{"entity":{"id":"paper-flame-focal-boost-prostate-jco-2021","kind":"paper","name":"Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer: results from the FLAME randomized phase III trial","aka":[],"tldr":"A trial of 571 men with intermediate or high-risk prostate cancer gave half of them an extra dose, up to 95 Gy, to the tumour visible on MRI inside the prostate. After five years 92 per cent of the boosted group were free of PSA relapse against 85 per cent, with no measurable increase in side effects and no difference in survival.","summary":"The Focal Lesion Ablative Microboost in Prostate Cancer (FLAME) trial enrolled 571 men with intermediate- and high-risk localised prostate cancer between 2009 and 2015. The standard arm received 77 Gy in 2.2 Gy fractions to the whole prostate. The focal boost arm received an additional simultaneous integrated boost of up to 95 Gy (fractions up to 2.7 Gy) to the lesion visible on multiparametric MRI, with organ-at-risk constraints taking priority over the boost dose. At a median follow-up of 72 months, biochemical disease-free survival was higher with the boost (hazard ratio 0.45, 95 per cent confidence interval 0.28 to 0.71), 92 against 85 per cent at five years. No difference was seen in prostate cancer-specific survival (P = .49) or overall survival (P = .50). Late genitourinary and gastrointestinal toxicity of grade 2 or worse was 23 and 12 per cent in the standard arm and 28 and 13 per cent with the boost, differences that were small and not statistically significant, as were those in quality of life.","asOf":"2026-10-20","links":[{"label":"Journal of Clinical Oncology 2021","url":"https://doi.org/10.1200/JCO.20.02873"},{"label":"PubMed 33471548","url":"https://pubmed.ncbi.nlm.nih.gov/33471548/"}],"tags":["precision","radiation"],"related":[],"cancers":["prostate"],"sections":["radiation"],"technologies":["dose-painting","imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["target-delineation-variability","organs-at-risk"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2021,"doi":"10.1200/JCO.20.02873","pmid":"33471548","authors":"Kerkmeijer LGW, Groen VH, Pos FJ, et al.","paperType":"rct","findings":["Five-year biochemical disease-free survival was 92 per cent with the focal boost and 85 per cent without (hazard ratio 0.45, 95 per cent confidence interval 0.28 to 0.71).","No difference in prostate cancer-specific survival (P = .49) or overall survival (P = .50).","Late grade 2 or worse genitourinary toxicity 28 against 23 per cent and gastrointestinal 13 against 12 per cent, not statistically significant."],"whatItMeans":"The clearest randomised evidence that putting more dose where imaging shows the tumour, rather than spreading it evenly, improves control. It depends on seeing and outlining the lesion on MRI, and on respecting the limits of the bladder and rectum first.","caveats":["The benefit is in biochemical (PSA-defined) control; survival did not differ at this follow-up.","Conventional fractionation over many weeks; whether the same holds with five-session stereotactic treatment is a separate question.","Requires a visible lesion on multiparametric MRI and reliable delineation of it."],"participants":571},"route":"/key-papers/paper-flame-focal-boost-prostate-jco-2021/","neighbours":{"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"dose-painting","kind":"technology","name":"Dose painting and biologically guided radiotherapy","route":"/technologies/dose-painting/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"}],"term":[{"id":"organs-at-risk","kind":"term","name":"Organs at risk and dose constraints","route":"/terms/organs-at-risk/"},{"id":"target-delineation-variability","kind":"term","name":"Variation between clinicians in drawing the radiotherapy target","route":"/terms/target-delineation-variability/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}