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Long-term Results of Hypofractionated Radiotherapy With Intra-prostatic Boosts in Men With Intermediate- and
R Chatterjee1, J Chan1, H Mayles1
1Department of Radiotherapy, Clatterbridge Cancer Centre, 65 Pembroke Place, Liverpool, UK.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|September 6, 2024
Summary
This study shows that moderately hypofractionated prostate radiotherapy with focal boosts offers good cancer control with acceptable toxicity. The treatment achieved high rates of biochemical disease-free survival (bDFS) and metastasis-free survival (MFS) in intermediate- to very high-risk patients.
Area of Science:
- Radiation Oncology
- Prostate Cancer Therapeutics
- Clinical Trial Analysis
Background:
- Phase III FLAME trial demonstrated focal boosts improve local control and biochemical disease-free survival (bDFS) in conventionally fractionated prostate radiotherapy.
- Need to evaluate toxicity and efficacy of focal boosts within a moderately hypofractionated schedule for prostate cancer.
Purpose of the Study:
- To explore the toxicity and effectiveness of a moderately hypofractionated radiotherapy schedule incorporating focal boosts for localized prostate cancer.
- To assess acute and late urinary and gastrointestinal toxicity, alongside cancer control outcomes.
Main Methods:
- Phase II, single-arm, non-randomized trial (BIOPROP20) for intermediate- to very high-risk prostate cancer patients with bulky tumors.
- Utilized multi-parametric MRI and 18F-choline PET-CT for staging and boost definition.
- Treatment involved 60Gy in 20 fractions with a focal boost up to 68Gy; pelvic lymph nodes treated in 5 patients.
Main Results:
- 61 patients completed radiotherapy; low cumulative acute (6.6%) and late (5.0%) gastrointestinal toxicity.
- Cumulative acute urinary toxicity was 49.2%, reducing to 5.9% at 5 years; late urinary toxicity was 30.1%.
- At 5 years, bDFS was 88.5%, metastasis-free survival (MFS) was 82.4%, and overall survival (OS) was 91.2%.
Conclusions:
- Focal boosts integrated into a 20-fraction hypofractionated prostate radiotherapy schedule are associated with acceptable GI and urinary toxicity.
- This approach demonstrates effective cancer control, achieving favorable bDFS and MFS rates.
- Optimal dose constraints for planning target volumes and organs at risk were met.
