05 Dose escalation RT in PCa

Question 1

Randomized trials that have established dose-escalation in Prostate cancer

Answer 1

There are 5 large studies
MD Anderson Study, Kuban et al. IJROBP 2008;
PROG-ACR Zietman et al. JCO 2010;
Dutch, Heemsbergen et al. Radiother Oncol 2014;
GETUG 06;
MRC RT01, Dearnaley et al. Lancet Oncol 2014,
which investigated the role of dose escalation.

Question 2

MD Anderson Study, Kuban et al. IJROBP 2008
PROG-ACR
Dutch study
GETUG 06
MRC RT01

Answer 2

All of them are similar, in that they included a standard dose (64-70 Gy) and compared that to a higher dose (74-80 Gy). They all showed a consistent effect of dose on freedom-from-biochemical-recurrence, (i.e higher doses are associated with decrease in biochemical recurrence), but none of them demonstrated an improvement of survival. To be fair, none of these studies were powered to find a survival difference.

Question 3

Dose-escalation RT in Prostate cancer: RTOG 0126 (more contemporary)

Answer 3