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Twenty Fraction Prostate Radiotherapy with Intra-prostatic Boost: Results of a Pilot Study.

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  • 1Clatterbridge Cancer Centre, Bebington, UK.

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|October 4, 2016
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Hypofractionated dose-painting radiotherapy for high-risk prostate cancer is feasible and safe, with no grade 3 toxicity observed. This approach allows for dose escalation to tumor volumes while respecting organ-at-risk constraints.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Urologic Oncology

Background:

  • High-risk, locally bulky prostate cancer requires advanced radiotherapy techniques for effective dose escalation.
  • Intra-prostatic dose-painting allows for risk-adapted treatment by targeting tumor volumes with higher doses.
  • Hypofractionation, delivering larger doses per fraction, can optimize treatment efficiency.

Purpose of the Study:

  • To evaluate the feasibility and toxicity of hypofractionated dose-painting radiotherapy in high-risk prostate cancer.
  • To investigate the potential for streamlining a radiobiologically optimized planning protocol.
  • To assess the safety profile and early outcomes of this advanced radiotherapy technique.

Main Methods:

  • Twenty-eight patients with high-risk prostate cancer were treated with hypofractionated dose-painting radiotherapy.
Keywords:
Dose paintinghypofractionationradiobiological optimisation

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  • Boost volumes were identified using functional magnetic resonance imaging (fMRI).
  • Rotational intensity-modulated radiotherapy with daily image guidance and fiducial markers was employed.

    • Main Results:

    • The intra-prostatic boost dose was escalated to a median of 69 Gy (range 68-70 Gy) in 20 fractions, respecting organ-at-risk constraints.
    • The mean normal tissue complication probability for rectal bleeding was 4.7% and for fecal incontinence was 3.5%.
    • At a median follow-up of 38 months, no grade 3 toxicity was observed; two patients (7.1%) experienced grade 2 genitourinary toxicity.

    Conclusions:

    • Hypofractionated dose-painting radiotherapy (60 Gy in 20 fractions with an intra-prostatic boost to 68 Gy) is feasible for high-risk prostate cancer.
    • This approach demonstrates an acceptable safety profile with low rates of severe toxicity.
    • The established planning protocol is being utilized in ongoing phase II and III clinical trials (BIOPROP20, PIVOTALboost).