Hannah Tharmalingam1, Yatman Tsang2, Ananya Choudhury3, Roberto Alonzi2, James Wylie4, Imtiaz Ahmed5, Ann Henry6, Catherine Heath7, Peter J Hoskin8. 1. Mount Vernon Cancer Centre, Northwood, United Kingdom; University of Manchester, Manchester, United Kingdom. 2. Mount Vernon Cancer Centre, Northwood, United Kingdom. 3. University of Manchester, Manchester, United Kingdom; The Christie Hospital, Manchester, United Kingdom. 4. The Christie Hospital, Manchester, United Kingdom. 5. Southend University Hospital, Southend, United Kingdom. 6. St James Hospital, Leeds, United Kingom. 7. Southampton General Hospital, Southampton, United Kingdom. 8. Mount Vernon Cancer Centre, Northwood, United Kingdom; University of Manchester, Manchester, United Kingdom. Electronic address: peterhoskin@nhs.net.
Abstract
PURPOSE: Whole pelvis radiation therapy (WPRT) may improve clinical outcomes over prostate-only radiation therapy (PORT) in high-risk prostate cancer patients by sterilization of micrometastatic nodal disease, provided there is optimal control of the primary site. METHODS AND MATERIALS: A prospective multicenter cohort study of eligible patients (stage ≥T2c, Gleason score ≥7 or presenting prostate-specific antigen ≥10) treated between 2009 and 2013 were enrolled in a United Kingdom national protocol delivering combined external beam radiation therapy and high-dose-rate brachytherapy. Centers elected to deliver WPRT, 46 Gy in 23 fractions or PORT 37.5 Gy in 15 fractions with 15 Gy single dose high-dose-rate brachytherapy. The primary endpoint was biochemical progression-free survival (bPFS). Secondary endpoints were overall survival, genitourinary, and gastrointestinal toxicity. This was not a randomized comparison and was subject to bias; the findings are therefore hypothesis generating, but not conclusive. RESULTS: Eight hundred and twelve patients were entered; 401 received WPRT and 411 received PORT. With a median follow-up of 4.7 years, 5-year bPFS rates for WPRT versus PORT arms were 89% versus 81% (P = .007) for all patients and 84% versus 77% (P = .001) for high-risk patients. Differences in bPFS remained significant after accounting for Gleason score, presenting prostate-specific antigen, T stage, and androgen deprivation therapy duration as covariates. There was no difference in overall survival. The overall post treatment toxicities across both cohorts were low with no greater than 1.5% of ≥grade 3 toxicities at any follow-up time point. WPRT increased both prevalence and cumulative incidence of acute genitourinary toxicity (P = .004) and acute gastrointestinal toxicity (P = .003). No difference in late radiation toxicity was observed. CONCLUSIONS: A significant improvement in 5-year bPFS was seen in intermediate and high-risk prostate cancer treated with WPRT compared with PORT in a combined external beam radiation therapy and brachytherapy schedule with no increase in late radiation toxicity.
PURPOSE: Whole pelvis radiation therapy (WPRT) may improve clinical outcomes over prostate-only radiation therapy (PORT) in high-risk prostate cancerpatients by sterilization of micrometastatic nodal disease, provided there is optimal control of the primary site. METHODS AND MATERIALS: A prospective multicenter cohort study of eligible patients (stage ≥T2c, Gleason score ≥7 or presenting prostate-specific antigen ≥10) treated between 2009 and 2013 were enrolled in a United Kingdom national protocol delivering combined external beam radiation therapy and high-dose-rate brachytherapy. Centers elected to deliver WPRT, 46 Gy in 23 fractions or PORT 37.5 Gy in 15 fractions with 15 Gy single dose high-dose-rate brachytherapy. The primary endpoint was biochemical progression-free survival (bPFS). Secondary endpoints were overall survival, genitourinary, and gastrointestinal toxicity. This was not a randomized comparison and was subject to bias; the findings are therefore hypothesis generating, but not conclusive. RESULTS: Eight hundred and twelve patients were entered; 401 received WPRT and 411 received PORT. With a median follow-up of 4.7 years, 5-year bPFS rates for WPRT versus PORT arms were 89% versus 81% (P = .007) for all patients and 84% versus 77% (P = .001) for high-risk patients. Differences in bPFS remained significant after accounting for Gleason score, presenting prostate-specific antigen, T stage, and androgen deprivation therapy duration as covariates. There was no difference in overall survival. The overall post treatment toxicities across both cohorts were low with no greater than 1.5% of ≥grade 3 toxicities at any follow-up time point. WPRT increased both prevalence and cumulative incidence of acute genitourinary toxicity (P = .004) and acute gastrointestinal toxicity (P = .003). No difference in late radiation toxicity was observed. CONCLUSIONS: A significant improvement in 5-year bPFS was seen in intermediate and high-risk prostate cancer treated with WPRT compared with PORT in a combined external beam radiation therapy and brachytherapy schedule with no increase in late radiation toxicity.
Authors: Lucas C Mendez; Andrew J Arifin; Glenn S Bauman; Vikram M Velker; Belal Ahmad; Michael Lock; Varagur M Venkatesan; Tracy L Sexton; George B Rodrigues; Jeff Chen; Bryan Schaly; Andrew Warner; David P D'Souza Journal: BMC Cancer Date: 2020-10-09 Impact factor: 4.430
Authors: Christina Phuong; Jason W Chan; Lisa Ni; Phillip Wall; Osama Mohamad; Anthony C Wong; I-Chow Hsu; Albert J Chang Journal: Radiat Oncol Date: 2022-01-20 Impact factor: 3.481