title: Late Toxicity and Outcomes in High-risk Prostate Cancer Patients Treated With Hypofractionated IMRT and Long-term Androgen Suppression Treatment.
abstract: OBJECTIVE
  To assess late toxicity and outcomes in high-risk prostate cancer patients treated with hypofractionated radiation treatment with androgen suppression therapy.
  
  
  METHODS
  Sixty high-risk prostate cancer patients were enrolled. IMRT prescription was 68 Gy/25 fractions (2.7 Gy/fraction) to the prostate and proximal seminal vesicles (SV). The pelvic lymph nodes (PLN) and distal SV concurrently received 45 Gy/25 fractions (1.8 Gy/fraction). The patients were treated with helical TomoTherapy-based IMRT and underwent daily megavoltage CT image-guided verification before each treatment. RTOG Toxicity scores were recorded for a 5-year period.
  
  
  RESULTS
  Sixty patients completed RT with median follow-up of 63 months (range, 7 to 80 mo).At 5 years follow-up timepoint: Grade (G)2 and G3 late genitourinary toxicity was experienced in 7 (17.0%) and 1 (2.44%), respectively; gastrointestinal G2 as highest toxicity recorded in only 1 (2.44%) patient. There was no G3 gastrointestinal toxicity recorded at this timepoint.With 63-month median follow-up (mean of 65.41±1.72 mo), the 5-year overall survival was 86.67%; 5 years freedom from biochemical failure was 91.67% and freedom from clinical failure was 96.67%.
  
  
  CONCLUSIONS
  Dose escalation and hypofractionated radiation treatment with IMRT treating the prostate and proximal SV concurrently with the pelvic lymph nodes and distal SV and long-term androgen suppression therapy is well tolerated with respect to acute and late toxicity with 5-year actuarial overall survival 86.67%, freedom from biochemical failure 91.38%, and freedom from clinical failure 96.67%. Longer follow-up will provide more information on 10-year survival outcomes.
authors.affiliation: Divisions of *Radiation Oncology ∥Medical Physics ¶Division of Experimental Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, AB †Department of Radiation Oncology, Cancer Care, Eastern Health, St Johns, NF ‡Radiation Oncology, Saskatoon Cancer Centre, Saskatoon, SK, Canada §Radiation Oncology, UPMC Beacon Hospital, Dublin, Republic of Ireland.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Pervez
authors.forename: Alex
authors.initials: A
authors.lastname: Boychak
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Drodge
authors.forename: Don
authors.initials: D
authors.lastname: Yee
authors.forename: Duc
authors.initials: D
authors.lastname: Le
authors.forename: Albert
authors.initials: A
authors.lastname: Murtha
authors.forename: Matthew
authors.initials: M
authors.lastname: Parliament
authors.forename: John
authors.initials: J
authors.lastname: Amanie
authors.forename: Alina
authors.initials: A
authors.lastname: Mihai
authors.forename: Colin
authors.initials: C
authors.lastname: Field
authors.forename: Marc
authors.initials: M
authors.lastname: Mackenzie
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Gino
authors.initials: G
authors.lastname: Fallone
authors.forename: Robert
authors.initials: R
authors.lastname: Pearcey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D000069473:Radiation Dose Hypofractionation; D050397:Radiotherapy, Intensity-Modulated; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016729:Leuprolide