Long-term outcomes of stereotactic body radiotherapy for low- and intermediate-risk prostate adenocarcinoma: A multi-institutional consortium study.

Authors

Amar Kishan

Amar Upadhyaya Kishan

University of California Los Angeles, Los Angeles, CA

Amar Upadhyaya Kishan , Alan J. Katz , Constantine Mantz , Fang-I Chu , Limor Appelbaum , Andrew Loblaw , Patrick Cheung , Irving D. Kaplan , Donald B. Fuller , Huong T. Pham , Robert Meier , Mark K. Buyyounouski , Narek Shaverdian , Audrey Dang , Ye Yuan , Hilary Bagshaw , Nicolas Prionas , Patrick Kupelian , Michael L. Steinberg , Christopher R. King

Organizations

University of California Los Angeles, Los Angeles, CA, Flushing Radiation, Flushing, NY, 21st Century Oncology, Fort Myers, FL, Beth Israel Deaconess Medical Center, Boston, MA, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, Genesis Healthcare Partners, San Diego, CA, Virginia Mason, Seattle, WA, Swedish Radiosurgical Center, Seattle, WA, Stanford Cancer Institute, Stanford, CA, UCLA David Geffen School of Medicine, Los Angeles, CA, Northwestern University Feinberg School of Medicine, Chicago, IL, Stanford Radiation Oncology, Stanford, CA, University of California Los Angeles Health Syst, Los Angeles, CA, UCLA School of Medicine, Los Angeles, CA

Research Funding

Other

Background: While a growing body of evidence supports the use of stereotactic body radiotherapy (SBRT) for the treatment of low- and intermediate-risk prostate adenocarcinoma (PCa), some trepidation exists regarding its long-term efficacy and safety. Methods: Men with low- and intermediate-risk PCa, as defined per the National Comprehensive Cancer Network guidelines, who were enrolled on various institutional phase II trials of SBRT between 2000-2012 were included in a multi-institutional consortium. Biochemical relapse (BCR) was defined as PSA >“nadir +2” or initiation of androgen deprivation therapy (ADT). Toxicity data were scored according to the CTCAE v 3.0 or Radiation Therapy Oncology Group scoring systems. Results: A total of 1644 men were eligible for analysis, with a median followup of 7.2 years. 297 patients (18.1%) had at least 9 years of followup. Fractionation schemes ranged from 33.50-40 Gy in 4-5 fractions. 892 patients had low-risk disease and 752 had intermediate-risk disease. 59 patients (3.6%) received short-term ADT. 100 patients (6.0%) experienced BCR, and 7 (0.4%) experienced distant metastases. No patients died of PCa. By Kaplan-Meier analysis, 5- and 10-year BCR-free survival rates were 98% and 94% in the low-risk group and 96% and 90% in the intermediate-risk group (p < 0.05 by log-rank test). 5- and 10-year overall survival rates were 93% and 86% in the low-risk group and 95% and 91% in the intermediate-risk group (p > 0.05 by log-rank test). Five patients (0.3%) experienced grade 3 acute genitourinary (GU) toxicities, including urinary retention, hematuria, and frequency. 30 (2%) experienced grade 3 late GU toxicity, including urinary strictures, hematuria, and retention. One late grade 4 GU toxicity (hemorrhagic urethritis) and one late grade 4 gastrointestinal toxicity (fistula-in-ano) were seen. Conclusions: To the best of our knowledge, this is the largest analysis of long-term outcomes following SBRT for PCa. The results indicate that SBRT has an efficacy and toxicity profile that compares favorably to more widespread forms of treatment, such as conventionally-fractionated external beam radiotherapy and brachytherapy.

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Abstract Details

Meeting

2018 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Prostate Cancer

Track

Prostate Cancer,Prostate Cancer

Sub Track

Prostate Cancer - Localized Disease

Citation

J Clin Oncol 36, 2018 (suppl 6S; abstr 84)

DOI

10.1200/JCO.2018.36.6_suppl.84

Abstract #

84

Poster Bd #

E4

Abstract Disclosures

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