Palliative radiotherapy to dominant symptomatic lesion in patients with hormone refractory prostate cancer (PRADO).

This study was conducted to investigate a new short-course radiotherapy regimen for patients with metastatic hormone refractory prostate cancer (HRPC) presenting with a dominant debilitating symptom.

This is an international, multi-center single arm prospective feasibility study that aims to include 34 patients with HRPC and a dominant debilitating symptom. The dominant symptomatic lesion will receive 4 × 5 Gy of high-precision radiotherapy, and the most aggressive part of the lesion 4 × 7 Gy using a simultaneous integrated boost technique. Based on advanced magnetic resonance imaging (MRI), an apparent diffusion coefficient (ADC) map will be calculated for the lesion using diffusion weighted imaging sequences. The dominant symptomatic lesion (GTV1) is drawn manually using the information from T2w-MRI and computed tomography scans. The most aggressive part of the dominant lesion (GTV2) is defined by using the ADC map. An auxiliary volume is created including only voxels in the GTV1 that presents with ADC values below 1200 × 10- 6 mm2/s. The most aggressive part is defined as voxels with an ADC value below the median ADC value. Primary endpoint is feasibility, i.e. proportion of patients who complete radiotherapy with ≥90% of the prescribed dose. Secondary endpoints include dominant symptom score, progression-free survival (freedom from symptoms), overall survival, acute toxicity, quality of life, change in ADC from baseline to end of treatment and 6 months following treatment.

If this new radiotherapy regimen proves to be feasible, a prospective randomized phase II/III dose escalation study will be designed in order to improve the outcomes of palliative radiotherapy of symptomatic metastatic HRPC.

The study is ongoing and will be recruiting patients soon. NCT03658434 . Initially registered on 30th of July, 2018.

Radiation oncology (London, England). 2019 Jan 10*** epublish ***

Jesper Carl, Dirk Rades, Claudia Doemer, Cornelia Setter, Jürgen Dunst, Niels Henrik Holländer

Department of Oncology and Palliative Units, Zealand University Hospital, Naestved, Denmark., Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. ., Department of Radiation Oncology, University of Lübeck, Lübeck, Germany., Department of Radiation Oncology, Christian-Albrechts University Kiel, Kiel, Germany.