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. 2021 Mar 12;7(4):52-64.
doi: 10.14338/IJPT-20-00021.1. eCollection 2021 Spring.

Postoperative or Salvage Proton Radiotherapy for Prostate Cancer After Radical Prostatectomy

Shivam M Kharod  1 , Catherine E Mercado  2 , Christopher G Morris  1 , Curtis M Bryant  1 , Nancy P Mendenhall  1 , William M Mendenhall  1 , R Charles Nichols  1 , Bradford S Hoppe  3 , Xiaoying Liang  1 , Zhong Su  1 , Zuofeng Li  1 , Randal H Henderson  1
Affiliations

Postoperative or Salvage Proton Radiotherapy for Prostate Cancer After Radical Prostatectomy

Shivam M Kharod et al. Int J Part Ther. .

Abstract

Purpose: Postprostatectomy radiation improves disease control, but limited data exist regarding outcomes, toxicities, and patient-reported quality of life with proton therapy.

Method and materials: The first 102 patients who were enrolled on an outcome tracking protocol between 2006 and 2017 and treated with double-scattered proton therapy after prostatectomy were retrospectively reviewed. Eleven (11%) received adjuvant radiation, while 91 (89%) received salvage radiation. Seventy-four received double-scattered proton therapy to the prostate bed only. Twenty-eight received a double-scattered proton therapy prostate-bed boost after prostate-bed and pelvic-node treatment. Eleven adjuvant patients received a median dose of 66.6 GyRBE (range, 66.0-70.2). Ninety-one salvage patients received a median dose of 70.2 GyRBE (range, 66.0-78.0). Forty-five patients received androgen deprivation therapy for a median 9 months (range, 1-30). Toxicities were scored using Common Terminology Criteria for Adverse Events v4.0 criteria, and patient-reported quality-of-life data were reviewed.

Results: The median follow-up was 5.5 years (range, 0.8-11.4 years). Five-year biochemical relapse-free and distant metastases-free survival rates were 72% and 91% for adjuvant patients, 57% and 97% for salvage patients, and 57% and 97% overall. Acute and late grade 3 or higher genitourinary toxicity rates were 1% and 7%. No patients had grade 3 or higher gastrointestinal toxicity. Acute and late grade 2 gastrointestinal toxicities were 5% and 2%. The mean values and SDs of the International Prostate Symptom Score, International Index of Erectile Function, and Expanded Prostate Cancer Index Composite bowel function and bother were 7.5 (SD = 5.9), 10.2 (SD = 8.3), 92.8 (SD = 11.1), and 91.2 (SD = 6.4), respectively, at baseline, and 12.1 (SD = 9.1), 10.1 (SD = 6.7), 87.3 (SD = 18), and 86.7 (SD = 13.8) at the 5-year follow-up.

Conclusion: High-dose postprostatectomy proton therapy provides effective long-term biochemical control and freedom from metastasis, with low acute and long-term gastrointestinal and genitourinary toxicity.

Keywords: prostate cancer; proton therapy; quality of life; radiotherapy.

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Conflict of interest statement

Conflicts of Interest: Nancy P. Mendenhall, MD, and William M. Mendenhall, MD, are Editor-in-Chief and Operating Editor of the International Journal of Particle Therapy, respectively. Bradford S. Hoppe, MD, MPH, is an Associate Editor of the International Journal of Particle Therapy and a Scientific Consultant for Merck & Co., Inc., and Bristol-Myers Squibb

Figures

Figure.
Figure.
Actuarial rates of (A) overall survival, (B) freedom from biochemical progression, and (C) distant metastasis-free survival.
See this image and copyright information in PMC

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