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Stereotactic body radiotherapy as treatment for organ confined low- and intermediate-risk prostate carcinoma, a 7-year study.

Katz AJ, Kang J - Front Oncol (2014)

Bottom Line: Among patients with intermediate-risk disease, those considered to have low intermediate-risk (Gleason 6 with PSA >10, or Gleason 3 + 4 with PSA <10; n = 106) had a significantly higher bDFS than patients with high intermediate-risk (Gleason 3 + 4 with PSA 10-20 or Gleason 4 + 3; n = 47), with bDFS of 93.5 vs. 79.3%, respectively.Median PSA levels compare favorably with other radiation modalities and strongly suggest durability of response.These results also strongly suggest that 35 Gy is as effective as 36.25 Gy for low- and intermediate-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Flushing Radiation Oncology Services , Flushing, NY , USA.

ABSTRACT

Objectives: Stereotactic body radiation therapy (SBRT) takes advantage of the prostate's low α/β ratio to deliver a large radiation dose in few fractions. Initial studies on small groups of low-risk patients support SBRT's potential for clinical efficacy while limiting treatment-related morbidity and maintained quality of life. This prospective study expands upon prior studies to further evaluate SBRT efficacy for a large patient population with organ confined, low- and intermediate-risk prostate cancer patients.

Methods: Four hundred seventy-seven patients with prostate cancer received CyberKnife SBRT. The median age was 68.6 years and the median PSA was 5.3 ng/mL. Three hundred twenty-four patients were low-risk (PSA <10 ng/mL and Gleason <7), 153 were intermediate-risk (PSA 10-20 ng/mL or Gleason = 7). Androgen deprivation therapy was administered to 51 patients for up to 6 months. One hundred fifty-four patients received 35 Gy delivered in five daily fractions; the remaining patients received a total dose of 36.25 Gy in five daily fractions. Biochemical failure was assessed using the phoenix criterion.

Results: Median follow-up was 72 months. The median PSA at 7 years was 0.11 ng/mL. Biochemical failures occurred for 11 low-risk patients (2 locally), 14 intermediate-risk patients (3 locally). The actuarial 7-year freedom from biochemical failure was 95.6 and 89.6% for low- and intermediate-risk groups, respectively (p < 0.012). Among patients with intermediate-risk disease, those considered to have low intermediate-risk (Gleason 6 with PSA >10, or Gleason 3 + 4 with PSA <10; n = 106) had a significantly higher bDFS than patients with high intermediate-risk (Gleason 3 + 4 with PSA 10-20 or Gleason 4 + 3; n = 47), with bDFS of 93.5 vs. 79.3%, respectively. For the low-risk and low intermediate-risk groups, there was no difference in median PSA nadir or biochemical disease control between doses of 35 and 36.25 Gy.

Conclusion: CyberKnife SBRT produces excellent biochemical control rates. Median PSA levels compare favorably with other radiation modalities and strongly suggest durability of response. These results also strongly suggest that 35 Gy is as effective as 36.25 Gy for low- and intermediate-risk patients.

No MeSH data available.


Related in: MedlinePlus

Median PSA value in the entire patient cohort. Error bars reflect interquartile range. The Number of patients with PSA data at each time point is listed below. Patients with biochemical recurrence are excluded.
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Figure 8: Median PSA value in the entire patient cohort. Error bars reflect interquartile range. The Number of patients with PSA data at each time point is listed below. Patients with biochemical recurrence are excluded.

Mentions: PSA decline after SBRT gradually fell to an overall median of 0.11 ng/mL at 7 years (Figure 8). For the cohort of patients with 8-year follow up, median PSA remained low, at 0.11 ng/mL. Median time to nadir was 48 months (range, 3–84 months). A PSA bounce of >0.2 ng/mL was noted among 16% of patients at a median of 36 months (range, 3–60 months), with median bounce height of 0.50 ng/mL (range, 0.2–5.29). There was no statistically significant difference in bDFS for patients with PSA bounce vs. no bounce. Dose made no difference in the level of median PSAs at all measurement points (Figure 9).


