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Early results of localised, high-risk prostate cancer treated by moderate hypo-fractionation (70 Gy at 2·5 Gy per fraction): 5-year experiences of a moderate hypo-fractionation regimen

Published online by Cambridge University Press:  07 November 2019

Ekkasit Tharavichitkul Open the ORCID record for Ekkasit Tharavichitkul [Opens in a new window] ,
Somvilai Chakrabandhu ,
Pitchayaponne Klunklin ,
Wimrak Onchan ,
Bongkot Jia-Mahasap ,
Pooriwat Meungwong ,
Wannapha Nobnop ,
Damrongsak Tippanya ,
Patumrat Sripun  and
Razvan M. Galalae
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Ekkasit Tharavichitkul*
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Somvilai Chakrabandhu
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Pitchayaponne Klunklin
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wimrak Onchan
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Bongkot Jia-Mahasap
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Pooriwat Meungwong
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wannapha Nobnop
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Damrongsak Tippanya
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Patumrat Sripun
Affiliation:
Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Razvan M. Galalae
Affiliation:
Faculty of Medicine, Christian-Albrechts-University, Kiel, Germany
Imjai Chitapanarux
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*
Author for correspondence: Ekkasit Tharavichitkul, The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Tel: +66 053935456. E-mail: [email protected]
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Abstract

Background:

Radiotherapy is one of the treatments used to treat prostate cancer, and dose escalation to 74–78 Gy in conventional fractionation is the standard regimen. Currently, according to the hypothesis of low alpha/beta ratio in prostate cancer cells, using hypo-fractionation has been reported in many publications with promising results. This retrospective study was designed to evaluate the implementation of a moderate hypo-fractionation regimen in high-risk prostate cancer in our division.

Materials and Methods:

Between 2012 and 2017, 40 patients with high-risk, localised prostate cancer were treated by a moderate hypo-fractionation regimen (70 Gy at 2·5 Gy per fraction) with intensity-modulated radiation therapy. The data related to treatment outcomes and toxicities were evaluated.

Results:

The mean PSA at diagnosis was 86·2 ng/mL (95% CI 49·9–122·4). Thirty-eight patients received long-term hormonal therapy. Fifty-two percent had a Gleason score of 8–10, and 65% had an initial PSA >20 ng/mL. The mean doses (in EQD2) to the D50% of PTV, D2% of organs at risk (bladder, rectum and bowels) were 80, 78·3, 76·4, and 50·2 Gy, respectively. Two patients had biochemical recurrence during the follow-up period.

Conclusion:

A moderate hypo-fractionation regimen (70 Gy at 2·5 Gy per fraction) is feasible. Our experience found that this regimen yields tolerable, acceptable toxicity profiles in high-risk, localised prostate cancer patients.

Keywords

high risklocalised diseasemoderately hypo-fractionationprostate cancer
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 3 , September 2020 , pp. 233 - 236
Copyright
© Cambridge University Press 2019

