The early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: results from the MRC RT01 trial (ISRCTN47772397).

2.50
Hdl Handle:
http://hdl.handle.net/10541/70035
Title:
The early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: results from the MRC RT01 trial (ISRCTN47772397).
Authors:
Dearnaley, David P; Sydes, Matthew R; Langley, Ruth E; Graham, John D; Huddart, Robert A; Syndikus, Isabel; Matthews, John H L; Scrase, Christopher D; Jose, Chakiath C; Logue, John P; Stephens, Richard J
Abstract:
BACKGROUND: Five-year disease-free survival rates for localised prostate cancer following standard doses of conventional radical external beam radiotherapy are around 80%. Conformal radiotherapy (CFRT) raises the possibility that radiotherapy doses can be increased and long-term efficacy outcomes improved, with safety an important consideration. METHODS: MRC RT01 is a randomised controlled trial of 862 men with localised prostate cancer comparing Standard CFRT (64Gy/32f) versus Escalated CFRT (74Gy/37f), both administered with neo-adjuvant androgen suppression. Early toxicity was measured using physician-reported instruments (RTOG, LENT/SOM, Royal Marsden Scales) and patient-reported questionnaires (MOS SF-36, UCLA Prostate Cancer Index, FACT-P). RESULTS: Overall early radiotherapy toxicity was similar, apart from increased bladder, bowel and sexual toxicity, in the Escalated Group during a short immediate post-radiotherapy period. Toxicity in both groups had abated by week 12. Using RTOG Acute Toxicity scores, cumulative Grade 2 bladder and bowel toxicity was 38% and 30% for Standard Group and 39% and 33% in Escalated Group, respectively. Urinary frequency (Royal Marsden Scale) improved in both groups from pre-androgen suppression to 6 months post-radiotherapy (p<0.001), but bowel and sexual functioning deteriorated. This pattern was supported by patient-completed assessments. Six months after starting radiotherapy the incidence of RTOG Grade > or = 2 side-effects was low (<1%); but there were six reports of rectal ulceration (6 Escalated Group), six haematuria (5 Escalated Group) and eight urethral stricture (6 Escalated Group). CONCLUSIONS: The two CFRT schedules with neo-adjuvant androgen suppression have broadly similar early toxicity profiles except for the immediate post-RT period. At 6 months and compared to before hormone therapy, bladder symptoms improved, whereas bowel and sexual symptoms worsened. These assessments of early treatment safety will be complemented by further follow-up to document late side-effects and efficacy.
Affiliation:
Institute of Cancer Research and Royal Marsden Hospitals, Sutton, UK. david.dearnaley@icr.ac.uk
Citation:
The early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: results from the MRC RT01 trial (ISRCTN47772397). 2007, 83 (1):31-41 Radiother Oncol
Journal:
Radiotherapy and Oncology
Issue Date:
Apr-2007
URI:
http://hdl.handle.net/10541/70035
DOI:
10.1016/j.radonc.2007.02.014
PubMed ID:
17391791
Type:
Article
Language:
en
ISSN:
0167-8140
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorDearnaley, David P-
dc.contributor.authorSydes, Matthew R-
dc.contributor.authorLangley, Ruth E-
dc.contributor.authorGraham, John D-
dc.contributor.authorHuddart, Robert A-
dc.contributor.authorSyndikus, Isabel-
dc.contributor.authorMatthews, John H L-
dc.contributor.authorScrase, Christopher D-
dc.contributor.authorJose, Chakiath C-
dc.contributor.authorLogue, John P-
dc.contributor.authorStephens, Richard J-
dc.date.accessioned2009-06-09T16:30:28Z-
dc.date.available2009-06-09T16:30:28Z-
dc.date.issued2007-04-
dc.identifier.citationThe early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: results from the MRC RT01 trial (ISRCTN47772397). 2007, 83 (1):31-41 Radiother Oncolen
dc.identifier.issn0167-8140-
dc.identifier.pmid17391791-
dc.identifier.doi10.1016/j.radonc.2007.02.014-
dc.identifier.urihttp://hdl.handle.net/10541/70035-
dc.description.abstractBACKGROUND: Five-year disease-free survival rates for localised prostate cancer following standard doses of conventional radical external beam radiotherapy are around 80%. Conformal radiotherapy (CFRT) raises the possibility that radiotherapy doses can be increased and long-term efficacy outcomes improved, with safety an important consideration. METHODS: MRC RT01 is a randomised controlled trial of 862 men with localised prostate cancer comparing Standard CFRT (64Gy/32f) versus Escalated CFRT (74Gy/37f), both administered with neo-adjuvant androgen suppression. Early toxicity was measured using physician-reported instruments (RTOG, LENT/SOM, Royal Marsden Scales) and patient-reported questionnaires (MOS SF-36, UCLA Prostate Cancer Index, FACT-P). RESULTS: Overall early radiotherapy toxicity was similar, apart from increased bladder, bowel and sexual toxicity, in the Escalated Group during a short immediate post-radiotherapy period. Toxicity in both groups had abated by week 12. Using RTOG Acute Toxicity scores, cumulative Grade 2 bladder and bowel toxicity was 38% and 30% for Standard Group and 39% and 33% in Escalated Group, respectively. Urinary frequency (Royal Marsden Scale) improved in both groups from pre-androgen suppression to 6 months post-radiotherapy (p<0.001), but bowel and sexual functioning deteriorated. This pattern was supported by patient-completed assessments. Six months after starting radiotherapy the incidence of RTOG Grade > or = 2 side-effects was low (<1%); but there were six reports of rectal ulceration (6 Escalated Group), six haematuria (5 Escalated Group) and eight urethral stricture (6 Escalated Group). CONCLUSIONS: The two CFRT schedules with neo-adjuvant androgen suppression have broadly similar early toxicity profiles except for the immediate post-RT period. At 6 months and compared to before hormone therapy, bladder symptoms improved, whereas bowel and sexual symptoms worsened. These assessments of early treatment safety will be complemented by further follow-up to document late side-effects and efficacy.en
dc.language.isoenen
dc.subjectProstate Canceren
dc.subject.meshAged-
dc.subject.meshAndrogen Antagonists-
dc.subject.meshGonadotropin-Releasing Hormone-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoadjuvant Therapy-
dc.subject.meshProstatic Neoplasms-
dc.subject.meshRadiation Injuries-
dc.subject.meshRadiotherapy Dosage-
dc.subject.meshRadiotherapy, Conformal-
dc.subject.meshRectum-
dc.subject.meshUrinary Bladder-
dc.titleThe early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: results from the MRC RT01 trial (ISRCTN47772397).en
dc.typeArticleen
dc.contributor.departmentInstitute of Cancer Research and Royal Marsden Hospitals, Sutton, UK. david.dearnaley@icr.ac.uken
dc.identifier.journalRadiotherapy and Oncologyen

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