Radiation dose response in patients with favorable localized prostate cancer (Stage T1-T2, biopsy Gleason ≤ 6, and pretreatment prostate-specific antigen ≤ 10)

Patrick A. Kupelian, Jeffrey C. Buchsbaum, Chandana A. Reddy, Eric A. Klein

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Purpose: To study the radiation dose response as determined by biochemical relapse-free survival in patients with favorable localized prostate cancers, i.e., Stage T1-T2, biopsy Gleason score (bGS) ≤ 6, and pretreatment prostate-specific antigen (iPSA) ≤ 10 ng/mL. Methods and Materials: A total of 292 patients with favorable localized prostate cancer were treated with radiotherapy alone between 1986 and 1999. The median age was 69 years. Sixteen percent of cases (n = 46) were African-American. The distribution by clinical T stage was as follows: T1/T2A, 243 (83%); and T2B/T2C, 49 (17%). The distribution by iPSA was as follows: ≤ 4 ng/mL, 49 (17%); and > 4 ng/mL, 243 (83%). The mean iPSA level was 6.2 (median, 6.4). The distribution by bGS was as follows: ≤ 5 in 89 cases (30%) and 6 in 203 cases (70%). The median radiation dose was 70.0 Gy (range, 63.0-78.0 Gy). Doses of ≤ 70.0 Gy were delivered in 175 cases, 70.2-72.0 Gy in 24 cases, 74 Gy in 30 cases, and 78 Gy in 63 cases. For patients receiving <72 Gy, the median dose was 68 Gy, vs. 78 Gy for patients receiving ≥ 72 Gy. A conformal technique was used in 129 (44%) of cases. The median follow-up was 43 months (range, 3-153). Results: For the entire cohort, the projected 5- and 8-year biochemical relapse-free survival (bRFS) rates were both 81%. For patients receiving ≥ 72 Gy, the 5- and 8-year bRFS rates were both 95% vs. only 77% for patients receiving <72 Gy, p = 0.010. For patients receiving 74 Gy, the 4-year bRFS rate was 94% vs. 96% for patients receiving 78 Gy, p = 0.90. A multivariate analysis for factors affecting bRFS rates using Cox proportional hazards was performed for all cases using the following variables: age (continuous variable), race (black vs. white), iPSA (continuous variable), bGS (≤ 5 vs. 6), Stage (T1-2A vs. T2B-C), radiation dose (continuous variable), and radiation technique (conformal vs. standard). From the multivariate analysis, only iPSA (p = 0.017, χ 2 = 5.7), and radiation dose (p = 0.021, χ 2 = 5.3) were independent predictors of outcome. Age (p = 0.94), race (p = 0.89), stage (p = 0.45), biopsy GS (p = 0.40), and radiation technique (p = 0.45) were not. Conclusion: There is a clear radiation dose response in patients with favorable localized prostate cancers (i.e., Stage T1-T2, biopsy Gleason score ≤ 6, and iPSA ≤ 10 ng/mL). At least 74 Gy should be delivered to the prostate and periprostatic tissues. With our cohort of patients, longer follow-up will be needed to assess the importance of doses exceeding 74 Gy.

Original languageEnglish (US)
Pages (from-to)621-625
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume50
Issue number3
DOIs
StatePublished - Jul 1 2001
Externally publishedYes

Fingerprint

antigens
Prostate-Specific Antigen
pretreatment
Prostatic Neoplasms
cancer
Radiation
Biopsy
dosage
radiation
Neoplasm Grading
Recurrence
Survival Rate
Multivariate Analysis
Hospital Distribution Systems
African Americans
hazards
Prostate
radiation therapy
Radiotherapy
Survival

Keywords

  • Biochemical relapse-free survival
  • Localized prostate cancer
  • Radiation dose
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Radiation dose response in patients with favorable localized prostate cancer (Stage T1-T2, biopsy Gleason ≤ 6, and pretreatment prostate-specific antigen ≤ 10). / Kupelian, Patrick A.; Buchsbaum, Jeffrey C.; Reddy, Chandana A.; Klein, Eric A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 50, No. 3, 01.07.2001, p. 621-625.