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References

Chitapanarux, I, Srisukho, S. Cancer Incidence and Mortality in Chiang Mai 2011. Chiang Mai, Thailand: Chiang Mai Cancer Registry, 2014.Google Scholar
Bolla, M, Gonzalez, D, Warde, Pet al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997; 337: 295–300.CrossRefGoogle ScholarPubMed
Denham, J W, Steigler, A, Lamb, D Set al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial. Lancet Oncol 2011; 12: 451–459.CrossRefGoogle ScholarPubMed
D’Amico, A V, Chen, M H, Renshaw, A Aet al. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. J Am Med Assoc 2008; 299: 289–295.CrossRefGoogle ScholarPubMed
Jones, C U, Hunt, D, McGowan, D Get al. Radiotherapy and shortterm androgen deprivation for localized prostate cancer. N Engl J Med 2011; 365: 107–118.CrossRefGoogle Scholar
Pollak, A, Zaagars, G K, Starkschall, Get al. Prostate cancer radiation dose response: results of the M.D. Anderson phase III randomized Trial. Int J Radiat Oncol Biol Phys 2002; 53: 1097–1105.CrossRefGoogle Scholar
Kuban, D A, Tucker, L, Dong, Let al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70: 67–74.CrossRefGoogle Scholar
Al-Mamgani, A, Van Putten, W L J, Heemsbergen, W Det al. Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 72: 980–988.CrossRefGoogle ScholarPubMed
Heemsbergen, W D, Al-Mamgani, A, Slot, A, Dielwart, M F H, Lebsque, J V. Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol 2014; 110: 104–109.CrossRefGoogle ScholarPubMed
Dearnaley, D P, Jovic, G, Syndikus, Iet al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol 2014; 14: 464–473.CrossRefGoogle Scholar
Beckendorf, V, Guerif, S, Le Prise, Eet al. 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys 2011; 80: 1056–1063.CrossRefGoogle ScholarPubMed
Zietman, A L, Bae, K, Slater, J Det al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/American colleague of radiology 95-09. J Clin Oncol 2010; 28: 1106–1111.CrossRefGoogle Scholar
Zapatero, A, Guerrero, A, Maldonado, Xet al. High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial. Lancet Oncol 2015; 16: 320–327.CrossRefGoogle ScholarPubMed
Joiner, M C, van der Kogel, A. Basic Clinical Radiobiology, 4th edition. London, UK: Edward Arnold, 2009.CrossRefGoogle Scholar
Kupelian, P A, Willoughby, T R. Short-course, intensity-modulated radiotherapy for localized prostate cancer. Cancer J 2001; 7: 421–426.Google ScholarPubMed
Kupelian, P A, Reddy, C A, Klein, E A, Willoughby, T R. Short-course intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: preliminary results on late toxicity and quality of life. Int J Radiat Oncol Biol Phys 2001; 51: 988–993.CrossRefGoogle ScholarPubMed
Kupelian, P A, Reddy, C A, Carlson, T P, Altsman, K A, Willoughby, T R. Preliminary observations on biochemical relapse-free survival rates after short-course intensity-modulated radiotherapy (70 Gy at 2.5 Gy/fraction) for localized prostate cancer. Int J Radiat Oncol Biol Phys 2002; 53: 904–912.CrossRefGoogle ScholarPubMed
Aluwini, S, Pos, F, Schimmel, Eet al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomized non-inferiority phase 3 trial. Lancet Oncol 2016; 17: 464–474.CrossRefGoogle ScholarPubMed
Dearnaley, D P, Syndikus, I, Mossop, Het al. Comparison of hypofractionated high-dose intensity-modulated radiotherapy schedules for prostate cancer: Results from the phase III randomized CHHiP trial (CRUK/06/016). Lancet Oncol 2016; 17: 1047–1060.CrossRefGoogle Scholar
Roach, M, Marquez, C, Yuo, H Set al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 1994; 28: 33–37.CrossRefGoogle ScholarPubMed
Prescribing, Recording, and Reporting Photon-Beam Intensity-modulated Radiation Therapy (IMRT). J ICRU 2010; 10 (1): 1–92 (Report 83).CrossRefGoogle Scholar
Cox, J D, Stetz, J, Pajak, T F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341–1346.CrossRefGoogle Scholar
Roach, M, Hanks, G, Thames, H Jret al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65: 965–974.CrossRefGoogle ScholarPubMed
Thompson, I, Thrasher, J B, Aus, Get al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177: 2106–2131.CrossRefGoogle ScholarPubMed
Fowler, J F. The radiobiology of prostate cancer including new aspects of fractionated radiotherapy. Acta Oncol 2005; 44: 265–276.CrossRefGoogle ScholarPubMed
Kupelian, P A, Thakkar, V V, Khunitia, D, Reddy, C A, Klein, E A, Mahadevan, A. Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: long-term outcomes. Int J Radiat Oncol Biol Phys. 2005; 63: 1463–1468.CrossRefGoogle ScholarPubMed
Kupelian, P A, Willoughby, T R, Reddy, C A, Klein, E A, Mahadevan, A. Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 2007; 68: 1424–1430.CrossRefGoogle ScholarPubMed
Abu-Gheida, I, Reddy, C A, Kotecha, Ret al. Ten-year outcomes of moderately hypofractionated (70 Gy in 28 fractions) intensity modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2019; 104: 325–333.10.1016/j.ijrobp.2019.01.091CrossRefGoogle ScholarPubMed
Lee, W R, Dignam, J J, Amin, Met al. NRG oncology RTOG 0415: a randomized phase 3 non-inferiority study comparing 2 fractionation schedules in patients with low-risk prostate cancer. Int J Radiat Oncol Biol Phys 2016; 94: 3–4.CrossRefGoogle Scholar