Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial

Citation
Dp. Dearnaley et al., Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial, LANCET, 353(9149), 1999, pp. 267-272
Citations number
32
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
LANCET
ISSN journal
0140-6736 → ACNP
Volume
353
Issue
9149
Year of publication
1999
Pages
267 - 272
Database
ISI
SICI code
0140-6736(19990123)353:9149<267:CORSOC>2.0.ZU;2-S
Abstract
Background Radical radiotherapy is commonly used to treat localised prostat e cancer. Late chronic side-effects limit the dose that can be given, and m ay be linked to the volume of normal tissues irradiated. Conformal radiothe rapy allows a smaller amount of rectum and bladder to be treated, by shapin g the high-dose volume to the prostate. We assessed the ability of this new technology to lessen the risk of radiation-related effects in a randomised controlled trial of conformal versus conventional radiotherapy. Methods We recruited men with prostate cancer for treatment with a standard dose of 64 Gy in daily 2 Gy fractions. The men were randomly assigned conf ormal or conventional radiotherapy treatment. The primary endpoint was the development of late radiation complications (>3 months after treatment) mea sured with the Radiation Therapy and Oncology Group (RTOG) score. Indicator s of disease (cancer) control were also recorded. Findings In the 225 men treated, significantly fewer men developed radiatio n-induced proctitis and bleeding in the conformal group than in the convent ional group (37 vs 56% greater than or equal to RTOG grade 1, p = 0.004; 5 vs 15% greater than or equal to RTOG grade 2, p = 0.01). There were no diff erences between groups in bladder function after treatment (53 vs 59% great er than or equal to grade 1, p = 0.34; 20 vs 23% greater than or equal to g rade 2, p = 0.61). After median follow-up of 3.6 years there was no signifi cant difference between groups in local tumour control (conformal 78% [95% CI 66-86], conventional 83% [69-90]). Interpretation Conformal techniques significantly lowered the risk of late radiation-induced proctitis after radiotherapy for prostate cancer. Widespr ead introduction of these radiotherapy treatment methods is appropriate. Ou r results are the basis for dose-escalation studies to improve local tumour control.