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Intensive Radiotherapy Holds More Benefits for Localized Prostate Cancer

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According to a study spanning 10 years, a radiotherapy treatment plan involving higher doses of radiation is regarded as a much better option as opposed to lowering doses for men with localized prostate cancer.

Having 37 sessions, or fractions, of radiotherapy at 74 Gray (Gy) as opposed to 32 fractions at 64 Gy, controlled the disease more efficiently and diminished the chance that men would require follow-up hormone-deprivation therapy, which can lead to long-term side-effects.

The study’s findings, published in The Lancet Oncology, come from the major RT01 phase III trial. The trial was led by Professor Dearnaley at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, and was funded and conducted by the Medical Research Council Clinical Trials Unit at UCL. The study also featured several leading clinical research centers in the UK, New Zealand, and Australia.

In addition, the study exhibited the overall efficiency of radiotherapy for men with localized disease. Around three quarters of men treated with either the more or less intensive radiotherapy treatment plans were still alive after 10 years.

Established in 1998, the trial divided 843 men with localized prostate cancer into two groups to contrast the two doses of radiotherapy. Some 421 men had the less and 422 the more intensive treatment plans. Both cohorts also had standard hormone-deprivation treatment concurrently with their radiotherapy.

The five-year results of the trial have previously demonstrated the benefits of dose-escalated radiotherapy, and served as an influential role in changing NICE guidance to recommend it in prostate cancer. Dose escalation is now the standard for localized prostate cancer in the UK.

The new 10-year results further fortify the evidence for selecting higher does radiotherapy, in addition to showing the long-term benefits of the treatment.

Following 10 years, 55 per cent of men on the 37-fraction regime, when juxtaposed with 43 per cent of men on the 32-fraction regime, had survived without their cancer progressing into a more perilous form, as measured by the standard prostate-specific antigen (PSA) test. In each half of the study, 71 per cent of men were alive following 10 years, with only 11 per cent dying from prostate cancer.intense RT

Men who were administered the higher dose were more likely to have side-effects connected with radiotherapy, but few men had severe side-effects. Receiving the higher dose reduced the need for follow-up hormone treatment, which also has its own risk of side-effects.

The trial did not reveal that men given dose-escalated radiotherapy live longer, however both cohorts of men lived much longer than expected. Almost three quarters of all the men in the study were still alive after 10 years, and of the 236 men who had died since treatment, only 91 had died of prostate cancer.

"Our study has proved that treating men with localized prostate cancer using higher doses of radiotherapy is more effective than a less intensive regime. The dose-escalated regime is safe in the long term, and reduces the chances that a cancer will return and men will require further hormone-deprivation treatment. The side-effects of hormone treatment do need to be balanced against those of the extra radiotherapy doses, but overall our study has shown men are better off after having the escalated regime, as is now the norm in the UK,” said Study leader Professor David Dearnaley, Professor of Uro-Oncology at The Institute of Cancer Research, London, and Honorary Consultant at the Royal Marsden NHS Foundation Trust.

"Another key finding to come out of our study is that radiotherapy in general is both a safe and an effective treatment for localized prostate cancer. Almost three quarters of men treated with either the more or less intensive radiotherapy regimes are still alive after 10 years, and of the men who have died, less than half actually died from prostate cancer. Further refinements in radiotherapy techniques since our trial began have made treatment even safer and are very important as men with localized prostate cancer have such favorable long-term survival prospects,” he added.

Senior Scientist and Statistician at the MRC Clinical Trials Unit at UCL, Matthew Sydes said:

"The RT01 trial has already changed how men with localized prostate cancer are treated. The current NICE guidelines recommend the use of the higher dose of radiotherapy, based on the five-year results of RT01. The trial also helped to develop guidelines on how to limit the radiation that organs near the tumor receive, and helped hospitals across the UK to introduce quality-assured conformal radiotherapy. It is now contributing to biological studies to help better understand the disease and the side-effects of radiotherapy."

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