“Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiotherapy”

Publication date: Available online 20 January 2017
Source:Practical Radiation Oncology
Author(s): Sergio Faria, Russel Ruo, Fabio Cury, Marie Duclos, Luis Souhami
PurposeTo report acute and late toxicity rates in patients with high-risk prostate cancer treated with androgen deprivation therapy (ADT) and moderate hypofractionated radiotherapy (HypoRT) to the prostate and nodal areas.Material and MethodsPatients with localized, high-risk prostate cancer were treated with a HypoRT regimen of 60Gy in 20 fractions (4weeks) to the prostate volume while the nodal areas received 44Gy in the same 20 fractions delivered with intensity modulated radiation therapy (IMRT) with a simultaneous integrated boost technique. ADT started 2–3months before HypoRT and was given to all patients. Acute and late toxicity was prospectively assessed and graded according to the Common Terminology Criteria for Adverse Events, version 3.Results105 patients treated between September/2010 and November/2013 were reviewed. Median follow up is 41months with 97% of patients followed for more than 26months. Median ADT duration was 18months. Acute grade 2 or higher gastrointestinal (GI) or genitourinary (GU) toxicity was seen in 18 (17%) and 19 (17%) patients respectively, with only 1 and 3 patients experiencing either a GI or GU acute grade 3 toxicity. The worst grade 2 or higher late GI and GU toxicity was seen in 7 (7%) and 8 (8%) patients, respectively. There was no grade 4 or 5 toxicity. At the last follow-up, the rate of grade=2 GI and GU toxicity was 5% and 3%, respectively with no residual grade≥3 toxicity. The 48-month actuarial progression free survival is 82%.ConclusionADT with moderate HypoRT delivered with IMRT and an integrated simultaneous boost to the prostate (60Gy) and pelvic nodes (44Gy) in 20 fractions is feasible and well tolerated. This approach shortens treatment duration, is convenient to patients and the health system and its results support a randomized trial.SummaryWe report toxicity results of moderate hypofractionated radiotherapy delivered to the prostate (60Gy in 20 fractions) and pelvic nodal (44Gy in 20 fractions) volumes in patients with high-risk prostate cancer treated concurrently with androgen deprivation therapy. Toxicity was prospectively assessed. After a median follow up of 41months, this regimen proved to be feasible and well-tolerated.



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