Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: A 6-year follow-up

Figures & data

Table I.  Patient characteristics covering age at diagnosis, PSA levels, differentiation grade according to WHO, T-stage and N-stage.

	Mean	Range	Total
Age (years)	67	(46–79)	154
PSA (µg/L)	21	(2–116)	153*
	Number	Percent
PSA <10 µg/l	56†	37
PSA 10–20 µg/l	40	26
PSA >20 µg/l	57	37
Total	153*
Histopathology	34†	22
Cytology	120	78
Total	154
Differentiation (WHO)
Grade I	44	29
Grade II	82†	53
Grade III	28	18
Total	154
T-stage (WHO)
T1	20	13
T2	52	34
T3	81†	52
T unknown	1	1
Total	154
N-stage
N0	103	67
NX	51†	33
Total	154

* PSA at diagnose was missing in one patient.

† Denoting a 71 years old man with PSA 8 µg/l who violated the protocol and was excluded in the outcome analyses.

Table II.  Prognostic value of WHO grade, T-stage and PSA in PSA relapse-free survival. Tested by Cox regression multivariate analyses.

	Hazard ratios	95% confidence interval
WHO grade	2.46	1.44–4.18
T-stage	1.64	0.91–2.98
PSA	1.49	0.96–2.30

Table III.  The calculated values for the probability of 5-year PSA relapse-free survival using nomograms for surgery and dose-escalated radiotherapy are demonstrated. The patient characteristics in this study are used. The result is divided into the number of risk factors in terms of PSA, T-stage and WHO grade. The actual result from the present study is also demonstrated.

	Actual 5-year PSA relapse-free survival		Calculated 5-year PSA relapse-free survival
Number of riskfactors	Number of patients	Present study (%)	Surgery (%)	Radiotherapy (%)
0	32	97	84	88
1	54	83	61	75
2	52	83	37	60
3	14	51	21	45
Total	152	84	54	70

Figure 1.  PSA relapse-free survival related to the number of risk factors. The risk factors are defined as PSA >10 µg/l, T-stage = 3 and high grade prostate cancer WHO = 3.

Figure 2.  PSA-relapse free survival in stage T3 patients. The number of patients at risk each year is noted in the diagram.

Figure 3.  Side effects from urinary tract according to RTOG score and reported as proportion of patients at 6 weeks, 6 months and 6 years follow-up.

Figure 4.  Side effects from lower intestinal tract according to RTOG score and reported as proportion of patients at 6 weeks, 6 months and 6 years follow-up.

Table IV.  Radiobiological calculation for tumour tissue and the rectum: F = fractions, BED = biologically effective dose, Gy3 = assuming α/β = 3, NTD = normalized dose to 2Gy per fraction.

	Total Dose×RE	BED	NTD @ 2 Gy Fractions
Tumour
25 F×2 Gy = 50 Gy	50×1.667	83.35 Gy3	50 Gy
2 F×10 Gy = 20 Gy	20×4.333	86.66 Gy3	52 Gy
Total Tumor Dose		170.00 Gy3	102 Gy
Rectum
25 F×2 Gy 50 Hy	50×1.667	83.35 Gy3	50.0 Gy
60% = 6 Gy×2 F = 12 Gy	12×3	36.00 Gy3	21.6 Gy
Total rectum Dose		119.35 Gy3	71.6 Gy

Table V.  Review of the literature. Abbreviations: 3D EBRT = Three dimensional conformal external beam radiotherapy, HDR = high dose rate brachytherapy, NTD (α/β = 3) = Normalised dose to 2 Gy per fraction and alfa/beta ratio equal to 3, RFS = relapse free survival, RTOG GU = symptoms from the urogenital tract according to the Radiation Therapy Oncology Group, RTOG GI = symptoms from lower intestinal according to RTOG.

Centres	Number of patients	3D EBRT Dose (Gy)	HDR dose	NTD α/β = 3 (Gy)	Median Follow-up (months)	Outcome 5 years RFS	RTOG Uro	RTOG GI
Royal Oak USA [15]	207	46	5.5–11.5Gy×3	74–146	56	74%	8%	0.5%
Seattle USA [16]	104	50	3–4Gy×4	64–72	45	86%	10%	0%
Kiel Germany [17]	189	40	15Gy×2	148	78	78%	NR	NR
Multi-Institutional [24]	611				60	67%	NR	NR
Sao Paulo Brasil [18]	119	45	4–5Gy×4	66–76	41	75%	0%	0%
Kurashiki Japan [19]	71	42–45	5.5Gy×3–4	70–81	44	93%	6%	0%
Sydney Australia [20]	82	45	5.5Gy×3	72	36	92%	6%	1%
Berlin
Germany [21]	230	40–50	9–10Gy×2	83–102	40	82%	10%	2%
Offenbach am Main Germany [22]	102	40–45	5–7Gy×4	72–100	31	82%	5%	1%
Gothenburg Sweden [23]	214	50	10Gy×2	102	48	82%	10%	0%
Present trial	154	50	10Gy×2	102	72	84%	4%	1%

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