{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:10:46Z","timestamp":1793139046457,"version":"4.5.0"},"reference-count":8,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"28","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>The FLAME trial hypothesized that focal boosting of intraprostatic tumor lesion(s) in addition to standard external beam radiotherapy (EBRT) improves biochemical disease-free survival (bDFS). In this multicenter randomized phase III trial, patients with intermediate- and high-risk prostate cancer (PCa) were assigned to the standard (EBRT of 77 Gy in 35 fractions to the whole prostate gland) or focal boost arm (standard EBRT with a focal boost of up to 95 Gy to magnetic resonance imaging\u2013visible lesion(s)). Initial 5-year results showed a significant improvement in the focal boost arm for bDFS without additional toxicity. Here, we report bDFS, disease-free survival (DFS), local DFS, regional lymph node DFS, distant metastasis-free survival (DMFS), and overall survival (OS) after a 10-year follow-up. Dose-response curves were created using the dose heterogeneity in the study arm. Between 2009 and 2015, 571 patients were randomly assigned. The 10-year bDFS was 71% in the standard arm versus 86% in the focal boost arm. A significant improvement was also observed for other end points, except DMFS and OS. However, the dose-response curve suggests an association between dose and distant metastatic failure. The 10-year results demonstrated the sustained benefit of focal boosting on bDFS. By preventing biochemical failure, men are spared the potential burden of PCa recurrence.<\/jats:p>","DOI":"10.1200\/jco-25-00274","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T19:59:12Z","timestamp":1754337552000},"page":"3065-3069","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":39,"title":["Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: 10-Year Outcomes of the FLAME Trial"],"prefix":"10.1200","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5409-6608","authenticated-orcid":true,"given":"Karol\u00edna","family":"Menne Guricov\u00e1","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, the Netherlands Cancer Institute (NKI-AVL), Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-7874","authenticated-orcid":true,"given":"C\u00e9dric","family":"Draulans","sequence":"additional","affiliation":[{"name":"Department of Oncology, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0903-4149","authenticated-orcid":false,"given":"Floris J.","family":"Pos","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, the Netherlands Cancer Institute (NKI-AVL), Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda G.W.","family":"Kerkmeijer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-7605","authenticated-orcid":false,"given":"Evelyn M.","family":"Monninkhof","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Smeenk","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Kunze-Busch","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans C.J.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70040-3"},{"key":"e_1_3_9_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-12-255"},{"key":"e_1_3_9_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02873"},{"key":"e_1_3_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.06.072"},{"key":"e_1_3_9_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.01.010"},{"key":"e_1_3_9_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.00586"},{"key":"e_1_3_9_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13225795"},{"key":"e_1_3_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2018.04.015"}],"container-title":["Journal of Clinical 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