(P070) High-Risk Prostate Adenocarcinoma Treated With Whole-Pelvis Radiotherapy HDR Brachytherapy Boost Results in Very High Disease-Specific Survival

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Pelvic radiotherapy followed by HDR brachytherapy boost is an effective treatment for high-risk prostate cancer. It provides excellent long-term disease control and very low rates of severe (grade ≥ 3) toxicity when delivered in two or three fractions.

Julian Johnson, MD, Mack Roach, MD, Alexander Gottschalk, MD, PhD, Adam Cunha, PhD, Zachary Seymour, David Raleigh, MD, PhD, Katsuto Shinohara, MD, I-Chow Hsu, MD, Albert Chang, MD, PhD; University of California, San Francisco

PURPOSE/OBJECTIVES: To report the long-term clinical outcomes of patients with high-risk adenocarcinoma of the prostate treated with pelvic radiotherapy followed by inverse planned, template-free high-dose-rate (HDR) brachytherapy boost treated at a single institution.

MATERIALS AND METHODS: A total of 115 patients with high-risk prostate cancer (≥ cT3, Gleason score [GS] 8–10, or PSA ≥ 20 ng/mL) treated between July 1997 and November 2005 were included in this study. All patients underwent whole-pelvis external beam radiotherapy to 45 Gy followed by HDR brachytherapy boost. HDR brachytherapy boost consisted of 6 Gy × 3 (38 patients) or 9.5 Gy × 2 (77 patients) to the prostate and seminal vesicles. A total of 47%, 48%, and 5% of patients received long-term (> 18 mo), short-term (4–6 mo), or no androgen deprivation therapy, respectively.

RESULTS: The median age at diagnosis was 64.8 years; 50 (43%), 90 (78.2%), and 24 (20.8%) patients were diagnosed with GS 8–10, cT3 disease, and PSA ≥ 20 ng/mL, respectively. Mean PSA was 14.94 ng/mL (range: 0.21–99.3 ng/mL). Further, 21 patients (18.1%) had seminal vesicle invasion, and 42 patients (37%) had at least two high-risk features. With a median follow-up time of 94 months, 5- and 10- year biochemical-free survival, as defined by the Phoenix definition, was 90% and 73%, respectively. At 10 years, four patients failed locally, as determined by biopsy, for a local control rate of 94%. The 5- and 10-year distant metastasis-free survival rates were 97% and 87%, respectively. The 5- and 10-year disease-specific survival rates were 100% and 92.5%, respectively. Six secondary malignancies (bladder carcinoma 1 year posttreatment, colon, lung, melanoma, and hepatocellular carcinoma) developed. One patient developed grade 3 ureteral stricture that caused hydronephrosis and required stent placement. There were no other grade ≥ 3 genitourinary or gastrointestinal toxicities.

CONCLUSION: Pelvic radiotherapy followed by HDR brachytherapy boost is an effective treatment for high-risk prostate cancer. It provides excellent long-term disease control and very low rates of severe (grade ≥ 3) toxicity when delivered in two or three fractions.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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