Research output: Contribution to journalArticle

@article{9fac99dbd7a149dc96b51cf030d12e7f,
title = "Radiation dose response in patients with favorable localized prostate cancer (Stage T1-T2, biopsy Gleason ≤ 6, and pretreatment prostate-specific antigen ≤ 10)",
abstract = "Purpose: To study the radiation dose response as determined by biochemical relapse-free survival in patients with favorable localized prostate cancers, i.e., Stage T1-T2, biopsy Gleason score (bGS) ≤ 6, and pretreatment prostate-specific antigen (iPSA) ≤ 10 ng/mL. Methods and Materials: A total of 292 patients with favorable localized prostate cancer were treated with radiotherapy alone between 1986 and 1999. The median age was 69 years. Sixteen percent of cases (n = 46) were African-American. The distribution by clinical T stage was as follows: T1/T2A, 243 (83{\%}); and T2B/T2C, 49 (17{\%}). The distribution by iPSA was as follows: ≤ 4 ng/mL, 49 (17{\%}); and > 4 ng/mL, 243 (83{\%}). The mean iPSA level was 6.2 (median, 6.4). The distribution by bGS was as follows: ≤ 5 in 89 cases (30{\%}) and 6 in 203 cases (70{\%}). The median radiation dose was 70.0 Gy (range, 63.0-78.0 Gy). Doses of ≤ 70.0 Gy were delivered in 175 cases, 70.2-72.0 Gy in 24 cases, 74 Gy in 30 cases, and 78 Gy in 63 cases. For patients receiving <72 Gy, the median dose was 68 Gy, vs. 78 Gy for patients receiving ≥ 72 Gy. A conformal technique was used in 129 (44{\%}) of cases. The median follow-up was 43 months (range, 3-153). Results: For the entire cohort, the projected 5- and 8-year biochemical relapse-free survival (bRFS) rates were both 81{\%}. For patients receiving ≥ 72 Gy, the 5- and 8-year bRFS rates were both 95{\%} vs. only 77{\%} for patients receiving <72 Gy, p = 0.010. For patients receiving 74 Gy, the 4-year bRFS rate was 94{\%} vs. 96{\%} for patients receiving 78 Gy, p = 0.90. A multivariate analysis for factors affecting bRFS rates using Cox proportional hazards was performed for all cases using the following variables: age (continuous variable), race (black vs. white), iPSA (continuous variable), bGS (≤ 5 vs. 6), Stage (T1-2A vs. T2B-C), radiation dose (continuous variable), and radiation technique (conformal vs. standard). From the multivariate analysis, only iPSA (p = 0.017, χ 2 = 5.7), and radiation dose (p = 0.021, χ 2 = 5.3) were independent predictors of outcome. Age (p = 0.94), race (p = 0.89), stage (p = 0.45), biopsy GS (p = 0.40), and radiation technique (p = 0.45) were not. Conclusion: There is a clear radiation dose response in patients with favorable localized prostate cancers (i.e., Stage T1-T2, biopsy Gleason score ≤ 6, and iPSA ≤ 10 ng/mL). At least 74 Gy should be delivered to the prostate and periprostatic tissues. With our cohort of patients, longer follow-up will be needed to assess the importance of doses exceeding 74 Gy.",
keywords = "Biochemical relapse-free survival, Localized prostate cancer, Radiation dose, Radiotherapy",
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TY - JOUR

T1 - Radiation dose response in patients with favorable localized prostate cancer (Stage T1-T2, biopsy Gleason ≤ 6, and pretreatment prostate-specific antigen ≤ 10)

AU - Kupelian, Patrick A.

AU - Buchsbaum, Jeffrey C.

AU - Reddy, Chandana A.

AU - Klein, Eric A.

