Stereotactic body radiation therapy for the primary treatment of localized prostate cancer

Abstract

ObjectiveThe low alpha/beta ratio of prostate cancer suggests that hypofractionated schemes of dose-escalated radiotherapy should be advantageous. We report our experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer to assess efficacy and toxicity.MethodsFrom 2007 to 2010, 70 patients (51 % low risk, 31 % intermediate risk, and 17 % high risk) with localized prostate cancer were treated with SBRT using the CyberKnife system. One-third of patients received androgen deprivation therapy. Doses of 37.5 Gy (n = 29), 36.25 Gy (n = 36), and 35 Gy (n = 5) were administered in five fractions and analyzed as high dose (37.5 Gy) vs. low dose (36.25 and 35 Gy).ResultsAt a median 27 and 37 months follow-up, the low and high dose groups' median PSA nadir to date was 0.3 and 0.2 ng/ml, respectively. The 3-year freedom from biochemical failure (FFBF) was 100 %, 95.0 % and 77.1 % for the low-, intermediate- and high-risk patients. A dose response was observed in intermediate- and high-risk patients with 72 % vs. 100 % 3-year FFBF for the low and high dose groups, respectively (p = 0.0363). Grade III genitourinary toxicities included 4 % acute and 3 % late (all high dose). Potency was preserved in 83 % of hormone naïve patients.ConclusionCyberKnife dose escalated SBRT for low-, intermediate- and high-risk prostate cancer exhibits favorable efficacy with acceptable toxicity.

Image-guided hypofractionated proton beam therapy for low-risk prostate cancer: Analysis of quality of life and toxicity, PCG GU 002

“…3,[20][21][22]24,30 In our present study, AUA scores and EPIC urinary scores had no significant change over time. Most symptoms were related to weak urinary stream that improved with medications, as reflected by an almost flat AUA score over time.…”

“…18 Clinical results for hypofractionated photon prostate cancer treatments have also been favorable. 3,[19][20][21][22][23][24][25][26][27][28][29][30][31] Many different fractionations, from 6.75 Gy in 5 treatments to 10 Gy in 5 treatments, have been used. Our design was based on data published with high-dose-rate brachytherapy for prostate cancer and the published normal tissue ˛/ř atio.…”

Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

“…Outcome data from eight SBRT studies of patients with early-stage prostate cancer with a combined patient cohort of n=2007 were included (17)(18)(19)(20)(21)(22)(23)(24). This included 1,281 low-risk, 622 intermediate-risk and 104 highrisk patients.…”

“…This included 1,281 low-risk, 622 intermediate-risk and 104 highrisk patients. Rates of bPFS reported ranged from 77.1% to 100% (17)(18)(19)(20)(21)(22)(23)(24), at endpoints ranging 2-7 years post treatment.…”

“…Aim: Stereotactic body radiation therapy (SBRT)is [12][13][14][15][16][17][18][19][20][21][22][23][24][25] respectively,, respectively, in the CF-EBRT cohort. Incidence of acute grade 1, 2, and 3 gastrointestinal toxicities were reported in the range of respectively, of the SBRT cohort compared to 16…”