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EP-1341: Pelvic SABR with HDR boost in intermediate and high risk prostate cancer (spare): early results
S719 ESTRO 36 _______________________________________________________________________________________________
period were retrospectively collected. Dosimetric data were captured including method of treatment delivery: static intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT); dose to prostate and pelvic node volume, as well as a single dose level indicating normal tissue exposure (V50 to bowel, rectum and bladder, that is volume of normal tissue of each receiving ≥50Gy). Results The median age was 64 years. 88.1% of patients had Gleason grade ≥8 cancer and 78.6% had local staging ≥T3a. 52.4% of patients were N0 with the remaining 47.6% N1; 1 patient had M1a disease. Treatment was by IMRT in 61.9% of patients and by VMAT in 38.1%. All patients received 74 Gy to prostate. Dose to pelvic nodes was 60Gy in 78.6%, 55Gy in 19% and 56Gy in 1 patient. There was no significant difference in nodal dose received by IMRT vs VMAT groups. All patients had neo-adjuvant and adjuvant hormone therapy. Median follow up was 37 months. Acute bowel toxicity (RTOG) was <2 in 73.8% and maximally =2 in 26.2%. Late bowel toxicity was <2 in 83.3%, and maximally =2 in 16.7% Acute urinary toxicity was <2 in 85.7%, =2 in 7.1% and maximally 3 in 7.1%. Late urinary toxicity was <2 in 59.5%, =2 in 35.7% and maximally 3 in 4.8%. Endoscopy rates during follow up were low: 7 patients had lower GI endoscopy with radiation proctitis confirmed in 5; 8 patients had cystoscopy with radiation related mucosal changes in 3. 14.3% of patients have experienced biochemical failure during follow up. V50 rectum and bladder are significantly lower in patients treated by VMAT versus IMRT; V50 rectum by VMAT = 48.81% vs by IMRT = 56.19% p=0.017; V50 bladder by VMAT = 46.88% vs by IMRT = 58.85% p=0.010. This has not translated into any significant difference in acute or late toxicities between the groups split by treatment modality. No significance difference was seen between V50 bowel in VMAT vs IMRT treated patients. Conclusion In high-risk N0 and N1 prostate cancer, treatment by advanced conformal radiotherapy to prostate and pelvis is associated with acceptable levels of toxicity and good biochemical control at 37 months. There is evidence of a dosimetric advantage with VMAT over static field IMRT. EP-1341 Pelvic SABR with HDR boost in intermediate and high risk prostate cancer (spare): early results H.B. Musunuru1, A. Deabreu1, M. Davidson1, A. Ravi1, J. Hlou1, L. Ho1, P. Cheung1, D. Vesprini1, S. Liu1, W. Chu1, H. Chung1, L. Zhang1, A. Loblaw1 1 Odette Cancer Centre- Sunnybrook Hospital- University of Toronto, Radiation Oncology, Toronto, Canada Purpose or Objective ASCENDE-RT has provided level 1 evidence supporting the use of androgen deprivation therapy (ADT), external beam radiotherapy and brachytherapy boost in intermediateand high-risk prostate cancer. The objectives of this study are to report early toxicity and quality of life (QOL) outcomes in patients treated on a hybrid protocol using five-fraction pelvic stereotactic ablative radiotherapy (SABR) with a MRI dose painted HDR brachytherapy boost (HDR-BT). Material and Methods A phase I/II study was performed where intermediate (IR) and high-risk (HR) prostate cancer patients received HDRBT 15Gy in single fraction to the prostate and up to 22.5Gy to the MRI nodule. Gantry-based 25Gy SABR was delivered to pelvis, seminal vesicles and prostate in 5 weekly fractions. ADT was used for 6-18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess toxicities. QOL was captured using EPIC questionnaire at 3months 6months and then every 6 months. A minimally clinically important change (MCIC)
definition was triggered if the EPIC QOL score at each time point decreases > 0.5 SD, where SD is the standard deviation of baseline scores. Results Thirty-three patients (NCCN 6.0% low IR, 45.5% high IR and 48.5% HR) completed the planned treatment with a median follow-up of 13.8 months (IQR 12.1, 18.8). The incidence of worst toxicities is shown in Table 1. The 3 grade 3 GU patients were due to temporary urinary catheterization in the acute period following HDR-BT. Mean (95% SD) EPIC urinary QOL scores were 82.5 (16.5), 83.2 (12.9) and 83.7 (16.3) at baseline, 3 months and 12 months and the bowel scores were 95.9 (3.8), 92.6(8.2) and 90.5 (8.3), respectively. Proportion of patients experiencing MCIC at 3 months and 12 months were 20.8% and 14.3% for urinary domain, 47.8% and 53.9% for bowel domain; respectively. GRADE GRADE QOL DOMAIN TIMING 2(%) 3(%) MCIC(%) GENIOURINARY
