Urologic Oncology Survey
Commentary on “70 Gy vs. 80 Gy in localized prostate cancer: 5-Year results of GETUG 06 randomized trial.” Beckendorf V, Guerif
S, Le Prisé E, Cosset JM, Bougnoux A, Chauvet B, Salem N, Chapet O, Bourdain S, Bachaud JM, Maingon P, Hannoun-Levi JM, Malissard
L, Simon JM, Pommier P, Hay M, Dubray B, Lagrange JL, Luporsi E, Bey P, Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
Int J Radiat Oncol Biol Phys 2011;80:1056 – 63
A total of 306 patients with localized prostate cancer were randomized. No androgen deprivation was allowed. The primary endpoint was
biochemical relapse according to the modiﬁed 1997 American Society for Therapeutic Radiology and Oncology and Phoenix deﬁnitions.
Toxicity was graded using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective, objective,
management, analytical scales (LENT-SOMA) scales. The patients’ quality of life was scored using the European Organization for Research
and Treatment of Cancer Quality of Life Questionnaire 30-item cancer-speciﬁc and 25-item prostate-speciﬁc modules.
The median follow-up was 61 months. According to the 1997 American Society for Therapeutic Radiology and Oncology deﬁnition, the
5-year biochemical relapse rate was 39% and 28% in the 70- and 80-Gy arms, respectively (P ϭ 0.036). Using the Phoenix deﬁnition, the
5-year biochemical relapse rate was 32% and 23.5%, respectively (P ϭ 0.09). The subgroup analysis showed a better biochemical outcome
for the higher dose group with an initial prostate-speciﬁc antigen level Ͼ15 ng/ml. At the last follow-up date, 26 patients had died, 10 of
their disease and none of toxicity, with no differences between the 2 arms. According to the Radiation Therapy Oncology Group scale, the
grade 2 or greater rectal toxicity rate was 14% and 19.5% for the 70- and 80-Gy arms (P ϭ 0.22), respectively. Grade 2 or greater urinary
toxicity was 10% at 70 Gy and 17.5% at 80 Gy (P ϭ 0.046). Similar results were observed using the LENT-SOMA scale. Bladder toxicity
was more frequent at 80 Gy than at 70 Gy (P ϭ 0.039). The quality-of-life questionnaire results before and 5 years after treatment were
available for 103 patients with no differences found between the 70- and 80-Gy arms. High-dose radiotherapy provided a better 5-year
biochemical outcome with slightly greater toxicity.
This randomized trial of 306 patients comparing 70 vs. 80 Gy for localized prostate cancer shows what is expected; improved biochemical
control at 5 years (61% vs. 72%). While underpowered to look at other endpoints, such as distant metastasis and overall survival, this trial
demonstrates acceptable late toxicity using 3D conformal radiation techniques. Radiation oncology/toxicity grading (RTOG) grade 3 rectal
toxicity (1.9% vs. 5.9%), RTOG grade 3– 4 urinary toxicity (2.6% vs. 1.9%), LENT-SOMA grade 3 rectal toxicity (1.9% vs. 6.5%),
LENT-SOMA grade 3– 4 urinary toxicity (3.6% vs. 6.0%). While these toxicities are deemed acceptable, more modern studies using
intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) show lower rates of toxicity .
Alexander Gottschalk, M.D., Ph.D.
 Eade TN, Guo L, Forde E, et al. Commentary on Image-guided dose-escalated intensity-modulated radiation therapy for prostate cancer: Treating to doses
beyond 78 Gy. BJU Int. October 28, 2011. [Epub ahead of print].
Commentary on “Twice-weekly hypofractionated intensity-modulated radiotherapy for localized prostate cancer with low-risk
nodal involvement: Toxicity and outcome from a dose escalation pilot study.” T. Zilli, S. Jorcano, M. Rouzaud, G. Dipasquale, P. Nouet,
J.I. Toscas, N. Casanova, H. Wang, L. Escudé, M. Mollà, D. Linero, D.C. Weber, R. Miralbell, Service de Radio-oncologie, Hôpitaux
Universitaires de Genève, Geneva, Switzerland.
Int J Radiat Oncol Biol Phys 2011;81:382–9
To evaluate the toxicity and preliminary outcome of patients with localized prostate cancer treated with twice-weekly hypofractionated
intensity-modulated radiotherapy (IMRT).
Urologic Oncology: Seminars and Original Investigations 30 (2012) 347-350
1078-1439/$ – see front matter © 2012 Elsevier Inc. All rights reserved.