Prostate radiotherapyProstate stereotactic ablative body radiotherapy using a standard linear accelerator: Toxicity, biochemical, and pathological outcomes
Section snippets
Materials and methods
This study was approved by Sunnybrook Health Sciences Centre Research Ethics Board (REB 371-2006) and was registered on ClinicalTrials.gov (NCT01578902). Informed written consent was obtained from all patients participating in the study.
Results
The study was activated in October 2006. Due to acute financial issues in our clinical trials department in 2008, the last 16 patients could not be accrued. By July 2008, 95 patients were screened for the study. There were 3 screen failures (1 patient exceeded protocol defined girth limit of 40 cm; 2 patients had hip replacements) and 8 chose not to participate in the study. This left 84 patients accrued into the study.
Eight patients withdrew from the study before 5 years of follow-up with no
Discussion
In this prospective study, we showed that 5 weekly fractions (or treatments) of SABR were feasible and well tolerated in patients with localized prostate cancer. A summary of other prospective SABR protocols for prostate cancer is shown in Supplementary Table 1. A large multi-institutional retrospective series has been recently presented with similar results. [34] It should be emphasized that, while impossible to draw conclusions about relative tolerability across studies (due to varying
Conclusions
Stereotactic ablative body radiotherapy (SABR) for low-risk localized prostate cancer is feasible, well-tolerated and has excellent efficacy signals up to six years of follow-up. SABR allows safe biological dose escalation of prostate cancer with greater patient convenience, lower out-of-pocket and departmental costs and increased radiation therapy departmental treatment capacity. Further research is needed to refine the optimal SABR technique and machine requirements but ultimately SABR should
Conflict of interest statement
None of the authors has any conflict of interest with respect to this work.
Acknowledgements
This work was presented at the 2012 ASCO/ASTRO/AUA Genitourinary Cancer Symposium. Drs Loblaw and Cheung are co-primary investigators for this project. We would like to acknowledge Lori Holden and Angela Cesta for helping with patient support and data collection.
References (43)
- et al.
Radiotherapy doses of 80 Gy and higher are associated with lower mortality in men with gleason score 8–10 prostate cancer
Int J Radiat Oncol∗Biol ∗Phys
(2012) - et al.
Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials
Int J Radiat Oncol Biol Phys
(2009) - et al.
The Canadian Association of Radiation Oncology Scope of Practice Guidelines for Lung, Liver and Spine Stereotactic Body Radiotherapy
Clin Oncol (R Coll Radiol)
(2012) - et al.
Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5969 patients in seven international institutional datasets: α/β = 1.4 (0.9–2.2) Gy
Int J Radiat Oncol Biol Phys
(2012) - et al.
Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: first clinical trial results
Int J Radiat Oncol Biol Phys
(2007) - et al.
Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial
Int J Radiat Oncol Biol Phys
(2009) - et al.
Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer
Int J Rad Onc Biol Phys
(2012) - et al.
Phase I/II study of a five-fraction hypofractionated accelerated radiotherapy treatment for low-risk localised prostate cancer: early results of pHART3
Clin Oncol (R Coll Radiol)
(2008) - et al.
The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association
J Urol
(1992) - et al.
The role of overall treatment time in the outcome of radiotherapy of prostate cancer: an analysis of biochemical failure in 4839 men treated between 1987 and 1995
Radiother Oncol
(2010)
Individualized planning target volumes for intrafraction motion during hypofractionated intensity-modulated radiotherapy boost for prostate cancer
Int J Radiat Oncol Biol Phys
Intra-fraction motion during extreme hypofractionated radiotherapy of the prostate using pre- and post-treatment imaging
Clin Oncol (R Coll Radiol)
CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment
Semin Radiat Oncol
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)
Int J Radiat Oncol Biol Phys
Adverse drug reactions: definitions, diagnosis, and management
Lancet
Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference
Int J Radiat Oncol Biol Phys
Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer
Urology
Ultra-high dose (86.4 Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes
Int J Radiat Oncol Biol Phys
Reduced late rectal mucosal changes after prostate three-dimensional conformal radiotherapy with endorectal balloon as observed in repeated endoscopy
Int J Radiat Oncol Biol Phys
Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer?
Radiother Oncol
High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence
Int J Radiat Oncol Biol Phys
Cited by (146)
Strategic enhancement of immune checkpoint inhibition in refractory Colorectal Cancer: Trends and future prospective
2021, International ImmunopharmacologyProstate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response
2021, International Journal of Radiation Oncology Biology PhysicsA Phase I/II Study of Stereotactic Hypofractionated Once-weekly Radiation Therapy (SHORT) for Prostate Cancer
2020, Clinical OncologyCitation Excerpt :If further dose escalation is proven to be beneficial, meeting the same OAR constraints may not be a challenge. The once-weekly fractionation used in this trial was modelled on early reports from trials in Canada, notably the pHART3 study [22]. We also felt that the once-weekly fractionation would enable us to keep the overall treatment time (29 days) similar to our standard moderate hypofractionated protocol of 60 Gy in 20 fractions over 4 weeks (26–28 days) and facilitate a future matched comparison without a time bias.
- 1
Co-primary investigators.