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A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy.

Bolzicco G, Favretto MS, Satariano N, Scremin E, Tambone C, Tasca A - BMC Urol (2013)

Bottom Line: In the SBRT-monotherapy group, the median PSA nadir at 36 months was 0.62 ng/ml; in the ADT-SBRT group, it was 0.18 ng/ml.Four patients had clinical recurrence: one local, two lymph nodes, and one to the bone.Ninety-six patients had no evidence of biochemical or clinical recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology, San Bortolo Hospital, Vicenza, Italy. giampaolo.bolzicco@ulssvicenza.it.

ABSTRACT

Background: Radiotherapy is an increasingly preferred treatment option for localized prostate cancer, and stereotactic body radiation therapy (SBRT) a relatively established modality of therapeutic irradiation. The present study analyzes the toxicity and biochemical efficacy of SBRT in 100 consecutive prostate cancer patients treated with CyberKnife Robotic Radiosurgery System.

Methods: One hundred patients were treated with SBRT at the Radiation Oncology department of San Bortolo Hospital, Vicenza, Italy. All patients included in this IRB-approved protocol-driven prospective study had biopsy-proven prostate cancer. Risk category was low in 41, intermediate in 42, and high in 17 patients. The patients were treated with CyberKnife-SBRT (CK-SBRT), the prescription dose was 35 Gy in five fractions, corresponding to 92 Gy in 2-Gy fractions (α/β =1.5 Gy); 29 patients also received androgen deprivation therapy (ADT).

Results: Median follow-up was 36 months (range, 6-76 months). Acute Grade 2 genitourinary and gastrointestinal toxicity occurred in respectively 12% and 18% of the patients; there were no Grade 3 or higher acute toxicities. Late Grade 1, 2, and 3 genitourinary toxicities occurred in 4%, 3%, and 1% of the patients, respectively; late Grade 1 gastrointestinal toxicity occurred in two patients and Grade 2 toxicity in one patient; no late gastrointestinal toxicities of grade 3 or 4 were observed. Median PSA nadir was 0.45 ng/ml at 36 months for all patients. In the SBRT-monotherapy group, the median PSA nadir at 36 months was 0.62 ng/ml; in the ADT-SBRT group, it was 0.18 ng/ml. Four patients had clinical recurrence: one local, two lymph nodes, and one to the bone. Ninety-six patients had no evidence of biochemical or clinical recurrence. A benign PSA bounce of median 1.08 ng/ml occurred in 12% of the 71 SBRT monotherapy patients at a mean 23 months (range, 18-30 months).

Conclusions: In this study CK-SBRT has provided promising outcomes in localized prostate cancer with good PSA response, minimal toxicity and patient inconvenience.

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Related in: MedlinePlus

Conventional treatment plane with IrisTM collimator: 35 Gy delivered to the 80% isodose line, tumor coverage 99%, and conformality index 1.22.
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Figure 1: Conventional treatment plane with IrisTM collimator: 35 Gy delivered to the 80% isodose line, tumor coverage 99%, and conformality index 1.22.

Mentions: Image-guided SBRT was delivered to all patients using the CyberKnife 6-MV linac[3,14-16]. Four gold fiducial markers were implanted transperineally into the prostate under TRUS guidance. After allowing time for the fiducials to settle, usually 10–15 days, treatment planning was performed, using two simultaneous supine axial CT scans with 1-mm slice thickness. An indwelling Foley catheter was used for urethra delineation and precise control of bladder volume; the second scan was conducted with bladder contrast. Patient preparation consisted of a gas-minimizing diet the week before treatment and an empty rectum[17]. After a 3T-MRI scanner has become available in our institution, a pelvic T2-weighted MRI sequence with 0.9-mm slice thickness and gadolinium contrast was performed for each patient, and fused with the planning CT. A total dose of 35 Gy was delivered in five fractions of 7 Gy over consecutive days. The prescription dose covered at least 95% of the planning target volume, normalized to 80% isodose line. The treatments were delivered using a G4 600-MU/min CyberKnife System until the end of 2010, at which time, a G4 800-MU/min was installed, which also included an IRISTM Variable Aperture Collimator and a RoboCouch® (Accuray) (Figure 1).


A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy.

