Late toxicity and outcomes in high-risk prostate cancer patients treated with hypofractionated IMRT and long-term androgen suppression treatment - Abstract

OBJECTIVE: To assess late toxicity and outcomes in high-risk prostate cancer patients treated with hypofractionated radiation treatment with androgen suppression therapy.

METHODS: Sixty high-risk prostate cancer patients were enrolled. IMRT prescription was 68 Gy/25 fractions (2.7 Gy/fraction) to the prostate and proximal seminal vesicles (SV). The pelvic lymph nodes (PLN) and distal SV concurrently received 45 Gy/25 fractions (1.8 Gy/fraction). The patients were treated with helical TomoTherapy-based IMRT and underwent daily megavoltage CT image-guided verification before each treatment. RTOG Toxicity scores were recorded for a 5-year period.

RESULTS: Sixty patients completed RT with median follow-up of 63 months (range, 7 to 80 mo).At 5 years follow-up timepoint: Grade (G)2 and G3 late genitourinary toxicity was experienced in 7 (17.0%) and 1 (2.44%), respectively; gastrointestinal G2 as highest toxicity recorded in only 1 (2.44%) patient. There was no G3 gastrointestinal toxicity recorded at this timepoint. With 63-month median follow-up (mean of 65.41±1.72 mo), the 5-year overall survival was 86.67%; 5 years freedom from biochemical failure was 91.67% and freedom from clinical failure was 96.67%.

CONCLUSIONS: Dose escalation and hypofractionated radiation treatment with IMRT treating the prostate and proximal SV concurrently with the pelvic lymph nodes and distal SV and long-term androgen suppression therapy is well tolerated with respect to acute and late toxicity with 5-year actuarial overall survival 86.67%, freedom from biochemical failure 91.38%, and freedom from clinical failure 96.67%. Longer follow-up will provide more information on 10-year survival outcomes.

Written by:
Pervez N, Boychak A, Drodge CS, Yee D, Le D, Murtha A, Parliament M, Amanie J, Mihai A, Field C, Mackenzie M, Ghosh S, Fallone G, Pearcey R.   Are you the author?
Divisions of Radiation Oncology; Medical Physics; Division of Experimental Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, AB; Department of Radiation Oncology, Cancer Care, Eastern Health, St Johns, NF; Radiation Oncology, Saskatoon Cancer Centre, Saskatoon, SK, Canada; Radiation Oncology, UPMC Beacon Hospital, Dublin, Republic of Ireland.

Reference: Am J Clin Oncol. 2014 Sep 29. Epub ahead of print.
doi: 10.1097/COC.0000000000000133

PubMed Abstract
PMID: 25268067 Prostate Cancer Section