Prostate hypofractionated radiotherapy (62Gy at 3.1Gy per fraction) with injection of hyaluronic acid: final results of the RPAH1 study

Objectives: The present multicenter Phase II study evaluated the rate of late grade ≥2 gastrointestinal (GI) toxicities at 3 years, after hypofractionated radiotherapy (HFR) of prostate cancer with injection of hyaluronic acid (HA) between the prostate and the rectum. Methods: Between 2010 and 2013, 36 patients with low- or intermediate-risk prostate cancer were treated by HFR/IMRT-IGRT. 20 fractions of 3.1 Gy were delivered, 5 days per week for a total dose of 62 Gy. A transperineal injection of 10cc of HA was performed between the rectum and the prostate. Late toxicities were evaluated between 3 and 36 months after the end of treatment (CTCAE v4). Results: Median pretreatment prostate-specific antigen was 8 ng ml−1. Among the 36 included patients, 2 were not evaluated because they withdrew the study in the first 3 months of follow-up, and 4 withdrew between 3 and 36 months, the per protocol population was therefore composed. Late grade ≥2 GI toxicities occurred in 4 (12%) patients with 3 (9%) Grade 2 rectal bleedings and one diarrhoea. Therefore, the inefficacy hypothesis following Fleming one-stage design cannot be rejected. None of the patients experienced late Grade 3–4 toxicities. Among the 30 patients completing the 36 months’ visit, none still had a grade ≥2 GI toxicity. Late grade ≥2 genitourinary (GU) toxicities occurred in 14 (41%) patients. The most frequent toxicities were dysuria and pollakiuria. Four patients still experienced a grade ≥2 GU toxicity at 36 months. The biochemical relapse rate (nadir +2 ng ml−1) was 6% (2 patients). Overall, HA was very well tolerated with no pain or discomfort. Conclusion: Despite the inefficacy of HA injection was not rejected, we observed the absence of Grade 3 or 4 rectal toxicity as well as a rate of Grade 2 rectal bleeding below 10% at 36 months of follow-up. Late urinary toxicities are the most frequent but the rate decreases largely at 3 years. Advances in knowledge: With an injection of HA, hypofractionated irradiation in 4 weeks is well tolerated with no Grade 3 or 4 GI toxicity and a rate of Grade 2 rectal bleeding below 10% at 36 months of follow-up.

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Proton Therapy of Prostate and Pelvic Lymph Nodes for High Risk Prostate Cancer: Acute Toxicity

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00094.1 ◽

2021 ◽

Vol 8 (2) ◽

pp. 41-50

Author(s):

Richard Choo ◽

David W. Hillman ◽

Thomas Daniels ◽

Carlos Vargas ◽

Jean Claude Rwigema ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Acute Toxicity ◽

