IMRT use in a community hospital is equally as efficacious and minimally toxic as it is in leading academic institutions. Age at diagnosis was the only significant predictor of survival, suggesting that cancer-specific mortality is minimal after IMRT in localized prostate cancer.
Anthony G. Ricco, Rachelle Lanciano, MD, Alexandra Hanlon, PhD; Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia CyberKnife; University of Pennsylvania
OBJECTIVES: The primary goal of this study is to determine prognostic factors associated with freedom from biochemical failure (FFBF) and survival for men with localized prostate cancer treated with intensity-modulated radiation therapy (IMRT) in a community hospital setting according to the new National Comprehensive Cancer Network (NCCN) 2015 risk stratification guidelines.
METHODS: A total of 228 consecutive men treated with IMRT for organ-confined prostate cancer at Delaware County Memorial Hospital from 2003-when the IMRT program began-to 2012 were reviewed in this institutional review board–approved retrospective study. Biochemical failure was assessed using the Phoenix Nadir +2 definition (a rise by ≥ 2 ng/mL above the nadir prostate-specific antigen level). Toxicity was assessed using the Radiation Therapy Oncology Group group criteria with modification.
RESULTS: Ten-year actuarial FFBF for the entire group was 83.18%. Ten-year actuarial FFBF, stratified by 2015 NCCN risk stratification, was 95.2% for very-low-risk, 96.3% for low-risk, 81.5% for intermediate-risk, and 75.4% for high-risk patients. Eight-year actuarial FFBF was 38.7% for the very-high-risk group. Multivariable analysis revealed that only the five NCCN risk groups were independent predictors of FFBF.
Ten-year actuarial survival for the entire group was 61.14%. Ten-year actuarial overall survival (OS), stratified by 2015 NCCN risk stratification, was 68.80% for very-low-risk, 81.47% for low-risk, 67.24% for intermediate-risk, 46.30% for high-risk, and 54.93% for very-high-risk men. Ten-year OS rates, stratified by age, were 75.92% for age ≤ 71.5 years and 55.19% for age > 71.5 years. Multivariable analysis revealed that only age was an independent significant factor for survival, with P = .0008.
CONCLUSIONS: IMRT use in a community hospital is equally as efficacious and minimally toxic as it is in leading academic institutions. Age at diagnosis was the only significant predictor of survival, suggesting that cancer-specific mortality is minimal after IMRT in localized prostate cancer.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org