Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Christina Phuong; Jason W Chan; Lisa Ni; Phillip Wall; Osama Mohamad; Anthony C Wong; I-Chow Hsu; Albert J Chang

doi:10.1186/s13014-021-01976-2

Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Radiat Oncol. 2022 Jan 20;17(1):12. doi: 10.1186/s13014-021-01976-2.

Authors

Christina Phuong^#¹, Jason W Chan^#¹, Lisa Ni¹, Phillip Wall¹, Osama Mohamad¹, Anthony C Wong¹, I-Chow Hsu¹, Albert J Chang^{2

3}

Affiliations

¹ Department of Radiation Oncology, University of California San Francisco, San Francisco, USA.
² Department of Radiation Oncology, University of California Los Angeles, Los Angeles, USA. ajchang@mednet.ucla.edu.
³ UCLA Radiation Oncology, 200 Medical Plaza Suite B265, Los Angeles, CA, 90024, USA. ajchang@mednet.ucla.edu.

^# Contributed equally.

Abstract

Background: To evaluate acute and late genitourinary and gastrointestinal toxicities and patient reported urinary and sexual function following accelerated, hypofractionated external beam radiotherapy to the prostate, seminal vesicles and pelvic lymph nodes and high dose rate (HDR) brachytherapy or stereotactic body radiation therapy (SBRT) prostate boost.

Methods: Patients at a single institution with NCCN intermediate- and high-risk localized prostate cancer with logistical barriers to completing five weeks of whole pelvic radiotherapy (WPRT) were retrospectively reviewed for toxicity following accelerated, hypofractionated WPRT (41.25 Gy in 15 fractions of 2.75 Gy). Patients also received prostate boost radiotherapy with either HDR brachytherapy (1 fraction of 15 Gy) or SBRT (19 Gy in 2 fractions of 9.5 Gy). The duration of androgen deprivation therapy was at the discretion of the treating radiation oncologist. Toxicity was evaluated by NCI CTCAE v 5.0.

Results: Between 2015 and 2017, 22 patients with a median age of 71 years completed accelerated, hypofractionated WPRT. Median follow-up from the end of radiotherapy was 32 months (range 2-57). 5%, 73%, and 23% of patients had clinical T1, T2, and T3 disease, respectively. 86% of tumors were Gleason grade 7 and 14% were Gleason grade 9. 68% and 32% of patients had NCCN intermediate- and high-risk disease, respectively. 91% and 9% of patients received HDR brachytherapy and SBRT prostate boost following WPRT, respectively. Crude rates of grade 2 or higher GI and GU toxicities were 23% and 23%, respectively. 3 patients (14%) had late or persistent grade 2 toxicities of urinary frequency and 1 patient (5%) had late or persistent GI toxicity of diarrhea. No patient experienced grade 3 or higher toxicity at any time. No difference in patient-reported urinary or sexual function was noted at 12 months.

Conclusions: Accelerated, hypofractionated whole pelvis radiotherapy was associated with acceptable GU and GI toxicities and should be further validated for those at risk for harboring occult nodal disease.

Keywords: HDR brachytherapy; Hypofractionation; Nodal radiotherapy; Pelvic radiotherapy; Prostate cancer.

MeSH terms

Aged
Brachytherapy*
Humans
Male
Prostatic Neoplasms / radiotherapy*
Radiation Dose Hypofractionation*
Radiosurgery*
Radiotherapy Dosage
Retrospective Studies