Curative external beam radiotherapy for prostate carcinoma: Results in 231patients treated in Lyon

Background: Radical prostatectomy and external beam radiation therapy (EBRT ) are the mainstays of treatment of prostate cancer with curative intent. T he possible development of radiation proctitis and rectal bleeding are majo r concerns when using EBRT. Recently, conformal radiotherapy has been intro duced in an attempt to improve the results of EBRT. This paper presents an overview of the Lyon experience using standard EBRT with doses of 68 Gy, an d reports the preliminary results of a study of conformal radiotherapy with dose escalation. Methods: From 1981 to 1995, EBRT was used to treat 231 patients with locali zed adenocarcinomas of the prostate. The dose of EBRT was 68 Gy/34 fraction s/7 weeks using a four-field box technique with 18-MeV photons. A feasibili ty study of conformal radiotherapy was commenced in 1996. To date, 145 pati ents have been treated with doses escalating from 68 to 80 Gy. Results: In the EBRT group of 231 patients, the 5-year overall survival was 80.3%. Anorectal function was scored as excellent in 90%, of patients. Rec tal bleeding was seen in 14.3% of patients and required local treatment in only seven. In the group treated with conformal radiotherapy, the prelimina ry results indicate good early tolerance. Conclusion: The curative treatment of patients with prostate cancer using E BRT gives good long-term survival with low rectal toxicity. Conformal radio therapy appears to be an interesting approach to improve local control and perhaps survival.