Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results.
acute toxicity
dosimetry
pencil beam scanning
prostate cancer
proton therapy
Journal
Journal of medical imaging and radiation oncology
ISSN: 1754-9485
Titre abrégé: J Med Imaging Radiat Oncol
Pays: Australia
ID NLM: 101469340
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
22
02
2019
accepted:
29
07
2019
pubmed:
6
9
2019
medline:
20
6
2020
entrez:
6
9
2019
Statut:
ppublish
Résumé
Extreme hypofractionated radiotherapy for prostate cancer is a common modality in photon therapy. Pencil beam scanning (PBS) in similar fractionation allows better dose distribution and makes proton therapy more available for such patients. The purpose of this study is the feasibility of extreme proton hypofractionated radiotherapy and publication of early clinical results. Two hundred patients with early-stage prostate cancer were treated with IMPT (intensity-modulated proton therapy), extreme hypofractionated schedule (36.25 GyE in five fractions) between February 2013 and December 2015. Mean age of the patients was 64.3 years, and the mean value of prostate-specific antigen (PSA) before treatment was 6.83 μg/L (0.6-17.3 μg/L). Ninety-three patients (46.5%) were in the low-risk group. One hundred and seven patients (53.5%) were in the intermediate-risk group. Twenty-nine patients (14.5%) had neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. Acute toxicity, late toxicity and short-term results were evaluated. All patients finished radiotherapy without interruptions. The median follow-up time was 36 months. The mean treatment time was 9.5 days (median 9 days). Acute toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0 was (gastrointestinal toxicity) GI (grade) G1-17%, G2-3.5%; (genitourinary toxicity) GU G1-40%, G2-19%; and no G3 toxicity was observed. Late toxicity was GI G1-19%, G2-5.5%; GU G1-17%, G2-4%; and no G3 toxicity was observed. PSA relapse was observed in one patient (1.08%) in the low-risk group (pelvic lymph node involvement was detected) and in seven patients (6.5%) in the intermediate-risk group (three lymph node metastases, two lymph node and bone metastases, two PSA relapses). No patient died of prostate cancer, and three patients died from other reasons. No local recurrence of cancer in the prostate was observed. Proton beam radiotherapy for prostate cancer is feasible with a low rate of acute toxicity and promising late toxicity and effectivity.
Identifiants
pubmed: 31486267
doi: 10.1111/1754-9485.12947
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
829-835Subventions
Organisme : European Regional Development Fund-Project "Engineering applications of microworld physics
ID : CZ.02.1.01/0.0/0.0/16_019/0000766
Informations de copyright
© 2019 The Royal Australian and New Zealand College of Radiologists.
Références
Tran A, Zhang J, Woods K et al. Treatment planning comparison of IMPT, VMAT and 4π radiotherapy for prostate cases. Radiat Oncol 2017; 12: 10.
Bryant C, Smith TL, Henderson RH et al. Five-year biochemical results, toxicity, and patient-reported quality of life after delivery of dose-escalated image guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2016; 95: 422-34.
Takagi M, Demizu Y, Terashima K et al. Long-term outcomes in patients treated with proton therapy for localized prostate cancer. Cancer Med 2017; 6: 2234-43.
Ho CK, Bryant CM, Mendenhall NP. Long-term outcomes following proton therapy for prostate cancer in young men with a focus on sexual health. Acta Oncol 2018; 57: 582-8.
Katz AJ, Kang J. Stereotactic body radiotherapy as treatment for organ confined low- and intermediate-risk prostate carcinoma, a 7-year study. Front Oncol 2014; 4: 240.
Kole TP, Nichols RC, Lei S. A dosimetric comparison of ultra-hypofractionated passively scattered proton radiotherapy and stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2015; 54: 825-31.
Skácelíková E, Feltl D, Cvek J et al. Stereotactic body radiotherapy of prostate cancer - effectiveness and toxicity. Klin Onkol 2017; 30: 121-7.
Roach M III, Hanks G, Thames H Jr et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65: 965-74.
Henderson RH, Bryant C, Hoppe BS et al. Five-year outcomes from a prospective trial of image-guided accelerated hypofractionated proton therapy for prostate cancer. Acta Oncol 2017; 56: 963-70.
Vargas CE, Hartsell WF, Dunn M et al. Hypofractionated versus standard fractionated proton-beam therapy for low-risk prostate cancer: interim results of a randomized trial PCG GU 002. Am J ClinOncol 2018 Feb;41(2): 115-20.
Vargas CE, Hartsell WF, Dunn M et al. Image-guided hypofractionated proton beam therapy for low-risk prostate cancer: analysis of quality of life and toxicity, PCG GU 002. Rep Pract Oncol Radiother 2016;21:207-12.
Legge K, Nguyen D, Ng JA et al. Real-time intrafraction prostate motion during linac based stereotactic radiotherapy with rectal displacement. J ApplClin Med Phys 2017; 18: 130-6.
Curtis W, Khan M, Magnelli A et al. Relationship of imaging frequency and planning margin to account for intrafraction prostate motion: analysis based on real-time monitoring data. Int J Radiat Oncol Biol Phys 2013; 85: 700-6.
Tang S, Deville C, McDonough J et al. Effect of intrafraction prostate motion on proton pencil beam scanning delivery: a quantitative assessment. Int J Radiat Oncol Biol Phys. 2013; 87: 375-82.
Katz AJ, Kang J. Quality of life and toxicity after SBRT for organ-confined prostate cancer, a 7-year study. Front Oncol 2014; 4: 301.
Boyer MJ, Papagikos MA, Kiteley R, et al. Toxicity and quality of life report of a phase II study of stereotactic body radiotherapy (SBRT) for low and intermediate risk prostate cancer. Radiat Oncol 2017; 12: 14.
Fang P, Mick R, Deville C et al. A case-matched study of toxicity outcomes after proton therapy and intensity-modulated radiation therapy for prostate cancer. Cancer 2015; 121: 1118-27.
Huang EH, Pollack A, Levy L et al. Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2002; 54: 1314-2.
Katz A. Stereotactic body radiotherapy for low-risk prostate cancer: a ten-year analysis. Cureus 2017; 9: e1668.
Hoffman KE, Voong KR, Pugh TJ. Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial. Int J Radiat Oncol Biol Phys 2014; 88: 1074-84.