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A French trial of 470 men compared checking the prostate's position with imaging before every radiotherapy session against checking weekly. Daily imaging lowered rectal side effects and PSA-defined progression, but the main endpoint, recurrence-free survival, did not differ, and overall survival was worse in the daily group.
De Crevoisier and colleagues randomised 470 men with node-negative localised prostate cancer at 21 centres between 2007 and 2012 to daily image guidance or weekly image guidance (days 1, 2 and 3 and then weekly), with prostate doses of 70 to 80 Gy. At a median follow-up of 4.1 years, recurrence-free survival, the primary outcome, did not differ significantly (hazard ratio 0.81, P = .330). Overall survival was worse in the daily group (hazard ratio 2.12, 95 per cent confidence interval 1.03 to 4.37, P = .042), as was the post hoc other-cancer-free interval (hazard ratio 2.21). Acute rectal bleeding was lower with daily imaging (6 against 11 per cent), late rectal toxicity was lower (hazard ratio 0.71), and the post hoc biochemical progression-free interval was better (hazard ratio 0.45).
Imaging the prostate before every session is now standard, and this trial supports it for rectal side effects and PSA control. It also shows how hard it is to turn a physical gain in accuracy into a survival result, and that a randomised trial can throw up an unexplained difference that should be reported rather than smoothed over.
Shares GTV, CTV and PTV (target volumes), International Journal of Radiation Oncology, Biology, Physics, IMRT / IGRT (modern external beam) and the tags precision, radiation.
Shares GTV, CTV and PTV (target volumes), International Journal of Radiation Oncology, Biology, Physics, IMRT / IGRT (modern external beam) and the tags precision, radiation.
Shares GTV, CTV and PTV (target volumes) and the tags precision, radiation.
Shares GTV, CTV and PTV (target volumes), IMRT / IGRT (modern external beam) and the tags precision, radiation.
Shares IMRT / IGRT (modern external beam), Prostate cancer and the tags precision, radiation.
Shares GTV, CTV and PTV (target volumes) and the tags precision, radiation.
Shares IMRT / IGRT (modern external beam) and the tags precision, radiation.
Shares the tags precision, radiation.
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