of cancer control shows that 83% of patients presenting with a pretreatment PSA level less than 10 are bNED at 5 years and only 13% of those with pretreatment PSA level greater than 20. Cancer 1995;75:1972–7.