Lymph Nodes ◽

Seminal Vesicles ◽

Pelvic Lymph Nodes ◽

Gu Toxicity ◽

Risk Prostate Cancer ◽

Gi Toxicity ◽

Grade 3

Abstract Purpose To assess acute gastrointestinal (GI) and genitourinary (GU) toxicities of intensity-modulated proton therapy (IMPT) targeting the prostate/seminal vesicles and pelvic lymph nodes for prostate cancer. Materials and Methods A prospective study (ClinicalTrials.gov: NCT02874014), evaluating moderately hypofractionated IMPT for high-risk or unfavorable intermediate-risk prostate cancer, accrued a target sample size of 56 patients. The prostate/seminal vesicles and pelvic lymph nodes were treated simultaneously with 6750 and 4500 centigray radiobiologic equivalent (cGyRBE), respectively, in 25 daily fractions. All received androgen-deprivation therapy. Acute GI and GU toxicities were prospectively assessed from 7 GI and 9 GU categories of the Common Terminology Criteria for Adverse Events (version 4), at baseline, weekly during radiotherapy, and 3-month after radiotherapy. Fisher exact tests were used for comparisons of categorical data. Results Median age was 75 years. Median follow-up was 25 months. Fifty-five patients were available for acute toxicity assessment. Sixty-two percent and 2%, respectively, experienced acute grade 1 and 2 GI toxicity. Grade 2 GI toxicity was proctitis. Sixty-five percent and 35%, respectively, had acute grade 1 and 2 GU toxicity. The 3 most frequent grade 2 GU toxicities were urinary frequency, urgency, and obstructive symptoms. None had acute grade ≥ 3 GI or GU toxicity. The presence of baseline GI and GU symptoms was associated with a greater likelihood of experiencing acute GI and GU toxicity, respectively. Of 45 patients with baseline GU symptoms, 44% experienced acute grade 2 GU toxicity, compared with only 10% among 10 with no baseline GU symptoms (P = 0.07). Although acute grade 1 and 2 GI and GU toxicities were common during radiotherapy, most resolved at 3 months after radiotherapy. Conclusion A moderately hypofractionated IMPT targeting the prostate/seminal vesicles and regional pelvic lymph nodes was well tolerated with no acute grade ≥ 3 GI or GU toxicity. Patients with baseline GU symptoms had a higher rate of acute grade 2 GU toxicity.

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Multi-institutional analysis of high-risk prostate cancer patients treated with stereotactic body radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.51 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 51-51

Author(s):

Naomi Y Jiang ◽

Christopher R. King ◽

Alan J. Katz ◽

Sean P. Collins ◽

Nima Aghdam ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Stereotactic Body Radiotherapy ◽

Radiation Therapy Oncology Group ◽

Distant Metastases ◽

Chi Square ◽

Gu Toxicity ◽

Risk Prostate Cancer ◽

Gi Toxicity

51 Background: Stereotactic Body Radiotherapy (SBRT) delivers ablative doses of radiation (RT) over a course of five treatments and has been increasingly used as a definitive RT option for low- and intermediate-risk prostate cancer (PCa). Ongoing prospective trials are evaluating the efficacy of SBRT for high-risk PCa, but clinical outcomes reports are limited. Methods: Patients treated for high-risk PCa between 2006-2017 at any of five institutions were included. SBRT doses ranged from 35-40 Gy in 5 fractions per institutional standards, with one institution using an integrated boost approach. The Phoenix definition was used to define biochemical failure (BCR). Physician-reported genitourinary (GU) and gastrointestinal (GI) toxicity outcomes were scored using the Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events systems. Results: In total, 182 patients were included in this study with a median follow-up time of 38.4 months (mos). The median age was 72. Most patients (72%) had Gleason 8-10 disease. Sixty-eight percent of patients received androgen deprivation therapy (ADT) for a median of 9 mos (interquartile range 6-9 mos). The rate of distant metastases was 3.8%. There were no acute Grade 3 (G3) or higher GU or GI toxicities. Three patients (1.6%) experienced a late G3 GU toxicity and one patient (0.5%) experienced a late G3 GI toxicity. The incidence of BCR was significantly higher in patients who did not receive ADT (30% vs. 15%, p = 0.02 by Chi-square). Conclusions: In this multi-institutional study, SBRT demonstrated an acceptable safety profile for the treatment of high-risk PCa. Longer term follow-up is necessary to evaluate the oncologic efficacy of this approach, but given the potentially higher incidence of BCR without ADT, ADT likely has an important oncologic role even with SBRT regimens.

