BACKGROUND: To evaluate the feasibility and early side effects of a short course hypo-fractionated SBRT programme with Volumetric Modulated Arc Therapy (VMAT) and Flattening Filter Free (FFF) beams.
METHODS: A prospective phase I-II study, started on February 2012. Inclusion criteria were: age <= 80 years, WHO-PS <= 2, PSA <= 20 ng/ml, histologically proven prostate adenocarcinoma, T1-T2 stage, no distant metastases, no previous surgery other than TURP, no malignant tumours in the previous 5 years, IPSS 0--7. The schedule was 35Gy in 5 alternative days. SBRT was delivered with RapidArc VMAT, with 10MV FFF photons. Toxicity assessment was performed according to CTCAE v4.0 scale. EPIC questionnaires assessed Quality-of-Life. Neo-adjuvant/concomitant hormonal-therapy was prescribed according to risk classification. SpaceOARTM gel was optionally implanted to increase the separation space between the prostate and the rectal wall.
RESULTS: Median follow-up was 11 months (range: 5--16); 40 patients were recruited in the protocol and treated.. According to NCCN criteria, 26/40 patients were low-risk and 14/40 were intermediate risk. Median age was 70 years (56--80), median initial PSA was 6.25 ng/ml (0.50-13.43 ng/ml). Median Gleason score was 6 (6--7). All patients completed the treatment as programmed (median 11.8 days (9--22). Acute Toxicities were as follow: Rectum G0: 30/40 cases (75%); G1: 6/40 (15%); G2: 4/40 (10%). Genito-urinary: G0: 16/40 (40%); G1: 8/40 (20%); G2: 16/34 (40%). In two G2 urinary retention cases, intermittent catheter was needed. No acute G3 or greater toxicity was found. Median treatment time was 126 sec (120--136). SpaceOARTM was implanted in 8 patients. PSA reduction from the pre-treatment value of the marker was documented in all patients.
CONCLUSIONS: Early findings suggest that SBRT with RapidArc and FFF beams for prostate cancer in 5 fractions is feasible and tolerated in acute setting. Longer follow-up is needed for assessment of late toxicity and outcome.
Written by:
Alongi F, Cozzi L, Arcangeli S, Iftode C, Comito T, Villa E, Lobefalo F, Navarria P, Reggiori G, Mancosu P, Clerici E, Fogliata A, Tomatis S, Taverna G, Graziotti P, Scorsetti M. Are you the author?
Istituto Clinico Humanitas Cancer Center, Radiotherapy and Radiosurgery, Rozzano, Milan, Italy.
Reference: Radiat Oncol. 2013 Jul 8;8(1):171.
doi: 10.1186/1748-717X-8-171
PubMed Abstract
PMID: 23835141
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