Gantry-Mounted Linear Accelerator-Based Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer.

Autor:	Dang AT; Department of Radiation Oncology, University of California, Los Angeles, California., Levin-Epstein RG; Department of Radiation Oncology, University of California, Los Angeles, California., Shabsovich D; David Geffen School of Medicine at UCLA, Los Angeles, California., Cao M; Department of Radiation Oncology, University of California, Los Angeles, California., King C; Department of Radiation Oncology, University of California, Los Angeles, California., Chu FI; Department of Radiation Oncology, University of California, Los Angeles, California., Mantz CA; 21st Century Oncology, Fort Myers, Florida., Stephans KL; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio., Reddy CA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio., Loblaw DA; Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto., Cheung P; Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto., Scorsetti M; Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Milan, Italy.; Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy., Cozzi L; Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Milan, Italy.; Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy., DeNittis AS; Department of Radiation Oncology, Lankenau Medical Center Main Line Health, Wynnewood, Pennsylvania.; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania., Wang Y; Department of Radiation Oncology, Lankenau Medical Center Main Line Health, Wynnewood, Pennsylvania.; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania., Zaorsky N; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania., Nickols NG; Department of Radiation Oncology, University of California, Los Angeles, California.; Department of Radiation Oncology, VA Greater Los Angeles Health care System, Los Angeles, California., Kupelian PA; Department of Radiation Oncology, University of California, Los Angeles, California., Steinberg ML; Department of Radiation Oncology, University of California, Los Angeles, California., Kishan AU; Department of Radiation Oncology, University of California, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Advances in radiation oncology [Adv Radiat Oncol] 2019 Oct 14; Vol. 5 (3), pp. 404-411. Date of Electronic Publication: 2019 Oct 14 (Print Publication: 2020).
DOI:	10.1016/j.adro.2019.09.010
Abstrakt:	Purpose: To establish the safety and efficacy of gantry-mounted linear accelerator-based stereotactic body radiation therapy (SBRT) for low- and intermediate-risk prostate cancer. Methods: We pooled 921 patients enrolled on 7 single-institution prospective phase II trials of gantry-based SBRT from 2006 to 2017. The cumulative incidences of biochemical recurrence (defined by the Phoenix definition) and physician-scored genitourinary (GU) and gastrointestinal (GI) toxicities (defined per the original trials using Common Terminology Criteria for Adverse Events) were estimated using a competing risk framework. Multivariable logistic regression was used to evaluate the relationship between late toxicity and prespecified covariates: biologically effective dose, every other day versus weekly fractionation, intrafractional motion monitoring, and acute toxicity. Results: Median follow-up was 3.1 years (range, 0.5-10.8 years). In addition, 505 (54.8%) patients had low-risk disease, 236 (25.6%) had favorable intermediate-risk disease, and 180 (19.5%) had unfavorable intermediate-risk disease. Intrafractional motion monitoring was performed in 78.0% of patients. The 3-year cumulative incidence of biochemical recurrence was 0.8% (95% confidence interval [CI], 0-1.7%), 2.2% (95% CI, 0-4.3%), and 5.1% (95% CI, 1.0-9.2%) for low-, favorable intermediate-, and unfavorable intermediate-risk disease. Acute grade ≥2 GU and GI toxicity occurred in 14.5% and 4.6% of patients, respectively. Three-year cumulative incidence estimates of late grade 2 GU and GI toxicity were 4.1% (95% CI, 2.6-5.5%) and 1.3% (95% CI, 0.5-2.1%), respectively, with late grade ≥3 GU and GI toxicity estimates of 0.7% (95% CI, 0.1-1.3%) and 0.4% (95% CI, 0-0.8%), respectively. The only identified significant predictors of late grade ≥2 toxicity were acute grade ≥2 toxicity ( P < .001) and weekly fractionation ( P < .01), although only 12.4% of patients were treated weekly. Conclusions: Gantry-based SBRT for prostate cancer is associated with a favorable safety and efficacy profile, despite variable intrafractional motion management techniques. These findings suggest that multiple treatment platforms can be used to safely deliver prostate SBRT. (© 2019 The Authors.)
Databáze:	MEDLINE
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