It is a well-known fact that there is a dose-response relationship for
clinical control of localized prostate cancer. As a result of the
promising high local control rates observed in different prospective
dose-escalation studies in the USA, the CKVO 96-10 study was initiated
in four cancer institutes in The Netherlands in 1997 investigating the
tumor control and toxicity as a consequence of dose-escalation,
comparing the standard dose of 68 Gy with the experimental dose of 78
Gy.
• The benefit of dose-escalation of RT for localized prostate cancer in
terms of local control is undisputed.
• Patients with intermediate-risk prostate cancer and those with iPSA
between 8 and 18 ug/L seem to benefit most from high-dose RT. However,
from the current knowledge, neither low-risk nor high-risk patients
could be safely excluded from high-dose RT because of the negative test
of heterogeneity. Randomized trials are warranted to answer this
important issue.
• The associated increased GI toxicity would be reduced by the recent
implementation of image-guide intensity-modulated radiotherapy at our
institute.
• Despite the increased GI toxicity seen in patients treated in the
high-dose arm, dose-escalation did not appear to decrease QoL-scores
significantly in these patients.
• Predictive models need to be developed in order to identify patients
at high risk of toxicity from high-dose RT. The possible risks of
complications and deterioration of QoL-scores must be carefully weighted
against the benefit from dose-escalation.
• The optimal combination of HT and RT in high-risk prostate cancer
patients are not yet well-defined.http://repub.eur.nl/res/pub/20899/101008_Al-Mamgani%2C%20Abrahim.pdf
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