Measuring Radiation Toxicity Using Circulating Cell-Free DNA in Prostate Cancer Patients

Natalie A Lockney; Randal H Henderson; Steven G Swarts; Zhenhuan Zhang; Bingrong Zhang; Jennifer Li; Robert A Zlotecki; Christopher G Morris; Katherine A Casey-Sawicki; Paul G Okunieff

doi:10.14338/IJPT-D-21-00008

Measuring Radiation Toxicity Using Circulating Cell-Free DNA in Prostate Cancer Patients

Int J Part Ther. 2021 Jul 27;8(3):28-35. doi: 10.14338/IJPT-D-21-00008. eCollection 2022 Winter.

Affiliation

¹ Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA.

Abstract

Background: After radiation therapy (RT), circulating plasma cell-free DNA (cfDNA) released in response to RT damage to tissue can be measured within hours. We examined for a correlation between cfDNA measured during the first week of therapy and early and late gastrointestinal (GI) and genitourinary (GU) toxicity.

Material and methods: Patients were eligible for enrollment if they planned to receive proton or photon RT for nonmetastatic prostate cancer in the setting of an intact prostate or after prostatectomy. Blood was collected before treatment and on sequential treatment days for the first full week of therapy. Toxicity assessments were performed at baseline, weekly during RT, and 6 months and 12 months after RT. Data were analyzed to examine correlations among patient-reported GI and GU toxicities.

Results: Fifty-four patients were evaluable for this study. Four (7%) and 3 (6%) patients experienced acute and late grade 2 GI toxicity, respectively. Twenty-two (41%) and 18 (35%) patients experienced acute and late grade 2 GU toxicity, respectively. No patients developed grade 3 or higher toxicity. Grade 2 acute GI toxicity, but not grade 2 acute GU toxicity, was significantly correlated with pre-RT cfDNA levels and on all days 1, 2, 3, 4, and 5 of RT (P < .005). Grade 2 late GI toxicity, but not GU toxicity, was significantly correlated with pre-RT cfDNA levels (P = .021).

Conclusions: Based on this preliminary study, cfDNA levels can potentially predict the subset of patients destined to develop GI toxicity during prostate cancer treatment. Given that the toxicity profiles of the various fractionations and modalities are highly similar, the data support the expectation that cfDNA could provide a biological estimate to complement the dose-volume histogram. A test of this hypothesis is under evaluation in a National Cancer Institute-funded multi-institutional study.

Keywords: biomarker; cell-free DNA; circulating DNA; intensity modulated radiation therapy; prostate cancer; protons; radiation toxicity.