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Urethrogram-Directed Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Patients with Contraindications to Magnetic Resonance Imaging.

Paydar I, Kim BS, Cyr RA, Rashid H, Anjum A, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP - Front Oncol (2015)

Bottom Line: Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer.Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia.The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.

ABSTRACT

Purpose: Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer.

Methods: Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram-directed SBRT with or without supplemental intensity-modulated radiation therapy (IMRT) at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35-36.25 Gy in five fractions or as a boost of 19.5 Gy in three fractions followed by supplemental conventionally fractionated IMRT (45-50.4 Gy). Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0).

Results: The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70), and comorbidities were common (Carlson comorbidity index ≥2 in 36%). Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

Conclusion: Magnetic resonance imaging is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram-directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.

No MeSH data available.


Related in: MedlinePlus

Cumulative late CTCAE graded toxicities: (A) genitourinary (GU) and (B) Gastrointestinal (GI) toxicities at each time point.
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Figure 2: Cumulative late CTCAE graded toxicities: (A) genitourinary (GU) and (B) Gastrointestinal (GI) toxicities at each time point.

Mentions: From February 2009 to January 2014, 31 prostate cancer patients were treated with urethrogram-directed SBRT (Table 1). The median follow-up was 3.7 years. Patients were ethnically diverse, with 54.8% of non-Caucasian ancestry. Median age was 70 years (range, 56–85 years). The most common contraindication to MRI was a pacemaker/defibrillator (58%). Comorbidities were common (CCI ≥2 in 36%). Fifty-five percent of patients had moderate to severe lower urinary tract symptoms prior to treatment (baseline AUA ≥8) with a median baseline AUA of 8 (Table 2). The median prostate volume was 38 (13–75) cc, and 9.7% had prior procedures for benign prostatic hyperplasia (BPH). Seventy-one percent of patients utilized alpha-antagonists prior to SBRT. By D’Amico classification, 3 patients had low-, 19 intermediate-, and 9 high-risk diseases. Eleven patients (35.5%) also received androgen deprivation therapy (ADT). Seventy-five percent of the patients were treated with 35–36.25 Gy in five fractions. The remaining 25% of the patients were treated with 19.5 Gy in three 6.5 Gy fractions delivered via SBRT and had supplemental radiation delivered using intensity-modulated radiation therapy (IMRT) (median of 45 Gy over 25 fractions). There was a biochemical failure in one intermediate risk patient. At last follow-up, 26 (84%) were alive, and 5 (16%) had died from non-prostate cancer causes. Actuarial incidence rates of late GU and GI toxicities are demonstrated in Figure 2. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2% and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.


Urethrogram-Directed Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Patients with Contraindications to Magnetic Resonance Imaging.

Paydar I, Kim BS, Cyr RA, Rashid H, Anjum A, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP - Front Oncol (2015)

Cumulative late CTCAE graded toxicities: (A) genitourinary (GU) and (B) Gastrointestinal (GI) toxicities at each time point.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556038&req=5

Figure 2: Cumulative late CTCAE graded toxicities: (A) genitourinary (GU) and (B) Gastrointestinal (GI) toxicities at each time point.
Mentions: From February 2009 to January 2014, 31 prostate cancer patients were treated with urethrogram-directed SBRT (Table 1). The median follow-up was 3.7 years. Patients were ethnically diverse, with 54.8% of non-Caucasian ancestry. Median age was 70 years (range, 56–85 years). The most common contraindication to MRI was a pacemaker/defibrillator (58%). Comorbidities were common (CCI ≥2 in 36%). Fifty-five percent of patients had moderate to severe lower urinary tract symptoms prior to treatment (baseline AUA ≥8) with a median baseline AUA of 8 (Table 2). The median prostate volume was 38 (13–75) cc, and 9.7% had prior procedures for benign prostatic hyperplasia (BPH). Seventy-one percent of patients utilized alpha-antagonists prior to SBRT. By D’Amico classification, 3 patients had low-, 19 intermediate-, and 9 high-risk diseases. Eleven patients (35.5%) also received androgen deprivation therapy (ADT). Seventy-five percent of the patients were treated with 35–36.25 Gy in five fractions. The remaining 25% of the patients were treated with 19.5 Gy in three 6.5 Gy fractions delivered via SBRT and had supplemental radiation delivered using intensity-modulated radiation therapy (IMRT) (median of 45 Gy over 25 fractions). There was a biochemical failure in one intermediate risk patient. At last follow-up, 26 (84%) were alive, and 5 (16%) had died from non-prostate cancer causes. Actuarial incidence rates of late GU and GI toxicities are demonstrated in Figure 2. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2% and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

Bottom Line: Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer.Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia.The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.

ABSTRACT

Purpose: Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer.

Methods: Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram-directed SBRT with or without supplemental intensity-modulated radiation therapy (IMRT) at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35-36.25 Gy in five fractions or as a boost of 19.5 Gy in three fractions followed by supplemental conventionally fractionated IMRT (45-50.4 Gy). Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0).

Results: The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70), and comorbidities were common (Carlson comorbidity index ≥2 in 36%). Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

Conclusion: Magnetic resonance imaging is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram-directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.

No MeSH data available.


Related in: MedlinePlus