ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1654174
This article is part of the Research TopicThe Insights of Multi-Omics into the Microenvironment After Tumor Metastasis: A Paradigm Shift in Molecular Targeting Modeling and Immunotherapy for Advanced Cancer PatientsView all 12 articles
Analysis of Standard vs Dose-Escalated Stereotactic Body Radiation Therapy in Localized Prostate Cancer：A Comparative Evaluation of Survival Outcomes
Provisionally accepted
Bichun Xu1,2
Xianzhi Zhao1,3Tingting Wei4Yiyin Liang1Weiwei Zhang1Liang Chen1Zuping Lian4
Huojun Zhang1*- 1Changhai Hospital, Shanghai, China
- 2Tongji Hospital Affiliated to Tongji University, Shanghai, China
- 3Second Affiliated Hospital of Soochow University, Suzhou, China
- 4Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
This study aimed to compare the safety and efficacy of high-dose biologically effective dose (BED) versus standard dose regimens in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) using a propensity score matching (PSM) analysis. Methods: Between June 2012 and February 2022, prostate-localized SBRT patients from two institutions were retrospectively reviewed. The high-dose group (n=12) received high-dose BED1.5 (>250Gy), and the control group (n=119) according to NCCN guidelines (35-37.5 Gy/5f, BED1.5 198.3-225Gy). PSM was performed in a 1:4 ratio based on key clinical variables. Survival outcomes, in overall survival(OS), cancer-specific survival (CSS), biochemical progression-free survival (bPFS), local control (LC), and distant metastasis-free survival (DMFS)were analyzed using Kaplan-Meier methods with SPSS v26. Results: In the 7-year follow-up, the high-dose group exhibited a 66.7% OS rate vs. 83.4% in controls (p=0.402) and an 88.9% CSS rate compared to 90.5% in controls (p=0.480). The high-dose group demonstrated a 91.7% 7-year bPFS rate, while controls had a 67.4% rate (p=0.497). Higher gleason score correlated with impaired biochemical control (p=0.028), and adverse NCCN classifications indicated suboptimal control (p=0.028). The high-dose group achieved a 100% 7-year LC rate vs. 95.1% in controls (p=0.569) and a 91.7% 7-year DMFS rate compared to 81.6% in controls (p=0.918). Patients with pre-existing health conditions were less likely to develop to distant metastasis (p=0.047). Most patients tolerated SBRT with minimal toxicity, and no grade 3 or higher adverse events were observed. Conclusion: Escalating the biologically effective dose above standard levels did not yield a significant improvement in tumor control or survival outcomes compared to conventional SBRT dosing for localized PCa.Further prospective studies are warranted to clarify the role of dose escalation in this setting.
Keywords: Stereotactic body radiation therapy (SBRT), prostate cancer, localized, dose-escalated, overall surviva
Received: 26 Jun 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Xu, Zhao, Wei, Liang, Zhang, Chen, Lian and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huojun Zhang, Changhai Hospital, Shanghai, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.