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Senior Citizen Health & Medicine
Prostate Cancer Appears Cured in 89 Percent of Men
Treated with IMRT
After eight years
they are alive and show no signs of cancer
September 27, 2006 - The vast majority of prostate
cancer victims 89 percent - treated with high-dose, intensity
modulated radiation therapy (IMRT) are alive and show no evidence of the
cancer eight years after the treatment. This is the encouraging report
on the largest study ever of men with prostate cancer treated by IMRT.
The 561 patients, primarily senior citizens with an average age of 68,
were treated at Memorial Sloan-Kettering Cancer Center.
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The men were classified into prognostic risk
groups. After an average of eight years, 89 percent of the men in the
favorable risk group were disease-free and none of the men in any group
developed secondary cancers as a result of the radiation therapy.
This report, published in the October 2006 issue of
The Journal of Urology, is the first description of long-term outcomes
for prostate cancer patients using IMRT.
"Our results suggest that IMRT should be the
treatment of choice for delivering high-dose, external beam radiotherapy
for patients with localized prostate cancer," said Dr. Michael J.
Zelefsky, Chief of the Brachytherapy Service at Memorial
Sloan-Kettering.
"We were able to show long-term safety and
long-term efficacy in a very diverse group of prostate cancer patients
that we followed many for as long as ten years."
"Despite the fact that some patients had an
aggressive form of their disease with high Gleason scores and PSA
(prostate specific antigen) levels, the overwhelming majority of
patients had good tumor control with neither recurrence of their
original cancer nor development of second cancers, which one might have
expected from the high doses of radiation," he added.
Pre-treatment diagnostic evaluations were performed
for all of the patients to better define their clinically localized
prostate cancer. They were classified into prognostic risk groups as
defined by the National Comprehensive Cancer Network guidelines (www.nccn.org).
These are based on clinical characteristics including age, T stage,
Gleason score, PSA level, and pre-treatment with neoadjuvant androgen
deprivation.
Between April 1996 and January 2000, 561 patients
with a median age of 68 (ranging from 46 to 86 years old) were treated
with IMRT, an improved form of three-dimensional conformal radiation
therapy (3D-CRT), also used in radiotherapy.
IMRT uses enhanced planning treatment software that
more precisely targets the prostate, allowing the beam of radiation to
deliver a high dose (81 Gy) to the tumor target while sparing the
adjacent bladder and rectum from exposure to the higher amounts of
radiation.
Perhaps because of this, the eight-year results
show urinary continence was maintained for all patients, and only 1.6
percent of the five hundred sixty-one patients experienced rectal
bleeding.
The high-dose radiotherapy was curative for the
majority of the patients in all three prognostic risk groups, with 89
percent of the favorable, 78 percent of the intermediate, and 67 percent
of the unfavorable group alive after an average period of eight years.
Of those men who were potent prior to IMRT, erectile dysfunction
developed in 49 percent.
"This study confirms that we can improve patients'
quality of life by reducing the side effects of radiotherapy while
maintaining disease-free survival," said Dr. Zelefsky. "However, there
is still room for improvement. We are incorporating image-guided
approaches that may continue the excellent tumor control but further
limit the area we are irradiating and reduce side-effects."
Notes:
The study's co-authors are Heather Chan, Margie
Hunt, Yoshiya Yamada, MD, Alison M. Shippy, and Howard Amols, PhD, of
Memorial Sloan-Kettering.
Memorial Sloan-Kettering Cancer Center is the
world's oldest and largest institution devoted to prevention, patient
care, research, and education in cancer. Our scientists and clinicians
generate innovative approaches to better understand, diagnose, and treat
cancer. Our specialists are leaders in biomedical research, and in
translating the latest research to advance the standard of cancer care
worldwide.
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