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10-RadiationTherapyProstateCancer-Chen.pptx
- 1. Radiation Therapy for Prostate Cancer NASPCC 10-13-18 Ronald Chen, MD MPH Associate Professor, Radiation Oncology University of North Carolina – Chapel Hill Associate Director, UNC Lineberger Comprehensive Cancer Center
- 2. Disclosures • Accuray Inc: consulting and research funding • Bayer: consulting
- 3. Outline 1) Shortening radiation treatment for prostate cancer 2) “Oligometastatic” prostate cancer
- 5. Definitions Daily Dose (Gy) Number of Treatments Total Dose (Gy) Duration (Weeks) Conventional 1.8-2 38-45 75-81 8-9 Moderate Hypofractionation 2.4-3.4 15-30 57-70 3-6 Extreme Hypofractionation 7-10 4-5 35-50 1-2
- 6. Concern – is this effective? Daily Dose (Gy) Number of Treatments Total Dose (Gy) Duration (Weeks) Conventional 1.8-2 38-45 75-81 8-9 Moderate Hypofractionation 2.4-3.4 15-30 57-70 3-6 Extreme Hypofractionation 7-10 4-5 35-50 1-2
- 7. Concern – is this safe? Daily Dose (Gy) Number of Treatments Total Dose (Gy) Duration (Weeks) Conventional 1.8-2 38-45 75-81 8-9 Moderate Hypofractionation 2.4-3.4 15-30 57-70 3-6 Extreme Hypofractionation 7-10 4-5 35-50 1-2
- 8. Moderate Hypofractionation N Daily Dose # Doses Total Dose Daily Dose # Doses Total Dose Italy 168 2 40 80 3.1 20 62 MDACC 204 1.8 42 75.6 2.4 30 72 Australia 217 2 32 64 2.75 20 55 Fox Chase 303 2 38 76 2.7 26 70.2 HYPRO 804 2 39 78 3.4 19 64.6 Lukka 936 2 33 66 2.62 20 52.5 RTOG 1092 1.8 41 73.8 2.5 24 60 PROFIT 1206 2 39 78 3 20 60 CHHiP 3216 2 37 74 3 20 60
- 9. Moderate Hypofractionation • 9 clinical trials • Low risk prostate cancer to high risk cancer • Hypofractionation – No increase in recurrence – Similar side effects • Benefits to patients: – Patient convenience – Equally effective and cheaper cost = more cost- effective
- 10. Extreme Hypofractionation • Reducing radiation treatment to only 1-2 weeks • “Cyberknife” is a branded machine that is often used
- 11. Extreme Hypofractionation • Largest reported study to date: – Pooled analysis of patients from 8 institutions (UCLA, Harvard/Beth-Israel, Italy, Georgetown, Swedish Medical Center/Seattle, etc) – N=1100, enrolled 2003-2011 – 35-40 Gy/4-5 fractions King CR et al. Radiat Oncol 109:217-221, 2013.
- 12. Efficacy • 5-year relapse free survival – Low risk (N=641): 95% – Intermediate (N=334): 84% – High (N=125): 81%
- 13. Efficacy • N=477, low or intermediate risk • 7-7.25 Gy/fraction x 5 = 35-36.25 Gy total Katz AJ et al. Frontier Oncol 4:article 240, 2014.
- 14. Efficacy Median PSA at 7 years: 0.11
- 15. Quality of Life • Prospectively collected using EPIC Urinary Bowel Sexual (14% ADT) Katz AJ et al. Frontier Oncol 4:article 301, 2014.
- 16. Randomized Trial • Intermediate/high risk prostate cancer • 2 Gy x 39 = 78 Gy • 6.1Gy x 7 = 42.7 Gy • N=1180 patients • 5-year free from recurrence: 84% vs 84% • No difference in toxicity Widmark A et al. ESTRO 2018.
- 17. Conclusions Daily Dose (Gy) Number of Treatments Total Dose (Gy) Duration (Weeks) Conventional 1.8-2 38-45 75-81 8-9 Moderate Hypofractionation 2.4-3.4 15-30 57-70 3-6 Extreme Hypofractionation 7-10 4-5 35-50 1-2
- 18. TREATMENT FOR OLIGOMETASTATIC PROSTATE CANCER
- 19. Oligometastatic Cancer • Cancer that has metastasized to only a few places • Currently, standard treatment is ADT • Can aggressive treatment help some patients? Is this potentially curable?
- 20. STOMP Trial • 62 patients with prostate cancer recurrence • ≤ 3 metastases • Randomize: – Observation – Surgery or stereotactic body RT to all metastases Ost P et al. JCO 36(5):446-53, 2018.
- 21. Results Time to starting ADT • Obs: 13 months • Treatment: 21 months
- 22. Conclusion • Targeted (surgery or SBRT) to all metastases for patients with oligometastatic prostate cancer is – Well tolerated – Delays the need for ADT – which may be beneficial to patients
- 23. Other Ongoing Trials • Patient with newly diagnosed metastatic prostate cancer – Few areas of metastasis • Treat all the areas of disease (prostate and metastases) – does that help improve patient outcomes?
Editor's Notes
- #16: No ADT