Bolzicco G, Favretto MS, Satariano N, Scremin E, Tambone C, Tasca A - BMC Urol (2013)

Conventional treatment plane with IrisTM collimator: 35 Gy delivered to the 80% isodose line, tumor coverage 99%, and conformality index 1.22.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016542&req=5

Figure 1: Conventional treatment plane with IrisTM collimator: 35 Gy delivered to the 80% isodose line, tumor coverage 99%, and conformality index 1.22.
Mentions: Image-guided SBRT was delivered to all patients using the CyberKnife 6-MV linac[3,14-16]. Four gold fiducial markers were implanted transperineally into the prostate under TRUS guidance. After allowing time for the fiducials to settle, usually 10–15 days, treatment planning was performed, using two simultaneous supine axial CT scans with 1-mm slice thickness. An indwelling Foley catheter was used for urethra delineation and precise control of bladder volume; the second scan was conducted with bladder contrast. Patient preparation consisted of a gas-minimizing diet the week before treatment and an empty rectum[17]. After a 3T-MRI scanner has become available in our institution, a pelvic T2-weighted MRI sequence with 0.9-mm slice thickness and gadolinium contrast was performed for each patient, and fused with the planning CT. A total dose of 35 Gy was delivered in five fractions of 7 Gy over consecutive days. The prescription dose covered at least 95% of the planning target volume, normalized to 80% isodose line. The treatments were delivered using a G4 600-MU/min CyberKnife System until the end of 2010, at which time, a G4 800-MU/min was installed, which also included an IRISTM Variable Aperture Collimator and a RoboCouch® (Accuray) (Figure 1).

Bottom Line: In the SBRT-monotherapy group, the median PSA nadir at 36 months was 0.62 ng/ml; in the ADT-SBRT group, it was 0.18 ng/ml.Four patients had clinical recurrence: one local, two lymph nodes, and one to the bone.Ninety-six patients had no evidence of biochemical or clinical recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology, San Bortolo Hospital, Vicenza, Italy. giampaolo.bolzicco@ulssvicenza.it.

ABSTRACT

Background: Radiotherapy is an increasingly preferred treatment option for localized prostate cancer, and stereotactic body radiation therapy (SBRT) a relatively established modality of therapeutic irradiation. The present study analyzes the toxicity and biochemical efficacy of SBRT in 100 consecutive prostate cancer patients treated with CyberKnife Robotic Radiosurgery System.

Methods: One hundred patients were treated with SBRT at the Radiation Oncology department of San Bortolo Hospital, Vicenza, Italy. All patients included in this IRB-approved protocol-driven prospective study had biopsy-proven prostate cancer. Risk category was low in 41, intermediate in 42, and high in 17 patients. The patients were treated with CyberKnife-SBRT (CK-SBRT), the prescription dose was 35 Gy in five fractions, corresponding to 92 Gy in 2-Gy fractions (α/β =1.5 Gy); 29 patients also received androgen deprivation therapy (ADT).

Results: Median follow-up was 36 months (range, 6-76 months). Acute Grade 2 genitourinary and gastrointestinal toxicity occurred in respectively 12% and 18% of the patients; there were no Grade 3 or higher acute toxicities. Late Grade 1, 2, and 3 genitourinary toxicities occurred in 4%, 3%, and 1% of the patients, respectively; late Grade 1 gastrointestinal toxicity occurred in two patients and Grade 2 toxicity in one patient; no late gastrointestinal toxicities of grade 3 or 4 were observed. Median PSA nadir was 0.45 ng/ml at 36 months for all patients. In the SBRT-monotherapy group, the median PSA nadir at 36 months was 0.62 ng/ml; in the ADT-SBRT group, it was 0.18 ng/ml. Four patients had clinical recurrence: one local, two lymph nodes, and one to the bone. Ninety-six patients had no evidence of biochemical or clinical recurrence. A benign PSA bounce of median 1.08 ng/ml occurred in 12% of the 71 SBRT monotherapy patients at a mean 23 months (range, 18-30 months).

Conclusions: In this study CK-SBRT has provided promising outcomes in localized prostate cancer with good PSA response, minimal toxicity and patient inconvenience.

Show MeSH
Related in: MedlinePlus