Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer

Abstract

In our center, the feasibility and related acute toxicities of hypofractionated helical tomotherapy have been evaluated in older aged patients with prostate cancer . Between February 2009 and February 2014, 67 patients (older than 65 years) were enrolled in a prospective phase I-II study (registered number, ChiCTR-ONC-13004037). Patients in cohort 1 (n ¼ 33) and cohort 2 (n ¼ 34) received 76 Gy in 34 fractions (2.25 Gy/F) and 71.6 Gy in 28 fractions (2.65 Gy/F), respectively, to the prostate and seminal vesicles, while 25 patients in cohort 2 also received integrated elective lymph node irradiation (50.4 Gy). All patients were treated with helical tomotherapy, and daily image guidance was performed before each treatment. Acute toxicities were assessed with Radiation Therapy Oncology Group (RTOG)/European Organization for Research on Treatment of Cancer (EORTC) criteria. No significant difference was detected between the 2 cohorts in the incidence of acute toxicities. In cohort 1, the incidences of grade 1 and 2 genitourinary and gastrointestinal toxicities were 45.5% and 45.4%, respectively, and without grade 3 and 4 toxicities. In cohort 2, the incidences of acute grade 1 and 2 genitourinary and gastrointestinal toxicities were 47.1% and 55.9%, respectively, and grade 3 genitourinary toxicity (hematuria) was noted only in 1 patient. No significant difference was detected in the incidence of acute toxicities between the patients receiving integrated elective lymph node irradiation and those receiving irradiation to prostate and seminal vesicle in cohort 2. Univariate and multivariate analyses were performed with clinical parameters. Only the baseline weight was found negatively correlated with genitourinary toxicities at a weak level (relative risk ¼ 0.946, 95% confidence interval 0.896-0.998], P ¼ .043). This study shows that 2 hypofractionation regimens (76 Gy/34F and 71.6 Gy/28F) delivered with HT are well tolerated in older aged patients having prostate cancer without significant difference for acute toxicities between the 2 cohorts. Late toxicities and treatment outcomes for these patients are under investigation.

Moderate hypofractionated helical tomotherapy for localized prostate cancer: preliminary report of an observational prospective study

“…Also, 3 years cumulative incidence of late grade ⩾2 rectal or urinary toxicities were 13% and 4.8%, with no statistically significant differences with a comparison cohort of younger patients. Similarly, Liu et al 26 reported a prostate PTV delineation with the addition of a 5-mm margin in all directions except anterior and posterior, where they applied a 3-mm expansion; evaluating the early toxicity outcomes in 2 moderate hypofractionated HT-based regimens (2.25 Gy/fr and 2.65 Gy/fr), the authors described in their series of 67 patients only one late grade 3 toxicity in the subgroup of 34 cases treated with the 2.65 Gy schedule. Additionally, on-board image guidance enables verification of the prostate location before the treatment and assures a daily verification of the patient's setup.…”

A Japanese multi-institutional phase II study of moderate hypofractionated intensity-modulated radiotherapy with image-guided technique for prostate cancer

“…There are few prospective studies of moderately hypofractionated radiotherapy for localized prostate cancer using modern radiation techniques in Asian countries, although these fractionated regimens have been established as a standard of care [12]. Liu et performed a prospective phase I-II study using helical tomotherapy with daily image guidance in 67 patients on the feasibility of two fractionated regimens (76 Gy in 34 fractions and 71.6 Gy in 28 fractions) and showed acute toxicities were acceptable [13]. Nakamura et al reported a pilot study of hypofractionated IMRT of 54 Gy in 15 fractions in combination with neoadjuvant hormonal therapy for 24 patients with low-or intermediate-risk prostate cancer [14].…”

A Japanese Multi-Institutional Phase II Study of Moderate Hypofractionated Intensity-Modulated Radiotherapy with Image-Guided Technique for Prostate Cancer

“…There are few prospective studies of moderately hypofractionated radiotherapy for localized prostate cancer using modern radiation techniques in Asian countries, although these fractionated regimens have been established as a standard of care [12]. Liu et performed a prospective phase I-II study using helical tomotherapy with daily image guidance in 67 patients on the feasibility of two fractionated regimens (76 Gy in 34 fractions and 71.6 Gy in 28 fractions) and showed acute toxicities were acceptable [13]. Nakamura et al reported a pilot study of hypofractionated IMRT of 54 Gy in 15 fractions in combination with neoadjuvant hormonal therapy for 24 patients with low-or intermediate-risk prostate cancer [14].…”