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Alexandra L Hanlon

Publications and source records attributed to Alexandra L Hanlon.

At least 37 records · Page 2Linked to original sources
PubMed2004

A comparison of the single and double factor high-risk models for risk assignment of prostate cancer treated with 3D conformal radiotherapy.

PURPOSE: Two models for stratification of prostate cancer aggressiveness predominate for the purposes of daily treatment decision making. This study investigates the relationships between these two clinically popular models. METHODS: Both risk stratification models use the same definition for low risk: Gleason score (GS) 10-20 ng/mL, without the presence of any high-risk feature; high risk (HR) was defined as the presence of GS 8-10, iPSA >20, or palpation stage T3. For the double factor high risk (DF) model, IR and HR were defined as one and more than one of the following: GS >or=7, iPSA >10, or stage T3. Between April 1989 and October 2001, 1,597 patients were treated definitively with 3D conformal radiation therapy (3D-CRT) alone for prostate cancer at our institution. The main clinical endpoint was freedom from biochemical failure (FFBF). RESULTS: The 5-year actuarial FFBF rate for the low-risk group was 83%. The SF model resulted in FFBF rates of 76% and 47% for IR and HR patients respectively. The DF model resulted in FFBF rates of 70% and 52% for IR and HR patients, respectively. The FFBF rate for patients defined as IR and HR by both models was 76% and 40%, respectively. Those classified as IR by the DF model and then further subdivided into IR and HR by the SF model had a 76% and 52% 5-year FFBF rate (p = 0.0004). Those classified as HR by the DF model and then further subdivided into IR and HR by the SF model had a 71% and 40% 5-year FFBF (p = 0.0014). CONCLUSIONS: The SF model created prognostic groups with a greater internal consistency than the DF model. The SF was also better at identifying patients with high-risk prostate cancer who may benefit from a more aggressive approach.

Aged↗
PubMed2004

Intensity-modulated radiotherapy with MRI simulation to reduce doses received by erectile tissue during prostate cancer treatment.

PURPOSE: The radiation doses received by erectile tissue may contribute to erectile dysfunction after treatment of prostate cancer. This is the first description of the ability to limit the dose received by the penile bulb (PB) and corporal bodies (CB) using intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Twenty-three patients with palpation Stage T1c-T2bN0M0 prostate cancer received IMRT alone. The dose prescribed to the planning target volume was 74-78 Gy. All patients underwent CT and MRI simulation to define the target and normal structures. Three plans with identical beam arrangements and energy were generated for each patient, with varying dose constraints for the PB and CB: no dose constraint, intermediate-dose constraint (20 Gy and 15 Gy, respectively) and low-dose constraint (15 Gy and 7 Gy, respectively). All plans were normalized, such that 95% of the planning target volume received at least 100% of the prescribed dose. For each plan, the ability to meet prostate dose homogeneity criteria (PHC; prostate maximal dose </=120% prescribed dose) and rectal tolerance dose-volume histogram criteria (RTC; </=35% and </=17% of rectal volume received 40 Gy and 65 Gy, respectively) was determined. The D(90), V(50), and V(75) were determined for both PB and the CB, where D(i) was the dose received by i% of the target volume and V(i) was the target volume receiving i% of the prescribed dose. RESULTS: The median PB D(90), V(50), and V(75) for the plans with no dose, intermediate-dose, and low-dose constraints was 20.8 Gy, 33.8%, and 9.9%; 8.0 Gy, 1.7%, and 0%; and 7.1 Gy, 0.1%, and 0%, respectively. The median CB D(90), V(50), and V(75) for plans with no dose, intermediate-dose, and low-dose constraints was 10.2 Gy, 3.8%, and 0%; 6.0 Gy, 0%, and 0%; and 4.9 Gy, 0%, and 0%, respectively. Overall differences in the D(90), V(50), and V(75) among the groups were significant for both the PB and the CB (p <0.0001). All plans with no dose constraint met the PHC and RTC. Twenty plans with an intermediate-dose constraint met the PHC and 21 met the RTC. Eighteen plans with a low-dose constraint met the PHC and 19 met the RTC. No statistically significant difference was found in the number of beam segments for the three groups (median of 51, 55, and 53; p = 0.8). CONCLUSION: In the vast majority of cases, it is possible to limit the dose to erectile tissue with IMRT, usually by >/=50% without significantly compromising the PHC, RTC, or treatment duration. A Phase III randomized trial has been designed to test the clinical significance of the erectile tissue-sparing technique described here.

