What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation.
Publication/Presentation Date
6-1-2015
Abstract
PURPOSE: To determine if increasing the biologically equivalent dose (BED) via various radiation fractionation regimens is correlated with clinical outcomes or toxicities for prostate cancer.
METHODS AND MATERIALS: We performed a meta-analysis that included 12,756 prostate cancer patients from 55 studies published from 2003 to 2013 who were treated with non-dose-escalated conventionally fractionated external beam radiation therapy (non-DE-CFRT), DE-CFRT, hypofractionated RT, and high dose rate brachytherapy (HDR-BT; either mono or boost) with ⩾5-year actuarial follow-up. BEDs were calculated based on the following formula: (nd[1+d/(α/β)]), where n is the number of fractions, and d is dose per fraction; assuming an α/β of 1.5 for prostate cancer and 3.0 for late toxicities. Mixed effects meta-regression models were used to estimate weighted linear relationships between BED and the observed percentages of patients experiencing late toxicities or 5-year freedom from biochemical failure (FFBF).
RESULTS: Increases in 10 Gy increments in BED (at α/β of 1.5) from 140 to 200 Gy were associated with 5-unit improvements in percent FFBF. Dose escalation of BED above 200 Gy was not correlated with FFBF. Increasing BED (at α/β of 3.0) from 98 to 133 Gy was associated with increased gastrointestinal toxicity. Dose escalation above 133 Gy was not correlated with toxicity.
CONCLUSIONS: An increase in the BED to 200 Gy (at α/β of 1.5) was associated with increased disease control. Doses above 200 Gy did not result in additional clinical benefit.
Volume
115
Issue
3
First Page
295
Last Page
300
ISSN
1879-0887
Published In/Presented At
Zaorsky, N. G., Palmer, J. D., Hurwitz, M. D., Keith, S. W., Dicker, A. P., & Den, R. B. (2015). What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 115(3), 295–300. https://doi.org/10.1016/j.radonc.2015.05.011
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
26028229
Department(s)
Administration and Leadership
Document Type
Article