Tumor Control Probability Modeling and Systematic Review of the Literature of Stereotactic Body Radiotherapy for Prostate Cancer
Abstract
BACKGROUND Dose escalation improves localized prostate cancer disease control and moderately-hypofractionationed external beam radiation is non-inferior to conventional fractionation. The evolving treatment approach of ultra-hypofractionation with stereotactic body radiation therapy (SBRT) allows possible further “biological-dose escalation” and shortened treatment time. METHODS The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse (FFBR). Results were stratified by prostate cancer risk group. RESULTS Twenty-five published cohorts were identified for inclusion with a total of 4,821 patients (2,235 low-risk, 1,894 intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up over 5 years. Dosing regimens ranged from 32-50 Gy in 4-5 fractions, with total BED (α/β=1.5 Gy) between 183.1-383.3 Gy. At 5 years, we found in patients with low-intermediate risk disease, an EQD2 of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,821 participants or records.
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