Stereotactic body radiation therapy for prostate cancer: Review of experience of a multicenter phase I/II dose-escalation study

D. W Nathan Kim, Christopher Straka, L. Chinsoo Cho, Robert D. Timmerman

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Introduction: Stereotactic body radiation therapy (SBRT) is an area of active investigation for treatment of prostate cancer. In our phase I dose-escalation study, maximum-tolerated dose (MTD) was not reached, and subsequently phase II study has been completed. The purpose of this article is to review our experiences of dose-escalated SBRT for localized prostate cancer. Methods and materials: Patients enrolled to phase I/II study from 2006 to 2011 were reviewed. Prescription dose groups were 45, 47.5, and 50 Gray (Gy) in five fractions over 2.5 weeks. Toxicity and quality of life questionnaire data were collected and analyzed. Descriptive statistics were obtained in the form of means, medians, and ranges for the continuous variables, and frequencies and percentages for the categoric variables. Results: Ninety-one patients were enrolled from five institutions. Median follow-up for prostate specific antigen (PSA) evaluation was 42 months. PSA control remains at 99%. While the MTD was not reached in the phase I study, excess high grade rectal toxicity (10.6%) was noted in the phase II study. The 13 patients treated to 50 Gy in the phase I study that did not have high grade rectal toxicity, in retrospect met these parameters and have not had further events on longer follow-up. Conclusion: Prostate specific antigen control rate, even for patients with intermediate risk, is thus far excellent at these dose levels. This study provides a platform for exploration of SBRT based clinical trials aimed at optimizing outcome for intermediate and high risk patients. High grade toxicities specifically related to the rectum were observed in a small but meaningful minority at the highest dose level. Dose constraints based on physiologic parameters have been defined to mitigate this risk, and strategies to minimize rectal exposure to such doses are being explored.

Original languageEnglish (US)
Article number319
JournalFrontiers in Oncology
Volume4
Issue numberNOV
DOIs
StatePublished - 2014

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Prostatic Neoplasms
Radiotherapy
Prostate-Specific Antigen
Maximum Tolerated Dose
Rectum
Prescriptions
Quality of Life
Clinical Trials
Therapeutics

Keywords

  • Intermediate risk
  • Low risk
  • Prostate cancer
  • Rectal toxicity
  • SBRT

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Stereotactic body radiation therapy for prostate cancer : Review of experience of a multicenter phase I/II dose-escalation study. / Kim, D. W Nathan; Straka, Christopher; Cho, L. Chinsoo; Timmerman, Robert D.

In: Frontiers in Oncology, Vol. 4, No. NOV, 319, 2014.

Research output: Contribution to journalArticle

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abstract = "Introduction: Stereotactic body radiation therapy (SBRT) is an area of active investigation for treatment of prostate cancer. In our phase I dose-escalation study, maximum-tolerated dose (MTD) was not reached, and subsequently phase II study has been completed. The purpose of this article is to review our experiences of dose-escalated SBRT for localized prostate cancer. Methods and materials: Patients enrolled to phase I/II study from 2006 to 2011 were reviewed. Prescription dose groups were 45, 47.5, and 50 Gray (Gy) in five fractions over 2.5 weeks. Toxicity and quality of life questionnaire data were collected and analyzed. Descriptive statistics were obtained in the form of means, medians, and ranges for the continuous variables, and frequencies and percentages for the categoric variables. Results: Ninety-one patients were enrolled from five institutions. Median follow-up for prostate specific antigen (PSA) evaluation was 42 months. PSA control remains at 99{\%}. While the MTD was not reached in the phase I study, excess high grade rectal toxicity (10.6{\%}) was noted in the phase II study. The 13 patients treated to 50 Gy in the phase I study that did not have high grade rectal toxicity, in retrospect met these parameters and have not had further events on longer follow-up. Conclusion: Prostate specific antigen control rate, even for patients with intermediate risk, is thus far excellent at these dose levels. This study provides a platform for exploration of SBRT based clinical trials aimed at optimizing outcome for intermediate and high risk patients. High grade toxicities specifically related to the rectum were observed in a small but meaningful minority at the highest dose level. Dose constraints based on physiologic parameters have been defined to mitigate this risk, and strategies to minimize rectal exposure to such doses are being explored.",
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