SynthesisAmerican journal of clinical oncology2018
Impact of Radiation Therapy Dose Escalation on Prostate Cancer Outcomes and Toxicities.
Synthesis in American journal of clinical oncology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 4 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Prognostic value of PSA bounce in prostate cancer following definitive radiation therapy: a systematic review and meta-analysis.Prostate cancer and prostatic diseases · 2021Pooled it
- Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2018Pooled it
- Hypofractionated radiation therapy for basal and squamous cell skin cancer: A meta-analysis.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2017Pooled it
- Splenic irradiation for splenomegaly: A systematic review.Cancer treatment reviews · 2017Pooled it
- Quality of Life Implications of Dose-Escalated External Beam Radiation for Localized Prostate Cancer: Results of a Prospective Randomized Phase 3 Clinical Trial, NRG/RTOG 0126.International journal of radiation oncology, biology, physics · 2022Trial
- Physician- and Patient-Reported Outcomes Following Contemporary Image Guided Intensity Modulated Proton Therapy for Prostate Cancer: Results From the Prospective PRO-Cube Study.Advances in radiation oncology · 2026Article
- Intermediate clinical endpoints as surrogates for overall survival after salvage prostatectomy.BJU international · 2026Article
- Robust Four-Field and Arc LET-Optimized Proton Prostate Cancer Treatment Plans With Urethral Sparing.International journal of particle therapy · 2026Article
- Combining Statins with Radiotherapy for Prostate Cancer: From Photon Experience to Proton Potential.Journal of clinical medicine · 2026Review
- Moderately hypofractionated prostate-only versus whole-pelvis radiotherapy for high-risk prostate cancer: A retrospective real-world single-center cohort study.Clinical and translational radiation oncology · 2024Article
- The expanding role of radiation oncology across the prostate cancer continuum.Abdominal radiology (New York) · 2024Review
- Long-term prognosis and prognostic factors of brachytherapy and propensity score matched comparisons of the outcomes between brachytherapy and radical prostatectomy: a retrospective cohort study.Translational andrology and urology · 2022Article
- Article
- Local versus systemic treatment intensification: what is the optimal strategy for localized prostate cancer?Prostate cancer and prostatic diseases · 2022Article
- Salvage therapy for prostate cancer after radical prostatectomy.Nature reviews. Urology · 2021Review
- Inverse planning in high-dose rate brachytherapy improves quality of life of prostate cancer patients compared with forward planning.International journal of clinical oncology · 2021Article
- Review
- Stereotactic radiotherapy with focal boost for intermediate and high-risk prostate cancer: Initial results of the SPARC trial.Clinical and translational radiation oncology · 2020Article
- Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry.Clinical and translational radiation oncology · 2020Article
- Comparative Effectiveness of Different Radical Radiotherapy Treatment Regimens for Prostate Cancer: A Population-Based Cohort Study.JNCI cancer spectrum · 2020Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesFreedom from biochemical failure (FFBF) is a common primary outcome of randomized-controlled trials of prostate cancer (PCa). We aimed to determine how increasing the PCa biologically equivalent dose (BED) of external radiation therapy (RT) is correlated with FFBF and overall patient outcomes: overall survival (OS), distant metastasis (DM), and cancer-specific mortality (CSM); as well as genitourinary (GU), and gastrointestinal toxicities. MATERIALS AND
methodsWe performed a meta-analysis of 6884 PCa patients from 12 randomized-controlled trials of external beam RT. Mixed effects regression models were used to estimate weighted linear relationships between BED and observed percentages of 5- and 10-year outcomes. For toxicities, a subset analysis of using 3-dimensional conformal RT (3D-CRT) versus intensity-modulated RT (IMRT) was performed.
resultsIncreasing BED correlated with improved FFBF: 10-year absolute improvement of 9.6% and 7.2% for low-risk and intermediate-risk patients, respectively (P<0.05); but not with improvement of OS, DM, or CSM at either time point. BED escalation was not correlated with increased acute toxicities; it was correlated with increased late gastrointestinal toxicities in patients treated with 3D-CRT (1.5% increase over BED range, P<0.01). IMRT patients had significantly fewer late toxicities, despite being treated at higher BED.
conclusionsRT BED escalation has resulted in significantly improved PCa FFBF at up to 10 years; but not with improvement in OS, DM, or CSM. Thus, FFBF is a poor surrogate of overall patient outcomes for trials of RT. Late toxicities were less frequent with IMRT than with 3D-CRT, even at higher BED.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.