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Radiation Therapy in Treating Patients With Stage II Prostate Cancer

A Phase III Randomized Study Of High Dose 3D-CRT/IMRT Versus Standard Dose 3D-CRT/IMRT In Patients Treated For Localized Prostate Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00033631
Enrollment
1534
Registered
2003-01-27
Start date
2002-03-31
Completion date
2022-12-22
Last updated
2023-01-18

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Prostate Cancer

Keywords

adenocarcinoma of the prostate, stage IIB prostate cancer, stage IIA prostate cancer

Brief summary

RATIONALE: Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. It is not yet known which dose of radiation therapy is more effective in treating stage II prostate cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of two different doses of specialized radiation therapy in treating patients who have stage II prostate cancer.

Detailed description

OBJECTIVES: * Compare the overall survival of patients with stage II adenocarcinoma of the prostate treated with high- vs standard-dose three-dimensional conformal or intensity-modulated radiotherapy. * Compare the freedom from prostate-specific antigen failure, disease-specific survival, local progression, and distant metastases in patients treated with these regimens. * Compare the probability of tumor control and normal tissue complications in patients treated with these regimens. * Compare the incidence of grade 2 or greater genitourinary and gastrointestinal acute and late toxicity in patients treated with these regimens. * Compare the quality of life, including sexual function, of patients treated with these regimens. * Correlate histopathologic or tumor-specific cytogenetic or chromosomal markers with cancer control outcomes in patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to Gleason score and prostate-specific antigen (PSA) level (Gleason score 2-6, PSA ≥10 mg/mL but \< 20 ng/mL vs Gleason score 7, PSA \< 15 ng/mL) and radiation modality (three-dimensional conformal radiotherapy \[3D-CRT\] vs intensity-modulated radiotherapy \[IMRT\]). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo standard-dose 3D-CRT or IMRT once daily, 5 days a week, for 7.8 weeks (39 treatment days). * Arm II: Patients undergo high-dose 3D-CRT or IMRT once daily, 5 days a week, for 8.8 weeks (44 treatment days). Quality of life (QOL) is assessed initially at baseline. After completion of radiotherapy, QOL is assessed every 3 months for 1 year and then every 6 months for 4 years. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 1,520 patients (760 per treatment arm) will be accrued for this study within 5 years.

Interventions

RADIATION70.2 Gy 3D-CRT/IMRT

Radiation will be delivered via 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) in 1.8 Gy minimum dose fractions to a total of 70.2 Gy in 39 Fractions. All fields treated once daily, five fractions per week. No more than 2% of the planning target volume and none of the clinical target volume may receive less than 70.2 Gy.

RADIATION79.2 Gy 3D-CRT/IMRT

Radiation will be delivered via 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) in 1.8 Gy minimum dose fractions to a total of 79.2 Gy in 44 fractions. All fields treated once daily, five fractions per week. No more than 2% of the planning target volume and none of the clinical target volume may receive less than 79.2 Gy.

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Radiation Therapy Oncology Group
Lead SponsorNETWORK

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed adenocarcinoma of the prostate * Clinical stage T1b-T2b * Meets one of the following criteria: * Gleason score 2-6 AND prostate-specific antigen (PSA) ≥ 10 ng/mL but \< 20 ng/mL * Gleason score 7 AND PSA \< 15 ng/mL * No regional lymph node involvement * No distant metastases PATIENT CHARACTERISTICS: Age: * Any age Performance status: * Zubrod 0-1 Life expectancy: * Not specified Hematopoietic: * Not specified Hepatic: * Not specified Renal: * Not specified Other: * No other invasive malignancy within the past 5 years except localized basal cell or squamous cell skin cancer * No other major medical or psychiatric illness that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy: * Not specified Chemotherapy: * No prior cytotoxic chemotherapy * No concurrent cytotoxic chemotherapy Endocrine therapy: * At least 3 months since prior finasteride * No other prior hormonal therapy, including: * Luteinizing hormone-releasing hormone agonists (e.g., goserelin or leuprolide) * Antiandrogens (e.g., flutamide or bicalutamide) * Estrogens (e.g., diethylstilbestrol) * No concurrent (neoadjuvant or adjuvant) hormonal therapy Radiotherapy: * No prior pelvic irradiation or brachytherapy Surgery: * No prior radical surgery (prostatectomy) or cryosurgery for prostate cancer * No prior surgical castration (bilateral orchiectomy) Other: * At least 3 months since prior finasteride or phytoestrogen preparation (PC-SPES)

Design outcomes

Primary

MeasureTime frameDescription
Overall SurvivalFrom randomization to date of failure (death) or last follow-up. Analysis occurs after all patients have been potentially followed for 8 years.Survival time is defined as time from randomization to the date of death from any cause and is estimated by the Kaplan-Meier Method. Patients last know to be alive are censored at date of last contact.