Aged↗
PubMed2004

The relationship of increasing radiotherapy dose to reduced distant metastases and mortality in men with prostate cancer.

BACKGROUND: The association of increasing radiotherapy (RT) dose with reduced biochemical failure (BF) is accepted widely. However, there is little direct evidence that dose escalation has an impact on distant metastasis (DM) or overall mortality (OM). These associations were examined in the current study. METHODS: The outcome of 835 patients who were treated at the Fox Chase Cancer Center (Philadelphia, PA) between 1989 and 1997 using 3-dimensional, conformal RT alone (median dose, 74 Gray [Gy]) was analyzed. Stepwise multivariate Cox proportional hazards regression analyses (MVAs) were performed with RT dose included as a covariate along with log-transformed initial pretreatment PSA level, Gleason score, palpation T status, age, and year of treatment (YOT), where indicated. To minimize the effect of YOT, an analysis was performed on a subgroup of 363 patients who were treated prior to 1994. RESULTS: With a median follow-up of 64 months, there were 220 PSA failures, 44 distant metastases, and 162 deaths. In MVA, RT dose (as a continuous variable) was a significant predictor for BF, DM, and OM. When YOT was included as a covariate, it was related strongly to all endpoints, and the correlations of RT dose with DM and OM were lost. When the effect of YOT was minimized by limiting the MVA to patients who were treated prior to 1994, RT dose again emerged as a significant predictor of DM. CONCLUSIONS: Escalation of RT dose reduced the rates of BF, DM, and OM significantly in patients with prostate cancer. The inclusion of YOT had a pronounced effect on these correlations that may confound interpretation.

Adenocarcinoma↗
PubMed2004

Short-term androgen deprivation and PSA doubling time: their association and relationship to disease progression after radiation therapy for prostate cancer.

PURPOSE: The goal of this study was to investigate the relationship between PSA doubling time (PSADT) and initial management of prostate cancer with short-term androgen deprivation (STAD) and the impact of these factors on disease progression after radiation therapy. METHODS AND MATERIALS: Between May 1989 and October 1998, 284 patients treated with 3D-CRT experienced biochemical failure (BF) as defined under the ASTRO consensus statement. All patients had sufficient follow-up data for PSADT calculations. Linear regression was used to assess predictors of PSADT among STAD, time to biochemical failure (TTBF), Gleason Score, tumor stage, dose, posttreatment PSA nadir, pretreatment PSA, and age. A composite covariate was created from the various combinations of factors found to be predictive of PSADT. The composite covariate was then included, along with PSADT and the factors previously mentioned, in proportional hazards modeling of freedom from distant metastasis (FDM), cause-specific survival (CSS), and overall survival (OS). RESULTS: Fifty-four (19%) patients developed distant metastasis, 20 (7%) died of prostate cancer, and 53 (19%) died of any cause. The median PSADT was 12 months. Predictors of a longer PSADT were TTBF >12 months, Gleason Score 2-6, and STAD. An ordinal composite covariate was created with eight levels on the basis of the magnitude of observed mean PSADT within the eight possible combinations of the three dichotomized predictors. The most significant predictor of higher FDM rates in Cox modeling was the composite covariate, followed by longer PSADT, STAD, lower PSA nadir, higher RT dose, and Gleason Score 2-6. Predictors of higher CSS rates were lower nadir, longer PSADT, T1/T2ab tumors, the composite covariate, and STAD. The most significant predictor of a higher OS rate was STAD, followed by longer PSADT, younger age at diagnosis, the composite covariate, lower nadir, and T1/T2ab tumors. CONCLUSIONS: Longer TTBF, Gleason Score 2-6 tumors, and STAD were predictive of longer PSADT. Even after adjusting for these factors in the capacity of their predictive properties for PSADT, STAD and observed PSADT continued to be significant independent predictors of FDM, CSS, and OS. STAD appears to have a pronounced impact on disease progression, probably the result partly of the prolongation of PSADT.

