title: Comparing morbidity and cancer control after 3D-conformal (70/74 Gy) and intensity modulated radiotherapy (78/82 Gy) for prostate cancer.
abstract: OBJECTIVE
  The purpose of this work was to compare toxicity and cancer control between patients with prostate cancer treated using three-dimensional conformal radiotherapy (3D-CRT) and those treated using intensity-modulated radiation therapy (IMRT).
  
  
  METHODS
  A total of 553 patients with prostate cancer were treated with 3D-CRT 70-74 Gy (3D-CRT 70, 3D-CRT 74) or IMRT 78-82 Gy (IMRT 78, IMRT/SIB 82). Late toxicity was scored according to FC-RTOG/LENT criteria. Biochemical failure was defined using the Phoenix and ASTRO definitions.
  
  
  RESULTS
  The 5-year risk of grade 2-4 genitourinary toxicity was 26.3 % (3D-CRT 70), 27.2 % (3D-CRT 74), 17.3 % (IMRT 78), and 25.1 % (IMRT/SIB 82) without statistical differences. The 5-year risk of grade 2-4 gastrointestinal toxicity was 19.4 % (3D-CRT 70), 42.1 % (3D-CRT 74), 20.5 % (IMRT 78), and 26.6 % (IMRT/SIB 82). The differences between 3D-CRT 74 and 3D-CRT 70 and between 3D-CRT 74 and IMRT 78 were statistically significant (log rank p = 0.03). The 5-year Phoenix PSA relapse-free survival (PSA-RFS) in low-risk, intermediate-risk, and high-risk patients treated using 3D-CRT were 89.4, 65.5, and 57.8 %, respectively. Patients treated with IMRT achieved the following results: 90.9, 89.4, and 83.9 %. Clinical relapse-free survival (C-RFS) in patients treated using 3D-CRT vs. IMRT for the aforementioned groups were 94.7 vs. 100 %, 86.8 vs. 98.6 %, and 84.4 vs. 94.5 %. Disease-free survival (DFS) for patients treated using 3D-CRT were 83.1, 70.9, and 71.5 %. The IMRT group reached 95.8, 89.1, and 87.6 %. The PSA-RFS for intermediate- and high-risk patients were statistically significant, while C-RFS and DFS were marginally better.
  
  
  CONCLUSIONS
  Dose escalation with IMRT was associated with improved cancer control in intermediate- and high-risk patients in comparison with 3D-CRT, without compromising toxicity.
authors.affiliation: Oncology Centre, Multiscan α Pardubice Regional Hospital, Kyjevska 44, 532 03, Pardubice, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Dolezel
authors.forename: Karel
authors.initials: K
authors.lastname: Odrazka
authors.forename: Milan
authors.initials: M
authors.lastname: Zouhar
authors.forename: Miloslava
authors.initials: M
authors.lastname: Vaculikova
authors.forename: Jana
authors.initials: J
authors.lastname: Sefrova
authors.forename: Jan
authors.initials: J
authors.lastname: Jansa
authors.forename: Petr
authors.initials: P
authors.lastname: Paluska
authors.forename: Tereza
authors.initials: T
authors.lastname: Kohlova
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Vanasek
authors.forename: Josef
authors.initials: J
authors.lastname: Kovarik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D018153:Czech Republic / Q000453:epidemiology; D018572:Disease-Free Survival; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis / Q000378:metabolism*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000401:mortality*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment