Prostate Dose Escolation

== Dose Escalation Trials ==


  • Phase III study by Zietman (Mass Gen) showed improved bDFS with 79.2 Gy vs 70 Gy for low-risk group.


  • Phase III study by Pollock (MDA) showed improved bDFS wtih 78 Gy (isocenter) vs 70 Gy for intermediate risk group.

Institutional Review

  • Instituitional review by Zelefsky (MSK) and Fox Chase (not shown)
Risk Group RT dose bRFS
Favorable 70.2 57%
Favorable 75.6 83%
Intermediate 70.2 42%
Intermediate 75.6 50%
Unfavorable 70.2 24%
Unfavorable 75.6 42%
  • IMRT group had bRFS 96%, 86% and 81% (81.0 Gy or 86.4 Gy)
  • dose escalation improved bDFS in low and intermediate risk groups
  • dose escalation should be considered in high-risk group as well based on instituitional (MSK, Fox) data.
  • Zietman report significant increase in grade 2 or greater rectal adverse effects (18% vs 10%) and that the genitourinary tract–related adverse effects seem to continue to accumulate with longer follow-up.
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