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Title: Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity

Abstract

Purpose: To report the acute and late toxicities of patients with high-risk localized prostate cancer treated using a concomitant hypofractionated, intensity-modulated radiotherapy boost combined with long-term androgen deprivation therapy. Methods and Materials: A prospective Phase I-II study of patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level {>=}20 ng/mL, or Gleason score 8-10. A dose of 45 Gy (1.8 Gy/fraction) was delivered to the pelvic lymph nodes with a concomitant 22.5 Gy prostate intensity-modulated radiotherapy boost, to a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions within 5 weeks. Image guidance was performed using three gold seed fiducials. The National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, and Radiation Therapy Oncology Group late morbidity scores were used to assess the acute and late toxicities, respectively. Biochemical failure was determined using the Phoenix definition. Results: A total of 97 patients were treated and followed up for a median of 39 months, with 88% having a minimum of 24 months of follow-up. The maximal toxicity scores were recorded. The grade of acute gastrointestinal toxicity was Grade 0 in 4%, 1 in 59%, and 2 in 37%. The grade of acute urinary toxicity was Grademore » 0 in 8%, 1 in 50%, 2 in 39%, and 3 in 4%. The grade of late gastrointestinal toxicity was Grade 0 in 54%, 1 in 40%, and 2 in 7%. No Grade 3 or greater late gastrointestinal toxicities developed. The grade of late urinary toxicity was Grade 0 in 82%, 1 in 9%, 2 in 5%, 3 in 3%, and 4 in 1% (1 patient). All severe toxicities (Grade 3 or greater) had resolved at the last follow-up visit. The 4-year biochemical disease-free survival rate was 90.5%. Conclusions: A hypofractionated intensity-modulated radiotherapy boost delivering 67.5 Gy in 25 fractions within 5 weeks combined with pelvic nodal radiotherapy and long-term androgen deprivation therapy was well tolerated, with low rates of severe toxicity. The biochemical control rate at early follow-up has been promising. Additional follow-up is needed to determine the long-term biochemical control and prostate biopsy results.« less

Authors:
 [1]; ; ; ; ;  [1];  [2];  [1]; ; ;  [1]
  1. Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada)
  2. Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States)
Publication Date:
OSTI Identifier:
22056055
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 82; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANDROGENS; ANTIGENS; BIOPSY; DISEASE INCIDENCE; FAILURES; GOLD; HAZARDS; LYMPH NODES; NEOPLASMS; PATIENTS; PROSTATE; RADIATION DOSES; RADIATION INJURIES; RADIOTHERAPY; TOXICITY

Citation Formats

Quon, Harvey, Department of Radiation Oncology, University of Toronto, Toronto, ON, Cheung, Patrick C.F., E-mail: patrick.cheung@sunnybrook.ca, Department of Radiation Oncology, University of Toronto, Toronto, ON, Loblaw, D Andrew, Morton, Gerard, Pang, Geordi, Szumacher, Ewa, Danjoux, Cyril, Department of Radiation Oncology, University of Toronto, Toronto, ON, Choo, Richard, Thomas, Gillian, Department of Radiation Oncology, University of Toronto, Toronto, ON, Kiss, Alex, Mamedov, Alexandre, and Deabreu, Andrea. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2010.11.003.
Quon, Harvey, Department of Radiation Oncology, University of Toronto, Toronto, ON, Cheung, Patrick C.F., E-mail: patrick.cheung@sunnybrook.ca, Department of Radiation Oncology, University of Toronto, Toronto, ON, Loblaw, D Andrew, Morton, Gerard, Pang, Geordi, Szumacher, Ewa, Danjoux, Cyril, Department of Radiation Oncology, University of Toronto, Toronto, ON, Choo, Richard, Thomas, Gillian, Department of Radiation Oncology, University of Toronto, Toronto, ON, Kiss, Alex, Mamedov, Alexandre, & Deabreu, Andrea. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity. United States. https://doi.org/10.1016/J.IJROBP.2010.11.003
Quon, Harvey, Department of Radiation Oncology, University of Toronto, Toronto, ON, Cheung, Patrick C.F., E-mail: patrick.cheung@sunnybrook.ca, Department of Radiation Oncology, University of Toronto, Toronto, ON, Loblaw, D Andrew, Morton, Gerard, Pang, Geordi, Szumacher, Ewa, Danjoux, Cyril, Department of Radiation Oncology, University of Toronto, Toronto, ON, Choo, Richard, Thomas, Gillian, Department of Radiation Oncology, University of Toronto, Toronto, ON, Kiss, Alex, Mamedov, Alexandre, and Deabreu, Andrea. 2012. "Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity". United States. https://doi.org/10.1016/J.IJROBP.2010.11.003.
@article{osti_22056055,
title = {Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity},
author = {Quon, Harvey and Department of Radiation Oncology, University of Toronto, Toronto, ON and Cheung, Patrick C.F., E-mail: patrick.cheung@sunnybrook.ca and Department of Radiation Oncology, University of Toronto, Toronto, ON and Loblaw, D Andrew and Morton, Gerard and Pang, Geordi and Szumacher, Ewa and Danjoux, Cyril and Department of Radiation Oncology, University of Toronto, Toronto, ON and Choo, Richard and Thomas, Gillian and Department of Radiation Oncology, University of Toronto, Toronto, ON and Kiss, Alex and Mamedov, Alexandre and Deabreu, Andrea},
abstractNote = {Purpose: To report the acute and late toxicities of patients with high-risk localized prostate cancer treated using a concomitant hypofractionated, intensity-modulated radiotherapy boost combined with long-term androgen deprivation therapy. Methods and Materials: A prospective Phase I-II study of patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level {>=}20 ng/mL, or Gleason score 8-10. A dose of 45 Gy (1.8 Gy/fraction) was delivered to the pelvic lymph nodes with a concomitant 22.5 Gy prostate intensity-modulated radiotherapy boost, to a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions within 5 weeks. Image guidance was performed using three gold seed fiducials. The National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, and Radiation Therapy Oncology Group late morbidity scores were used to assess the acute and late toxicities, respectively. Biochemical failure was determined using the Phoenix definition. Results: A total of 97 patients were treated and followed up for a median of 39 months, with 88% having a minimum of 24 months of follow-up. The maximal toxicity scores were recorded. The grade of acute gastrointestinal toxicity was Grade 0 in 4%, 1 in 59%, and 2 in 37%. The grade of acute urinary toxicity was Grade 0 in 8%, 1 in 50%, 2 in 39%, and 3 in 4%. The grade of late gastrointestinal toxicity was Grade 0 in 54%, 1 in 40%, and 2 in 7%. No Grade 3 or greater late gastrointestinal toxicities developed. The grade of late urinary toxicity was Grade 0 in 82%, 1 in 9%, 2 in 5%, 3 in 3%, and 4 in 1% (1 patient). All severe toxicities (Grade 3 or greater) had resolved at the last follow-up visit. The 4-year biochemical disease-free survival rate was 90.5%. Conclusions: A hypofractionated intensity-modulated radiotherapy boost delivering 67.5 Gy in 25 fractions within 5 weeks combined with pelvic nodal radiotherapy and long-term androgen deprivation therapy was well tolerated, with low rates of severe toxicity. The biochemical control rate at early follow-up has been promising. Additional follow-up is needed to determine the long-term biochemical control and prostate biopsy results.},
doi = {10.1016/J.IJROBP.2010.11.003},
url = {https://www.osti.gov/biblio/22056055}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 82,
place = {United States},
year = {Wed Feb 01 00:00:00 EST 2012},
month = {Wed Feb 01 00:00:00 EST 2012}
}