Aged↗
PubMed2004

Prostate cancer radiotherapy dose response: an update of the fox chase experience.

PURPOSE: The effectiveness of increasing radiotherapy dose for men with prostate cancer was evaluated with reference to prognostic groups as defined by pretreatment serum prostate specific antigen (PSA), Gleason score, T stage and perineural invasion. MATERIALS AND METHODS: There were 839 men treated between April 1989 and December 1997 with conformal radiotherapy alone. Cox multivariate analysis was used to establish important predictors of biochemical failure (BF) separately for patients with an initial pretreatment PSA (iPSA) of less than 10, 10 to 19.9, or 20 or greater ng/ml. Radiotherapy (RT) dose was evaluated as a continuous and categorical (dose groups of less than 72, 72 to 75.9 and 76 Gy or greater) variable. RESULTS: At a median 63-month followup multivariate analysis demonstrated that iPSA and radiotherapy (RP) dose were the most significant predictors of BF, followed by Gleason score and T stage. Perineural invasion was not an independent correlate of outcome. RT dose was significant in all iPSA groups (less than 10, 10 to 19.9 and 20 or greater ng/ml). Gleason score was significant when iPSA was less than 10 ng/ml. T stage was significant when iPSA was 20 ng/ml or greater and it was borderline when iPSA was 10 to 19.9 ng/ml (p = 0.08). Prognostic subgroups were derived from these results and tested for an effect of RT dose on univariate analysis. Radiation dose was not a correlate of BF in the most favorable (PSA less than 10 ng/ml and Gleason score 2 to 6) and the most unfavorable (PSA 20 ng/ml or greater and stage T3-T4) prognostic groups but it was otherwise an influential determinant of outcome. CONCLUSIONS: RT dose escalation to 76 Gy or greater improved patient outcome for all prognostic groups except those at the favorable and unfavorable extremes.

Adult↗
PubMed2004

Matched-cohort analysis of patients with prostate cancer followed with observation or treated with three-dimensional conformal radiation therapy.

OBJECTIVES: To compare the outcome of similar patients with prostate cancer treated by either observation or three-dimensional conformal radiation therapy (3-DCRT). PATIENTS AND METHODS: The study included 69 patients with nonmetastatic prostate cancer who were observed only; the indications included indolent disease, significant medical comorbidities and refusal of treatment. Of these, 62 patients had palpable T1-T2a and seven T2b-T3a disease, a median Gleason score of 6 and a median initial prostate-specific antigen (PSA) level of 5.3 ng/mL. A matched-cohort analysis of 69 patients, based on palpation T category, Gleason score and initial PSA, was used to compare the outcome between the observation and 3-DCRT groups. The median radiation dose for latter was 72 Gy. RESULTS: The median follow-up for the observed patients was 49 months. The 5- and 8-year actuarial rates of freedom from distant metastases were 100% and 93%, respectively, and the actuarial overall survival rates 94% and 73%, respectively. Seven observed patients had local disease progression on physical examination. Four patients who initially were observed received radiation therapy later for a rising PSA and/or local disease progression. For the 69 matched 3-DCRT patients, the overall 5-year rate for no biochemically evident disease was 74%. The respective 5- and 8-year actuarial rates of freedom from distant metastases were 95% and 95%, and actuarial overall survival rates 95% and 75%. There were no significant differences in distant metastasis and overall survival rates between the groups, and no deaths from prostate cancer in either group. CONCLUSIONS: Observation is a reasonable alternative to treatment in selected patients. During the 5-year follow-up the progression rates were relatively low, and there was no difference in distant metastasis or overall survival between the groups. As the follow-up was short a longer follow-up is needed to determine whether the outcome of those patients who chose observation will remain comparable to that in those undergoing immediate 3-DCRT.

