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A Phase 1 Pilot Study of Preoperative Radiation Therapy for Prostate Cancer: Long-Term Toxicity and Oncologic Outcomes.
- Source :
-
International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2019 May 01; Vol. 104 (1), pp. 61-66. Date of Electronic Publication: 2019 Jan 06. - Publication Year :
- 2019
-
Abstract
- Purpose: Neoadjuvant radiation therapy (RT) improves disease control in various cancers and has become an established oncologic treatment strategy. During 2001 to 2004, we conducted a phase 1 pilot study assessing the role of short-course preoperative RT (PreORT) for men with unfavorable intermediate- and high-risk localized prostate cancer. Herein, we present long-term follow-up toxicity and oncologic outcomes.<br />Methods and Materials: Eligible patients had histologically proven prostate cancer, cT1-T2N0M0 disease, prostate-specific antigen >15 to 35 ng/mL regardless of Gleason score, or prostate-specific antigen 10 to 15 ng/mL with Gleason score ≥7. Patients received 25 Gy in 5 consecutive daily fractions (5 Gy per fraction) to the prostate only, followed by radical prostatectomy within 14 days after RT completion. Primary outcomes were intraoperative morbidity and late genitourinary (GU) and gastrointestinal toxicities.<br />Results: In total, 15 patients were enrolled; 14 patients completed PreORT followed by radical prostatectomy, which also included bilateral lymph node dissections in 13 cases. Median follow-up was 12.2 years (range, 6.7-16.3). Late GU toxicity was common, with 2 patients (13.3%) experiencing G2 toxicity and 6 patients (40%) G3 toxicity. There were no patients with G4 to G5 late GU toxicity. Late gastrointestinal toxicity was infrequent, with only 1 patient (6.7%) experiencing transient G2 proctitis. At last follow-up, 8 (53.3%) and 6 (40%) patients experienced biochemical and metastatic disease recurrence, respectively.<br />Conclusions: The use of PreORT in men with high-risk prostate cancer is associated with unexpected high rates of late GU toxicity. Future studies examining the role of RT preradical prostatectomy must cautiously select RT technique and dose schedule. Importantly, long-term follow-up data are essential to fully determine the therapeutic index of PreORT in the management of localized disease.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Dose Fractionation, Radiation
Humans
Lymph Node Excision
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Pilot Projects
Preoperative Care
Proctitis etiology
Prospective Studies
Prostate-Specific Antigen blood
Prostatectomy methods
Prostatic Neoplasms blood
Prostatic Neoplasms pathology
Prostatic Neoplasms surgery
Radiotherapy, Conformal
Time Factors
Treatment Outcome
Urogenital System radiation effects
Prostatic Neoplasms radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-355X
- Volume :
- 104
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- International journal of radiation oncology, biology, physics
- Publication Type :
- Academic Journal
- Accession number :
- 30625410
- Full Text :
- https://doi.org/10.1016/j.ijrobp.2018.12.054