SHARP hypofractionated stereotactic radiotherapy is well tolerated in prostate cancer

Abstract

BackgroundQuality of life (QoL) is one of the most significant issues in prostate cancer treatment decisions. This study aimed to investigate the toxicity of hypofractionated stereotactic radiotherapy (SBRT) and QoL after treatment in localized prostate cancer patients.Materials and methodsA prospective single-center clinical study was performed in low- and intermediate-risk prostate cancer patients. Patients received 33.5 Gy in 5 fractions (SHARP regimen). Acute and late toxicity was assessed according to RTOG/EORTC score. Patients filled out EORTC QLQ-C30 and prostate cancer-specific QLQ-PR25 questionnaires.ResultsThe analysis included 68 prostate cancer patients (55–83 years, median 73) with clinical stage T1c-T2cN0M0, median combined Gleason score of 6 (3–8), and median prostate-specific antigen (PSA) level of 10 ng/mL (4–20 ng/mL). Neoadjuvant androgen deprivation therapy was given to 52 patients (76.5 %), and stopped in 31 patients (45.5 %) after 6 months; in 21 patients (31 %) after 2–3 years. Average and median follow-up was 24 months (18–45). Median nadir PSA level was 0.03 ng/mL for all patients and 0.6 ng/mL for patients without hormone treatment. No patients had PSA failure. There were no acute grade IV toxicities. One patient (1.5 %) developed grade III and 24 patients (35.3 %) grade II acute bladder toxicity. No one developed grade III and 7 patients (10.3 %) grade II acute rectal toxicity. No grade III or IV late gastrointestinal or genitourinary toxicities were reported. Grade II late urinary symptoms were observed in 8 patients (11.8 %) and gastrointestinal symptoms in 3 patients (4.4 %). Global health status/QoL was good and improved during the observational period.ConclusionSBRT for prostate cancer patients is a well-tolerated treatment in terms of toxicity and QoL, has no negative impact on functioning and everyday life, with the important benefit of a short treatment period. However, long-term follow-up data are needed.

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

“…The first 4 have evaluated treatments with dose/fraction of 6.7- 10 Gy for a total dose 33.5-50 Gy and number of fractions between 4 and 5. The mean of percentage of acute urinary and rectal G2 toxicity was between 24% and 16%, the late G2 toxicity was between 13% and 7% [59–62]. Regarding the studies that evaluated treatment using SBRT technique with Cyberknife system, were carried out using a 7-9.5 Gy dose/fraction for a total dose of 35-38 Gy and number of fractions between 4-5.…”

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.…”

High Dose “HDR-Like” Prostate SBRT: PSA 10-Year Results From a Mature, Multi-Institutional Clinical Trial

“…Although all published SBRT regimens create a low PSA nadir, the more conservatively dosed regimens (33.5 -37.5 Gy/5 fractions) do not reach a full ablation level, with reported nadirs from 0.2 -0.48 ng/mL (10)(11)(12). One institution published two separate post-SBRT PSA kinetic response papers, using a dose of 35-37.5 ng/mL, demonstrating that the median PSA level decreased from 0.3 ng/mL at 3 years to 0.2 ng/mL at 5.6 years of median follow-up, though only 40% of the patients in the longer-term study achieved an "ablation" PSA nadir level (11,12).…”

“…Once again, this suggests that the more conservatively dosed regimens are potent, but not routinely ablative. The more conservatively dosed prostate SBRT regimens create a PSA nadir that resembles that of dose escalated IMRT (6,10).…”