Rachel Glicksman1, Noelia Sanmamed2, John Thoms3, Alexandre R Zlotta4, Antonio Finelli4, Theodorus van der Kwast5, Joan Sweet5, Michael Jewett4, Laurence H Klotz6, Tara Rosewall2, Neil E Fleshner4, Robert G Bristow7, Padraig Warde2, Alejandro Berlin8. 1. Department of Radiation Oncology, University of Toronto, Toronto, Canada. Electronic address: rachelmglicksman@gmail.com. 2. Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. 3. Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada. 4. Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. 5. Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada. 6. Department of Surgery (Urology), Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. 7. Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom. 8. Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Techna Institute, University Health Network, Toronto, Canada. Electronic address: alejandro.berlin@rmp.uhn.ca.
Abstract
PURPOSE: Neoadjuvant radiation therapy (RT) improves disease control in various cancers and has become an established oncologic treatment strategy. During 2001 to 2004, we conducted a phase 1 pilot study assessing the role of short-course preoperative RT (PreORT) for men with unfavorable intermediate- and high-risk localized prostate cancer. Herein, we present long-term follow-up toxicity and oncologic outcomes. METHODS AND MATERIALS: Eligible patients had histologically proven prostate cancer, cT1-T2N0M0 disease, prostate-specific antigen >15 to 35 ng/mL regardless of Gleason score, or prostate-specific antigen 10 to 15 ng/mL with Gleason score ≥7. Patients received 25 Gy in 5 consecutive daily fractions (5 Gy per fraction) to the prostate only, followed by radical prostatectomy within 14 days after RT completion. Primary outcomes were intraoperative morbidity and late genitourinary (GU) and gastrointestinal toxicities. RESULTS: In total, 15 patients were enrolled; 14 patients completed PreORT followed by radical prostatectomy, which also included bilateral lymph node dissections in 13 cases. Median follow-up was 12.2 years (range, 6.7-16.3). Late GU toxicity was common, with 2 patients (13.3%) experiencing G2 toxicity and 6 patients (40%) G3 toxicity. There were no patients with G4 to G5 late GU toxicity. Late gastrointestinal toxicity was infrequent, with only 1 patient (6.7%) experiencing transient G2 proctitis. At last follow-up, 8 (53.3%) and 6 (40%) patients experienced biochemical and metastatic disease recurrence, respectively. CONCLUSIONS: The use of PreORT in men with high-risk prostate cancer is associated with unexpected high rates of late GU toxicity. Future studies examining the role of RT preradical prostatectomy must cautiously select RT technique and dose schedule. Importantly, long-term follow-up data are essential to fully determine the therapeutic index of PreORT in the management of localized disease.
PURPOSE: Neoadjuvant radiation therapy (RT) improves disease control in various cancers and has become an established oncologic treatment strategy. During 2001 to 2004, we conducted a phase 1 pilot study assessing the role of short-course preoperative RT (PreORT) for men with unfavorable intermediate- and high-risk localized prostate cancer. Herein, we present long-term follow-up toxicity and oncologic outcomes. METHODS AND MATERIALS: Eligible patients had histologically proven prostate cancer, cT1-T2N0M0 disease, prostate-specific antigen >15 to 35 ng/mL regardless of Gleason score, or prostate-specific antigen 10 to 15 ng/mL with Gleason score ≥7. Patients received 25 Gy in 5 consecutive daily fractions (5 Gy per fraction) to the prostate only, followed by radical prostatectomy within 14 days after RT completion. Primary outcomes were intraoperative morbidity and late genitourinary (GU) and gastrointestinal toxicities. RESULTS: In total, 15 patients were enrolled; 14 patients completed PreORT followed by radical prostatectomy, which also included bilateral lymph node dissections in 13 cases. Median follow-up was 12.2 years (range, 6.7-16.3). Late GU toxicity was common, with 2 patients (13.3%) experiencing G2 toxicity and 6 patients (40%) G3 toxicity. There were no patients with G4 to G5 late GU toxicity. Late gastrointestinal toxicity was infrequent, with only 1 patient (6.7%) experiencing transient G2 proctitis. At last follow-up, 8 (53.3%) and 6 (40%) patients experienced biochemical and metastatic disease recurrence, respectively. CONCLUSIONS: The use of PreORT in men with high-risk prostate cancer is associated with unexpected high rates of late GU toxicity. Future studies examining the role of RT preradical prostatectomy must cautiously select RT technique and dose schedule. Importantly, long-term follow-up data are essential to fully determine the therapeutic index of PreORT in the management of localized disease.
Authors: Neil R Parikh; Amar U Kishan; Nathanael Kane; Silvia Diaz-Perez; Ekambaram Ganapathy; Ramin Nazarian; Carol Felix; Colleen Mathis; Margaret Bradley; Ankush Sachdeva; Bashir Wyatt; Vince Basehart; Nazy Zomorodian; Lin Lin; Christopher R King; Patrick A Kupelian; Matthew B Rettig; Michael L Steinberg; Minsong Cao; Beatrice S Knudsen; David Elashoff; Dorthe Schaue; Robert E Reiter; Nicholas G Nickols Journal: Int J Radiat Oncol Biol Phys Date: 2020-06-17 Impact factor: 7.038
Authors: Casey Liveringhouse; Austin Sim; Kosj Yamoah; Michael Poch; Richard B Wilder; Julio Pow-Sang; Peter A S Johnstone Journal: Rep Pract Oncol Radiother Date: 2021-04-14