Feasibility and safety of definite volumetric modulated arc therapy with simultaneous integrated boost to the dominant intraprostatic lesion in patients with unfavorable intermediate to high-risk prostate cancer
Abstract
Background: The most common site of recurrence of prostate cancer after definite radiation therapy is the dominant intraprostatic lesion (DIL). This study aimed to investigate the feasibility and safety of definite volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) to the DIL in patients with unfavorable intermediate to high-risk prostate cancer.
Materials and methods: In this prospective uncontrolled clinical trial, patients were delivered VMAT at a dose of 87.75 Gy in 39 fractions or 70 Gy in 20 fractions to the DIL in combination with androgen deprivation therapy. Genitourinary (GU) and rectal toxicity, International Prostate Symptom Score (IPSS) and IPSS quality of life (IPSS-QOL) score were collected.
Results: Forty-five patients with a median follow-up of 20 months were analyzed. The cumulative incidence of acute grade ³ 2 GU and rectal toxicity was 33.1% and 9.5%, respectively. Regarding late toxicity, the cumulative incidence of grade ≥ 2 GU and rectal toxicity was 12.6% and 2.8%, respectively. During treatment, the mean increase of IPSS was +7.4 ± 4.2 and the mean increase of IPSS-QOL was +1.7 ± 1.3. However, both IPSS and IPSS-QOL scores returned to their baseline levels by 3-months post-treatment. No significant correlation between baseline characteristics and grade ³ 2 GU or rectal toxicity was found.
Conclusion: Focal SIB to the DIL of ≥ 90 Gy EQD2 in unfavorable intermediate to high-risk prostate cancer patients resulted in tolerable toxicity profiles. The mean IPSS and IPSS-QOL scores both worsened during treatment; however, both scores returned to baseline level by 3 months after treatment.
Keywords: feasibilitysafetyvolumetric modulated arc therapysimultaneous integrated boostdominant intraprostatic lesionprostate cancer
References
- Zumsteg ZS, Spratt DE, Romesser PB, et al. Anatomical Patterns of Recurrence Following Biochemical Relapse in the Dose Escalation Era of External Beam Radiotherapy for Prostate Cancer. J Urol. 2015; 194(6): 1624–1630.
- Pucar D, Hricak H, Shukla-Dave A, et al. Clinically significant prostate cancer local recurrence after radiation therapy occurs at the site of primary tumor: magnetic resonance imaging and step-section pathology evidence. Int J Radiat Oncol Biol Phys. 2007; 69(1): 62–69.
- Mendez LC, Ravi A, Chung H, et al. Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high-dose-rate brachytherapy. Brachytherapy. 2018; 17(2): 291–297.
- Chopra S, Toi A, Taback N, et al. Pathological predictors for site of local recurrence after radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2012; 82(3): e441–e448.
- Arrayeh E, Westphalen AC, Kurhanewicz J, et al. Does local recurrence of prostate cancer after radiation therapy occur at the site of primary tumor? Results of a longitudinal MRI and MRSI study. Int J Radiat Oncol Biol Phys. 2012; 82(5): e787–e793.
- Tan CH, Hobbs BP, Wei W, et al. Diffusion-weighted MRI in the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol. 2012; 199(4): 822–829.
- Schild MH, Schild SE, Wong WW, et al. Early Outcome of Prostate Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Intra-Prostatic MRI Directed Boost. OMICS J Radiol. 2014; 3(4).
- Miralbell R, Mollà M, Rouzaud M, et al. Hypofractionated boost to the dominant tumor region with intensity modulated stereotactic radiotherapy for prostate cancer: a sequential dose escalation pilot study. Int J Radiat Oncol Biol Phys. 2010; 78(1): 50–57.
- von Eyben FE, Kiljunen T, Kangasmaki A, et al. Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion-A Systematic Review and Meta-Analysis. Clin Genitourin Cancer. 2016; 14(3): 189–197.
- Fonteyne V, Villeirs G, Speleers B, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys. 2008; 72(3): 799–807.
- Sundahl N, De Meerleer G, Villeirs G, et al. Combining high dose external beam radiotherapy with a simultaneous integrated boost to the dominant intraprostatic lesion: Analysis of genito-urinary and rectal toxicity. Radiother Oncol. 2016; 119(3): 398–404.
- Ippolito E, Mantini G, Morganti AG, et al. Intensity-modulated radiotherapy with simultaneous integrated boost to dominant intraprostatic lesion: preliminary report on toxicity. Am J Clin Oncol. 2012; 35(2): 158–162.
- Bauman G, Haider M, Van der Heide UA, et al. Boosting imaging defined dominant prostatic tumors: a systematic review. Radiother Oncol. 2013; 107(3): 274–281.
- Kerkmeijer LGW, Groen VH, Pos FJ, et al. Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial. J Clin Oncol. 2021; 39(7): 787–796.
- Purysko AS, Rosenkrantz AB, Turkbey IB, et al. PI-RADS Version 2: A Pictorial Update. Radiographics. 2016; 36(5): 1354–1372.
- Bastian-Jordan M. Magnetic resonance imaging of the prostate and targeted biopsy, Comparison of PIRADS and Gleason grading. J Med Imaging Radiat Oncol. 2018; 62(2): 183–187.
- Common Terminology Criteria for Adverse Events (CTCAE) [Internet]. Cancer Therapy Evaluation Program (CTEP). https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm (2020 Feb 10).
- Nontakaew K, Kochakarn W, Kijvika K, et al. Reliability of a Thai version of the International Prostate Symptom Score (IPSS) for the Thai population. J Med Assoc Thai. 2014; 97(6): 615–620.
- Monninkhof EM, van Loon JWL, van Vulpen M, et al. Standard whole prostate gland radiotherapy with and without lesion boost in prostate cancer: Toxicity in the FLAME randomized controlled trial. Radiother Oncol. 2018; 127(1): 74–80.
- Dickinson L, Ahmed HU, Allen C, et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol. 2011; 59(4): 477–494.
- Crook J, Ots A, Gaztañaga M, et al. Ultrasound-planned high-dose-rate prostate brachytherapy: dose painting to the dominant intraprostatic lesion. Brachytherapy. 2014; 13(5): 433–441.
- Malik R, Jani AB, Liauw SL. External beam radiotherapy for prostate cancer: urinary outcomes for men with high International Prostate Symptom Scores (IPSS). Int J Radiat Oncol Biol Phys. 2011; 80(4): 1080–1086.
- Aghdam N, Pepin A, Buchberger D, et al. Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men With a High Baseline International Prostate Symptom Score (IPSS ≥ 15). Front Oncol. 2020; 10: 1060.