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Virtual HDR SBRT for localized prostate carcinoma: Efficacy and quality-of-life assessment.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.45 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 45-45 ◽

Cited By ~ 3

Author(s):

Donald B. Fuller ◽

Reza Shirazi ◽

John Naitoh ◽

George Mardirossian

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Disease Free Survival ◽

Life Assessment ◽

Intermediate Risk ◽

Gu Toxicity ◽

Gi Toxicity ◽

Grade 3

45 Background: We designed a CyberKnife (CK) prostate Stereotactic Body Radiotherapy (SBRT) method to recapitulate HDR fractionation and target volume coverage (“Virtual HDR”). We report 4 year efficacy, toxicity and quality of life (QoL) outcomes. Methods: Eligible patients had low- (Gleason < 6, PSA < 10 ng/mL, < T2bN0) or intermediate-risk (Gleason < 6 with PSA 10.01 – 20 ng/mL or Gleason 7 with PSA < 10 ng/mL, < T2bN0) prostate cancer. A dose of 38 Gy/4 fractions was given to > 95% of the PTV; with “HDR-like” bladder, urethral and rectal dose constraints, and “HDR-like” dose escalation in the PTV. Toxicities were assessed using CTCAE3.0 criteria. QoL was assessed using the Expanded Prostate Cancer Index Composite (EPIC). Results: Since July 2006, 59 patients were treated. Two were lost to follow-up and 6 have been followed < 6 months, leaving 51 (32 low- and 19 intermediate-risk) patients for analysis. Median f/u is 42 months (range, 6-60). 4-year actuarial biochemical-disease free survival is 98% (ASTRO, Phoenix). Freedom from local and distant relapse is 100% and 98%. Median baseline PSA of 6.3 ng/mL (range 1.0 – 14.1) decreased to 0.1 ng/mL by 48 months. Acute grade 2 GU and GI toxicity rates were 22% and 4%, respectively (0% Grade 3+). Three (6%) late Grade 3 GU toxicities occurred at 18, 48 and 48 months. No grade 3+ GI toxicity occurred. Late grade 2 GU and GI toxicity rates were 18% and 2%, respectively. Only 2 patients (4%) had ongoing late > grade 2 GU toxicity at last follow-up (0% GI). Mean EPIC urinary and bowel scores decreased at 2 months, with subsequent improvement and stability to 48 months. Mean EPIC sexual scores gradually declined to 48 months. Of patients potent at baseline, 63% were potent at 3 years, including 100% < age 60, 64% age 61-70 and 60% > age 70. Conclusions: To 4 years, HDR-like CK SBRT for low- and intermediate-risk prostate cancer results in a very low PSA nadir and relapse rate, minimal toxicity and a favorable QoL outcome, with an age-dependent potency preservation rate. The occasional occurrence of late grade 3 urethral stricture can likely be reduced by better patient selection (caution re: patients with significant pre-existing uropathy). Acute and late grade 2 GU toxicity usually resolves with conservative management.

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Hypofractionated radiotherapy (66Gy at 3Gy per fraction) for favorable-risk prostate cancer: Long-term outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.141 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 141-141

Author(s):

Nita Patel ◽

Sergio Faria ◽

Fabio L. Cury ◽

Marc David ◽

Marie Duclos ◽

...

Keyword(s):

Prostate Cancer ◽

Hypofractionated Radiotherapy ◽

High Dose ◽

Biochemical Control ◽

Long Term Outcomes ◽

Cancer Specific Survival ◽

Gu Toxicity ◽

Risk Prostate Cancer

141 Background: Hypofractionated radiotherapy (HypoRT) is increasingly being used to treat prostate cancer to take advantage of its likely low α/β ratio. There is limited experience in delivering a high biologically equivalent dose with HypoRT. We report long-term outcomes from patients treated with high-dose HypoRT. Methods: Patients with low and intermediate risk prostate cancer were treated using 3-dimensional conformal radiotherapy at a dose of 66Gy in 22 daily fractions of 3Gy without hormonal therapy. A uniform 7mm margin was created around the prostate for the planning target volume (PTV) and treatment was prescribed to the isocentre. Treatment was delivered using daily ultrasound image guided radiotherapy (IGRT). The CTCv3.0 was used to prospectively score toxicity. Biochemical failure was defined using the Phoenix criteria of nadir+2ng/ml. Results: A total of 129 patients were treated between November 2002 and December 2005. With a median follow-up of 90 months, the 5- and 8-year actuarial biochemical control rate was 97% and 92% respectively. The 5- and 8-year actuarial overall survival was 92% and 88% respectively. Only one patient died from prostate cancer at 92 months after treatment resulting in an 8-year actuarial cancer specific survival of 98%. Radiotherapy was well tolerated with 57% of patients experiencing no acute gastrointestinal (GI) or genitourinary (GU) toxicity. For late toxicity, the worst grade ≥2 rate for GI and GU toxicity was 27% and 33% respectively, but at the last follow-up the rate of grade ≥2 was only 1.5% for both GI and GU toxicity (Table). Conclusions: High dose HypoRT delivering 66 Gy in 22 fractions at 3Gy per fraction is a safe, effective and convenient modality of delivering radiotherapy to patients with favorable risk prostate cancer with excellent biochemical control rates and acceptable rates of acute and late GI and GU toxicity. [Table: see text]

