Whole-pelvis, "mini-pelvis," or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial

Mack Roach, Michelle DeSilvio, Richard K Valicenti, David Grignon, Sucha O. Asbell, Colleen Lawton, Charles R. Thomas, William U. Shipley

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Purpose: The Radiation Therapy Oncology Group (RTOG) 9413 trial demonstrated a better progression-free survival (PFS) with whole-pelvis (WP) radiotherapy (RT) compared with prostate-only (PO) RT. This secondary analysis was undertaken to determine whether "mini-pelvis" (MP; defined as ≥10 × 11 cm but <11 × 11 cm) RT resulted in progression-free survival (PFS) comparable to that of WP RT. To avoid a timing bias, this analysis was limited to patients receiving neoadjuvant and concurrent hormonal therapy (N&CHT) in Arms 1 and 2 of the study. Methods and Materials: Eligible patients had a risk of lymph node (LN) involvement >15%. Neoadjuvant and concurrent hormonal therapy (N&CHT) was administered 2 months before and during RT for 4 months. From April 1, 1995, to June 1, 1999, a group of 325 patients were randomized to WP RT + N&CHT and another group of 324 patients were randomized to receive PO RT + N&CHT. Patients randomized to PO RT were dichotomized by median field size (10 × 11 cm), with the larger field considered an "MP" field and the smaller a PO field. Results: The median PFS was 5.2, 3.7, and 2.9 years for WP, MP, and PO fields, respectively (p = 0.02). The 7-year PFS was 40%, 35%, and 27% for patients treated to WP, MP, and PO fields, respectively. There was no association between field size and late Grade 3+ genitourinary toxicity but late Grade 3+ gastrointestinal RT complications correlated with increasing field size. Conclusions: This subset analysis demonstrates that RT field size has a major impact on PFS, and the findings support comprehensive nodal treatment in patients with a risk of LN involvement of >15%.

Original languageEnglish (US)
Pages (from-to)647-653
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume66
Issue number3
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

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pelvis
Radiation Oncology
Pelvis
Prostate
radiation therapy
therapy
Radiotherapy
progressions
Disease-Free Survival
Therapeutics
grade
toxicity
set theory

Keywords

  • Prostate cancer
  • Radiation field size
  • Randomized trials

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Whole-pelvis, "mini-pelvis," or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial. / Roach, Mack; DeSilvio, Michelle; Valicenti, Richard K; Grignon, David; Asbell, Sucha O.; Lawton, Colleen; Thomas, Charles R.; Shipley, William U.

In: International Journal of Radiation Oncology Biology Physics, Vol. 66, No. 3, 01.11.2006, p. 647-653.

Research output: Contribution to journalArticle

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abstract = "Purpose: The Radiation Therapy Oncology Group (RTOG) 9413 trial demonstrated a better progression-free survival (PFS) with whole-pelvis (WP) radiotherapy (RT) compared with prostate-only (PO) RT. This secondary analysis was undertaken to determine whether {"}mini-pelvis{"} (MP; defined as ≥10 × 11 cm but <11 × 11 cm) RT resulted in progression-free survival (PFS) comparable to that of WP RT. To avoid a timing bias, this analysis was limited to patients receiving neoadjuvant and concurrent hormonal therapy (N&CHT) in Arms 1 and 2 of the study. Methods and Materials: Eligible patients had a risk of lymph node (LN) involvement >15{\%}. Neoadjuvant and concurrent hormonal therapy (N&CHT) was administered 2 months before and during RT for 4 months. From April 1, 1995, to June 1, 1999, a group of 325 patients were randomized to WP RT + N&CHT and another group of 324 patients were randomized to receive PO RT + N&CHT. Patients randomized to PO RT were dichotomized by median field size (10 × 11 cm), with the larger field considered an {"}MP{"} field and the smaller a PO field. Results: The median PFS was 5.2, 3.7, and 2.9 years for WP, MP, and PO fields, respectively (p = 0.02). The 7-year PFS was 40{\%}, 35{\%}, and 27{\%} for patients treated to WP, MP, and PO fields, respectively. There was no association between field size and late Grade 3+ genitourinary toxicity but late Grade 3+ gastrointestinal RT complications correlated with increasing field size. Conclusions: This subset analysis demonstrates that RT field size has a major impact on PFS, and the findings support comprehensive nodal treatment in patients with a risk of LN involvement of >15{\%}.",
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AU - DeSilvio, Michelle

AU - Valicenti, Richard K

AU - Grignon, David

AU - Asbell, Sucha O.

AU - Lawton, Colleen

AU - Thomas, Charles R.

AU - Shipley, William U.

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