Treatment of low-risk prostate cancer with radical hypofractionated accelerated radiotherapy with cytoprotection (HypoARC): an interim analysis of toxicity and efficacy.

Abstract

AIM:

Radiobiological analysis of clinical data suggests that prostate cancer has a low α/β ratio, implying that large radiotherapy fractions may better control the disease. Acceleration of radiotherapy may be also of importance in a subset of tumors. In this study we assessed the feasibility and efficacy of a highly accelerated and hypofractionated scheme of radiotherapy (HypoARC), for the treatment of localized low risk prostate cancer.

PATIENTS AND METHODS:

Fifty-five patients with prostate cancer (T1-2 stage, Gleason score <7 and prostate specific antigen (PSA) <10 ng/ml) were treated with localized conformal 4-field radiotherapy to the prostate and seminal vesicles: 51 Gy were delivered (3.4 Gy/fraction, within 19 days). The biological dose to the prostate ranged from 67.9-91.7 Gy. Amifostine (0-1000 mg depending upon tolerance) was delivered daily for cytoprotection. The median follow-up of patients is 30 (6-69) months.

RESULTS:

Early toxicity was overall low, proctitis being the most frequent side-effect (23.6% grade II). High dose amifostine significantly protected against proctitis (p=0.005). Grade 2 frequency and dysurea occurred in 1.8% and 3.7% of cases, respectively. There was no late toxicity ≥grade 2. Amifostine significantly protected against chronic frequency (p=0.02). Within a median follow-up of 30 months, one patient (1.8%) experienced a biochemical relapse.

CONCLUSION:

HypoARC is feasible and safe for patients with low-risk prostate cancer and, considering also the high efficacy noted, a strong rationale is provided for the further evaluation of HypoARC in randomized trials.

• Authors: Michael I Koukourakis, George Kyrgias, Aikaterini Papadopoulou, Marianthi Panteliadou, Alexandra Giatromanolaki, Efthimios Sivridis, Sophia Mavropoulou, Kriton Kalogeris, Pavlos Nassos, Nicolaos Milioudis, Stavros Touloupidis
• Journal: Anticancer research (Anticancer Res) Vol. 31 Issue 5 Pg. 1745-51 (May 2011) ISSN: 1791-7530 [Electronic] Greece
• PMID: 21617234 (Publication Type: Clinical Trial, Phase II, Journal Article)

Chemical References

• Radiation-Protective Agents
• Prostate-Specific Antigen
• Amifostine

Topics

• Aged
• Aged, 80 and over
• Amifostine (therapeutic use)
• Cytoprotection
• Dose Fractionation, Radiation
• Feasibility Studies
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (drug therapy, radiotherapy)
• Radiation Injuries (drug therapy, prevention & control)
• Radiation-Protective Agents (therapeutic use)
• Radiotherapy, Conformal
• Survival Rate
• Treatment Outcome