Alessandro Magli1, Eugenia Moretti2, Annarita Tullio3, Gianluca Giannarini4, Fabrizio Tonetto5, Mauro Urpis6, Margherita Crespi2, Claudio Foti2, Agnese Prisco6, Margherita Polsinelli6, Gioacchino De Giorgi4, Giulia Bravo7, Paolo Scalchi2, Marco Trovò6. 1. Department of Radiation Oncology, University Hospital of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy. alessandro.magli@asuiud.sanita.fvg.it. 2. Department of Medical Physics, University Hospital of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy. 3. Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy. 4. Department of Urology, University Hospital of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy. 5. Department of Radiation Oncology, IOV-IRCCS Padova, Via Gattamelata, 64, 35128, Padova, Italy. 6. Department of Radiation Oncology, University Hospital of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy. 7. Department of Medical Area, University of Udine, ASUIUD - piazzale S.M della Misericordia 15, 33100, Udine, Italy.
Abstract
OBJECTIVE: The approach for treating high-risk prostate cancer still presents different unresolved issues. We report the safety and efficacy of a radiation therapy strategy based on the combination of moderate hypofractioned simultaneous integrated boost (SIB) and Image Guidance. MATERIALS AND METHODS: In this phase II trial of patients with high-risk prostate cancer, Image Guided SIB-IMRT plans (Simultaneous Intensity Modulated - Intensity Modulated Radiotherapy) were delivered between 2009 and 2012. All patients enrolled (41) received in 25 fractions a total dose of 67.5 Gy (2.7 Gy/fraction) to the prostatic volume, 56.25 Gy (2.25 Gy/fraction) to the seminal vescicles, and 50 Gy (2.0 Gy/fraction) to the pelvic lymph nodes (LN) chains with concurrent androgen deprivation therapy (ADT). The image-guided radiotherapy (IGRT) procedure was performed using three gold seeds. RTOG late gastrointestinal and genitourinary toxicities and 6-year biochemical relapse-free survival (BRFS) were assessed in combination of their statistical correlation with clinical factors and dosimetric parameters. RESULTS: Rate of late genitourinary toxicity grade 2 was 9.8%, while rates of late gastrointestinal toxicity were 14.6% and 2.4%, for grade 1 and 2, respectively. Diabetes and maximum doses to rectum appeared to be statistically relevant risk factors for late rectal toxicity. Five-year BRFS was 95.1%. CONCLUSIONS: In our study, we observed positive results in terms of toxicity and good efficacy in a cohort of high-risk prostate cancer patients treated with a multimodality therapy approach comprising hypofractionation, irradiation of pelvic nodes (common iliac nodes included), and concurrent ADT. These favorable results may merit further investigation in a phase III randomized trial to confirm that whole pelvic radiation therapy (WPRT) combined with moderate hypofractionation and ADT could be performed safely and effectively.
OBJECTIVE: The approach for treating high-risk prostate cancer still presents different unresolved issues. We report the safety and efficacy of a radiation therapy strategy based on the combination of moderate hypofractioned simultaneous integrated boost (SIB) and Image Guidance. MATERIALS AND METHODS: In this phase II trial of patients with high-risk prostate cancer, Image Guided SIB-IMRT plans (Simultaneous Intensity Modulated - Intensity Modulated Radiotherapy) were delivered between 2009 and 2012. All patients enrolled (41) received in 25 fractions a total dose of 67.5 Gy (2.7 Gy/fraction) to the prostatic volume, 56.25 Gy (2.25 Gy/fraction) to the seminal vescicles, and 50 Gy (2.0 Gy/fraction) to the pelvic lymph nodes (LN) chains with concurrent androgen deprivation therapy (ADT). The image-guided radiotherapy (IGRT) procedure was performed using three gold seeds. RTOG late gastrointestinal and genitourinary toxicities and 6-year biochemical relapse-free survival (BRFS) were assessed in combination of their statistical correlation with clinical factors and dosimetric parameters. RESULTS: Rate of late genitourinary toxicity grade 2 was 9.8%, while rates of late gastrointestinal toxicity were 14.6% and 2.4%, for grade 1 and 2, respectively. Diabetes and maximum doses to rectum appeared to be statistically relevant risk factors for late rectal toxicity. Five-year BRFS was 95.1%. CONCLUSIONS: In our study, we observed positive results in terms of toxicity and good efficacy in a cohort of high-risk prostate cancerpatients treated with a multimodality therapy approach comprising hypofractionation, irradiation of pelvic nodes (common iliac nodes included), and concurrent ADT. These favorable results may merit further investigation in a phase III randomized trial to confirm that whole pelvic radiation therapy (WPRT) combined with moderate hypofractionation and ADT could be performed safely and effectively.
Authors: Matthew G Parry; Arunan Sujenthiran; Thomas E Cowling; Julie Nossiter; Paul Cathcart; Noel W Clarke; Heather Payne; Jan van der Meulen; Ajay Aggarwal Journal: J Clin Oncol Date: 2019-06-04 Impact factor: 44.544
Authors: Stefan A Koerber; Gerald Stach; Clemens Kratochwil; Matthias F Haefner; Henrik Rathke; Klaus Herfarth; Klaus Kopka; Tim Holland-Letz; Peter L Choyke; Uwe Haberkorn; Juergen Debus; Frederik L Giesel Journal: J Nucl Med Date: 2019-07-13 Impact factor: 11.082
Authors: Hyunsoo Jang; Jiyeon Park; Mark Artz; Yawei Zhang; Jacob C Ricci; Soon Huh; Perry B Johnson; Mi-Hwa Kim; Mison Chun; Young-Taek Oh; O Kyu Noh; Hae-Jin Park Journal: Front Oncol Date: 2021-08-18 Impact factor: 6.244