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• W1983901363 abstract "The outcome for patients with Gleason 8–10 prostate cancer has been disappointing. In an effort to improve results, three trials of radiotherapy delivering a very high biological dose via an intensity modulated high dose rate (HDR) brachytherapy boost were performed at three different centers. The combined 5 and 10-year outcomes are reported. During the PSA era, from 1987 to 2002, 1,697 patients were treated for clinically localized prostate cancer in three prospective trials of HDR prostate boost. Patients with Gleason 8–10 were selected for this analysis and 313 met the inclusion criteria. The total conformal EBRT dose ranged from 38.6 to 50.4 Gy in 1.8 to 2 Gy daily fractions. Following HDR Boost, the total combined BED dose ranged from 80.2 to 136.3 Gy based upon an α/β ratio of 1.2. Multiple biochemical control (BC) definitions were used including ASTRO (3 rises), Nadir +2 ng/ml (Phoenix), and Threshold 3 (3 ng/ml at/after nadir). Standard definitions were applied for overall survival (OS), cause-specific survival (CSS), clinical failure (CF) and distant metastasis (DM). The median age was 68 yrs (44–85) and median follow-up was 4.4 yrs (0.3–14.9). Follow-up was >5 years for 147 patients and >8 years for 68 patients. Gleason scores of 8, 9, and 10 were seen in 65.1%, 32.4%, and 2.5% of patients, respectively. Stage T2-3 was seen in 87% of the cases. Initial PSA (iPSA) was 10–20 ng/ml and >20 ng/ml in 30.4% and 27% of patients, respectively. Androgen deprivation therapy (ADT) was utilized in 65.8% of patients. Maximal duration of ADT was 6 months. BC for ASTRO, Nadir+2, and Threshold 3 definitions were 74.3%, 70.6%, and 73.5% at 5-years and 67.0%, 58.8%, 57.3% at 10-yrs, respectively. At 10-yrs, rates of DM, CF, CSS, and OS were 28.2%, 34.8%, 80.0% and 65.2%, respectively. Ten-year rates of DM and CSS were not significantly different when stratified by Gleason score (DM, p = 0.8; CSS, p = 0.6). In multivariate analysis, iPSA was the only factor significant for DM (p = 0.005) and CSS (p = 0.02). Results with intensity modulated HDR-brachytherapy boost for Gleason 8–10 prostate cancer show very good BC at 5- and 10-yrs based on multiple BC definitions. CSS remains high at 10-yrs in this historically aggressive disease (Table).Tabled 1The 5 and 10-year outcomes: Gleason 8-10 cases (n = 313)End point5-yr outcome10-yr outcomeBiochemical Control ASTRO74.3%67.0% Nadir + 2 ng/ml70.6%58.8% Threshold 373.5%57.3%Distant Metastases15.6%28.2%Clinical Failure19.5%34.8%Cause-Specific Survival90.7%80.0%Overall Survival81.5%65.2% Open table in a new tab" @default.
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• W1983901363 date "2007-11-01" @default.
• W1983901363 modified "2023-09-26" @default.
• W1983901363 title "Improved 10-year Outcomes for Prostate Cancer Patients With Gleason 8–10 Treated With Intensity Modulated High Dose Rate Brachytherapy Boost in the PSA Era" @default.
• W1983901363 doi "https://doi.org/10.1016/j.ijrobp.2007.07.152" @default.
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