Proton Therapy of Prostate and Pelvic Lymph Nodes for High Risk Prostate Cancer: Acute Toxicity

Richard Choo, David W Hillman, Thomas Daniels, Carlos Vargas, Jean Claude Rwigema, Kimberly Corbin, Sameer Keole, Sujay Vora, Kenneth Merrell, Bradley Stish, Thomas Pisansky, Brian Davis, Adam Amundson, William Wong, Richard Choo, David W Hillman, Thomas Daniels, Carlos Vargas, Jean Claude Rwigema, Kimberly Corbin, Sameer Keole, Sujay Vora, Kenneth Merrell, Bradley Stish, Thomas Pisansky, Brian Davis, Adam Amundson, William Wong

Abstract

Purpose: To assess acute gastrointestinal (GI) and genitourinary (GU) toxicities of intensity-modulated proton therapy (IMPT) targeting the prostate/seminal vesicles and pelvic lymph nodes for prostate cancer.

Materials and methods: A prospective study (ClinicalTrials.gov: NCT02874014), evaluating moderately hypofractionated IMPT for high-risk or unfavorable intermediate-risk prostate cancer, accrued a target sample size of 56 patients. The prostate/seminal vesicles and pelvic lymph nodes were treated simultaneously with 6750 and 4500 centigray radiobiologic equivalent (cGyRBE), respectively, in 25 daily fractions. All received androgen-deprivation therapy. Acute GI and GU toxicities were prospectively assessed from 7 GI and 9 GU categories of the Common Terminology Criteria for Adverse Events (version 4), at baseline, weekly during radiotherapy, and 3-month after radiotherapy. Fisher exact tests were used for comparisons of categorical data.

Results: Median age was 75 years. Median follow-up was 25 months. Fifty-five patients were available for acute toxicity assessment. Sixty-two percent and 2%, respectively, experienced acute grade 1 and 2 GI toxicity. Grade 2 GI toxicity was proctitis. Sixty-five percent and 35%, respectively, had acute grade 1 and 2 GU toxicity. The 3 most frequent grade 2 GU toxicities were urinary frequency, urgency, and obstructive symptoms. None had acute grade ≥ 3 GI or GU toxicity. The presence of baseline GI and GU symptoms was associated with a greater likelihood of experiencing acute GI and GU toxicity, respectively. Of 45 patients with baseline GU symptoms, 44% experienced acute grade 2 GU toxicity, compared with only 10% among 10 with no baseline GU symptoms (P = 0.07). Although acute grade 1 and 2 GI and GU toxicities were common during radiotherapy, most resolved at 3 months after radiotherapy.

Conclusion: A moderately hypofractionated IMPT targeting the prostate/seminal vesicles and regional pelvic lymph nodes was well tolerated with no acute grade ≥ 3 GI or GU toxicity. Patients with baseline GU symptoms had a higher rate of acute grade 2 GU toxicity.

Keywords: acute toxicity; hypofractionation; prostate cancer; proton therapy.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

©Copyright 2021 The Author(s).

Figures

Figure 1.
Figure 1.
(A) Baseline gastrointestinal (GI) symptoms and maximum acute GI toxicity scores in the 7 GI categories during radiotherapy (RT) and at 3 months after RT. (B) Baseline genitourinary (GU) symptoms and maximum acute GU toxicity scores in the 9 GU categories during RT and at 3 months after RT.
Figure 2.
Figure 2.
Gastrointestinal toxicity during radiotherapy (RT) and at 3 months after RT.
Figure 3.
Figure 3.
Genitourinary toxicity during radiotherapy (RT) and at 3 months after RT.

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