Acute
45.2%
9.7%
20.8%
Late
12.9%
0%
14.3%
9.7%
0%
47.8%
0%
0%
GASTROINTESTINAL Acute Late
53.9% Conclusion This novel treatment protocol incorporating MRI dose painted HDR brachytherapy boost and SABR pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible and well tolerated in the acute setting. EP-1342 Salvage stereotactic body radiotherapy for lymph node oligorecurrent prostate cancer G. Fanetti1, C. Fodor2, D. Ciardo2, L. Santoro3, C.M. Francia1, M. Muto4, A. Surgo4, D. Zerini2, G. Marvaso2, G. Timon5, P. Romanelli2, E. Rondi6, S. Comi6, F. Cattani6, D.V. Matei7, M. Ferro7, G. Musi7, F. Nolè8, O. De Cobelli7, P. Ost9, R. Orecchia10, B.A. Jereczek-Fossa1 1 European Institute of Oncology - University of Milan, Department of Radiation Oncology, Milan, Italy 2 European Institute of Oncology, Department of Radiation Oncology, Milan, Italy 3 European Institute of Oncology, Department of Epidemiology and Statistics affiliation at the time of the study, Milan, Italy 4 European Institute of Oncology - University of Milan, Department of Radiation Oncology affiliation at the time of the study, Milan, Italy 5 European Institute of Oncology, Department of Radiation Oncology affiliation at the time of the study, Milan, Italy 6 European Institute of Oncology, Unit of Medical Physics, Milan, Italy 7 European Institute of Oncology, Department of Urology, Milan, Italy 8 European Institute of Oncology, Department of Medical Oncology- Division of Urogenital and Head & Neck Tumours, Milan, Italy 9 Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium 10 European Institute of Oncology - University of Milan, Department of Medical Imaging and Radiation Science, Milan, Italy Purpose or Objective To evaluate the PSA response, progression free survival (PFS), local control and toxicity of stereotactic body radiotherapy (SBRT) for lymph-node (LN) oligorecurrent prostate cancer. Material and Methods We retrospectively reviewed 95 patients with LN oligorecurrent prostate cancer treated between 05/2012 and 10/2015. We evaluated biochemical response with
period were retrospectively collected. Dosimetric data were captured including method of treatment delivery: static intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT); dose to prostate and pelvic node volume, as well as a single dose level indicating normal tissue exposure (V50 to bowel, rectum and bladder, that is volume of normal tissue of each receiving ≥50Gy). Results The median age was 64 years. 88.1% of patients had Gleason grade ≥8 cancer and 78.6% had local staging ≥T3a. 52.4% of patients were N0 with the remaining 47.6% N1; 1 patient had M1a disease. Treatment was by IMRT in 61.9% of patients and by VMAT in 38.1%. All patients received 74 Gy to prostate. Dose to pelvic nodes was 60Gy in 78.6%, 55Gy in 19% and 56Gy in 1 patient. There was no significant difference in nodal dose received by IMRT vs VMAT groups. All patients had neo-adjuvant and adjuvant hormone therapy. Median follow up was 37 months. Acute bowel toxicity (RTOG) was <2 in 73.8% and maximally =2 in 26.2%. Late bowel toxicity was <2 in 83.3%, and maximally =2 in 16.7% Acute urinary toxicity was <2 in 85.7%, =2 in 7.1% and maximally 3 in 7.1%. Late urinary toxicity was <2 in 59.5%, =2 in 35.7% and maximally 3 in 4.8%. Endoscopy rates during follow up were low: 7 patients had lower GI endoscopy with radiation proctitis confirmed in 5; 8 patients had cystoscopy with radiation related mucosal changes in 3. 14.3% of patients have experienced biochemical failure during follow up. V50 rectum and bladder are significantly lower in patients treated by VMAT versus IMRT; V50 rectum by VMAT = 48.81% vs by IMRT = 56.19% p=0.017; V50 bladder by VMAT = 46.88% vs by IMRT = 58.85% p=0.010. This has not translated into any significant difference in acute or late toxicities between the groups split by treatment modality. No significance difference was seen between V50 bowel in VMAT vs IMRT treated patients. Conclusion In high-risk N0 and N1 prostate cancer, treatment by advanced conformal radiotherapy to prostate and pelvis is associated with acceptable levels of toxicity and good