Secondary

MeasureTime frameDescription
Disease Specific SurvivalFrom randomization to date of failure (death due to prostate cancer) or death from other cause or last follow-up. Analysis occurs at the same time as the primary endpoint.Survival time is defined as time from randomization to the date of death due to prostate cancer and is estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact. Death due to prostate cancer was defined as primary cause of death certified as due to prostate cancer, or death in association with any of the following conditions: Further clinical tumor progression occurring after initiation of salvage anti-tumor therapy, a rise (that exceeds 1.0 ng/ml) in the serum PSA level on at least two consecutive occasions that occurred during or after salvage androgen suppression therapy, or disease progression in the absence of any anti-tumor therapy.
Local ProgressionFrom randomization to date of failure (local progression) or death or last follow-up. Analysis occurs at the same time as the primary endpoint.Failure time is defined as time from randomization to the date of progression (increase in palpable abnormality), failure of regression of the palpable tumor by two years, and redevelopment of a palpable abnormality after complete disappearance of previous abnormalities. Failure rates are estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact.
Distant MetastasesFrom randomization to date of failure (distant metastasis) or death or last follow-up. Analysis occurs at the same time as the primary endpoint.Failure time is defined as time from randomization to the date of documented regional nodal recurrence or development of distant disease. Failure rates are estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact.
Grade 2 or Greater Genitourinary or Gastrointestinal ToxicityFrom the start of treatment to 90 days. Analysis occurs at the same time as the primary endpointRate of acute 2+ grade genitourinary(GU)/gastrointestinal(GI) toxicity graded by Common Toxicity Criteria (CTC) version 2.0
Prostate-specific Antigen (PSA) Failure by American Society for Therapeutic Radiology and Oncology (ASTRO) DefinitionFrom randomization to date of failure (3 consecutive rises) or death or last follow-up. Analysis occurred after patients have been potentially followed for 5 years.Failure is defined as having 3 consecutive elevations of post-treatment PSA or starting hormones after one or more elevations in post-treatment PSA but before three consecutive elevations were documented. The failure day date was the midpoint between last non-rising PSA and first PSA rise. Failure rates are estimated by the cumulative incidence method. Patients last known to be alive are censored at date of last contact.
Number of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsBaseline and 12 months from randomizationThe SQLI measures quality of life for patients with cancer and other chronic diseases. Possible scores range from 0 to 10, with higher scores indicating a better outcome. Change from Baseline is defined as 12 month SQLI - baseline SQLI and is classified as follows: Improvement: when change \>= to the standard error of measurement with reliability quotient of 0.5 (SEM); Stable: when -SEM \< change \< SEM; Declined: when change \<= SEM.
Quality Adjusted Survival by SQLIFrom randomization to 5 years.
Tumor Control ProbabilityFrom randomization to date of failure (tumor progression) or last follow-up. Analysis can occur any time after the primary endpoint analysis.
Normal Tissue Complication ProbabilityFrom randomization to last follow-up. Analysis can occur any time after the primary endpoint analysis.
Percentage of Participants With Erectile Disfuction at 12 MonthsTwelve months from randomizationThe International Index of Erectile Function Questionnaire (IIEF) is the primary measure for erectile function (ED). IIEF question number 1 (How often were you able to get an erection during sexual activity?) is scored from: none/almost never (response 0-1) or \< half the time (response 2-3) to most times/almost always/always (response 4-5). A response of 0 to 3 on question number 1 of the IIEF is considered erectile dysfunction.