Stereotactic body radiotherapy as treatment for organ confined low- and intermediate-risk prostate carcinoma, a 7-year study.

Katz AJ, Kang J - Front Oncol (2014)

Median PSA value in the entire patient cohort. Error bars reflect interquartile range. The Number of patients with PSA data at each time point is listed below. Patients with biochemical recurrence are excluded.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150980&req=5

Figure 8: Median PSA value in the entire patient cohort. Error bars reflect interquartile range. The Number of patients with PSA data at each time point is listed below. Patients with biochemical recurrence are excluded.
Mentions: PSA decline after SBRT gradually fell to an overall median of 0.11 ng/mL at 7 years (Figure 8). For the cohort of patients with 8-year follow up, median PSA remained low, at 0.11 ng/mL. Median time to nadir was 48 months (range, 3–84 months). A PSA bounce of >0.2 ng/mL was noted among 16% of patients at a median of 36 months (range, 3–60 months), with median bounce height of 0.50 ng/mL (range, 0.2–5.29). There was no statistically significant difference in bDFS for patients with PSA bounce vs. no bounce. Dose made no difference in the level of median PSAs at all measurement points (Figure 9).

Bottom Line: Among patients with intermediate-risk disease, those considered to have low intermediate-risk (Gleason 6 with PSA >10, or Gleason 3 + 4 with PSA <10; n = 106) had a significantly higher bDFS than patients with high intermediate-risk (Gleason 3 + 4 with PSA 10-20 or Gleason 4 + 3; n = 47), with bDFS of 93.5 vs. 79.3%, respectively.Median PSA levels compare favorably with other radiation modalities and strongly suggest durability of response.These results also strongly suggest that 35 Gy is as effective as 36.25 Gy for low- and intermediate-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Flushing Radiation Oncology Services , Flushing, NY , USA.

ABSTRACT

Objectives: Stereotactic body radiation therapy (SBRT) takes advantage of the prostate's low α/β ratio to deliver a large radiation dose in few fractions. Initial studies on small groups of low-risk patients support SBRT's potential for clinical efficacy while limiting treatment-related morbidity and maintained quality of life. This prospective study expands upon prior studies to further evaluate SBRT efficacy for a large patient population with organ confined, low- and intermediate-risk prostate cancer patients.

Methods: Four hundred seventy-seven patients with prostate cancer received CyberKnife SBRT. The median age was 68.6 years and the median PSA was 5.3 ng/mL. Three hundred twenty-four patients were low-risk (PSA <10 ng/mL and Gleason <7), 153 were intermediate-risk (PSA 10-20 ng/mL or Gleason = 7). Androgen deprivation therapy was administered to 51 patients for up to 6 months. One hundred fifty-four patients received 35 Gy delivered in five daily fractions; the remaining patients received a total dose of 36.25 Gy in five daily fractions. Biochemical failure was assessed using the phoenix criterion.

Results: Median follow-up was 72 months. The median PSA at 7 years was 0.11 ng/mL. Biochemical failures occurred for 11 low-risk patients (2 locally), 14 intermediate-risk patients (3 locally). The actuarial 7-year freedom from biochemical failure was 95.6 and 89.6% for low- and intermediate-risk groups, respectively (p < 0.012). Among patients with intermediate-risk disease, those considered to have low intermediate-risk (Gleason 6 with PSA >10, or Gleason 3 + 4 with PSA <10; n = 106) had a significantly higher bDFS than patients with high intermediate-risk (Gleason 3 + 4 with PSA 10-20 or Gleason 4 + 3; n = 47), with bDFS of 93.5 vs. 79.3%, respectively. For the low-risk and low intermediate-risk groups, there was no difference in median PSA nadir or biochemical disease control between doses of 35 and 36.25 Gy.

Conclusion: CyberKnife SBRT produces excellent biochemical control rates. Median PSA levels compare favorably with other radiation modalities and strongly suggest durability of response. These results also strongly suggest that 35 Gy is as effective as 36.25 Gy for low- and intermediate-risk patients.

No MeSH data available.


Related in: MedlinePlus