Linac based SBRT for prostate cancer in 5 fractions with VMAT and flattening filter free beams: preliminary report of a phase II study

Radiation Oncology

Marta Scorsetti³  Pierpaolo Graziotti¹  Gianluigi Taverna¹  Stefano Tomatis³  Antonella Fogliata⁴  Elena Clerici³  Pietro Mancosu³  Giacomo Reggiori³  Pierina Navarria³  Francesca Lobefalo³  Elisa Villa³  Tiziana Comito³  Cristina Iftode³  Stefano Arcangeli³  Luca Cozzi⁴  Filippo Alongi² 

[1] Istituto Clinico Humanitas Cancer Center, Urology, Rozzano, Milan, Italy;Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy;Istituto Clinico Humanitas Cancer Center, Radiotherapy and Radiosurgery, Rozzano, Milan, Italy;Oncology Institute of Southern Switzerland, Medical Physics, Bellinzona, Switzerland

关键词: Stereotactic body radiation therapy;    RapidArc;    Prostate;   

Others  :  1153516
DOI  :  10.1186/1748-717X-8-171

 received in 2013-04-02, accepted in 2013-07-01,  发布年份 2013

【 摘 要 】

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 35 Gy 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. SpaceOAR™ 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). SpaceOAR™ 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.

【 授权许可】

   
2013 Alongi et al.; licensee BioMed Central Ltd.

【 图 表 】

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