5-Year Outcomes of a Prospective Phase 1/2 Study of Accelerated Hypofractionated Radiation Therapy to the Prostate Bed
| Autor: | Gerard Morton, Adam Gladwish, Kevin Martell, Andrew Loblaw, Geordi Pang, Alexandre Mamedov, Patrick Cheung, Yasir Alayed, Liying Zhang, Andrea Deabreu, Hans Chung |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Hypofractionated Radiation Therapy medicine.medical_treatment Urology 030218 nuclear medicine & medical imaging Androgen deprivation therapy 03 medical and health sciences 0302 clinical medicine medicine Humans Radiology Nuclear Medicine and imaging Cumulative incidence Prospective Studies Aged Genitourinary system business.industry Prostatectomy Common Terminology Criteria for Adverse Events Middle Aged Radiation therapy Oncology 030220 oncology & carcinogenesis Dose Fractionation Radiation Accelerated Radiation Therapy business Radiotherapy Image-Guided |
| Zdroj: | Practical Radiation Oncology. 9:354-361 |
| ISSN: | 1879-8500 |
| DOI: | 10.1016/j.prro.2019.04.010 |
| Popis: | To report the 5-year outcomes from a single institution, prospective, phase 1/2 study on hypofractionated, accelerated radiation therapy to the prostate bed after radical prostatectomy.Patients enrolled in this study were all eligible for postoperative radiation therapy and received a prescribed dose of 51 Gy in 17 fractions to the prostate bed. On follow-up, gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0; prostate-specific antigen (PSA) was evaluated and quality of life was assessed using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire.A total of 30 patients were enrolled between 2008 and 2011. Median age was 65 (52-75) years. Median pretreatment PSA was 0.12 ng/mL (0.01-1.42). Twenty-six (93%) patients had Gleason ≤7 disease, 13 (43%) had pT3 disease, and 20 (67%) had positive margins. Twenty-six patients (87%) underwent radiation therapy as salvage treatment. After a median follow-up of 6.4 (2.1-8.1) years, no patient experienced Common Terminology Criteria for Adverse Events grade 3/4 toxicity. Eleven patients (37%) had grade 2 genitourinary and 2 (7%) had grade 2 gastrointestinal toxicity. At baseline and 5 years after radiation therapy, mean EPIC urinary domain score was 80% (standard deviation, 18%) and 82% (17%). Mean EPIC bowel domain score was 93% (13%) and 93% (15%). One patient (4%) had a minimally clinically important change in urinary domain score and 1 patient (4%) had a minimally clinically important change in bowel domain score. Nelson-Aalen estimated cumulative incidence of biochemical failure was 31% (nadir +0.2) and 18% (nadir +2.0) at 5 years. Four-year PSA ≥0.4 was predictive of subsequent androgen deprivation therapy use (Nelson-Aalen cumulative incidence: 1.45; P .0001). Five patients (17%) received hormonal therapy for biochemical failure. Nelson-Aalen estimated cumulative incidence of hormone therapy use was 14% at 5 years. All patients who received hormone therapy had PSA0.4 at 4 years.In this phase 1/2 study, hypofractionated postoperative radiation therapy seems to have good clinical efficacy without significant late toxicity. Phase 3 studies are warranted. |
| Databáze: | OpenAIRE |
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