Five-Year Outcomes of a Phase 1 Dose-Escalation Study Using Stereotactic Body Radiosurgery for Patients With Low-Risk and Intermediate-Risk Prostate Cancer

Michael J. Zelefsky, Marisa Kollmeier, Sean McBride, Melissa Varghese, Borys Mychalczak, Richard Gewanter, Madhur K. Garg, Laura Happersett, Debra A. Goldman, Isaac Pei, Mary Lin, Zhigang Zhang, Brett W. Cox

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: To report toxicity outcomes, prostate-specific antigen (PSA) relapse, and cumulative incidence posttreatment biopsy results among patients treated on a prospective dose escalation study using ultra-hypofractionated stereotactic body radiation therapy (SBRT) for patients with low- and intermediate-risk prostate cancer. Methods and Materials: A total of 136 patients were enrolled in a phase 1 dose-escalation study to determine the tolerance of escalating radiation dose levels of SBRT for the treatment of localized prostate cancer. The initial dose level was 32.5 Gy in 5 fractions, and doses were then sequentially escalated to 35 Gy, 37.5 Gy, and 40 Gy. Eligibility criteria included only patients with low and intermediate risk, and the maximum prostate volume was 60 cm 3 . Patients treated with neoadjuvant androgen deprivation were excluded. The median follow-up in survivors for the 4 dose levels was 5.9, 5.4, 4.1, and 3.5 years, respectively. Results: The incidence of acute grade 2 rectal toxicities for dose levels 1 to 4 were 0%, 2.9%, 2.8%, and 11.4% respectively. No grade 3 or 4 acute rectal toxicities were observed. The incidence of acute grade 2 urinary toxicities for dose levels 1 to 4 were 16.7%, 22.9%, 8.3%, and 17.1%, respectively. No grade 3 or 4 acute urinary toxicities were observed. No grade 2 or higher rectal toxicities were observed. The incidence of late grade 2 urinary toxicities for dose levels 1 to 4 was 23.3%, 25.7%, 27.8%, and 31.4%, respectively. Only 1 late grade 3 urinary toxicity (urethral stricture) developed in the 40-Gy dose arm; the stricture was corrected with transurethral resection. No grade 4 late urinary toxicity was observed. The 5-year cumulative incidence of prostate-specific antigen failure for dose levels 1 to 4 was 15%, 6%, 0%, and 0%. The incidence of a 2-year positive posttreatment biopsy was 47.6%, 19.2%, 16.7%, and 7.7%, respectively for the 4 dose arms (P =.013). Conclusions: SBRT doses ranging from 32.5 to 40 Gy in 5 fractions were well tolerated without severe urinary or rectal toxicities. Biopsy outcomes suggest improved rates of tumor clearance observed with higher doses.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume104
Issue number1
DOIs
StatePublished - May 1 2019
Externally publishedYes

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Radiosurgery
Prostatic Neoplasms
cancer
toxicity
dosage
Incidence
grade
Radiotherapy
Prostate-Specific Antigen
Biopsy
incidence
Urethral Stricture
Radiation Tolerance
radiation therapy
antigens
Androgens
Survivors
Prostate
Pathologic Constriction
Recurrence

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Five-Year Outcomes of a Phase 1 Dose-Escalation Study Using Stereotactic Body Radiosurgery for Patients With Low-Risk and Intermediate-Risk Prostate Cancer. / Zelefsky, Michael J.; Kollmeier, Marisa; McBride, Sean; Varghese, Melissa; Mychalczak, Borys; Gewanter, Richard; Garg, Madhur K.; Happersett, Laura; Goldman, Debra A.; Pei, Isaac; Lin, Mary; Zhang, Zhigang; Cox, Brett W.

In: International Journal of Radiation Oncology Biology Physics, Vol. 104, No. 1, 01.05.2019, p. 42-49.

