The prognosis of high-risk prostate cancer is poor with a high mortality rate.
The Radiation Therapy Oncology Group (RTOG) has performed dose-escalation studies of external beam radiation therapy (EBRT) and has developed high-precision radiation therapy (RT) methods such as intensity-modulated RT, carbon ion therapy, and proton beam therapy. High-dose rate brachytherapy (HDR-BT) is also studied as an option for high-risk prostate cancer treatment. Past clinical trials have suggested that the local control rate of high-risk prostate cancer improves with total EBRT dose, even for doses >70Gy. Several randomized controlled trials, including RTOG 94-06, have shown significantly better prognoses with higher doses (>75Gy) than with lower doses (< 70Gy). A proton beam therapy trial (PROG 95-09) also showed similar results. A phase II clinical trial (National Institute for Radiological Sciences, Japan; trial 9904) showed that carbon ion therapy resulted in very good biochemical recurrence-free survival rates among high-risk prostate cancer patients, demonstrating particle therapy to be a valid treatment option. RTOG 86-10 showed that short-term neo-adjuvant hormonal therapy (HT) was inadequate for high-risk prostate cancer but effective for intermediate-risk prostate cancer, whereas RTOG 92-02 and the European Organisation for Research and Treatment of Cancer (EORTC) 22863 showed significant improvements in the prognosis of high-risk groups receiving long-term (>2years) HT combined with definitive RT. Further studies are warranted to elucidate optimal irradiation doses, HT treatment durations, and combination therapy schedules.
Written by:
Nomiya T, Tsuji H, Toyama S, Maruyama K, Nemoto K, Tsujii H, Kamada T. Are you the author?
National Institute for Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan.
Reference: Cancer Treat Rev. 2013 May 3. pii: S0305-7372(13)00075-3.
doi: 10.1016/j.ctrv.2013.04.003
PubMed Abstract
PMID: 23648323
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