Countries

Canada, United States

Participant flow

Participants by arm

ArmCount
70.2 Gy
70.2 Gy 3D-CRT/IMRT: Radiation will be delivered via 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) in 1.8 Gy minimum dose fractions to a total of 70.2 Gy in 39 Fractions. All fields treated once daily, five fractions per week. No more than 2% of the planning target volume and none of the clinical target volume may receive less than 70.2 Gy.
751
79.2 Gy
79.2 Gy 3D-CRT/IMRT: Radiation will be delivered via 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) in 1.8 Gy minimum dose fractions to a total of 79.2 Gy in 44 Fractions. All fields treated once daily, five fractions per week. No more than 2% of the planning target volume and none of the clinical target volume may receive less than 79.2 Gy.
748
Total1,499

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyProtocol Violation1411
Overall StudyWithdrawal by Subject44

Baseline characteristics

Characteristic70.2 Gy79.2 GyTotal
Age, Continuous71 years71 years71 years
Sex: Female, Male
Female
0 Participants0 Participants0 Participants
Sex: Female, Male
Male
751 Participants748 Participants1499 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
714 / 744704 / 737
serious
Total, serious adverse events
30 / 74443 / 737

Outcome results

Primary

Overall Survival

Survival time is defined as time from randomization to the date of death from any cause and is estimated by the Kaplan-Meier Method. Patients last know to be alive are censored at date of last contact.

Time frame: From randomization to date of failure (death) or last follow-up. Analysis occurs after all patients have been potentially followed for 8 years.

Population: All eligible patients who did not withdraw consent

ArmMeasureValue (NUMBER)
70.2 GyOverall Survival88.5 percentage of participants
79.2 GyOverall Survival88.1 percentage of participants
Comparison: The original target sample size was 1520 patients with a requirement of 715 deaths to test the hypothesis of overall survival (OS) efficacy of the 79.2 Gy arm. The trial was designed to detect a hazard ratio (HR) of 1.30 (standard/high-dose) with 90% statistical power at a one-sided significance level of 0.025.p-value: 0.9895% CI: [0.83, 1.2]Log Rank
Secondary

Disease Specific Survival

Survival time is defined as time from randomization to the date of death due to prostate cancer and is estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact. Death due to prostate cancer was defined as primary cause of death certified as due to prostate cancer, or death in association with any of the following conditions: Further clinical tumor progression occurring after initiation of salvage anti-tumor therapy, a rise (that exceeds 1.0 ng/ml) in the serum PSA level on at least two consecutive occasions that occurred during or after salvage androgen suppression therapy, or disease progression in the absence of any anti-tumor therapy.

Time frame: From randomization to date of failure (death due to prostate cancer) or death from other cause or last follow-up. Analysis occurs at the same time as the primary endpoint.

Population: All eligible patients who did not withdraw consent

ArmMeasureValue (NUMBER)
70.2 GyDisease Specific Survival1.4 percentage of participants
79.2 GyDisease Specific Survival0.8 percentage of participants
p-value: 0.1495% CI: [0.38, 1.15]Gray's test
Secondary

Distant Metastases

Failure time is defined as time from randomization to the date of documented regional nodal recurrence or development of distant disease. Failure rates are estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact.

Time frame: From randomization to date of failure (distant metastasis) or death or last follow-up. Analysis occurs at the same time as the primary endpoint.

Population: All eligible patients who have not withdrawn consent

ArmMeasureValue (NUMBER)
70.2 GyDistant Metastases3.1 percentage of participants
79.2 GyDistant Metastases2.2 percentage of participants
p-value: 0.05195% CI: [0.42, 1.01]Gray's test
Secondary

Grade 2 or Greater Genitourinary or Gastrointestinal Toxicity

Rate of acute 2+ grade genitourinary(GU)/gastrointestinal(GI) toxicity graded by Common Toxicity Criteria (CTC) version 2.0

Time frame: From the start of treatment to 90 days. Analysis occurs at the same time as the primary endpoint

Population: Eligible patients with acute adverse event data who did not withdraw consent.

ArmMeasureValue (NUMBER)
70.2 GyGrade 2 or Greater Genitourinary or Gastrointestinal Toxicity18.8 percentage of participants
79.2 GyGrade 2 or Greater Genitourinary or Gastrointestinal Toxicity21.0 percentage of participants
p-value: 0.29Chi-squared
Secondary

Local Progression

Failure time is defined as time from randomization to the date of progression (increase in palpable abnormality), failure of regression of the palpable tumor by two years, and redevelopment of a palpable abnormality after complete disappearance of previous abnormalities. Failure rates are estimated by the cumulative incidence method. Patients last know to be alive are censored at date of last contact.

