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Increased Dose of External Beam Radiation Therapy (EBRT) Improves Overall Survival in Men with Prostate Cancer

Dr. Anusha Kalbasi, MD, a resident in the Department of Radiation Oncology, Hospital of the University of Pennsylvania, and colleagues have reported that increased doses of external-beam radiation therapy (EBRT) improve overall survival in men with high and intermediate risk prostate cancer. However, Dr. Anusha Kalbasi and team found that increased dose of external-beam radiation therapy (EBRT) in men with low-risk prostate cancer were not associated with a difference in overall survival. This study was recently published in JAMA Oncology.

Dr. Anusha Kalbasi and colleagues conducted their study by comparing the effectiveness of normal dose versus increased dose EBRT for men diagnosed with prostate cancer from 2004 to 2006, utilizing the National Cancer Database. Three groups of men with prostate cancer were evaluated. The first group was men with high-risk prostate cancer, second with intermediate-risk prostate cancer, and third with low-risk prostate cancer. Comparison of overall survival was done between treatment groups, and in a sub-analysis, dose response for survival was analyzed. Their study result showed that patients with intermediate risk disease were associated with a 7.8% reduction in mortality for every 2-Gy dose of EBRT increased. Men with high-risk prostate cancer also experience a similar reduction of 6.3% in mortality for every 2-Gy dose of EBRT increased. Further details on the study result can be found here.

Dr. Anusha Kalbasi commented that their study suggests that physicians should factor in prostate cancer risk when weighing the benefits and risks of dose-escalated EBRT. Dr. Anthony L. Zietman, MD, and Dr. Phillip J. Gray, MD, both from Massachusetts General Hospital in Boston, uninvolved in this study, mentioned that past randomized clinical trials and studies with more than 10 years of follow-up have not shown any improvement in overall survival with increased dose of EBRT. Therefore, the improvement of overall survival seen in this study seems to suggest a true association between survival and dose that was missing in past randomized clinical trials.

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