Adenocarcinoma↗
PubMed2004

Parity confers better prognosis in older women with early-stage breast cancer treated with breast-conserving therapy.

A comparison was made of pretreatment characteristics and outcomes of patients with stage I/II breast cancer treated with breast-conserving therapy who had a history of parity with those who were nulliparous. From 1979 to 1996, 1358 women with stage I/II (T1/2 N0/1 M0) breast cancer underwent lumpectomy, axillary dissection, and radiation therapy with or without systemic therapy. Of the total population, 1162 patients (86%) were parous and 196 patients (14%) were nulliparous. The median follow-up was 87 months. The 2 groups were compared for clinical, pathologic, and treatment-related factors. Multivariate analysis was used to determine independent predictors of outcome. Outcome was also evaluated for patterns of failure including distant metastases (DM), cause-specific survival (CSS), and overall survival (OS). Significant differences between the 2 groups were observed for age > 60 years and median age. Multivariate analysis demonstrated that nulliparous status was an independent predictor of DM, CSS, and OS after adjusting for age. Multivariate analysis for DM, CSS, and OS for patients > 60 years of age demonstrated that parity was the most highly significant independent predictor of decreased DM and improved OS. Parity can be considered a prognostic factor in elderly patients with early-stage breast cancer, and therefore may be used as a tool for identifying patients who may benefit from a more aggressive treatment approach.

Adult↗
PubMed2003

Does short-term androgen deprivation substitute for radiation dose in the treatment of high-risk prostate cancer?

PURPOSE: Randomized trials have corroborated the clinical benefit of adding androgen deprivation (AD) to radiotherapy (RT) in the treatment of high-risk prostate cancer. Another competing strategy is to escalate the RT dose using three-dimensional conformal RT (3D-CRT). In this analysis, we asked whether the addition of short-term AD (STAD) ( 20 ng/mL, Gleason score 8-10, or T3-4) prostate cancer is an effective substitute for dose escalation. METHODS AND MATERIALS: Between March 1, 1990 and November 30, 1998, 296 high-risk prostate cancer patients were treated with 3D-CRT alone (n = 206) or in combination with STAD (n = 90). The patient characteristics were median age 68 years, median follow-up 58 months, pretreatment initial prostate-specific antigen 21.8 ng/mL, RT dose 75 Gy, STAD duration 3 months, and time off STAD 64 months. The impact of STAD with respect to dose was examined using univariate analysis for dose ranges of <75 Gy and >or=75 Gy. Stepwise Cox proportional hazards regression multivariate analysis was performed to determine independent correlates of freedom from biochemical failure (bNED), freedom from distant metastasis (FDM), and overall survival. In a separate matched-pair analysis (n = 44 per group), those treated to <75 Gy + STAD (Group A) were compared with those who received >or=75 Gy alone (Group B). RESULTS: On univariate analysis, the addition of STAD had no impact on bNED, FDM, or overall survival in either dose group. On multivariate analysis, initial prostate-specific antigen level, palpation T stage, and RT dose were significant correlates of bNED. For FDM and overall survival, the significant covariates were palpation T stage and Gleason score, respectively. Finally, in matched-pair analysis, the higher RT dose group had a significantly greater bNED rate at 5 years (Group A 35% vs. Group B 57%, p = 0.0190). CONCLUSION: Our data suggest that STAD, as used here (median 3 months), is not a substitute for RT dose in the treatment of high-risk prostate cancer. RT dose is an essential element in the treatment of high-risk prostate cancer.

Aged↗
PubMed2003

Routine mammography is associated with earlier stage disease and greater eligibility for breast conservation in breast carcinoma patients age 40 years and older.

