Abstract
BackgroundTo evaluate acute and late genitourinary and gastrointestinal toxicities and patient reported urinary and sexual function following accelerated, hypofractionated external beam radiotherapy to the prostate, seminal vesicles and pelvic lymph nodes and high dose rate (HDR) brachytherapy or stereotactic body radiation therapy (SBRT) prostate boost.MethodsPatients at a single institution with NCCN intermediate- and high-risk localized prostate cancer with logistical barriers to completing five weeks of whole pelvic radiotherapy (WPRT) were retrospectively reviewed for toxicity following accelerated, hypofractionated WPRT (41.25 Gy in 15 fractions of 2.75 Gy). Patients also received prostate boost radiotherapy with either HDR brachytherapy (1 fraction of 15 Gy) or SBRT (19 Gy in 2 fractions of 9.5 Gy). The duration of androgen deprivation therapy was at the discretion of the treating radiation oncologist. Toxicity was evaluated by NCI CTCAE v 5.0.ResultsBetween 2015 and 2017, 22 patients with a median age of 71 years completed accelerated, hypofractionated WPRT. Median follow-up from the end of radiotherapy was 32 months (range 2–57). 5%, 73%, and 23% of patients had clinical T1, T2, and T3 disease, respectively. 86% of tumors were Gleason grade 7 and 14% were Gleason grade 9. 68% and 32% of patients had NCCN intermediate- and high-risk disease, respectively. 91% and 9% of patients received HDR brachytherapy and SBRT prostate boost following WPRT, respectively. Crude rates of grade 2 or higher GI and GU toxicities were 23% and 23%, respectively. 3 patients (14%) had late or persistent grade 2 toxicities of urinary frequency and 1 patient (5%) had late or persistent GI toxicity of diarrhea. No patient experienced grade 3 or higher toxicity at any time. No difference in patient-reported urinary or sexual function was noted at 12 months.ConclusionsAccelerated, hypofractionated whole pelvis radiotherapy was associated with acceptable GU and GI toxicities and should be further validated for those at risk for harboring occult nodal disease.
Highlights
To evaluate acute and late genitourinary and gastrointestinal toxicities and patient reported urinary and sexual function following accelerated, hypofractionated external beam radiotherapy to the prostate, seminal vesi‐ cles and pelvic lymph nodes and high dose rate (HDR) brachytherapy or stereotactic body radiation therapy (SBRT) prostate boost
Phuong et al Radiation Oncology (2022) 17:12 for prostate cancer is delivered over a period of approximately 9 weeks, which is inconvenient for elderly patients and patients traveling long distances
The goal of this study was to evaluate the feasibility in terms of clinical outcome and toxicity of a hypofractionated regimen with inclusion of prostate, seminal vesicles, and pelvic lymph node irradiation for the treatment of intermediate- and high-risk prostate cancer in patients with logistical barriers to completing a course of conventionally fractionated pelvic radiotherapy
Summary
To evaluate acute and late genitourinary and gastrointestinal toxicities and patient reported urinary and sexual function following accelerated, hypofractionated external beam radiotherapy to the prostate, seminal vesi‐ cles and pelvic lymph nodes and high dose rate (HDR) brachytherapy or stereotactic body radiation therapy (SBRT) prostate boost. Hypofractionated radiotherapy may result in a greater therapeutic ratio for prostate cancer resulting in greater efficacy than conventional fractionation as suggested by the linear quadratic model with a low α/β ratio of 1.5–3. With improvements in the precision of radiation delivery, several studies have supported the use of moderate hypofractionation (240–340 cGy) directed to the prostate with favorable toxicity profiles [4,5,6]. In these studies, the clinical target volume consisted of the prostate with or without the seminal vesicles and pelvic lymph nodes were not treated. Limited data is available evaluating the safety and efficacy of hypofractionated pelvic nodal radiotherapy
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