biochemical control at 37 months. There is evidence of a dosimetric advantage with VMAT over static field IMRT. EP-1341 Pelvic SABR with HDR boost in intermediate and high risk prostate cancer (spare): early results H.B. Musunuru1, A. Deabreu1, M. Davidson1, A. Ravi1, J. Hlou1, L. Ho1, P. Cheung1, D. Vesprini1, S. Liu1, W. Chu1, H. Chung1, L. Zhang1, A. Loblaw1 1 Odette Cancer Centre- Sunnybrook Hospital- University of Toronto, Radiation Oncology, Toronto, Canada Purpose or Objective ASCENDE-RT has provided level 1 evidence supporting the use of androgen deprivation therapy (ADT), external beam radiotherapy and brachytherapy boost in intermediateand high-risk prostate cancer. The objectives of this study are to report early toxicity and quality of life (QOL) outcomes in patients treated on a hybrid protocol using five-fraction pelvic stereotactic ablative radiotherapy (SABR) with a MRI dose painted HDR brachytherapy boost (HDR-BT). Material and Methods A phase I/II study was performed where intermediate (IR) and high-risk (HR) prostate cancer patients received HDRBT 15Gy in single fraction to the prostate and up to 22.5Gy to the MRI nodule. Gantry-based 25Gy SABR was delivered to pelvis, seminal vesicles and prostate in 5 weekly fractions. ADT was used for 6-18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess toxicities. QOL was captured using EPIC questionnaire at 3months 6months and then every 6 months. A minimally clinically important change (MCIC)
definition was triggered if the EPIC QOL score at each time point decreases > 0.5 SD, where SD is the standard deviation of baseline scores. Results Thirty-three patients (NCCN 6.0% low IR, 45.5% high IR and 48.5% HR) completed the planned treatment with a median follow-up of 13.8 months (IQR 12.1, 18.8). The incidence of worst toxicities is shown in Table 1. The 3 grade 3 GU patients were due to temporary urinary catheterization in the acute period following HDR-BT. Mean (95% SD) EPIC urinary QOL scores were 82.5 (16.5), 83.2 (12.9) and 83.7 (16.3) at baseline, 3 months and 12 months and the bowel scores were 95.9 (3.8), 92.6(8.2) and 90.5 (8.3), respectively. Proportion of patients experiencing MCIC at 3 months and 12 months were 20.8% and 14.3% for urinary domain, 47.8% and 53.9% for bowel domain; respectively. GRADE GRADE QOL DOMAIN TIMING 2(%) 3(%) MCIC(%) GENIOURINARY
Acute
45.2%
9.7%
20.8%
Late
12.9%
0%
14.3%
9.7%
0%
47.8%
0%
0%
GASTROINTESTINAL Acute Late
53.9% Conclusion This novel treatment protocol incorporating MRI dose painted HDR brachytherapy boost and SABR pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible and well tolerated in the acute setting. EP-1342 Salvage stereotactic body radiotherapy for lymph node oligorecurrent prostate cancer G. Fanetti1, C. Fodor2, D. Ciardo2, L. Santoro3, C.M. Francia1, M. Muto4, A. Surgo4, D. Zerini2, G. Marvaso2, G. Timon5, P. Romanelli2, E. Rondi6, S. Comi6, F. Cattani6, D.V. Matei7, M. Ferro7, G. Musi7, F. Nolè8, O. De Cobelli7, P. Ost9, R. Orecchia10, B.A. Jereczek-Fossa1 1 European Institute of Oncology - University of Milan, Department of Radiation Oncology, Milan, Italy 2 European Institute of Oncology, Department of Radiation Oncology, Milan, Italy 3 European Institute of Oncology, Department of Epidemiology and Statistics affiliation at the time of the study, Milan, Italy 4 European Institute of Oncology - University of Milan, Department of Radiation Oncology affiliation at the time of the study, Milan, Italy 5 European Institute of Oncology, Department of Radiation Oncology affiliation at the time of the study, Milan, Italy 6 European Institute of Oncology, Unit of Medical Physics, Milan, Italy 7 European Institute of Oncology, Department of Urology, Milan, Italy 8 European Institute of Oncology, Department of Medical Oncology- Division of Urogenital and Head & Neck Tumours, Milan, Italy 9 Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium 10 European Institute of Oncology - University of Milan, Department of Medical Imaging and Radiation Science, Milan, Italy Purpose or Objective To evaluate the PSA response, progression free survival (PFS), local control and toxicity of stereotactic body radiotherapy (SBRT) for lymph-node (LN) oligorecurrent prostate cancer. Material and Methods We retrospectively reviewed 95 patients with LN oligorecurrent prostate cancer treated between 05/2012 and 10/2015. We evaluated biochemical response with