High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Abstract

Background: Stereotactic body radiotherapy (SBRT) can emulate high dose rate brachytherapy (HDR-BRT) dose fractionation. We report our preliminary results using SBRT in monotherapy or pre-external-beam radiotherapy (EBRT) boost in patients with localized prostate cancer (LpC). The primary end point was the evaluation of both acute and late toxicities; secondary end point was the observation of prostate-specific antigen (PSA) nadir. Patients and Methods: Patients with LpC having prostate volume 90 cm 3 were enrolled in the present study. Patients were treated with SBRT alone or in combined modality (SBRT þ EBRT). SBRT was performed using a CyberKnife System (Accuray Incorporated, Sunnyvale, California) and fiducial tracking system. Results: From February 2008 to July 2013, 21 patients for monotherapy (38 Gy/4 fractions) and 5 for combined modality (9.5 Gy/2 fractions plus 46 Gy/23 fractions EBRT) were enrolled. Androgen deprivation therapy (ADT) was administered in 16 of the 26 patients. The median pretreatment PSA was 9.4 (range, 4.5-14.3) ng/mL. All patients completed the planned therapy. Acute Grade 1 toxicity was observed in 18 patients, genitourinary (GU) in 12 / 26 patients, and gastrointestinal (GI) in 6 / 26 patients. Acute Grade 2 GU toxicity was reported in 1 / 26 patients, and Grade 2 GI toxicity was observed in 2 / 26 patients. The median PSA nadir was 0.15 (range, 0.02 ¼ 1.4) ng/mL. Late toxicities were observed in 5 / 26 patients: Grade 1 GU (3 of 26), Grade 2 GU (1 of 26), and Grade 1 GI (1 of 26). Median follow-up was 21.5 (range, 8-65) months. Conclusions: Our preliminary results of SBRT ''simulating'' HDR for LpC confirm a minimal toxicity and an optimal PSA response. The PSA nadirs appear comparable with HDR-BRT.

Rectal/urinary toxicity after hypofractionated vs conventional radiotherapy in low/intermediate risk localized prostate cancer: systematic review and meta analysis

“…The mean percentage of acute genitourinary and gastrointestinal toxicity was 5% and 7%; the mean percentage of late toxicity was 4% and 08% respectively [46,47]. …”

Stereotactic Body Radiotherapy for Localized Ureter Transitional Cell Carcinoma: Three Case Reports

“…The most commonly used one is a linear accelerator (LINAC), and we performed SBRT with a CT-LINAC system in all three cases. Incidentally, SBRT with dedicated machines, including cyberknife, is also often performed especially for localized prostate cancer in genitourinary organs [ 6 ].…”

Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6,000 Patients Treated On Prospective Studies

“…W.C.J and D.E.S independently extracted data from the 38 identified studies. [37][38][39][40][41][42][43][44][45][46][47][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Variables extracted included study and patient-level characteristics, such as study type, phase of trial, sample size, dose per fraction, fraction number, duration of follow-up, age, clinical tumor stage, baseline prostate-specific antigen, National Comprehensive Cancer Network (NCCN) 69 risk group of enrolled patients, receipt of androgen-deprivation therapy (ADT), bRFS, physician-reported toxicity, and patientreported QOL, if reported. Individual patient data was not used.…”