Abstract
Background
Studies using stereotactic body radiotherapy (SBRT) dose escalation in in low- and
intermediate-risk prostate cancer patients have indicated favorable outcomes.
Objective
To evaluate tolerance and tumor control outcomes in low- and intermediate-risk prostate
cancer patients treated with high-dose SBRT following our phase 1 trial.
Design, setting, and participants
A total of 551 patients with low- or intermediate-risk prostate cancer were treated
with SBRT.
Intervention
Treatment with 37.5–40 Gy SBRT in five fractions directed to the prostate and seminal vesicles.
Outcome measurements and statistical analysis
Outcome measurements included acute toxicities (<3 mo after radiotherapy [RT]) and
late toxicities (>3 mo after RT) and tumor control evaluation (prostate-specific antigen
[PSA] levels at 3–6-mo intervals and post-treatment prostate biopsy at 2 yr).
Results and limitations
Acute grade 2 gastrointestinal (GI) toxicities occurred in 1.8% of patients, and late
grade 2 and 3 GI toxicities were observed in 3.4% and 0.4% of patients, respectively.
Acute grade 2 genitourinary (GU) toxicities occurred in 10% of patients, and grade
3 acute GU toxicities were observed in 0.7% of patients. Late grade 2 and 3 GU toxicities
were observed in 21.1% and 2.5% of patients, respectively. The use of a hydrogel rectal
spacer was significantly associated with reduced late GI toxicity and lower odds of
developing late GU toxicity. The median follow-up was 17 mo, and 53% of those with
at least 2 yr of follow-up (103/193) had a biopsy performed. The 5-yr cumulative incidence of
PSA failure was 2.1%, and the incidence of a positive 2-yr treatment biopsy was 12%.
Limitations to this report include its retrospective nature and short follow-up time.
Conclusions
Favorable short-term outcomes were achieved with high-dose SBRT for low- and intermediate-risk
disease. Severe late toxicities were observed and favorable tumor control was found.
Patient summary
We utilized stereotactic body radiotherapy, a form of external beam radiotherapy that
delivers highly targeted high-dose treatment to the prostate, to treat over 500 localized
prostate cancer patients in five sessions over 1.5 wk. Treatments were well tolerated
without significant urinary or rectal side effects. Nearly 90% of those who underwent
biopsies after treatment did not demonstrate residual active disease.
Keywords
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References
- Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials.Radiother Oncol. 2013; 109: 217-221
- Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer.Int J Radiat Oncol Biol Phys. 2012; 82: 877-882
- Stereotactic body radiotherapy for low-risk prostate cancer: a 10-year analysis.Cureus. 2017; 9: e1668
- Stereotactic body radiotherapy for prostate cancer.Clin Oncol. 2015; 27: 270-279
- A phase II trial of stereotactic ablative body radiotherapy for low-risk prostate cancer using a non-robotic linear accelerator and real-time target tracking: report of toxicity, quality of life, and disease control outcomes with 5-year minimum follow-up.Front Oncol. 2014; 4: 279
- Multicenter trial of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer: survival and toxicity endpoints.Int J Radiat Oncol Biol Phys. 2018; 102: 296-303
- Stereotactic body radiation therapy (SBRT) for high-risk prostate cancer: where are we now?.Pract Radiat Oncol. 2018; 8: 185-202
- 5-Year outcomes of a Phase I dose escalation study using stereotactic body radiosurgery for patients with low and intermediate risk prostate cancer.Int J Radiat Oncol Biol Physics. 2019; 104: 42-49
- Stereotactic body radiation therapy for localized prostate cancer: a systematic review and meta-analysis of over 6,000 patients treated on prospective studies.Int J Radiat Oncol Biol Phys. 2019; 104: 778-789
- Hypofractionated radiation therapy for localized prostate cancer: an ASTRO, ASCO, and AUA evidence-based guideline.J Clin Oncol. 2018; 36: 3411-3430
- Early tolerance outcomes of stereotactic hypofractionated accelerated radiation therapy concomitant with pelvic node irradiation in high-risk prostate cancer.Adv Rad Oncol. 2019; 4: 337-344
- Clinical workflow for MR-only simulation and planning in prostate.Radiat Oncol. 2017; 12: 119
- Dosimetric and workflow evaluation of first commercial synthetic CT software for clinical use in pelvis.Phys Med Biol. 2017; 62: 2961-2975
- Simultaneous MV-kV imaging for intrafractional motion management during volumetric-modulated arc therapy delivery.J Appl Clin Med Phys. 2016; 17: 473-486
- Toxicity criteria of the radiation therapy oncology group (RTOG) and the european organization for research and treatment of Cancer (EORTC).Int J Radiat Oncol Biol Phys. 1995; 31: 1341-1346
- Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer.Int J Radiat Oncol Biol Phys. 2013; 85: 686-692
- Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial.Lancet. 2019; 394: 385-395
- Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer.Int J Radiat Oncol Biol Phys. 2012; 84: 125-129
- Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial.Int J Radiat Oncol Biol Phys. 2017; 97: 976-985
- Randomised trial of external beam radiotherapy alone or combined with high‐dose‐rate brachytherapy boost for localised prostate cancer.Radiother Oncol. 2012; 103: 217-222
- Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate.J Clin Oncol. 2005; 23: 1192-1199
- Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial.Lancet Oncol. 2007; 8: 475-487
- Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95‐09.J Clin Oncol. 2010; 28: 1106-1111
- Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy.J Clin Oncol. 2006; 24: 1990-1996
- The GETUG 70 Gy vs. 80 Gy randomized trial for localized prostate cancer: feasibility and acute toxicity.Int J Radiat Oncol Biol Phys. 2004; 60: 1056-1065
- Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer.Int J Radiat Oncol Biol Phys. 2017; 98: 275-285
- ASCENDE-RT: an analysis of treatment-related morbidity for a randomized trial comparing a low-dose-rate brachytherapy boost with a dose-escalated external beam boost for high- and intermediate-risk prostate cancer.Int J Radiat Oncol Biol Phys. 2017; 98: 286-295
- Multi-institutional phase 2 trial of high-dose stereotactic body radiation therapy with temporary hydrogel spacer for low- and intermediate-risk prostate cancer.Int J Radiat Oncol Biol. 2017; 99: 1319-1320
Article Info
Publication History
Published online: October 23, 2019
Accepted:
September 20,
2019
Received in revised form:
August 26,
2019
Received:
July 19,
2019
Associate Editor: Paul NguyenIdentification
Copyright
© 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
