High Dose Radiation Reduces Risk of Prostate Cancer Recurrence
Prostate Cancer Treatment
Men with localized prostate cancer who received high-dose external radiation therapy were less likely to have cancer recurrence than men who received conventional-dose radiation therapy, according to an article in the September 14 issue of JAMA.
The majority of cases of prostate cancer now diagnosed in the United States are detected while the disease is still clinically localized, according to background information in the article. External beam radiation is one of the options used to treat more than 26,000 U.S. men annually. Failure after treatment with conventional radiation therapy is common, with a resultant increase in prostate-specific antigen (PSA) levels, secondary treatment, and, ultimately, clinical recurrence. Increasing the delivered radiation dose may increase the probability of local tumor control but carries a risk of greater adverse effects unless the volume of normal tissue treated along with the tumor can be reduced.
In the 1990s a number of computed tomography-based techniques became available to deliver radiation more accurately and thus allow the delivery of higher doses. These techniques are together known as "3-dimensional conformal therapy" and include the use of conformal photon beams, intensity-modulated photon beams, and proton beams.
Anthony L. Zietman, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine whether tumor control could be improved in patients with prostate cancer, including those with low-risk disease, by the use of higher radiation doses. The study included 393 patients with stage T1b through T2b prostate cancer and prostate-specific antigen (PSA) levels less than 15 ng/mL, randomized between January 1996 and December 1999. The median (middle) value for PSA levels was 6.3 ng/mL, and the median follow-up time was 5.5 years. Patients received either external beam radiation to a total dose of either 70.2 Gy (radiation dose unit; conventional dose) or 79.2 Gy (high dose). This was delivered using a combination of conformal photon and proton beams.
The researchers found that the proportions of men free from biochemical failure (increasing PSA level) at 5 years were 61.4 percent for conventional-dose and 80.4 percent for high-dose therapy, a 49 percent reduction in the risk of failure. The advantage to high-dose therapy was observed in both the low-risk and the higher-risk subgroups (risk reduction, 51 percent and 44 percent, respectively). There has been no significant difference in overall survival rates between the treatment groups. Only 1 percent of patients receiving conventional-dose and 2 percent receiving high-dose radiation experienced acute urinary or rectal problems of Radiation Therapy Oncology Group (RTOG) grade 3 or greater. So far, only 2 percent and 1 percent, respectively, have experienced late problems having RTOG grade 3 or greater.
"This randomized trial shows that when men with clinically localized prostate cancer are treated with high-dose rather than conventional-dose external radiation therapy, they are more likely to be free from an increasing PSA level 5 years later and less likely to have locally persistent disease," the authors conclude.
(JAMA. 2005;294:1233-1239) - CHICAGO