Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics.: Estimation of  ratio of prostate cancer using repeated post-treatment PSA measures

Cécile Proust-Lima 1, * Jeremy Taylor 2, 3 Solène Sécher 1 Howard Sandler 4 Larry Kestin 5 Tom Pickles 6 Kyounghwa Bae 7 Roger Allison 8 Scott Williams 9, *
* Auteur correspondant
1 Epidémiologie et Biostatistique [Bordeaux]
2 Department of Biostatistics
3 Radonc - Department of Radiation Oncology [Michigan]
4 Department of Radiation Oncology [Los Angeles]
5 Department of Radiation Oncology [Royal Oak]
6 British Columbia Cancer Agency
7 Department of Statistics
8 Division of Oncology
9 Division of Radiation Oncology
Abstract : PURPOSE: To estimate the α/β ratio of prostate cancer treated with external beam radiation only by use of a model of long-term prostate-specific antigen (PSA) dynamics. METHODS AND MATERIALS: Repeated measures of PSA from 5,093 patients from 6 institutions treated for localized prostate cancer by external beam radiation therapy (EBRT) without planned androgen deprivation were analyzed. A biphasic linear mixed model described the post-treatment evolution of PSA, rather than a conventional model of time to biochemical recurrence. The model was adjusted for standard prognostic factors (T stage, initial PSA level, and Gleason score) and cohort-specific effects. The radiation dose fractionation effect was estimated from the long-term rate of rise of PSA level. RESULTS: Adjusted for other factors, total dose of EBRT and sum of squared doses per fraction were associated with long-term rate of change of PSA level (p = 0.0017 and p = 0.0003, respectively), an increase of each being associated with a lower rate of rise. The α/β ratio was estimated at 1.55 Gy (95% confidence band, 0.46-4.52 Gy). This estimate was robust to adjustment of the linear mixed model. CONCLUSIONS: By analysis of a large EBRT-only cohort along with a method that uses all the repeated measures of PSA after the end of treatment, a low and precise α/β was estimated. These data support the use of hypofractionation at fractional doses up to 2.8 Gy but cannot presently be assumed to accurately represent higher doses per fraction.
Keywords : Prostate cancer Prostate-specific Antigen Progression of disease Radiation therapy Alpha/beta Radiosensitivity
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Article dans une revue
International Journal of Radiation Oncology - Biology - Physics, Elsevier, 2011, 79 (1), pp.195-201. 〈10.1016/j.ijrobp.2009.10.008〉
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Cécile Proust-Lima, Jeremy Taylor, Solène Sécher, Howard Sandler, Larry Kestin, et al.. Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics.: Estimation of  ratio of prostate cancer using repeated post-treatment PSA measures. International Journal of Radiation Oncology - Biology - Physics, Elsevier, 2011, 79 (1), pp.195-201. 〈10.1016/j.ijrobp.2009.10.008〉. 〈inserm-00621004〉

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