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Hypofractionated stereotactic body radiotherapy in low-risk prostate adenocarcinoma
Preliminary results of a multi-institutional phase 1 feasibility trial
Article first published online: 13 DEC 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 15, pages 3681–3690, 1 August 2012
How to Cite
McBride, S. M., Wong, D. S., Dombrowski, J. J., Harkins, B., Tapella, P., Hanscom, H. N., Collins, S. P. and Kaplan, I. D. (2012), Hypofractionated stereotactic body radiotherapy in low-risk prostate adenocarcinoma. Cancer, 118: 3681–3690. doi: 10.1002/cncr.26699
- Issue published online: 20 JUL 2012
- Article first published online: 13 DEC 2011
- Manuscript Revised: 13 OCT 2011
- Manuscript Accepted: 13 OCT 2011
- Manuscript Received: 22 AUG 2011
- prostate cancer;
- low risk;
- prostate-specific antigen bounce
Recent reports using extreme hypofractionated regimens in the treatment of low-risk prostate adenocarcinoma have been encouraging. Here, the authors report on their own multi-institutional experience with extreme hypofractionated stereotactic radiotherapy for early stage disease.
In total, at 4 centers, 45 patients with National Comprehensive Cancer Network-defined, low-risk prostate adenocarcinoma were enrolled in a phase 1, multi-institutional trial of hypofractionated radiosurgery with a proprietary radiosurgical device (CyberKnife). Thirty-four patients received 7.5 grays (Gy) delivered in 5 fractions, 9 patients received 7.25 Gy delivered in 5 fractions, and 2 patients received other regimens. The variables evaluated were biochemical progression-free survival (bPFS), prostate-specific antigen (PSA) bounce, and toxicities. Health-related quality of life was evaluated using the Sexual Health Inventory for Men (SHIM), American Urological Association (AUA), and Expanded Prostate Cancer Index Composite (EPIC) questionnaires.
The median follow-up for surviving patients was 44.5 months (range, 0-62 months). The bPFS rate at 3 years was 97.7%. The median PSA declined from 4.9 ng/mL at diagnosis to 0.2 ng/mL at last follow-up, and the median percentage PSA decline at 12 months was 80%. Nine patients experienced at least 1 PSA bounce ≥0.4 ng/mL, and 4 patients experienced 2 PSA bounces. The median time to first PSA bounce was 11.6 months (range, 7.2-18.2 months), and the mean percentage PSA bounce was 1.07 ng/mL. There was 1 episode of late grade 3 urinary obstruction, and there were 2 episodes of late grade 3 proctitis. There was a significant late decline in SHIM and EPIC sexual scores and a small, late decline in the EPIC Bowel domain score.
In a select population, extreme hypofractionation with stereotactic radiosurgery was safe and effective for the treatment of low-risk prostate adenocarcinoma. Cancer 2012. © 2011 American Cancer Society.