High-Risk Prostate Cancer and Radiotherapy: The Past and the Future. A Benchmark for a New Mixed Beam Radiotherapy Approach

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Abstract

Radiotherapy still remains a fundamental approach in the treatment of prostate cancer even in high-risk patients. In the past decade, dose escalation has guaranteed a better local control of disease with a great tolerance in terms of side effects. Our results constitute a benchmarking exercise for a prospective trial that involves the use of heavy particles as integration of conventional treatment with photons. Background The prognosis for patients with high-risk prostate cancer is poor. No consensus exists on the most effective treatment. The aim of this retrospective study was to identify the biochemical progression-free survival and the toxicity profile of patients with localized high-risk prostate cancer treated with external beam radiation therapy. These results will constitute a benchmark for a prospective “mixed beam” trial: a boost with carbon ions followed by a pelvic photon intensity-modulated radiotherapy (NCT02672449 [clinicaltrials.gov]). Patients and Methods We retrospectively reviewed the data of 76 patients treated in our institution with photon radiation therapy according to the inclusion criteria of the future “mixed beam” trial: cT3a and/or serum prostate-specific antigen > 20 ng/mL and/or Gleason score of 8 to 10, cN0 cM0. Toxicity, and biochemical and clinical progression-free survival were assessed. Results Seventy-six patients fulfilled our criteria. The median follow-up was 30.2 months (range, 7.2-61.1). Biochemical progression was observed in 22 patients (28.9%) after a median time of 20.2 months (range, 5-58.1) from the end of radiotherapy. Sixteen patients had clinical progression, in all the cases preceded by biochemical progression. Fifty-seven patients (75%) are alive with no evidence of disease, 13 (17.1%) are alive with clinically evident disease, 6 died (3 of prostate disease 3.9%). Conclusion Our results suggest that a more aggressive treatment is necessary. Local treatment intensification based on the “mixed beam” approach combining carbon ions (with its known radiobiological advantages) and photons might represent a promising strategy in high-risk prostate cancer and it will be investigated with our prospective clinical trial.

Original languageEnglish
Pages (from-to)376-383
Number of pages8
JournalClinical Genitourinary Cancer
Volume15
Issue number3
DOIs
Publication statusPublished - Jun 1 2017

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Keywords

  • Carbon ions
  • Mix beam approach
  • Photons
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

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