Analysis of Biochemical Control and Prognostic Factors in Patients Treated With Either Low-Dose Three-Dimensional Conformal Radiation Therapy or High-Dose Intensity-Modulated Radiotherapy for Localized Prostate Cancer
ABSTRACT To identify prognostic factors and evaluate biochemical control rates for patients with localized prostate cancer treated with either high-dose intensity-modulated radiotherapy (IMRT) or conventional-dose three-dimensional conformal radiotherapy 3D-CRT.
Four hundred sixteen patients with a minimum follow-up of 3 years (median, 5 years) were included. Two hundred seventy-one patients received 3D-CRT with a median dose of 68.4 Gy (range, 66-71 Gy). The next 145 patients received IMRT with a median dose of 75.6 Gy (range, 70.2-77.4 Gy). Biochemical control rates were calculated according to both American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definitions. Prognostic factors were identified using both univariate and multivariate analyses.
The 5-year biochemical control rate was 60.4% for 3D-CRT and 74.1% for IMRT (p < 0.0001, first ASTRO Consensus definition). Using the ASTRO Phoenix definition, the 5-year biochemical control rate was 74.4% and 84.6% with 3D-RT and IMRT, respectively (p = 0.0326). Univariate analyses determined that PSA level, T stage, Gleason score, perineural invasion, and radiation dose were predictive of biochemical control. On multivariate analysis, dose, Gleason score, and perineural invasion remained significant.
On the basis of both ASTRO definitions, dose, Gleason score, and perineural invasion were predictive of biochemical control. Intensity-modulated radiotherapy allowed delivery of higher doses of radiation with very low toxicity, resulting in improved biochemical control.
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- "Additionally, the costs of patients having two enemas per day for 2 weeks were included for patients with grade 2 toxicity, as well as the cost of a blood transfusion for patients with grade 3 toxic effects. The average monitoring and treatment costs for the treatment of all late gastrointestinal toxic effects was calculated using the proportions of patients with grade 2 and 3 toxic effects, taken as a patient weighted average from included studies that reported these data  . "
ABSTRACT: AIMS: To determine the cost-effectiveness of intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3DCRT) for men with localised prostate cancer from a UK National Health Service perspective. MATERIALS AND METHODS: A discrete event simulation model was developed to simulate the progress of patients through advancing disease states until death from prostate cancer or other causes. Clinical effectiveness data for IMRT and 3DCRT were derived from a systematic review. Four scenarios were modelled based on different clinical studies. A probabilistic sensitivity analysis was undertaken and the incremental cost per quality adjusted life years (ICER) calculated. RESULTS: In scenarios where estimated survival was greater for IMRT than 3DCRT, IMRT was clearly cost-effective (ICER <£20 000). For scenarios where only a difference in late gastrointestinal toxicity was assumed, the ICER was highly sensitive to uncertain model parameters, including the magnitude of the difference, the duration of gastrointestinal toxicity and the cost difference between treatments. For the most likely scenario, a 15% difference in late gastrointestinal toxicity, the ICER was £35 000, with a 20% probability that it is cost-effective at a maximum threshold of £20 000 and a 48% probability at a threshold of £30 000. CONCLUSION: If IMRT can be used to prolong survival, it is very cost-effective. Otherwise cost-effectiveness is uncertain.Clinical Oncology 10/2012; 24(10). DOI:10.1016/j.clon.2012.09.003 · 2.83 Impact Factor
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ABSTRACT: Das Prostatakarzinom repräsentiert die häufigste Krebsneuerkrankung in der Bundesrepublik Deutschland. Die definitive Strahlentherapie ist eine der beiden empfohlenen kurativen Therapieoptionen dieser Erkrankung. Dabei werden verschiedene Formen unterschieden: die perkutane Strahlentherapie und die interstitielle Brachytherapie. Die technischen Entwicklungen der letzten beiden Jahrzehnte haben dazu geführt, dass für Patienten aller Erkrankungsstadien durch die Strahlentherapie bessere Heilungschancen bzw. eine effektivere Linderung krankheitsbedingter Symptome erreicht werden kann. Dabei kann die Therapie immer sicherer und nebenwirkungsärmer appliziert werden. Es werden sowohl die Ergebnisse der klassischen 3-D-konformalen als auch der neuen perkutanen Strahlentherapietechniken ausführlich dargestellt. Daneben wird auch das Konzept der Hypofraktionierung mit Ergebnissen randomisierter Studien betrachtet. Welche Therapie oder Technik für den individuellen Patienten angewendet wird, muss nach Wertung der Tumorausdehnung und der Risikofaktoren auf einer interdisziplinären Entscheidung basieren.Der Urologe 11/2012; 51(11). DOI:10.1007/s00120-012-3017-0 · 0.44 Impact Factor
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ABSTRACT: This study was undertaken to assess local control and toxicity with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy (CCRT) for early stage cervical cancer. Between June 2004 and February 2007, 54 patients with early stage cervical cancer (stage IB-IIA) with high-risk factors for treatment failure after surgery were treated with adjuvant pelvic IMRT and CCRT. Adjuvant chemotherapy consisted of cisplatin (50 mg/m2) weekly for 4 to 6 courses. All the patients received 50.4 Gy of external beam radiotherapy with IMRT in 28 fractions and 6 Gy of high-dose rate vaginal cuff brachytherapy in 3 insertions. Adjuvant CCRT with IMRT provided good local tumor control in posthysterectomy cervical cancer patients with high-risk pathologic features. The 3-year locoregional control and disease-free survival were 93% and 78%, respectively. Histology and lymph node metastasis were indicators for disease-free survival. Low acute and chronic treatment-related toxicities were noted with IMRT. All the patients completed the radiotherapy treatment without any major toxicity. In terms of chronic toxicity, only 1 patient had grade 3 genitourinary toxicity and none had grade 3 gastrointestinal toxicity. Our results indicate that adjuvant CCRT with IMRT technique for adjuvant treatment of early stage cervical cancer is associated with excellent local control and low toxicity.The Cancer Journal 05/2008; 14(3):200-6. DOI:10.1097/PPO.0b013e318173a04b · 3.61 Impact Factor