Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or HIFU

Publication date: Available online 19 December 2015
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Adam L. Holtzman, Bradford S. Hoppe, Haley P. Letter, Romaine C. Nichols, Randal H. Henderson, William M. Mendenhall, Christopher G. Morris, Christopher R. Williams, Zuofeng Li, Nancy P. Mendenhall
PurposeLocal recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. The purpose of this paper is to review a single institution's experience in using PT for salvage of local recurrent disease after HIFU or CS.Methods and MaterialsWe reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(RBE) (range, 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy (ADT) with RT. Patients were evaluated for quality of life (QOL) using the EPIC questionnaire and toxicity using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually.ResultsMedian follow-up was 37 months (range, 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year PT-related grade 3 toxicity rates was 17%. At 1 year, bowel summary, urinary incontinence and urinary obstructive quality of life (QOL) scores declined, but only the bowel QOL score at 12 months met the minimally important difference MID threshold.ConclusionPT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT function. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

Teaser

Local recurrence of prostate cancer after cryosurgery (CS) or high-intensity focused ultrasound (HIFU) is an emerging problem as these treatments are increasingly offered in lieu of standard radiation therapy and surgery. In this small study, salvage proton therapy (PT) achieved a high rate of bPFS with acceptable toxicity and minimal changes in the IPSS and EPIC summary scores compared with baseline pre-PT function.


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