BACKGROUND: Reduction in breast carcinoma mortality is a major benefit of screening mammography and has been demonstrated in multiple randomized clinical trials and service screening programs. Another benefit from screening is that it allows the patient a wider choice of treatment options, particularly the possibility of conservation surgery. The current study analyzed the impact of mammography in the staging and treatment of breast carcinoma. METHODS: A total of 1591 women aged > or = 40 years were treated for breast carcinoma between July 1995 and October 2001. Three subgroups were defined and compared. Group 1 had 192 patients with no previous mammography, Group 2 was comprised of 695 patients who underwent mammography on average less often than once yearly, and Group 3 was comprised of 704 patients who on average underwent mammography once yearly or more often. RESULTS: The difference in tumor stage was found to be statistically significant between the groups (P < 0.0001). In Group 1, 15% of the patients had ductal carcinoma in situ (DCIS) compared with 21% of patients in Group 2 and 26% of patients in Group 3. In addition, 32% of patients in Group 1 had T1 tumors, whereas 50% of patients in Group 2 and 56% of patients in Group 3 had T1 tumors. The tumor size was < or = 1 cm in 8% of the patients in Group 1 compared with 20-23% of patients in Groups 2 and 3 (P = 0.0092). Breast conservation was an option for 41% of the patients in Group 1 but mastectomy was recommended in another 41% of patients. However, in Groups 2 and 3, 61% of patients were offered breast conservation and mastectomy was recommended to 28% (P < 0.0001). CONCLUSIONS: In the current study, women age > or = 40 years with breast carcinoma who underwent mammography at least once yearly were diagnosed with DCIS more often compared with patients who underwent mammography less frequently or those who had no prior mammography. Women who underwent mammographic screening were found to have smaller tumors, which resulted in a majority of these patients being able to consider breast conservation as an alternative to mastectomy.

Adult↗
PubMed2003

Biochemical failure as a determinant of distant metastasis and death in prostate cancer treated with radiotherapy.

PURPOSE: Biochemical failure (BF), defined by a rising prostate-specific antigen (PSA) profile, is an early surrogate of treatment failure. However, little evidence is available to show that BF is associated with death for patents with prostate cancer treated with radiotherapy. We examined the relationship between BF and death from prostate cancer. METHODS AND MATERIALS: A total of 942 patients were treated between 1987 and 1998 with external beam radiotherapy who had sufficient PSA determinations in follow-up for the analyses described. The median radiation dose was 72 Gy, median PSA was 9.9 ng/mL, and median follow-up was 73 months. The American Society for Therapeutic Radiology and Oncology consensus definition was used to define BF. Kaplan-Meier calculations were from the start of radiotherapy. Cox proportional hazards regression multivariate analyses were used to investigate the association of BF (time-dependent variable) and other factors to distant metastasis (DM), cause-specific death (CSD), and overall death (OD). The year of treatment was included in some of the multivariate analyses to correct for potential unknown factors that may have occurred during the years of the study, such as stage migration. RESULTS: BF was observed in 316 patients (34%), and 66 (7%) experienced DM, 32 (3%) died of prostate cancer, and 230 (24%) died overall during the study period. The Kaplan-Meier 5-year rate estimates from the start of treatment for BF, DM, CSD, and OD were 38%, 6%, 3%, and 13%, respectively. All patients with DM had BF. In multivariate analyses, BF was associated with DM and CSD, but not OD. The inclusion of the year of treatment did not alter these relationships. CONCLUSION: BF, as a time-dependent covariate, was the strongest determinant of DM and was also very significantly related to CSD. The inclusion of the year of treatment had little effect on these associations. Longer follow-up is needed to determine conclusively the relationship of BF to OD.

Aged↗
PubMed2003

Effect of sequencing of androgen deprivation and radiotherapy on prostate cancer growth.