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Clinical outcomes and late toxicity of hypofractionated intensity-modulated radiotherapy for high-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.56 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 56-56

Author(s):

Michael Wang ◽

Robert Pearcey ◽

Nadeem Pervez ◽

Don Yee ◽

Alina Mihai ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Intensity Modulated Radiotherapy ◽

Late Toxicity ◽

Seminal Vesicles ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Gi Toxicity ◽

Grade 3

56 Background: Since prostate cancer has intrinsic high radiation-fraction sensitivity, hypofractionated radiotherapy (HFRT) could offer treatment advantages. However, dose-escalated HFRT may increase risks of late genitourinary (GU) and gastrointestinal (GI) toxicity. Intensity-modulated radiotherapy (IMRT) can potentially deliver dose-escalated HFRT without increasing late toxicities. This study’s acute toxicity data was previously published. We now present five-year efficacy results and late toxicity data for prostate cancer patients treated with HFRT using IMRT. Methods: From 2005-2012, our Phase II prospective study enrolled one hundred patients with either high risk disease (one or more of: Stage ≥ T3, Gleason ≥ 8, or PSA ≥ 20 ng/mL) or high tier intermediate risk disease (Gleason 7 and PSA ≥ 15 ng/mL). All patients received HFRT using IMRT in 25 daily fractions. Sixty patients received 68 Gy to the prostate and proximal seminal vesicles, with simultaneous integrated boost (SIB) of 45 Gy to pelvic lymph nodes and distal seminal vesicles. Forty patients received 68 Gy to the prostate, and a SIB of 50 Gy to pelvic lymph nodes and seminal vesicles. Adjuvant hormonal therapy was given for two to three years. Biochemical failure was determined by the Phoenix definition. Late toxicity scores were recorded every 6 months after completing RT. Results: Median age of patients was 67 years. 33% had Stage ≥ T3, 52% had Gleason ≥ 8, and 44% had PSA ≥ 20 ng/mL. After a median follow-up of 5.4 years, median PSA at last follow-up was 0.10 ng/mL. Five-year biochemical control rate (BCR) was 91.8%, five-year progression-free survival (PFS) was 92.8%, and five-year overall survival (OS) was 88.7%. Five-year cumulative incidence of Grade ≥ 3 GU and GI toxicity were 13.0% and 16.7% respectively. At the five-year efficacy endpoint, ongoing Grade ≥ 3 GU and GI toxicity were 1.9% and 0% respectively. Conclusions: Dose-escalated HFRT using IMRT results in favourable five-year BCR, PFS, and OS for patients with localized high-risk prostate cancer, and is well-tolerated with acceptable late GU and GI toxicity. These findings support ongoing Phase III trials that are assessing the clinical use of IMRT-based HFRT. Clinical trial information: NCT00126802.

