Exclusive image guided IMRT vs. radical prostatectomy followed by postoperative IMRT for localized prostate cancer: a matched-pair analysis based on risk-groups

Radiation Oncology

Gilles Créhange³  Philippe Maingon³  Jérôme Chamois³  Gilles Truc³  Karine Peignaux-Casasnovas³  Etienne Martin³  Luc Cormier¹  Céline Mirjolet³  Mélanie Gauthier²  Caroline Azelie³ 

[1] Department of Oncological Surgery, Anticancer center Georges François, Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France;Department of Biostatistics, Anticancer center Georges François, Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France;Department of Radiation Oncology, Anticancer center Georges François, Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France

关键词: Exclusive radiotherapy;    Postoperative radiotherapy;    IMRT;    IGRT;    Prostate cancer;   

Others  :  1155291
DOI  :  10.1186/1748-717X-7-158

 received in 2012-05-15, accepted in 2012-09-09,  发布年份 2012

【 摘 要 】

Background

To investigate whether patients treated for a localized prostate cancer (PCa) require a radical prostatectomy followed by postoperative radiotherapy or exclusive radiotherapy, in the modern era of image guided IMRT.

Methods

178 patients with PCa were referred for daily exclusive image guided IMRT (IG-IMRT) using an on-line 3D ultra-sound based system and 69 patients were referred for postoperative IMRT without image guidance after radical prostatectomy (RP + IMRT). Patients were matched in a 1:1 ratio according to their baseline risk group before any treatment. Late toxicity was scored using the CTV v3.0 scale. Biochemical failure was defined as a postoperative PSA ≤ 0.1 ng/mL followed by 1 consecutive rising PSA for the postoperative group of patients and by the Phoenix definition (nadir + 2 ng/mL) for the group of patients treated with exclusive radiotherapy.

Results

A total of 98 patients were matched (49:49). From the start of any treatment, the median follow-up was 56.6 months (CI 95% = [49.6-61.2], range [18.2-115.1]). No patient had late gastrointestinal grade ≥ 2 toxicity in the IG-IMRT group vs. 4% in the RP + IMRT group. Forty two percent of the patients in both groups had late grade ≥ 2 genitourinary toxicity. The 5-year FFF rates in the IG-IMRT group and in the RP + IMRT groups were 93.1% [80.0-97.8] and 76.5% [58.3-87.5], respectively (p = 0.031).

Conclusions

Patients with a localized PCa treated with IG-IMRT had better oncological outcome than patients treated with RP + IMRT. Further improvements in postoperative IMRT using image guidance and dose escalation are urgently needed.

【 授权许可】

   
2012 Azelie et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

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