PURPOSE: Androgen deprivation (AD) is frequently combined with radiotherapy (RT); however, the optimal sequence in vivo is currently unknown. Previous published work from our laboratory demonstrated that AD with RT was consistent with at least an additive, and possibly supra-additive, effect with the combined approach. We, therefore, performed additional experiments to elucidate the optimal sequence. METHODS AND MATERIALS: R3327-G Dunning rat prostate tumor cells were grown s.c. in the flanks of Copenhagen rats. Treatment was initiated when the tumor reached approximately 1 cm(3). Temporary AD was performed by a transscrotal orchiectomy followed 14 days later with androgen restoration using s.c. testosterone implants. RT was delivered using (60)Co to 7 Gy. Seven groups, including the controls, were analyzed: Group 1, sham control (Day 0: AD + testosterone); 2, AD control (Day 0: AD, Day 14: testosterone); 3, RT alone on Day 7 (Day 0: AD + testosterone, Day 7 RT); 4, RT alone on Day 3 (Day 0: AD + testosterone, Day 3: RT); 5, RT during AD (Day 0: AD, Day 7: RT, Day 14: testosterone); 6, RT before AD (Day 0: RT, Day 3: AD, Day 17: testosterone); and Group 7, RT after AD (Day 0: AD, Day 14: testosterone, Day 17: RT). The doubling times for tumor growth were calculated for the seven groups from the end of treatment plus 1 day. Differences in doubling time were assessed using analysis of variance, with pair-wise comparisons accomplished using post-hoc Bonferroni tests. RESULTS: An analysis of the differences in the tumor volume doubling time as measured from the end of treatment suggests that Groups 1 and 7 were statistically different from the other groups (p = 0.02). As expected, the sham control group had the shortest doubling time at 5.4 days and Group 7 (14 days of AD administered before RT) had the longest doubling time at 32.6 days. The findings were similar even after excluding an outlying doubling time of 85 days from Group 7 (p < 0.0001). To assess the effect of sequencing further, only Groups 5 through 7 (excluding the outlier) were compared in an analysis of variance with post-hoc Bonferroni tests. Group 7 (RT after AD) demonstrated a significantly longer doubling time than Groups 5 and 6 (p = 0.0024). CONCLUSION: The results suggest that neoadjuvant AD may result in prolonged suppression of tumor growth, even after testosterone replacement.

Animals↗
PubMed2003

The Gleason score shift: score four and seven years ago.

PURPOSE: There is some evidence that Gleason scores (GS) have shifted over time, although documentation of the extent to which this has occurred and its clinical significance is sparse. METHODS AND MATERIALS: Three types of analyses were performed to characterize the GS shift. First, the time-related changes in GS, T-stage category, and PSA for all 983 patients treated with conformal radiotherapy at our institution were examined between 1992 and 1997. Then a matched-pair analysis of patients treated without androgen deprivation was implemented. Patients were matched for grouped GS, grouped PSA, T category, and grouped radiation dose; 242 patients (Cohort 1) treated between 1992 and 1994 were compared to 242 patients treated between 1995 and 1997 (Cohort 2). Follow-up for each patient in Cohort 1 was truncated to match the length of follow-up for his counterpart in Cohort 2 (median follow-up 42 vs. 47 months). The ASTRO consensus definition of a rising PSA was used. Finally, the pathology slides of 106 patients treated with radiotherapy at another institution between 1987 and 1993 underwent a blind second review by one of the study pathologists (P.T.) in 1998. RESULTS: The percentages of prostate cancer patients treated with radiotherapy at our institution from 1992 to 1994 vs. 1995 to 1997 were GS 2-5: 49% vs. 16%, GS 6: 27% vs. 59%, GS 7: 20% vs. 19%, and GS > or =8: 8.3% vs. 6%. There was no clear difference in T category over time with 92-96% having T1-T2 disease. The percentage of patients with a PSA < or = 10 ng/mL rose rapidly from 35% in 1992 to 63% in 1994. In corroboration of these findings, the pathologic review of specimens from 106 patients at another institution yielded changes between the initial reading to the recent reading of 50% to 6% for GS 2-5, 22% to 31% for GS 6, 16% to 25% for GS 7, and 12% to 25% for GS 8-10 (p < 0.0001). From the matched-pair analysis, 5-year Kaplan-Meier bNED rates were 68% and 82% (p = 0.03) favoring Cohort 2. CONCLUSIONS: During the study period, pretreatment PSA values declined and T category remained stable; yet, GS increased. Upgrading of GS would be expected to lead to an improvement in outcome for all GS groups because of the Will Rogers effect, which explains in part the results of the matched-pair analysis. The GS shift confounds retrospective series spanning the 1990s.

Humans↗
PubMed2003

Validation of a treatment policy for patients with prostate specific antigen failure after three-dimensional conformal prostate radiation therapy.

