Clatterbridge Cancer Centre, Wirral, United Kingdom
Isabel Syndikus , Joachim Kwok-Chiu Chan , Thelma Rowntree , Laura Howard , John Staffurth
Background: Prostate dose painting (boosting intra-prostatic tumour volumes) may improve biochemical relapse-free survival similar to whole organ dose-escalation without the associated increased toxicity. We present a pre-defined secondary endpoint of 2 year outcome for patients at one of two UK centres in a phase II trial (BIOPROP20) on dose-painting radiotherapy for intermediate to high risk patients treated with 60Gy/20# and concurrent 68Gy boost. Methods: Pinnacle software was used for VMAT planning and boost volumes were outlined by18F choline PET/CT and mpMRI. Patients with positive lymph nodes also had concurrent pelvic radiotherapy of 45Gy with boost to 50Gy. Patients were followed up until year 2 with PSA and toxicity scores. Results: Overall 56 patients were treated, 5 with pelvic radiotherapy. Median age and PSA was 67.5 years (range 50 - 77) and 10.0ng/ml (3.9 - 39.4). All patients had tumour volumes > 10mm diameter on pre-biopsy mpMRI. 13 and 43 patients had intermediate and high risk disease. Median % LN risk was 18% (15 - 40). ADT duration was 6 months, 2 years, and 3 years for 42, 5, and 9 patients. At the 2 year follow up review, no grade 3 late toxicity was observed. For prostate only dose painting, grade 2 GU and GI toxicity was noted in 6% and 2% respectively. For prostate and nodal dose painting, no grade 2 toxicity was noted. Median IPSS score was 5 and 9, and median PSA was 0.3 and 0.1, in the two groups respectively. 1 patient had biochemical and metastatic relapse at 18 months (prostate, pelvic nodes and bone metastasis) and 1 patient had died of unrelated disease. Conclusions: Prostate radiotherapy with hypofractionated dose painting schedule of 60Gy/20# with 68Gy boost to intra-prostatic lesions was well tolerated at 2 years follow up. Clinical trial information: NCT02125175
At 2 year followup | Prostate (n = 50) | Prostate and node (n = 5) | ||||
---|---|---|---|---|---|---|
n | [%] | n | [%] | |||
Remains on adjuvant ADT | 6 | 12% | 3 | 60% | ||
Biochemical relapse | 1 | 2% | 0 | 0% | ||
Late CTCAE toxicity grade | Urinary | 0 | 23 | 46% | 2 | 40% |
1 | 24 | 48% | 3 | 60% | ||
2 | 3 | 6% | 0 | 0% | ||
Bowel | 0 | 43 | 86% | 3 | 60% | |
1 | 2 | 12% | 2 | 40% | ||
2 | 1 | 2% | 0 | 0% |
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