High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation
PurposeModern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1325200/full |
| _version_ | 1797316366499315712 |
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| author | Jonathan W. Lischalk Meredith Akerman Michael C. Repka Astrid Sanchez Christopher Mendez Vianca F. Santos Todd Carpenter David Wise Anthony Corcoran Herbert Lepor Aaron Katz Jonathan A. Haas |
| author_facet | Jonathan W. Lischalk Meredith Akerman Michael C. Repka Astrid Sanchez Christopher Mendez Vianca F. Santos Todd Carpenter David Wise Anthony Corcoran Herbert Lepor Aaron Katz Jonathan A. Haas |
| author_sort | Jonathan W. Lischalk |
| collection | DOAJ |
| description | PurposeModern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer.Methods and materialsA large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan–Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes.ResultsA total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir.ConclusionUtilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity. |
| first_indexed | 2024-03-08T03:18:19Z |
| format | Article |
| id | doaj.art-0ec567ed70034d06aa1ddb2c1679983f |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-08T03:18:19Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-0ec567ed70034d06aa1ddb2c1679983f2024-02-12T12:31:54ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-02-011410.3389/fonc.2024.13252001325200High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiationJonathan W. Lischalk0Meredith Akerman1Michael C. Repka2Astrid Sanchez3Christopher Mendez4Vianca F. Santos5Todd Carpenter6David Wise7Anthony Corcoran8Herbert Lepor9Aaron Katz10Jonathan A. Haas11Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDivision of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, Mineola, NY, United StatesDepartment of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Medical Oncology, Perlmutter Cancer Center at New York University Langone Health - Manhattan, New York, NY, United StatesDepartment of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, NY, United StatesDepartment of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United StatesPurposeModern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer.Methods and materialsA large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan–Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes.ResultsA total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir.ConclusionUtilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.https://www.frontiersin.org/articles/10.3389/fonc.2024.1325200/fullprostatestereotactic body radiation therapyhigh-riskpelvic nodesboost |
| spellingShingle | Jonathan W. Lischalk Meredith Akerman Michael C. Repka Astrid Sanchez Christopher Mendez Vianca F. Santos Todd Carpenter David Wise Anthony Corcoran Herbert Lepor Aaron Katz Jonathan A. Haas High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation Frontiers in Oncology prostate stereotactic body radiation therapy high-risk pelvic nodes boost |
| title | High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| title_full | High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| title_fullStr | High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| title_full_unstemmed | High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| title_short | High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| title_sort | high risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation |
| topic | prostate stereotactic body radiation therapy high-risk pelvic nodes boost |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1325200/full |
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