BACKGROUND: The objective of this report was to present an outcomes validation for the Fox Chase Cancer Center (FCCC) management policy for patients who demonstrate prostate specific antigen (PSA) failure after receiving three-dimensional conformal radiation therapy (3DCRT). METHODS: Eligible patients included 248 men with T1-T3N0M0 prostate carcinoma who demonstrated PSA failure (according to the American Society for Therapeutic Radiology and Oncology definition) after completing definitive 3DCRT alone or with androgen deprivation (AD) therapy between May 1989 and November 1997. The primary endpoint evaluated was freedom from distant metastasis (FDM). The secondary endpoints evaluated included cause specific survival (CSS) and overall survival (OS). The variables evaluated in the multivariate analyses (MVA) included initial PSA, Gleason score, T classification, dose, PSA nadir, time to PSA failure, PSA doubling time (PSADT), initial use of AD therapy, and the use of AD therapy upon PSA failure. RESULTS: The 5-year FDM, CSS, and OS rates for the entire group were 76%, 92%, and 76%, respectively. It was found that four variables were independent predictors of FDM: Gleason score (P = 0.0039), PSA nadir (P = 0.0001), PSADT (P = 0.0001), and the use of AD on PSA failure (P = 0.0001). One hundred forty-eight men demonstrated a PSADT < 12 months. AD therapy was started in 59 men, and 89 men refused AD therapy and were observed. The use of AD therapy was associated with a significant improvement in the 5-year FDM rate (57% vs. 78%; P = 0.0026). In the group of men with PSADT < 12 months, the median time to distant failure was significantly longer in the men who received AD therapy (6 months vs. 25 months; P = 0.02). Of the 100 men with a PSADT > or = 12 months, 89 men were observed, and 11 men received AD therapy. There was no improvement in the 5-year FDM rate with the use of AD therapy compared with observation (88% vs. 92%, respectively; P = 0.74). CONCLUSIONS: The current results validate the use of PSADT as an indicator of patients who may be observed expectantly or treated with AD therapy for PSA failure after 3DCRT. Prospective trials are needed to define further the optimal treatment for these patients.

Algorithms↗
PubMed2003

Late morbidity profiles in prostate cancer patients treated to 79-84 Gy by a simple four-field coplanar beam arrangement.

PURPOSE: To describe the frequency and magnitude of late GI and GU morbidity in prostate cancer patients treated to high dose levels with a simple three-dimensional conformal technique. METHODS AND MATERIALS: A total of 156 intermediate- and high-risk patients were treated between January 1, 1992 and February 28, 1999 with a simple four-field three-dimensional conformal technique to 79-84 Gy. All patients were treated with a four-field conformal technique; the prostate received 82 Gy and the seminal vesicles and periprostatic tissue 46 Gy. GI and GU toxicity was scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Morbidity Grading Scale and compared using Kaplan-Meier estimates. RESULTS: The late Grade 2 GI complication rate was 9% and 38% at 3 years for patients treated with and without rectal blocking, respectively (p = 0.0004). No Grade 3 late GI complications developed. The rate of Grade 2 late GU complications was 5%, 8%, and 12% at 12, 24, and 36 months, respectively. The Grade 3 late GU complication rate was 2% at 36 months. These differences were not statistically significant. CONCLUSION: The treatment method described is a simple four-field conformal technique that can be easily implemented in the general radiation community. A dose of 79-84 Gy can be safely delivered to the prostate, with a 9% rate of late Grade 2 GI, 12% rate of late Grade 2 GU, and 2% rate of late Grade 3 GU complications.

Digestive System↗
PubMed2003

Positive prostate biopsy laterality and implications for staging.

