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• W2105566053 abstract "We appreciate the comments of Dr. Halperin about the differences in patients with localized prostate cancer treated with different modalities as reported in our study ( 1 Kupelian P.A. Potters L. Khuntia D. et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Radiat Oncol Biol Phys. 2004; 58: 25-33 Abstract Full Text Full Text PDF PubMed Scopus (417) Google Scholar ). Specifically, the concern was that the difference in outcomes observed between patients receiving <72 Gy vs. ≥72 Gy is secondary to differences in follow-up period and/or a resultant of the ASTRO definition of biochemical failure. With respect to the failure definition, the differences observed in outcomes should be the same, because the same definition was applied to both groups. With respect to follow-up periods, there is no doubt that with the use of KM curves, some of the difference between the two dose levels is due to the difference in follow-up periods. Therefore, with analysis of subgroups that have closer follow-up periods, that difference will decrease. However, although the magnitude of the difference might vary, the dose effect is real, regardless of follow-up duration. This was demonstrated by the well-known randomized study reported by Pollack et al. ( 2 Pollack A. Zagars G.K. Starkschall G. et al. Prostate cancer radiation dose response: Results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys. 2002; 53: 1097-1105 Abstract Full Text Full Text PDF PubMed Scopus (1206) Google Scholar ), and more recently the randomized dose escalation protocol with protons reported by Zietman et al. ( 3 Zietman A. DeSilvio M. Slater J. et al. A randomized trial comparing conventional dose (70.2 GyE) and high-dose (79.2 GyE) conformal radiation in early stage adenocarcinoma of the prostate: Results of an interim analysis of PROG 95-09. Int J Radiat Oncol Biol Phys. 2004; 60: S131 Google Scholar ). In addition, in a separate multi-institutional data set that we looked at for patients treated only in 1994 and 1995, radiation therapy dose was again an independent predictor of failure ( 4 Kupelian P.A. Kuban D. Thames H. et al. Improved biochemical relapse-free survival with increased external radiation doses in patients with localized prostate cancer: The combined experience of nine institutions in patients treated in 1994 and 1995. Int J Radiat Oncol Biol Phys. 2003; 57: S271-272 Abstract Full Text Full Text PDF Google Scholar ). All these analyses were done with patient groups with identical follow-up periods. In regard to Kupelian et al.: Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy ≥72 Gy, permanent seed implantation, or combined seed/external beam radiotherapy for stage T1-T2 prostate cancer (Int J Radiat Oncol Biol Phys 2004;58:25–33)International Journal of Radiation Oncology, Biology, PhysicsVol. 61Issue 2PreviewKudos to Kupelian et al. for their excellent analysis describing biochemical failure rates for prostate cancer patients treated by radical prostatectomy, external beam radiotherapy, and brachytherapy (1). In this analysis, patients who received external beam radiotherapy with <72 Gy were reported to have a significantly higher biochemical failure rate than all other groups analyzed. A review of the data showed that the median follow-up duration for <72 Gy patients was 75 months, which is the longest of all of the evaluated groups by at least 9 months. Full-Text PDF" @default.
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• W2105566053 date "2005-02-01" @default.
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• W2105566053 title "In response to Dr. Halperin" @default.
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