PY - 2001/7/1

Y1 - 2001/7/1

N2 - Purpose: To study the radiation dose response as determined by biochemical relapse-free survival in patients with favorable localized prostate cancers, i.e., Stage T1-T2, biopsy Gleason score (bGS) ≤ 6, and pretreatment prostate-specific antigen (iPSA) ≤ 10 ng/mL. Methods and Materials: A total of 292 patients with favorable localized prostate cancer were treated with radiotherapy alone between 1986 and 1999. The median age was 69 years. Sixteen percent of cases (n = 46) were African-American. The distribution by clinical T stage was as follows: T1/T2A, 243 (83%); and T2B/T2C, 49 (17%). The distribution by iPSA was as follows: ≤ 4 ng/mL, 49 (17%); and > 4 ng/mL, 243 (83%). The mean iPSA level was 6.2 (median, 6.4). The distribution by bGS was as follows: ≤ 5 in 89 cases (30%) and 6 in 203 cases (70%). The median radiation dose was 70.0 Gy (range, 63.0-78.0 Gy). Doses of ≤ 70.0 Gy were delivered in 175 cases, 70.2-72.0 Gy in 24 cases, 74 Gy in 30 cases, and 78 Gy in 63 cases. For patients receiving <72 Gy, the median dose was 68 Gy, vs. 78 Gy for patients receiving ≥ 72 Gy. A conformal technique was used in 129 (44%) of cases. The median follow-up was 43 months (range, 3-153). Results: For the entire cohort, the projected 5- and 8-year biochemical relapse-free survival (bRFS) rates were both 81%. For patients receiving ≥ 72 Gy, the 5- and 8-year bRFS rates were both 95% vs. only 77% for patients receiving <72 Gy, p = 0.010. For patients receiving 74 Gy, the 4-year bRFS rate was 94% vs. 96% for patients receiving 78 Gy, p = 0.90. A multivariate analysis for factors affecting bRFS rates using Cox proportional hazards was performed for all cases using the following variables: age (continuous variable), race (black vs. white), iPSA (continuous variable), bGS (≤ 5 vs. 6), Stage (T1-2A vs. T2B-C), radiation dose (continuous variable), and radiation technique (conformal vs. standard). From the multivariate analysis, only iPSA (p = 0.017, χ 2 = 5.7), and radiation dose (p = 0.021, χ 2 = 5.3) were independent predictors of outcome. Age (p = 0.94), race (p = 0.89), stage (p = 0.45), biopsy GS (p = 0.40), and radiation technique (p = 0.45) were not. Conclusion: There is a clear radiation dose response in patients with favorable localized prostate cancers (i.e., Stage T1-T2, biopsy Gleason score ≤ 6, and iPSA ≤ 10 ng/mL). At least 74 Gy should be delivered to the prostate and periprostatic tissues. With our cohort of patients, longer follow-up will be needed to assess the importance of doses exceeding 74 Gy.

AB - Purpose: To study the radiation dose response as determined by biochemical relapse-free survival in patients with favorable localized prostate cancers, i.e., Stage T1-T2, biopsy Gleason score (bGS) ≤ 6, and pretreatment prostate-specific antigen (iPSA) ≤ 10 ng/mL. Methods and Materials: A total of 292 patients with favorable localized prostate cancer were treated with radiotherapy alone between 1986 and 1999. The median age was 69 years. Sixteen percent of cases (n = 46) were African-American. The distribution by clinical T stage was as follows: T1/T2A, 243 (83%); and T2B/T2C, 49 (17%). The distribution by iPSA was as follows: ≤ 4 ng/mL, 49 (17%); and > 4 ng/mL, 243 (83%). The mean iPSA level was 6.2 (median, 6.4). The distribution by bGS was as follows: ≤ 5 in 89 cases (30%) and 6 in 203 cases (70%). The median radiation dose was 70.0 Gy (range, 63.0-78.0 Gy). Doses of ≤ 70.0 Gy were delivered in 175 cases, 70.2-72.0 Gy in 24 cases, 74 Gy in 30 cases, and 78 Gy in 63 cases. For patients receiving <72 Gy, the median dose was 68 Gy, vs. 78 Gy for patients receiving ≥ 72 Gy. A conformal technique was used in 129 (44%) of cases. The median follow-up was 43 months (range, 3-153). Results: For the entire cohort, the projected 5- and 8-year biochemical relapse-free survival (bRFS) rates were both 81%. For patients receiving ≥ 72 Gy, the 5- and 8-year bRFS rates were both 95% vs. only 77% for patients receiving <72 Gy, p = 0.010. For patients receiving 74 Gy, the 4-year bRFS rate was 94% vs. 96% for patients receiving 78 Gy, p = 0.90. A multivariate analysis for factors affecting bRFS rates using Cox proportional hazards was performed for all cases using the following variables: age (continuous variable), race (black vs. white), iPSA (continuous variable), bGS (≤ 5 vs. 6), Stage (T1-2A vs. T2B-C), radiation dose (continuous variable), and radiation technique (conformal vs. standard). From the multivariate analysis, only iPSA (p = 0.017, χ 2 = 5.7), and radiation dose (p = 0.021, χ 2 = 5.3) were independent predictors of outcome. Age (p = 0.94), race (p = 0.89), stage (p = 0.45), biopsy GS (p = 0.40), and radiation technique (p = 0.45) were not. Conclusion: There is a clear radiation dose response in patients with favorable localized prostate cancers (i.e., Stage T1-T2, biopsy Gleason score ≤ 6, and iPSA ≤ 10 ng/mL). At least 74 Gy should be delivered to the prostate and periprostatic tissues. With our cohort of patients, longer follow-up will be needed to assess the importance of doses exceeding 74 Gy.

KW - Biochemical relapse-free survival

KW - Localized prostate cancer

KW - Radiation dose

KW - Radiotherapy

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