Hypofractionated Volumetric Modulated Arc Radiotherapy with simultaneous Elective Nodal Irradiation is feasible in prostate cancer patients: A single institution experience

• Published in: Journal of Egyptian National Cancer Institute Vol. 28; no. 2; pp. 101 - 110
• Main Authors: Hegazy, Mohamed W., Mahmood, Rana I., Al Otaibi, Mohammed F., Khalil, Ehab M.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Elsevier B.V 01.06.2016; Cairo University, National Cancer Institute; SpringerOpen
• Subjects: Aged; Aged, 80 and over; Disease-Free Survival; Humans; Hypo-fractionation; Lymph Nodes - radiation effects; Male; Middle Aged; Neoplasm Grading; Pelvis; Prospective Studies; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radiation Dose Hypofractionation; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Radiotherapy; Radiotherapy, Image-Guided - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Saudi Arabia; VMAT-intensity modulation; Saudi Arabia; VMAT-intensity modulation; Hypo-fractionation; Radiotherapy; Prostate cancer
• ISSN: 1110-0362; 1687-9996; 2589-0409
• DOI: 10.1016/j.jnci.2016.04.001

To assess feasibility, toxicity and biochemical relapse-free survival (b-RFS) for a group of organ confined (OC) Saudi prostate cancer patients treated by hypo-fractionated Volumetric Modulated Arc Radiation Therapy (VMAT) Simultaneous Integrated Boost (SIB) Elective Nodal Irradiation (ENI) whole pelvic radiotherapy (WPRT). Between March 2009 and January 2014, 29 OC prostate cancer patients; median age 64years, PS 0–1 were treated in King Faisal Specialist Hospital – Riyadh, Kingdom of Saudi Arabia using VMAT–SIB–ENI–WPRT, to a total dose of 70Gy in 28 fractions. Twenty Four patients (83%) were treated with neo-adjuvant; concurrent androgen deprivation therapy (ADT). Median follow-up (FU) was 42months (range: 18–72months). The 3-year actuarial b-RFS for low/intermediate and high risk groups were 100%, and 48%, respectively (p=0.09) with a median FU period of 34months (range: 14–53months). Gleason Score (p=0.02), and pretreatment PSA (p=0.01) were predictive for biochemical failure on univariate analysis; with no observed prostate cancer-related deaths. Grade 2 acute/late GI and GU toxicities were 28%/0% and 17%/10% respectively with no reported grade 3/4 toxicities. Four (50%) out of the 8 patients with baseline partial potency, retained sexual function on long term follow-up. Hypo-fractionation dose escalation VMAT–SIB–ENI–WPRT using 2 arcs is a feasible technique for intermediate/high risk OC prostate cancer patients, with acceptable rates of acute/late toxicities, much favorable planning target volume (PTV) coverage, and shorter overall treatment time. Prospective randomized controlled trials are encouraged to confirm its equivalence to other fractionation schemes.