Dose Response In Prostate Cancer
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The document discusses evidence for dose escalation in prostate cancer radiotherapy. It summarizes several randomized controlled trials that found dose escalation improved biochemical control rates with acceptable toxicity. The largest trial, RT01, found a significant improvement in progression-free survival but also greater bowel toxicity for the higher dose. Ongoing trials are further exploring dose escalation using newer techniques like intensity-modulated radiotherapy to better spare surrounding tissues.
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Dose Response In Prostate Cancer
- 1. The evidence for dose escalation in prostate cancer A. Choudhury SpR, Clinical Oncology
- 5. αβ ratios and radiosensitivity 2 Spinal cord 5 Squamous cell carcinoma Low 10 Mucosa 10 Lymphoma High αβ ratio
- 6. The therapeutic ratio Effect Tumour Dose normal tissue damage Maximum tumour kill with minimum normal tissue toxicity Tumour control
- 9. Radiation Dose Escalation improves biochemical control bPFS=biochemical progression free survival FFF= freedom from failure 64% vs. 80% bPFS at 5 years 55Gy/20 vs. 35.75Gy/13 + HDR 8.5Gy x 2 220 Hoskin (Mt Vernon) 2007 60% vs. 71% bPFS at 5 years 64Gy/32 vs. 74Gy/37 843 Dearnaley (RTO1) 2007 54% vs. 64% FFF at 5 years 68Gy/34 vs. 78Gy/39 664 Peeters (Dutch) 2006 61% vs. 80% bPFS at 5 years 70.2Gy vs. 79.2Gy (proton boost) 393 Zietman 2005 59% vs. 78% bPFS at 5 years 70Gy/35 vs. 78Gy/39 301 Pollack (MDA) 2007 update Result Comparison N RCT
- 11. Conformal CT planned radiotherapy
- 13. Radiation Dose Escalation improves biochemical control bPFS=biochemical progression free survival FFF= freedom from failure 64% vs. 80% bPFS at 5 years 55Gy/20 vs. 35.75Gy/13 + HDR 8.5Gy x 2 220 Hoskin (Mt Vernon) 2007 60% vs. 71% bPFS at 5 years 64Gy/32 vs. 74Gy/37 843 Dearnaley (RTO1) 2007 54% vs. 64% FFF at 5 years 68Gy/34 vs. 78Gy/39 664 Peeters (Dutch) 2006 61% vs. 80% bPFS at 5 years 70.2Gy vs. 79.2Gy (proton boost) 393 Zietman 2005 59% vs. 78% bPFS at 5 years 70Gy/35 vs. 78Gy/39 301 Pollack (MDA) 2007 update Result Comparison N RCT
- 17. Equivalent doses Hoskin et al, 2007 αβ ratio 77.0 122.0 214.5 35.75Gy/13# +17Gy/2# External beam + HDR boost 70.1 98.2 155.8 55Gy/20# 87.7 113.1 165.2 74Gy/37# External beam 10 3.5 1.5
- 20. Trial Schema T1B - T3A N0 M0 Estimated Risk of SV involvement ≤ 30% PSA ≤ 30ng/ml Randomise Group 1 74Gy / 37F 7.5 weeks (Standard) Group 2 60Gy / 20F 4.0 weeks (Hypofractionation) Group 3 57Gy / 19F 3.8 weeks (Hypofractionation)