Stereotactic body radiation therapy (8 fractions) versus moderate hypofractionation (20 fractions) for localized prostate cancer using helical tomotherapy

Abstract

Introduction. Brachytherapy allows administrating a highly conformed dose that is very important in prostate cancer disease control.Objectives. To assess outcomes of a single fraction high dose rate brachytherapy implant boost (HDR) to 3D external radiation with image guidance (IGRT) in patients with localized prostate adenocarcinoma. Methods. From 2009 to 2012, 25 consecutive patients with T1-2N0M0 were treated in our institution. Their median age was 67 years. In 20 patients IGRT + HDR was the primary treatment (90% RTOG's high risk). In 5 cases the IGRT + HDR was a salvage treatment after local failure of either previous I-125 brachytherapy (4 patients) or surgery (1 patient). Mean dose administered was 48.7 Gy (40-55.8) for external beam radiation and 11.21 Gy (9.5-14) for HDR. HDR was given about 1 month after completion of IGRT in 21 patients, in the middle of external radiation in 2 cases and before the beginning of IGRT in the other 2. The prostate dose (IGRT and HDR) resulted in biological equivalent doses (>128 Gy = 3). 75% of patients also had at least 6 months of hormonal treatment (/( (HT). Results. All patients completed treatment. Median follow up is 7 months (range: 2-36). No RTOG greater than grade 2 toxicities were found. Acute toxicities were: 45% and 10%. Late urinary and rectal toxicities presented in 10% and 5%. 96% of patients are free from biochemical relapse. The only patient with biochemical relapse has bone metastases resistant to HT. Conclusion. Single fraction HDR boost is a safe and effective method of dose escalation for newly diagnosed or relapsing localized prostate cancer, with acceptable acute and late toxicities. A larger follow-up is necessary to assess overall and biochemical relapse-free survival.http://dx. Introduction.Acute grade 3 toxicity is uncommon during stereotactic body radiation therapy (SBRT), mainly in low-risk prostate cancer (PCa), using robotic radiosurgery (Katz, 2010; Freeman, 2011). To our knowledge there is only one study evaluating in part tomotherapy SBRT (Boike, 2011). Purpose. Single-institution prospective study. Endpoint. To describe acute GU and GI toxicity of two dose-escalation hypofractionated schemes. Methods. Since 5-2012 thirteen patients were treated with 8 fx of 5.48-5.65 Gy to 43.84-45.20 Gy on alternate days (group A). In this same period of time, 13 patients were irradiated following the same protocol but delivering 19-20 fx of 3.17 Gy, 5 fx/week, to 60.23-63.40 Gy (group B). Both schemes are isoeffective for late-response tissues (a/b3): 74.3 and 78.2 Gy for low risk (LR) and intermediate-high risk (IHR). EQD2 PCa (a/b1.5): 87.4 Gy (LR) and 92.3 Gy (IHR) in group A; 80.3 Gy (LR) and 84.6 Gy (IHR) in group B. Exclusion criteria: Gleason score ≥8, PSA > 20, cT3b-4, cN1, cM1, IPSS ≥ 20 (only group A), history of acute urinary retention. MVCT for on-line correction was performed in every fraction. All men received neoadjuvant-concomitant ADT. Results. Patient characteristics groups A and B: mean age = 71.7 and 70.9, cT1 (53% and 43%) T2 (30%...

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

“…The study protocol was reviewed by an independent agency of the Ministry of Health (the Spanish Agency of Medicines and Medical Devices, AEMPS ) and approved by the institutional review board. All patients signed specific informed consent and were aware of the institution’s standard radiotherapy treatment, which consisted of 20 fractions of 3.17 Gy, five fractions per week . Patients with locally advanced prostate adenocarcinoma (cT3b) or disseminated disease (cN1 or cM1) were excluded.…”