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Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity

Journal of Radiotherapy in Practice ◽

10.1017/s1460396911000161 ◽

2011 ◽

Vol 11 (3) ◽

pp. 145-154

Author(s):

Moonkyoo Kong ◽

Seong Eon Hong ◽

Jinhyun Choi ◽

Sung-Goo Chang

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radiation Therapy Oncology Group ◽

Intensity Modulated Radiotherapy ◽

Intensity Modulated ◽

High Risk Prostate Cancer ◽

Gu Toxicity ◽

Risk Prostate Cancer ◽

Grade 3

AbstractPurpose: To evaluate the toxicity of hypofractionated helical intensity-modulated radiotherapy (IMRT) for men with intermediate- and high-risk prostate cancer.Methods and Materials: A retrospective toxicity analysis was performed in 22 patients treated definitively with hypofractionated helical IMRT. The helical IMRT were designed to deliver 75 Gy in 2.5 Gy/fraction to the prostate gland, 63 Gy in 2.1 Gy/fraction to seminal vesicle, and 54 Gy in 1.8 Gy/fraction to pelvic lymph nodes. No patient received hormonal therapy. Toxicity was graded by the Radiation Therapy Oncology Group (RTOG) scales.Results: All patients tolerated the treatment well without treatment interruption, and there was no Grade 3 or more acute toxicity. With a median follow-up of 24.5 months, there was no Grade 3 or more late toxicity. The late Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity for total 22 patients were 9.1% and 18.2%, respectively, and the late Grade 1 GI and GU toxicity were 18.2% and 50%, respectively. Late GU toxicity was associated with greater bladder volume irradiated ≥70 Gy. Late GI toxicity did not correlate with any of the dosimetric parameters.Conclusions: This study demonstrate that hypofractionated helical IMRT with high biologic effective dose (BED) is well tolerated with favourable toxicity rate. If longer follow-up periods and larger cohorts confirm the favourable biochemical control rate and our favourable toxicity assessment results, the hypofractionated IMRT (total 75 Gy, 2.5 Gy/fraction) might be implemented in clinical field for treatment of prostate cancer.

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Hypofractionated Proton Therapy in Early Prostate Cancer: Results of a Phase I/II Trial at Loma Linda University

International Journal of Particle Therapy ◽

10.14338/ijpt-19-00057 ◽

2019 ◽

Vol 6 (1) ◽

pp. 1-9

Author(s):

Jason M. Slater ◽

Jerry D. Slater ◽

Joseph I. Kang ◽

Ivan C. Namihas ◽

B. Rodney Jabola ◽

...

Keyword(s):

Prostate Cancer ◽

Proton Therapy ◽

Specific Antigen ◽

Low Risk ◽

Early Stage Disease ◽

Therapy Regimen ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Grade 3

Abstract Purpose: To determine whether a hypofractionated proton therapy regimen will control early-stage disease and maintain low rates of side effects similar to results obtained using standard-fraction proton therapy at our institution. Materials and Methods: A cohort of 146 patients with low-risk prostate cancer according to National Comprehensive Cancer Network guidelines (Gleason score <7, prostate-specific antigen [PSA] <10, tumor stage of T1–T2a) received 60 Gy (cobalt Gy equivalent) of proton therapy (20 fractions of 3.0 Gy per fraction) in 4 weeks, a dose biologically equivalent to standard fractionation (44–45 fractions of 1.8 Gy to a total of 79.2 to 81 Gy in 0 weeks). Patients were evaluated at least weekly during treatment, at which time documentation of treatment tolerance and acute reactions was obtained. Follow-up visits were conducted every 3 months for the first 1 years, every 6 months for the next 3 years, then annually. Follow-up visits consisted of history and physical examination, PSA measurements, and evaluation of toxicity. Results: The median follow-up time was 42 months (range, 3–96 months). Acute grade 2 urinary toxicity occurred in 16% (20/120) of the patients; acute grade 2 or higher gastrointestinal toxicity was seen in 1.7% (2/120). At 9 months, 1 patient had late grade 3 urinary toxicity, which resolved by 12 months; no grade 3 gastrointestinal toxicities occurred. The 3-year biochemical survival rate was 99.3% (144/145). The median time to PSA nadir was 30 months. Conclusion: Hypofractionated proton therapy of 60 Gy in 20 fractions was safe and effective for patients with low-risk prostate cancer.