OBJECTIVES: To examine the effect of including positive prostate biopsy information in palpation staging (2002 system) and the influence of this information on freedom from biochemical failure (bNED). Prostate biopsy laterality status (unilateral versus bilateral positive) is part of clinical staging using American Joint Commission on Cancer criteria, but is rarely used. METHODS: From April 1, 1989 to September 30, 1999, 1038 patients with palpable T1-T3Nx-0M0 prostate cancer were treated with three-dimensional conformal radiotherapy alone. Kaplan-Meier bNED curves were compared using the log-rank test. The Cox proportional hazards regression model of bNED was used for multivariate analysis. RESULTS: The median follow-up was 46 months. The proportion of patients with bilateral positive biopsies by palpation category T1c was 24%, by T2a was 17%, by T2b was 26%, by T2c was 65%, and by T3 was 53%. No statistically significant difference was noted in bNED on the basis of biopsy laterality status for the palpation T stages T1c, T2a, T2b, or T3. A statistically significant difference in the 5-year bNED in the T2c stage was found; those with unilateral positive biopsies fared worse (46% versus 74%, respectively, P = 0.04). CONCLUSIONS: Inclusion of positive biopsy laterality status into clinical staging causes stage migration without reflecting a change in outcome and should not be used.

Aged↗
PubMed2003

Mindless or mindful? Radiation oncologists' perspectives on the evolution of prostate cancer treatment.

The evolution of radiation therapy treatment for prostate cancer has been striking over the last 10 years. Advances in brachytherapy (BT), external beam radiotherapy (EBRT), and the combination of EBRT + BT have led to improved biochemical and clinical results. This article describes these advances in the context of the treatment decision process. Key to this process is the assignment of patient risk, which is based on the results of conventional radiation dose and techniques. Using the 1992 AJCC palpation staging system, Gleason score, and pretreatment prostate-specific antigen, two different risk assessment algorithms were compared. Both gave comparable approximations of risk, although the single factor high-risk model was superior in differentiating those patients with the highest probability of failing treatment after radiotherapy. Such criteria are the foundation for treatment selection. Objective findings support BT alone or EBRT alone for low-risk patients, high-dose EBRT or EBRT + BT for intermediate-risk patients, and EBRT + androgen deprivation for high-risk patients. In summary, advances in radiation oncology have led to significant gains in prostate cancer control. Clinical prognostic factor-based patient selection is central to the optimization of outcome.

Brachytherapy↗
PubMed2003

Impact of target volume coverage with Radiation Therapy Oncology Group (RTOG) 98-05 guidelines for transrectal ultrasound guided permanent Iodine-125 prostate implants.

PURPOSE: Despite the wide use of permanent prostate implants for the treatment of early stage prostate cancer, there is no consensus for optimal pre-implant planning guidelines that results in maximal post-implant target coverage. The purpose of this study was to compare post-implant target volume coverage and dosimetry between patients treated before and after Radiation Therapy Oncology Group (RTOG) 98-05 guidelines were adopted using several dosimetric endpoints. MATERIALS AND METHODS: Ten consecutively treated patients before the adoption of the RTOG 98-05 planning guidelines were compared with ten consecutively treated patients after implementation of the guidelines. Pre-implant planning for patients treated pre-RTOG was based on the clinical target volume (CTV) defined by the pre-implant TRUS definition of the prostate. The CTV was expanded in each dimension according to RTOG 98-05 and defined as the planning target volume. The evaluation target volume was defined as the post-implant computed tomography definition of the prostate based on RTOG 98-05 protocol recommendations. Implant quality indicators included V(100), V(90), V(100), and Coverage Index (CI). RESULTS: The pre-RTOG median V(100), V(90), D(90), and CI values were 82.8, 88.9%, 126.5 Gy, and 17.1, respectively. The median post-RTOG V(100), V(90), D(90), and CI values were 96.0, 97.8%, 169.2 Gy, and 4.0, respectively. These differences were all statistically significant. CONCLUSIONS: Implementation of the RTOG 98-05 implant planning guidelines has increased coverage of the prostate by the prescription isodose lines compared with our previous technique, as indicated by post-implant dosimetry indices such as V(100), V(90), D(90). The CI was also improved significantly with the protocol guidelines. Our data confirms the validity of the RTOG 98-05 implant guidelines for pre-implant planning as it relates to enlargement of the CTV to ensure adequate margin between the CTV and the prescription isodose lines.

Adult↗