title: Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion-A Systematic Review and Meta-Analysis.
abstract: External beam radiotherapy (EBRT) for prostate cancer can be performed with a high dose of 86 Gy; however, one-tenth or more of the patients will develop recurrence. Prostate cancer is mainly multifocal, but a dominant intraprostatic lesion (DIL) is often the site of local recurrence after EBRT. We undertook a systematic review and meta-analysis to clarify whether functional imaging might identify the DIL and whether a RT boost to the DIL might be increased to an ultrahigh dose level of ≥ 90 Gy without increased toxicity. Of 62 selected studies, 13 reported the size of the DIL. The mean of the median DIL volumes was 2.4 cm(3) (95% confidence interval, 0.9-4.4 cm(3)). Eighteen diagnostic studies with 1205 patients evaluated the diagnostic accuracy using multiparametric magnetic resonance imaging for intraprostatic cancer lesions. Evaluating 14,654 prostate segments, the diagnostic accuracy was 77%. Eleven therapeutic studies with 988 patients reported a RT boost for the DIL. The summary boost dose for the DIL was a mean of 89 Gy in 5 studies using intensity modulated RT (calculated as the equivalent dose in 2-Gy fractions) and a mean of 141 Gy in 4 studies using a combination of EBRT and brachytherapy (P = .018, t test). In 1 therapeutic study, 239 patients had a 98% 10-year disease-free survival rate. Many of our therapeutic studies used a boost dose to the DIL of > 90 Gy. The reported boost for DIL is effective and safe.
authors.affiliation: Center of Tobacco Control Research, Odense, Denmark. Electronic address: finn113edler@mail.tele.dk.
authors.forename: Finn Edler
authors.initials: FE
authors.lastname: von Eyben
authors.affiliation: Docrates Cancer Center, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Kiljunen
authors.affiliation: Docrates Cancer Center, Helsinki, Finland.
authors.forename: Aki
authors.initials: A
authors.lastname: Kangasmaki
authors.affiliation: Docrates Cancer Center, Helsinki, Finland; Department of Nuclear Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX.
authors.forename: Kalevi
authors.initials: K
authors.lastname: Kairemo
authors.affiliation: Department of Radiation Oncology, Stanford University, San Francisco, CA.
authors.forename: Rie
authors.initials: R
authors.lastname: von Eyben
authors.affiliation: Docrates Cancer Center, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Joensuu
mesh_terms: D001918:Brachytherapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated
keywords: Diagnostic accuracy; Functional magnetic resonance imaging; Prostatic neoplasms; Radiation injuries; Survival