Time frame: From randomization to date of failure (local progression) or death or last follow-up. Analysis occurs at the same time as the primary endpoint.

Population: All eligible patients who have not withdrawn consent

ArmMeasureValue (NUMBER)
70.2 GyLocal Progression3.5 percentage of participants
79.2 GyLocal Progression1.8 percentage of participants
p-value: 0.000195% CI: [0.25, 0.66]Gray's test
Secondary

Normal Tissue Complication Probability

Time frame: From randomization to last follow-up. Analysis can occur any time after the primary endpoint analysis.

Secondary

Number of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 Months

The SQLI measures quality of life for patients with cancer and other chronic diseases. Possible scores range from 0 to 10, with higher scores indicating a better outcome. Change from Baseline is defined as 12 month SQLI - baseline SQLI and is classified as follows: Improvement: when change \>= to the standard error of measurement with reliability quotient of 0.5 (SEM); Stable: when -SEM \< change \< SEM; Declined: when change \<= SEM.

Time frame: Baseline and 12 months from randomization

Population: Eligible participants with baseline and 12 month SQLI

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
70.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsImproved91 Participants
70.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsStable366 Participants
70.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsDeclined90 Participants
79.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsImproved91 Participants
79.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsStable331 Participants
79.2 GyNumber of Participants With Improved, Stable, and Declined Spitzer Quality of Life Index (SQLI) at 12 MonthsDeclined95 Participants
p-value: 0.59Chi-squared
Secondary

Percentage of Participants With Erectile Disfuction at 12 Months

The International Index of Erectile Function Questionnaire (IIEF) is the primary measure for erectile function (ED). IIEF question number 1 (How often were you able to get an erection during sexual activity?) is scored from: none/almost never (response 0-1) or \< half the time (response 2-3) to most times/almost always/always (response 4-5). A response of 0 to 3 on question number 1 of the IIEF is considered erectile dysfunction.

Time frame: Twelve months from randomization

Population: Eligible patients with a response of 4 or 5 (most times/almost always/always) to IIEF question 1 at baseline

ArmMeasureValue (NUMBER)
70.2 GyPercentage of Participants With Erectile Disfuction at 12 Months38.06 percentage of participants
79.2 GyPercentage of Participants With Erectile Disfuction at 12 Months49.66 percentage of participants
Comparison: With an expected percentage of erectile disfunction (ED) at 12 months of 29%, a two-sided significance level of 0.05, and 688 patients per arm provides 90% statistical power to detect a reduction in ED to 19%. This calculation assumes 26% ED at baseline and 80% compliance at 12 months. Only participants with baseline ED are analyzed.p-value: 0.0513Chi-squared
Secondary

Prostate-specific Antigen (PSA) Failure by American Society for Therapeutic Radiology and Oncology (ASTRO) Definition

Failure is defined as having 3 consecutive elevations of post-treatment PSA or starting hormones after one or more elevations in post-treatment PSA but before three consecutive elevations were documented. The failure day date was the midpoint between last non-rising PSA and first PSA rise. Failure rates are estimated by the cumulative incidence method. Patients last known to be alive are censored at date of last contact.

Time frame: From randomization to date of failure (3 consecutive rises) or death or last follow-up. Analysis occurred after patients have been potentially followed for 5 years.

Population: All eligible patients who did not withdraw consent

ArmMeasureValue (NUMBER)
70.2 GyProstate-specific Antigen (PSA) Failure by American Society for Therapeutic Radiology and Oncology (ASTRO) Definition40.2 percentage of participants
79.2 GyProstate-specific Antigen (PSA) Failure by American Society for Therapeutic Radiology and Oncology (ASTRO) Definition25.2 percentage of participants
p-value: <0.000195% CI: [0.5, 0.7]Gray's test
Secondary

Quality Adjusted Survival by SQLI

Time frame: From randomization to 5 years.

Population: This analysis will not be done because we are unable to find the required algorithm for converting SQLI scores into utilities, which is needed for quality adjusted survival analysis.

Secondary

Tumor Control Probability

Time frame: From randomization to date of failure (tumor progression) or last follow-up. Analysis can occur any time after the primary endpoint analysis.

Source: ClinicalTrials.gov · Data processed: Mar 5, 2026