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Prostate-Specific Antigen Dynamics After Carbon Ion Radiotherapy for Prostate Cancer

10.21203/rs.3.rs-32254/v1 ◽

2020 ◽

Author(s):

Yosuke Takakusagi ◽

Takahiro Oike ◽

Kio Kano ◽

Wataru Anno ◽

Keisuke Tsuchida ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Carbon Ion Radiotherapy ◽

Clinical Recurrence ◽

Carbon Ion ◽

Psa Bounce ◽

Psa Failure ◽

Risk Prostate Cancer

Abstract Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria.Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 26, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–116) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age was a significant predictor of PSA bounces and PSA failure. Conclusions The dynamics of PSA levels after CIRT was investigated in the present study. Further follow-up is needed to reveal the clinical significance of PSA dynamics.

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Five-Year Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer-The Largest Experience in China

10.21203/rs.3.rs-190455/v1 ◽

2021 ◽

Author(s):

Xianzhi Zhao ◽

Yusheng Ye ◽

Haiyan Yu ◽

Lingong Jiang ◽

Chao Cheng ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Cox Regression ◽

Progression Free Survival ◽

Cox Regression Analysis ◽

Gu Toxicity ◽

Biochemical Progression ◽

Grade 3 ◽

Very High

Abstract Objective To evaluate the efficacy and toxicity of SBRT for localized prostate cancer (PCa). Moreover, it is the largest-to-date pilot study to report 5-year outcomes of SBRT for localized PCa from China. Methods In this retrospective study, 133 PCa patients in our center were treated by SBRT with CyberKnife (Accuray) from October 2012 to July 2019. Follow-up was performed every 3 months for evaluations of efficacy and toxicity. Biochemical progression-free survival (bPFS) and toxicities were assessed using the Phoenix definition and the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0 respectively. Factors predictive of bPFS were identified with COX regression analysis. Results 133 patients (10 low-, 21 favorable intermediate-, 31 unfavorable intermediate-, 45 high-, and 26 very high risk cases on the basis of the NCCN risk classification) with a median age of 76 years (range: 54–87 years) received SBRT. The median dose was 36.25Gy (range: 34-37.5Gy) in 5 fractions. Median follow-up time was 57.7 months (3.5–97.2 months). The overall 5-year bPFS rate was 83.6% for all patients. The 5-year bPFS rate of patients with low-, favorable intermediate-, unfavorable intermediate-, high-, and very high risk PCa was 87.5%, 95.2%, 90.5%, 86.3%, and 61.6% respectively. Urinary symptoms were all alleviated after SBRT. All the patients tolerated SBRT with only 1 (0.8%) and 1 (0.8%) patient reporting grade-3 acute and late genitourinary (GU) toxicity, respectively. There were no grade 4 toxicities. Gleason score (P < 0.001, HR = 7.483, 95%CI: 2.686–20.846) was the independent predictor of bPFS rate after multivariate analysis Conclusion SBRT is an efficient and safe treatment modality for localized PCa with high 5-year bPFS rates and acceptable toxicities.

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Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

BioMed Research International ◽

10.1155/2014/541847 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Salvina Barra ◽

Stefano Vagge ◽

Michela Marcenaro ◽

Gladys Blandino ◽

Giorgia Timon ◽

...

Keyword(s):

Prostate Cancer ◽

Helical Tomotherapy ◽

Late Toxicity ◽

Conformal Radiotherapy ◽

Conventional Fractionation ◽

Gu Toxicity ◽

Gi Toxicity ◽

Low Toxicity ◽

Primary Radiotherapy

Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment.Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy.Results. Most of patients (83%) did not develop acute gastrointestinal (GI) toxicity and 50% did not present genitourinary (GU) toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL) of the conventionally treated cohort (P=0.02).Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.

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