Research output: Contribution to journalArticle

Zelefsky, MJ, Kollmeier, M, McBride, S, Varghese, M, Mychalczak, B, Gewanter, R, Garg, MK, Happersett, L, Goldman, DA, Pei, I, Lin, M, Zhang, Z & Cox, BW 2019, 'Five-Year Outcomes of a Phase 1 Dose-Escalation Study Using Stereotactic Body Radiosurgery for Patients With Low-Risk and Intermediate-Risk Prostate Cancer', International Journal of Radiation Oncology Biology Physics, vol. 104, no. 1, pp. 42-49. https://doi.org/10.1016/j.ijrobp.2018.12.045
Zelefsky, Michael J. ; Kollmeier, Marisa ; McBride, Sean ; Varghese, Melissa ; Mychalczak, Borys ; Gewanter, Richard ; Garg, Madhur K. ; Happersett, Laura ; Goldman, Debra A. ; Pei, Isaac ; Lin, Mary ; Zhang, Zhigang ; Cox, Brett W. / Five-Year Outcomes of a Phase 1 Dose-Escalation Study Using Stereotactic Body Radiosurgery for Patients With Low-Risk and Intermediate-Risk Prostate Cancer. In: International Journal of Radiation Oncology Biology Physics. 2019 ; Vol. 104, No. 1. pp. 42-49.
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abstract = "Purpose: To report toxicity outcomes, prostate-specific antigen (PSA) relapse, and cumulative incidence posttreatment biopsy results among patients treated on a prospective dose escalation study using ultra-hypofractionated stereotactic body radiation therapy (SBRT) for patients with low- and intermediate-risk prostate cancer. Methods and Materials: A total of 136 patients were enrolled in a phase 1 dose-escalation study to determine the tolerance of escalating radiation dose levels of SBRT for the treatment of localized prostate cancer. The initial dose level was 32.5 Gy in 5 fractions, and doses were then sequentially escalated to 35 Gy, 37.5 Gy, and 40 Gy. Eligibility criteria included only patients with low and intermediate risk, and the maximum prostate volume was 60 cm 3 . Patients treated with neoadjuvant androgen deprivation were excluded. The median follow-up in survivors for the 4 dose levels was 5.9, 5.4, 4.1, and 3.5 years, respectively. Results: The incidence of acute grade 2 rectal toxicities for dose levels 1 to 4 were 0{\%}, 2.9{\%}, 2.8{\%}, and 11.4{\%} respectively. No grade 3 or 4 acute rectal toxicities were observed. The incidence of acute grade 2 urinary toxicities for dose levels 1 to 4 were 16.7{\%}, 22.9{\%}, 8.3{\%}, and 17.1{\%}, respectively. No grade 3 or 4 acute urinary toxicities were observed. No grade 2 or higher rectal toxicities were observed. The incidence of late grade 2 urinary toxicities for dose levels 1 to 4 was 23.3{\%}, 25.7{\%}, 27.8{\%}, and 31.4{\%}, respectively. Only 1 late grade 3 urinary toxicity (urethral stricture) developed in the 40-Gy dose arm; the stricture was corrected with transurethral resection. No grade 4 late urinary toxicity was observed. The 5-year cumulative incidence of prostate-specific antigen failure for dose levels 1 to 4 was 15{\%}, 6{\%}, 0{\%}, and 0{\%}. The incidence of a 2-year positive posttreatment biopsy was 47.6{\%}, 19.2{\%}, 16.7{\%}, and 7.7{\%}, respectively for the 4 dose arms (P =.013). Conclusions: SBRT doses ranging from 32.5 to 40 Gy in 5 fractions were well tolerated without severe urinary or rectal toxicities. Biopsy outcomes suggest improved rates of tumor clearance observed with higher doses.",
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AU - Kollmeier, Marisa

AU - McBride, Sean

AU - Varghese, Melissa

AU - Mychalczak, Borys

AU - Gewanter, Richard

AU - Garg, Madhur K.

AU - Happersett, Laura

AU - Goldman, Debra A.

AU - Pei, Isaac

AU - Lin, Mary

AU - Zhang, Zhigang

AU - Cox, Brett W.

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N2 - Purpose: To report toxicity outcomes, prostate-specific antigen (PSA) relapse, and cumulative incidence posttreatment biopsy results among patients treated on a prospective dose escalation study using ultra-hypofractionated stereotactic body radiation therapy (SBRT) for patients with low- and intermediate-risk prostate cancer. Methods and Materials: A total of 136 patients were enrolled in a phase 1 dose-escalation study to determine the tolerance of escalating radiation dose levels of SBRT for the treatment of localized prostate cancer. The initial dose level was 32.5 Gy in 5 fractions, and doses were then sequentially escalated to 35 Gy, 37.5 Gy, and 40 Gy. Eligibility criteria included only patients with low and intermediate risk, and the maximum prostate volume was 60 cm 3 . Patients treated with neoadjuvant androgen deprivation were excluded. The median follow-up in survivors for the 4 dose levels was 5.9, 5.4, 4.1, and 3.5 years, respectively. Results: The incidence of acute grade 2 rectal toxicities for dose levels 1 to 4 were 0%, 2.9%, 2.8%, and 11.4% respectively. No grade 3 or 4 acute rectal toxicities were observed. The incidence of acute grade 2 urinary toxicities for dose levels 1 to 4 were 16.7%, 22.9%, 8.3%, and 17.1%, respectively. No grade 3 or 4 acute urinary toxicities were observed. No grade 2 or higher rectal toxicities were observed. The incidence of late grade 2 urinary toxicities for dose levels 1 to 4 was 23.3%, 25.7%, 27.8%, and 31.4%, respectively. Only 1 late grade 3 urinary toxicity (urethral stricture) developed in the 40-Gy dose arm; the stricture was corrected with transurethral resection. No grade 4 late urinary toxicity was observed. The 5-year cumulative incidence of prostate-specific antigen failure for dose levels 1 to 4 was 15%, 6%, 0%, and 0%. The incidence of a 2-year positive posttreatment biopsy was 47.6%, 19.2%, 16.7%, and 7.7%, respectively for the 4 dose arms (P =.013). Conclusions: SBRT doses ranging from 32.5 to 40 Gy in 5 fractions were well tolerated without severe urinary or rectal toxicities. Biopsy outcomes suggest improved rates of tumor clearance observed with higher doses.

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