Moderate Hypofractionation with Simultaneous Integrated Boost in Prostate Cancer: Long-term Results of a Phase I-II Study.
Clin Oncol (R Coll Radiol)
; 28(8): 490-500, 2016 08.
Article
em En
| MEDLINE
| ID: mdl-26961088
ABSTRACT
AIMS:
To report 5 year outcome and late toxicity in prostate cancer patients treated with image-guided tomotherapy with a moderate hypofractionated simultaneous integrated boost approach. MATERIALS ANDMETHODS:
In total, 211 prostate cancer patients, 78 low risk, 53 intermediate risk and 80 high risk were treated between 2005 and 2011. Intermediate- and high-risk patients received 51.8 Gy to pelvic lymph nodes and concomitant simultaneous integrated boost to prostate up to 74.2 Gy/28 fractions, whereas low-risk patients were treated to the prostate only with 71.4 Gy/28 fractions. Daily megavoltage computed tomography (MVCT) image guidance was applied. Androgen deprivation was prescribed for a median duration of 6 months for low-risk patients (for downsizing), 12 months for intermediate-risk and 36 months for high-risk patients. The 5 year biochemical relapse-free survival (bRFS), cancer-specific survival (CSS), overall survival and late gastrointestinal and genitourinary CTCAE.v3 toxicity were assessed. The effect of several clinical variables on both outcome and gastrointestinal/genitourinary toxicity was tested by uni- and multivariate Cox regression analyses.RESULTS:
After a median follow-up of 5 years, the late toxicity actuarial incidence was genitourinary ≥ grade 2 20.2%; genitourinary ≥ grade 3 5.9%; gastrointestinal ≥ grade 2 17%; gastrointestinal ≥ grade 3 6.3% with lower prevalence at the last follow-up visit (≥ grade 3 genitourinary 1.9%; gastrointestinal 1.9%). Major predictors of ≥ grade 3 genitourinary and gastrointestinal late toxicity were genitourinary acute toxicity ≥ grade 2 (hazard ratio 4.9) and previous surgery (hazard ratio 3.4). The overall 5 year bRFS was 93.7% (low risk 94.6%; intermediate risk 96.2%; high risk 91.1%), overall survival and CSS were 88.6% (low risk 90.5%; intermediate risk 87.4%; high risk 87%) and 97.5% (low risk 98.7%; intermediate risk 95%; high risk 94.3%), respectively. Risk classes and androgen deprivation were not significantly correlated with either bRFS, overall survival or CSS. Twelve patients experienced a biochemical relapse but none experienced clinically proven local and/or pelvic recurrence.CONCLUSION:
A satisfactory 5 year outcome with an acceptable toxicity profile was observed. The combination of image-guided radiotherapy-intensity-modulated radiotherapy, high equivalent 2 Gy dose (EQD2) with a moderate hypofractionated approach and extensive prophylactic lymph node irradiation also leads to very good outcome in high-risk patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
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Tipos_de_cancer
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Prostata
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Tratamento
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Radioterapia
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
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Radioterapia de Intensidade Modulada
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Radioterapia Guiada por Imagem
Tipo de estudo:
Guideline
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Clin Oncol (R Coll Radiol)
Assunto da revista:
NEOPLASIAS
Ano de publicação:
2016
Tipo de documento:
Article