Seo Hee Choi1,2, Young Seok Kim3, Jesang Yu3, Taek-Keun Nam4, Jae-Sung Kim5, Bum-Sup Jang5, Jin Ho Kim6, Youngkyong Kim7, Bae Kwon Jung8, Ah Ram Chang9, Young-Hee Park9, Sung Uk Lee10, Kwan Ho Cho10, Jin Hee Kim11, Hunjung Kim12, Youngmin Choi13, Yeon Joo Kim3,14, Dong Soo Lee15, Young Ju Shin16, Su Jung Shim17, Won Park18, Jaeho Cho2. 1. Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea. 2. Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea. 3. Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea. 4. Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju 61469, Korea. 5. Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea. 6. Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. 7. Department of Radiation Oncology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea. 8. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Korea. 9. Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea. 10. The Proton Therapy Center, National Cancer Center, Research Institute and Hospital, Goyang 10408, Korea. 11. Keimyung University Dongsan Medical Center, Department of Radiation Oncology, Keimyung University School of Medicine, Daegu 42601, Korea. 12. Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Korea. 13. Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan 49201, Korea. 14. Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon 24289, Korea. 15. Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Korea. 16. Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul 04551, Korea. 17. Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul 01830, Korea. 18. Samsung Medical Center, Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Abstract
PURPOSE: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. METHODS AND MATERIALS: We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. RESULTS: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524-0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy1.5 were significant factors in the high-risk group, whereas ≥170 Gy1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. CONCLUSIONS: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.
PURPOSE: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancerpatients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. METHODS AND MATERIALS: We included non-metastatic prostate cancerpatients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. RESULTS: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524-0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy1.5 were significant factors in the high-risk group, whereas ≥170 Gy1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. CONCLUSIONS: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.
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