SAN FRANCISCO, CA USA (UroToday.com) - In this session, Dr. Ronald C. Chen presented 3 studies published over the past year in the radiation oncology literature.
The first study examined the long-term outcomes from the Dutch trial looking at the impact of dose escalation (78Gy versus 68Gy) on freedom from biochemical failure (Heemsbergen WD, et al., Radiother Oncol 2013, epub). At a median follow up of 110 months, 78Gy was associated with improved freedom from biochemical or clinical failure at 10 years (49% vs 43%). This benefit of dose escalation was not seen, however, in patients with low-grade disease. No difference was seen in CSS or OS with dose escalation.
The second study presented by Dr. Chen was a randomized trial comparing hypofractionated to conventional EBRT (Pollack A, et al., J Clin Oncol (2013) 31: 3860-8). Hypofractionated radiotherapy provides similar overall doses of radiation in fewer treatments as a result of higher doses per treatment. The possibility that prostate cancer may be more sensitive to higher doses of radiation provides the rationale behind delivery of radiation in this manner. Hypofractionation thus provides the potential for improved response while also decreasing a patient’s burden by reducing the time required to deliver therapy (in this study, 5 weeks compared to 7.5 weeks for conventional therapy). This study utilized IMRT with image guidance, and the study population consisted of a heterogenous group of patients with intermediate- and high-risk disease. At a median follow up of 68 months, no difference was seen in biochemical or clinical failure between patients receiving conventional versus hypofractionated EBRT. No difference was seen in local or distant failure, PCSM, or overall mortality. No difference was seen with regards to bowel or bladder toxicity. This study’s hypothesis was that hypofractionated IMRT was superior to conventional therapy, and thus this hypothesis was rejected. The study was not powered for demonstration of non-inferiority but its findings are interesting in that they suggest that hypofractionation potentially could provide similar oncologic outcomes to conventional therapy.
The final paper presented by Dr. Chen focused on the importance of standardizing care and improving utilization of radiation protocols that are known to be effective. The article by Efstathiou et al., (J Oncol Pract (2013) 9(3):e90-95) reported on the establishment of a national radiation database – called the National Radiation Oncology Registry. Prostate cancer is the pilot disease for the registry, which aims to improve quality of care and outcomes by establishing radiation practice metrics and providing feedback to participating sites on utilization of these established quality measures.
Highlights of a presentation by Ronald C. Chen, MD, MPH at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
NC Health Care System, Chapel Hill, NC USA