Abstract
BackgroundThe optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain. At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. Hence, we evaluated CIRT for PC with bladder invasion in terms of the safety and efficacy.MethodsBetween March 2010 and December 2016, a total of 1337 patients with nonmetastatic PC received CIRT at a total dose of 57.6 Gy (RBE) in 16 fractions over 4 weeks. Among them, seven patients who had locally advanced PC with bladder invasion were identified. Long-term androgen-deprivation therapy (ADT) was also administered to these patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Event version 5.0.ResultsAt the completion of our study, all the patients with cT4 PC were alive with a median follow-up period of 78 months. Grade 2 acute urinary disorders were observed in only one patient. Regarding late toxicities, only one patient developed grade 2 hematuria and urinary urgency. There was no grade 3 or worse toxicity, and gastrointestinal toxicity was not observed. Six (85.7%) patients had no recurrence or metastasis. One patient had biochemical and local failures 42 and 45 months after CIRT, respectively. However, the recurrent disease has been well controlled by salvage ADT.ConclusionsSeven patients with locally advanced PC invading the bladder treated with CIRT were evaluated. Our findings seem to suggest positive safety and efficacy profiles for CIRT.
Highlights
The optimal management of clinical T4 prostate cancer (PC) is still uncertain.At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010
We retrospectively reviewed patients with locally advanced PC with bladder invasion treated with CIRT
Bladder invasion was diagnosed based on cystoscopic findings in principle; in cases when cystoscopy was not performed before androgendeprivation therapy (ADT) and when there were no apparent cystoscopic findings after ADT, magnetic resonance imaging (MRI) findings before ADT were used for the diagnosis
Summary
The optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain.At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. A recent study reported that the addition of local therapy, such as surgery and radiotherapy (RT) to systemic therapy, including ADT, provides a survival benefit even for cT4 PC [3] Optimization of these local therapies is of importance in the management of cT4 PC. Carbon ion radiotherapy (CIRT), which is one of the modalities of EBRT initiated at the National Institute of Radiological Sciences in 1994 in Japan, provides a sharp dose distribution with minimal penumbra and has biological advantages due to its high relative biological. We retrospectively reviewed patients with locally advanced PC with bladder invasion treated with CIRT
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