A multi-institutional phase II trial of prostate stereotactic body radiation therapy (SBRT) utilizing continuous real-time evaluation of prostate motion with patient reported quality of life

Publication date: Available online 16 August 2017
Source:Practical Radiation Oncology
Author(s): William C. Jackson, Robert T. Dess, Dale W. Litzenberg, Pin Li, Matthew Schipper, Seth A. Rosenthal, Garrick C. Chang, Eric M. Horwitz, Robert A. Price, Jeff M. Michalski, Hiram A. Gay, John T Wei, Mary Feng, Felix Y. Feng, Howard M. Sandler, Robert E. Wallace, Daniel E. Spratt, Daniel A. Hamstra
PurposeThe use of stereotactic body radiation therapy (SBRT) for prostate cancer has been reported predominantly from single institutional studies while concerns for broader adoption exist.Methods and MaterialsFrom 2011–2013, 66 men were accrued to a phase II trial at five centers. SBRT consisted of 5 fractions of 7.4 Gy to 37 Gy using conventional linear accelerators. Electromagnetic transponders were utilized for motion management. Health-related quality of life (HRQOL) was evaluated via the EPIC-26 questionnaire. Acute and late toxicities were collected by common terminology criteria for adverse events (CTCAE) version 4.0. Linear mixed modeling was performed to assess changes in HRQOL over time.ResultsMedian follow-up was 36 months. All men had low or intermediate-risk disease. There have been zero biochemical recurrences. No grade 3 urinary or bowel toxicity was reported. Twenty-three percent of patients had acute grade 2 urinary toxicity, with 9% late grade 2 urinary toxicity. Four and 5% experienced acute or late grade 2+ bowel toxicity, respectively. Urinary bother and bowel HRQOL transiently decreased during the first 6–12 months post-SBRT, and then returned to baseline. In men with good erectile function at baseline, sexual HRQOL declined during the first 6 months and stabilized thereafter. On linear mixed modeling the strongest predictor of sustained bowel and sexual HRQOL was baseline HRQOL.ConclusionsIn this multi-institutional phase II clinical trial utilizing continuous real-time evaluation of prostate motion, prostate SBRT has excellent intermediate-term tumor control with mild and expected treatment-related side effects.



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