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Radiation Oncology
Published in: Radiation Oncology 1/2013

Open Access 01-12-2013 | Research

Linac based SBRT for prostate cancer in 5 fractions with VMAT and flattening filter free beams: preliminary report of a phase II study

Authors: Filippo Alongi, Luca Cozzi, Stefano Arcangeli, Cristina Iftode, Tiziana Comito, Elisa Villa, Francesca Lobefalo, Pierina Navarria, Giacomo Reggiori, Pietro Mancosu, Elena Clerici, Antonella Fogliata, Stefano Tomatis, Gianluigi Taverna, Pierpaolo Graziotti, Marta Scorsetti

Published in: Radiation Oncology | Issue 1/2013

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Abstract

Background

To evaluate the feasibility and early side effects of a short course hypo-fractionated SBRT programme with Volumetric Modulated Arc Therapy (VMAT) and Flattening Filter Free (FFF) beams.

Methods

A prospective phase I-II study, started on February 2012. Inclusion criteria were: age ≤ 80 years, WHO-PS ≤ 2, PSA ≤ 20 ng/ml, histologically proven prostate adenocarcinoma, T1-T2 stage, no distant metastases, no previous surgery other than TURP, no malignant tumours in the previous 5 years, IPSS 0–7. The schedule was 35 Gy in 5 alternative days. SBRT was delivered with RapidArc VMAT, with 10MV FFF photons. Toxicity assessment was performed according to CTCAE v4.0 scale. EPIC questionnaires assessed Quality-of-Life. Neo-adjuvant/concomitant hormonal-therapy was prescribed according to risk classification. SpaceOAR™ gel was optionally implanted to increase the separation space between the prostate and the rectal wall.

Results

Median follow-up was 11 months (range: 5–16); 40 patients were recruited in the protocol and treated. According to NCCN criteria, 26/40 patients were low-risk and 14/40 were intermediate risk. Median age was 70 years (56–80), median initial PSA was 6.25 ng/ml (0.50-13.43 ng/ml). Median Gleason score was 6 (6–7). All patients completed the treatment as programmed (median 11.8 days (9–22). Acute Toxicities were as follow: Rectum G0: 30/40 cases (75%); G1: 6/40 (15%); G2: 4/40 (10%). Genito-urinary: G0: 16/40 (40%); G1: 8/40 (20%); G2: 16/34 (40%). In two G2 urinary retention cases, intermittent catheter was needed. No acute G3 or greater toxicity was found. Median treatment time was 126 sec (120–136). SpaceOAR™ was implanted in 8 patients. PSA reduction from the pre-treatment value of the marker was documented in all patients.

Conclusions

Early findings suggest that SBRT with RapidArc and FFF beams for prostate cancer in 5 fractions is feasible and tolerated in acute setting. Longer follow-up is needed for assessment of late toxicity and outcome.
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Metadata
Title
Linac based SBRT for prostate cancer in 5 fractions with VMAT and flattening filter free beams: preliminary report of a phase II study
Authors
Filippo Alongi
Luca Cozzi
Stefano Arcangeli
Cristina Iftode
Tiziana Comito
Elisa Villa
Francesca Lobefalo
Pierina Navarria
Giacomo Reggiori
Pietro Mancosu
Elena Clerici
Antonella Fogliata
Stefano Tomatis
Gianluigi Taverna
Pierpaolo Graziotti
Marta Scorsetti
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2013
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-8-171

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