Five-Year Prostate-Specific Membrane Antigen Positron Emission Tomography-Based Outcomes of Spot-Scanning Proton Radiation Therapy for Localized Prostate Cancer: A Single Institution Experience

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2024-09-18 DOI:10.1016/j.adro.2024.101639

Will Sperduto MD , Molly M. Voss BS , Brady Laughlin MD , Diego A.S. Toesca MD , William W. Wong MD , Sameer R. Keole MD, FASTRO , Jean-Claude M. Rwigema MD , Nathan Y. Yu MD , Steven E. Schild MD , Sarah E. James MD, PhD , Thomas B. Daniels MD , Todd A. DeWees PhD , Carlos E. Vargas MD

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Abstract

Purpose

We report 5-year oncologic outcomes of a prospective series of patients with prostate cancer treated with spot-scanning proton therapy (SSPT).

Methods and Materials

A prospective registry identified patients with prostate cancer treated with SSPT between January 2016 and December 2018. Five-year overall survival, local control, biochemical failure, regional and distant failures, and adverse events (AEs) were assessed. Biochemical failure was defined as rise in prostate-specific antigen ≥ 2.0 ng/mL above nadir prostate-specific antigen. Baseline-adjusted toxicities were assigned using the Common Terminology Criteria for Adverse Events version 5.0.

Results

With a median follow-up of 4.4 years, 284 patients with prostate cancer were treated with SSPT. Median total radiation dose was 79.2 Gy over 44 fractions, 70 Gy over 28 fractions, and 38 Gy over 5 fractions for conventional fractionation (CF), hypofractionation (HF), and stereotactic body radiation therapy (SBRT), respectively. Biochemical failure rate for all patients was 6.7%. Five-year local control rates for CF, HF, and SBRT were 100%, 100%, and 97.3%, respectively (P = .07). Regional recurrences occurred in 12 (4.2%) patients: 8 treated with CF, 2 with HF, and 2 with SBRT (P = .62). Distant failures occurred in 12 patients (4.2%): 5 treated with CF, 7 with HF, and none with SBRT (P = .05). Five-year overall survival for patients treated with CF, HF, and SBRT SSPT were 88.1%, 86.1%, and 97.2%, respectively (P = .1). Acute and chronic grade 2+ gastrointestinal AEs occurred in 8 (2.8%) and 51 (18.0%) patients, respectively. Acute and chronic grade 3+ gastrointestinal AEs occurred in 3 (1.1%) and 4 (1.4%) patients, respectively. Acute and chronic grade 2+ genitourinary-related AEs were observed in 71 (25%) and 63 (22.2%) patients, respectively. Acute and chronic grade 3+ genitourinary toxicity were observed in 3 (1.1%) and 6 (2.1%) patients, respectively.

Conclusions

SSPT provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.

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基于前列腺特异性膜抗原正电子发射断层扫描的点扫描质子放疗治疗局部前列腺癌的五年疗效：单个机构的经验

目的我们报告了一系列前列腺癌患者接受点扫描质子治疗（SSPT）的5年肿瘤学结果。方法和材料前瞻性登记确定了2016年1月至2018年12月期间接受SSPT治疗的前列腺癌患者。对五年总生存期、局部控制、生化失败、区域和远处失败以及不良事件（AEs）进行了评估。生化失败的定义是前列腺特异性抗原比萌芽期前列腺特异性抗原升高≥2.0纳克/毫升。结果中位随访时间为4.4年，284名前列腺癌患者接受了SSPT治疗。常规分次（CF）、低分次（HF）和立体定向体放射治疗（SBRT）的中位总放射剂量分别为79.2 Gy（44次分次）、70 Gy（28次分次）和38 Gy（5次分次）。所有患者的生化治疗失败率为6.7%。CF、HF和SBRT的五年局部控制率分别为100%、100%和97.3%（P = .07）。12例（4.2%）患者出现区域性复发：其中 8 人接受了 CF 治疗，2 人接受了 HF 治疗，2 人接受了 SBRT 治疗（P = .62）。12名患者（4.2%）出现远处失败：其中 5 人接受 CF 治疗，7 人接受 HF 治疗，没有人接受 SBRT 治疗（P = .05）。接受CF、HF和SBRT SSPT治疗的患者五年总生存率分别为88.1%、86.1%和97.2%（P = .1）。急性和慢性2级以上胃肠道AEs分别发生在8例（2.8%）和51例（18.0%）患者中。分别有 3 名（1.1%）和 4 名（1.4%）患者出现急性和慢性 3+ 级胃肠道不良反应。分别有 71 名（25%）和 63 名（22.2%）患者出现急性和慢性 2+ 级生殖泌尿系统相关不良反应。分别有3例（1.1%）和6例（2.1%）患者出现急性和慢性3+级泌尿生殖系统毒性。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.