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Hypofractionated proton boost combined with external beam radiotherapy for treatment of localized prostate cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.ORCID iD: 0000-0003-1887-1392
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science.
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2012 (English)In: Prostate Cancer, ISSN 2090-3111, E-ISSN 2090-312X, Vol. 2012, article id 654861Article in journal (Refereed) Published
Abstract [en]

Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT) of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity.

Place, publisher, year, edition, pages
2012. Vol. 2012, article id 654861
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-347410DOI: 10.1155/2012/654861PubMedID: 22848840OAI: oai:DiVA.org:uu-347410DiVA, id: diva2:1194343
Available from: 2018-03-31 Created: 2018-03-31 Last updated: 2018-05-08Bibliographically approved
In thesis
1. Dose Escalation with High Dose Rate Brachytherapy or Protons in Curative Radiotherapy of Prostate Cancer
Open this publication in new window or tab >>Dose Escalation with High Dose Rate Brachytherapy or Protons in Curative Radiotherapy of Prostate Cancer
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to study the outcome and side effects after dose-escalated radiotherapy with high dose rate brachytherapy (HDR-BT) or proton beam therapy (PBT) boost in prostate cancer.

The first cohorts of men in Sweden treated with either HDR-BT or PBT in combination with conventional photon beam therapy (2 Gray (Gy) fractions to 50 Gy) were analysed. The HDR-BT was given with two 10 Gy fractions, and the PBT with four fractions of 5 Gy. The analyses included 823 men in two HDR-BT cohorts, and 265 men in the PBT cohort. A large proportion of the cohorts, from 38% to 53%, were classified as high risk. After a follow-up between four and eleven years, both combinations showed low risks for relapse. The overall 5-year risk for PSA relapse was 0% for men with low risk. After PBT, the 5-year PSA relapse risk for intermediate and high risk were 5% and 26% respectively. After HDR-BT the 10-year risks for PSA relapse were 0%, 21% and 33% for low, intermediate, and high risk, respectively.

The risk for early and late toxicity was low. Genitourinary (GU) toxicity was more frequent than gastrointestinal (GI) toxicity. GU toxicity may have a late onset and progress slowly with time after HDR-BT. The 5- and 10-year actuarial incidences of urethral stricture were 6% and 10% respectively after HDR-BT. With applied dose constraints to the urethra the 10-year risk was 5%. The actuarial prevalence of GI toxicity declined slowly with time after HDR-BT as well as after PBT.

A PSA bounce after HDR-BT was seen in 26% of the patients, more frequent with younger age and lower Gleason score, and followed by a low risk for relapse.

For dose-escalated radiotherapy with HDR-BT or PBT:

  • long-term tumour control was achieved, not only for low- and intermediate risk, but also for the majority of high risk patients,
  • a PSA bounce after HDR-BT was folled by a good prognosis,
  • levels of late toxicity were low,
  • genitourinary toxicity was more frequent than gastrointestinal toxicity,
  • dose constraints to risk organs must be applied to minimise risks for late toxicity.
Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 58
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1471
Keywords
Prostate cancer, radiotherapy, brachytherapy, high dose rate, protons, PSA bounce
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-347414 (URN)978-91-513-0359-8 (ISBN)
Public defence
2018-08-31, Rudbecksalen, Dag Hammarskjölds väg 20, Uppsala, 09:00 (Swedish)
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Supervisors
Available from: 2018-06-08 Created: 2018-05-08 Last updated: 2018-06-08

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Johansson, SilviaÅström, LennartIsacsson, UlfMontelius, AndersTuresson, Ingela

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