Stereotactic pelvic radiotherapy with HDR boost for dose escalation in intermediate and high-risk prostate cancer (SPARE): Efficacy, toxicity and quality of life
Autor: | Patrick Cheung, Gerard Morton, Andrea Deabreu, Melanie Davidson, Andrew Loblaw, Ananth Ravi, Danny Vesprini, Stanley K. Liu, Hima Bindu Musunuru, Joelle Helou, Ling Ho, William Chu, Liying Zhang, Hans Chung |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Urinary system Brachytherapy Urology Pelvis 030218 nuclear medicine & medical imaging Androgen deprivation therapy 03 medical and health sciences Prostate cancer 0302 clinical medicine Quality of life Prostate medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies business.industry Prostatic Neoplasms Androgen Antagonists Radiotherapy Dosage Hematology medicine.disease medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Toxicity Quality of Life business |
Zdroj: | Radiotherapy and Oncology. 161:40-46 |
ISSN: | 0167-8140 |
Popis: | The ASCO/CCO guidelines recommend brachytherapy (BT) boost for eligible intermediate- (IR) or high-risk (HR) prostate cancer (PCa) patients. We present efficacy, toxicity and quality-of-life (QoL) outcomes in patients treated on a prospective protocol of MRI dose-painted high-dose-rate BT boost (HDR-BT) followed by 5-fraction pelvic radiotherapy (RT) and 6-18 months of androgen deprivation therapy (ADT).In this phase I/II study, IR or HR PCa patients received HDR-BT 15 Gy × 1 to prostate and up to 22.5 Gy to MRI nodule, followed by 25 Gy in 5, weekly fractions to pelvis. Toxicity was assessed using CTCAEv3.0, and QoL was captured using EPIC questionnaire. Biochemical failure (BF; nadir + 2.0), and proportion of patients with PSA 0.4 ng/ml at 4-years (4yPSARR) were evaluated. A minimally clinically important change (MCIC) was recorded if QoL score decreased0.5 standard deviation of baseline scores.Thirty-one patients (NCCN 3.2% favorable IR, 48.4% unfavorable IR and 48.4% HR) completed treatment with a median follow-up of 61 months. Median D90 to MR nodule was 19.0 Gy and median prostate V100% was 96.5%. The actuarial 5-year BF rate was 18.2%, and the 4yPSARR was 71%. One patient died of PCa. Acute grade 2 and 3 toxicities: GU: 50%, 7%, and GI: 3%, none, respectively. Late grade 2 and 3 toxicities were: GU: 23%, 3%, and GI: 7%, none, respectively. Proportion of patients with MCIC was 7.7% for urinary domain and 32.0% for bowel domain.This novel treatment protocol incorporating MRI dose-painted HDR-BT boost and 5-fraction pelvic RT with ADT is well tolerated. |
Databáze: | OpenAIRE |
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