Moderate Hypofractionation with Simultaneous Integrated Boost in Prostate Cancer: Long-term Results of a Phase I–II Study. Issue 8 (August 2016)

• Record Type: Journal Article
• Authors: Di Muzio, N.G.; Fodor, A.; Noris Chiorda, B.; Broggi, S.; Mangili, P.; Valdagni, R.; Dell'Oca, I.; Pasetti, M.; Deantoni, C.L.; Chiara, A.; Berardi, G.; Briganti, A.; Calandrino, R.; Cozzarini, C.; Fiorino, C.
• Is Part Of: Clinical oncology. Volume 28:Issue 8(2016)
• Page Start: 490
• Page End: 500
• Publication Date: 2016-08
• Subjects: Moderate hypofractionation -- prostate cancer -- simultaneous integrated boost -- tomotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2016.02.005
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: To report 5 year outcome and late toxicity in prostate cancer patients treated with image-guided tomotherapy with a moderate hypofractionated simultaneous integrated boost approach. Materials and methods: In total, 211 prostate cancer patients, 78 low risk, 53 intermediate risk and 80 high risk were treated between 2005 and 2011. Intermediate- and high-risk patients received 51.8 Gy to pelvic lymph nodes and concomitant simultaneous integrated boost to prostate up to 74.2 Gy/28 fractions, whereas low-risk patients were treated to the prostate only with 71.4 Gy/28 fractions. Daily megavoltage computed tomography (MVCT) image guidance was applied. Androgen deprivation was prescribed for a median duration of 6 months for low-risk patients (for downsizing), 12 months for intermediate-risk and 36 months for high-risk patients. The 5 year biochemical relapse-free survival (bRFS), cancer-specific survival (CSS), overall survival and late gastrointestinal and genitourinary CTCAE.v3 toxicity were assessed. The effect of several clinical variables on both outcome and gastrointestinal/genitourinary toxicity was tested by uni- and multivariate Cox regression analyses. Results: After a median follow-up of 5 years, the late toxicity actuarial incidence was: genitourinary ≥ grade 2: 20.2%; genitourinary ≥ grade 3: 5.9%; gastrointestinal ≥ grade 2: 17%; gastrointestinal ≥ grade 3: 6.3% with lower prevalence at the last follow-up visit (≥ grade 3: genitourinary: 1.9%; gastrointestinal: 1.9%). Major predictors of ≥ grade 3 genitourinary and gastrointestinal late toxicity were genitourinary acute toxicity ≥ grade 2 (hazard ratio: 4.9) and previous surgery (hazard ratio: 3.4). The overall 5 year bRFS was 93.7% (low risk: 94.6%; intermediate risk: 96.2%; high risk: 91.1%), overall survival and CSS were 88.6% (low risk: 90.5%; intermediate risk: 87.4%; high risk: 87%) and 97.5% (low risk: 98.7%; intermediate risk: 95%; high risk: 94.3%), respectively. Risk classes and androgen deprivation were not significantly correlated with either bRFS, overall survival or CSS. Twelve patients experienced a biochemical relapse but none experienced clinically proven local and/or pelvic recurrence. Conclusion: A satisfactory 5 year outcome with an acceptable toxicity profile was observed. The combination of image-guided radiotherapy–intensity-modulated radiotherapy, high equivalent 2 Gy dose (EQD2) with a moderate hypofractionated approach and extensive prophylactic lymph node irradiation also leads to very good outcome in high-risk patients. Highlights: Moderate hypofractionation for prostate cancer is effective with low toxicity. The outcome is the result of lymph node irradiation, high EQD2 and daily MVCT. Genitourinary acute toxicity ≥ grade 2 was correlated with genitourinary grade 3–4 late toxicity. Previous surgery (abdominal or pelvic) was correlated with gastrointestinal late grade 3 toxicity.