title: Radiation therapy for clinically localized prostate cancer: long-term results of 469 patients from a single institution in the era of dose escalation.
abstract: OBJECTIVE
  The aim of the following study is to analyze the long-term results of veterans treated with dose escalated radiation therapy for prostate cancer.
  
  
  METHODS
  This retrospective study analyzed 469 patients who were treated between 2003 and 2010 with dose escalated radiation therapy to a minimum dose of 7560 cGy for prostate cancer at the New York Harbor Department of Veterans Affairs. Biochemical failure-free survival (bFFS) and distant metastatic-free survival (DMFS) were compared using the Kaplan-Meier method. Univariate and multivariate Cox Regression were used to measure the impact of covariates on biochemical control.
  
  
  RESULTS
  The median follow-up was 61 months and 95.3% of patients were followed at least 2 years. The 5-year bFFS for National Cancer Care Network low, intermediate and high risk disease were 90.3%, 86.9% and 77.3% respectively (P=0.001). Patients with high risk disease were more likely to develop metastatic disease. The 5-year DMFS was 99.1% for low risk, 98.8% for intermediate risk and 94.5% for high-risk (P<0.001). There were 8 prostate cancer related deaths, of which 6 had high risk disease and 2 had intermediate risk disease. The 5-year prostate cancer specific survival was 98.4%. Toxicities were generally mild, however there were two genitourinary toxicity related deaths, though in both patients there were confounding medical issues that may have contributed to their deaths.
  
  
  CONCLUSIONS
  Dose escalated radiation in the treatment of United States Veterans appears to be well-tolerated with results in line with prior reports. Further follow-up is necessary to identify any additional late toxicities as well as to assess the durability of their biochemical control beyond 5 years.
authors.forename: Aparna
authors.initials: A
authors.lastname: Surapaneni
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nwokedi
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.forename: Marvin
authors.initials: M
authors.lastname: Rotman
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans