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Postoperative radiotherapy of carcinoma in bilharzial bladder. Improved disease-free survival through improving local control
Radiation
200
Oncology, Biology, Physics
October 1990, Volume 19, SuPPlement
1
145 ~cx3v.c~
INTER~ZCTION IN PROSTATE .~DENO~~RCIN~
TREATED WITH EXTERW
IRRADIATION
Jean-Philippe Austin; Karen Coveryf and -MarvinRotman Dspartment of Radiation Wdicinel, Mass,, General Hospital. Boston, *MA Department of Radiation Oncology', Suny/HSCB, Brooklyn, NY
Age-Race Interaction in Prostatic Adenocarcinoma Treated with External Irradiation The most important predictors of long-term survival in patients with adenocarcinoma of the prostate are histological grade and stage of disease. However, the significance of age and race is a controversial issue. There is a school of thought that black patients and younger patients have a biologically more aggressive disease. We analyzed the survival of 914 patients (867 whites, 47 blacks) with localized adenocarcinoma of the prostate treated with external beam irradiation from the Connecticut SEER Tumor Registry data base. Patient were treated from 1973-1987, and stages Al, A2, and D2 were excluded. Patients 260 years of age had a survival rate of 72% at 5 years compared to 61% for those >60 years of age (p=O.O6). When stratified by race, white patients had a 63% 5-year survival rate versus 47% in black patients (p=O.O2). When analyzed by race and age, an age-race interaction was noted. While younger whites fared better than older whites, 77% versus 61% at 5 years (p=O.O2), younger blacks fared worse than older blacks, 31% versus 52% at 5 years (p=O.21). Blacks, on average, presented at an earlier age than whites, _ 65 years versus 69 years (p=O.OOl). Both races had similar stage as well as similar grade disease. In older patients, both races presented with similar stage and grade of disease, and had similar survival. However, in the younger age group, black patients presented with similar grade, but higher stage disease than whites. This may explain the worse survival in young blacks compared to young whites, 31% versus 77% at 5 years (p=O.O07). Multivariate analysis revealed that controlling for stage and grade, blacks still did worse than whites (hazard ratio=120). Increased age was associated with decreased survival in whites (hazard increased 40% per decade), but increased survival in blacks (hazard decreased 25% per decade).
146 Postoperative Improved
radiotherapy
disease-free
M.S.Zaghloul,
H.K. Awwad,
Radiotherapy,
Surgery
H.Akoush,
and Medical
of Carcinoma
survival
through
Sh. Omar, Statistics
in bilharzial improving
0. Soliman departments
bladder.
local
control.
and I.El Attar. NCI,
Cairo,
Egypt.
Two hundreds and thirty six patients with T3 bladder cancer who survived radical into 3 groups: a) no surgery and proved to have P3a, P3b or P4a tumors were randomized further treatment (83 patients) b) postoperative raditherapy using 3 daily fractions (MDF) 1.25 Gy each with 3 hours interval between each fraction up to a dose of 37.5 Gy c) conventional postoperative radiotherapy fractionation in 12 days (75 patients) and The tolerance of the patients to (CF) giving a dose of 50 Gy/5 weeks (78 patients). postoperative radiotherapy were quite acceptable, with equal or slightly higher acute The 5-year were much lower with MDF. reactions in MDF than CF. Late complications disease-free survival (DFS) rate amounted to 49 and 44% in the MDF and CF Postoperative The 5-year local groups respectively compared to 25% in the cystectomy alone group. control rates were 87 and 92% for those treated with MDF and CF while it was only 50% The therapeutic benefit of post operative irradiation in the surgery alone group. grades and stages for both the DFS and local applied to all tumor types, histological control. Patients with nodal metastases demonstrated a lower recurrence rates in the post operative radiotherapy groups but this was not associated with improved DFS. The independent Multivariate analysis using Cox model confirmed these results. prognostic factors affecting both DFS and local control were : the addition of poststage and tumor grade. operative radiotherapy, nodal status, pathological
200
Oncology, Biology, Physics
October 1990, Volume 19, SuPPlement
1
145 ~cx3v.c~
INTER~ZCTION IN PROSTATE .~DENO~~RCIN~
TREATED WITH EXTERW
IRRADIATION
Jean-Philippe Austin; Karen Coveryf and -MarvinRotman Dspartment of Radiation Wdicinel, Mass,, General Hospital. Boston, *MA Department of Radiation Oncology', Suny/HSCB, Brooklyn, NY
Age-Race Interaction in Prostatic Adenocarcinoma Treated with External Irradiation The most important predictors of long-term survival in patients with adenocarcinoma of the prostate are histological grade and stage of disease. However, the significance of age and race is a controversial issue. There is a school of thought that black patients and younger patients have a biologically more aggressive disease. We analyzed the survival of 914 patients (867 whites, 47 blacks) with localized adenocarcinoma of the prostate treated with external beam irradiation from the Connecticut SEER Tumor Registry data base. Patient were treated from 1973-1987, and stages Al, A2, and D2 were excluded. Patients 260 years of age had a survival rate of 72% at 5 years compared to 61% for those >60 years of age (p=O.O6). When stratified by race, white patients had a 63% 5-year survival rate versus 47% in black patients (p=O.O2). When analyzed by race and age, an age-race interaction was noted. While younger whites fared better than older whites, 77% versus 61% at 5 years (p=O.O2), younger blacks fared worse than older blacks, 31% versus 52% at 5 years (p=O.21). Blacks, on average, presented at an earlier age than whites, _ 65 years versus 69 years (p=O.OOl). Both races had similar stage as well as similar grade disease. In older patients, both races presented with similar stage and grade of disease, and had similar survival. However, in the younger age group, black patients presented with similar grade, but higher stage disease than whites. This may explain the worse survival in young blacks compared to young whites, 31% versus 77% at 5 years (p=O.O07). Multivariate analysis revealed that controlling for stage and grade, blacks still did worse than whites (hazard ratio=120). Increased age was associated with decreased survival in whites (hazard increased 40% per decade), but increased survival in blacks (hazard decreased 25% per decade).
146 Postoperative Improved
radiotherapy
disease-free
M.S.Zaghloul,
H.K. Awwad,
Radiotherapy,
Surgery
H.Akoush,
and Medical
of Carcinoma
survival
through
Sh. Omar, Statistics
in bilharzial improving
0. Soliman departments
bladder.
local
control.
and I.El Attar. NCI,
Cairo,
Egypt.
Two hundreds and thirty six patients with T3 bladder cancer who survived radical into 3 groups: a) no surgery and proved to have P3a, P3b or P4a tumors were randomized further treatment (83 patients) b) postoperative raditherapy using 3 daily fractions (MDF) 1.25 Gy each with 3 hours interval between each fraction up to a dose of 37.5 Gy c) conventional postoperative radiotherapy fractionation in 12 days (75 patients) and The tolerance of the patients to (CF) giving a dose of 50 Gy/5 weeks (78 patients). postoperative radiotherapy were quite acceptable, with equal or slightly higher acute The 5-year were much lower with MDF. reactions in MDF than CF. Late complications disease-free survival (DFS) rate amounted to 49 and 44% in the MDF and CF Postoperative The 5-year local groups respectively compared to 25% in the cystectomy alone group. control rates were 87 and 92% for those treated with MDF and CF while it was only 50% The therapeutic benefit of post operative irradiation in the surgery alone group. grades and stages for both the DFS and local applied to all tumor types, histological control. Patients with nodal metastases demonstrated a lower recurrence rates in the post operative radiotherapy groups but this was not associated with improved DFS. The independent Multivariate analysis using Cox model confirmed these results. prognostic factors affecting both DFS and local control were : the addition of poststage and tumor grade. operative radiotherapy, nodal status, pathological