EVALUATION OF OUTCOMES AFTER STEREOTACTIC HYPOFRACTIONATED RADIOTHERAPY FOR PROSTATE CANCER

In accordance with the new radiobiological knowledge concerning prostate cancer, several randomized trials support the use of high doses of radiation. Hypofractionated stereotactic radiotherapy schedules are now proposed as a suitable approach in patients with localized prostate cancer. We retrospec...

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Bibliographic Details
Published in:Anticancer research 2018-04, Vol.38 (4), p.2492
Main Authors: Beltramo, Giancarlo, Longo, Giovanni, Locatelli, Cristina, Zanetti, Isa Bossi, Bergantin, Achille, Martinotti, Anna Stefania, Redaelli, Irene, Bonfanti, Paolo, Bresolin, Andrea, Bianchi, Livia Corinna, Maggioni, Matteo, Dormia, Guido
Format: Article
Language:English
Subjects:
Bladder
Bone cancer
Cancer
Cancer therapies
Clinical trials
Colorectal cancer
Computed tomography
Confidence intervals
Constipation
Delivery scheduling
Deprivation
Diarrhea
Fistulae
Gastrointestinal symptoms
Health risks
Instrumentation
Magnetic resonance imaging
Metastases
Patients
Proctitis
Prostate cancer
Prostate-specific antigen
Radiation
Radiation therapy
Rectum
Risk
Risk groups
Schedules
Seminal vesicle
Stricture
Toxicity
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Summary:In accordance with the new radiobiological knowledge concerning prostate cancer, several randomized trials support the use of high doses of radiation. Hypofractionated stereotactic radiotherapy schedules are now proposed as a suitable approach in patients with localized prostate cancer. We retrospectively report collected data from a cohort of localized prostate cancer patients treated with Cyberknife (CK) Stereotactic Body Radiotherapy Treatment (SBRT) in our Center. From July 2007 to 2016, a retrospective analysis was carried out on 217 consecutive patients with a median age of 75 years (range=52-86), median prostate volume of 75.6 cc (range=37.03-163.16), and clinically localized prostate cancer. Cyberknife was used to deliver fiducial-based imageguided hypofractionated SBRT. The majority of patients 116 (53%) were low-risk, 60 patients (28%) were intermediaterisk, and 41 patients (19%) were high-risk (according to the National Comprehensive Cancer Network criteria). Pretreatment prostate-specific antigen (PSA) ranged from 1.51 to 51 ng/ml (median=8.51 ng/ml). Seventeen (41%) of 41 high-risk patients received androgen deprivation therapy (ADT), that was not administered to any low-/intermediaterisk patient. Computed tomography and magnetic resonance imaging were used for treatment planning in all patients. The course of radiotherapy consisted of 38 Gy over 4 fractions (9.5 Gy/fraction) given daily to the planning target volume (PTV), which was defined as the clinical target volume (CTV) on prostate (plus at least 1 cm extension in seminal vesicles in intermediate- and high-risk patients) expanded 3 mm in all directions, except posteriorly (2 mm). Heterogeneous dose planning was used; dose was normalized to the 75% isodose line in order for the prescription dose to cover at least 95% of PTV. Real-time intrafractional motion tracking was used. Radiation therapy oncology group (RTOG) toxicity grades were assigned for genitourinary and gastrointestinal symptoms. Results: With a median follow-up of 61 months (range=12-120), the 6-year actuarial PSA relapse-free survival rate was 94.4% (confidence interval=90.8%-98.2%) with 98.2% for low-risk, 94.5% for intermediate-risk, and 85.6% for high-risk. In total 23 (10.5%) patients died during the follow-up for unrelated causes, only one (0.5%) died for prostate cancer with bone metastases. The patterns of PSA response showed a gradual decline with a PSA nadir below 1.0 ng/ml, 12 months after the radiation treatment
ISSN:0250-7005
1791-7530