gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Hypofractionation variants of proton boost in prostate cancer treating

Meeting Abstract

  • E. Khmelevsky - Russian Scientific Centre of Roentgeno-Radiology, Moscow, Russian Federation
  • V. Kharchenko - Russian Scientific Centre of Roentgeno-Radiology, Moscow, Russian Federation
  • I. Kancheli - Medical Physics, ITEP, Moscow, Russian Federation
  • G. Klenov - Medical Physics, ITEP, Moscow, Russian Federation
  • M. Lomanov - Medical Physics, ITEP, Moscow, Russian Federation
  • V. Lyulevich - Medical Physics, ITEP, Moscow, Russian Federation
  • V. Pokhvata - Medical Physics, ITEP, Moscow, Russian Federation
  • V. Khoroshkov - Medical Physics, ITEP, Moscow, Russian Federation

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog110

DOI: 10.3205/09ptcog110, URN: urn:nbn:de:0183-09ptcog1105

Published: September 24, 2009

© 2009 Khmelevsky et al.
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Outline

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Purpose. A method of combined proton-photon radiation therapy of the prostate cancer was elaborated.

Methods. The method is distinguished by the mean regime of the dose fractionation at the prostate local irradiation with the proton beam 220 MeV: 28,8 CoGy E for 8 daily fractions in 3CoGy, or 28 CoGy E for 5 fractions in 4 CoGy (5 or 3 fr./week). With the photon component (44 - 46 Gy in 22–23 fractions for the whole volume of small pelvis or for prostate and seminal vesicles only), the dose on the prostate was brought up to 72–74.8.CoGy E.

Results. The clinical effectiveness was estimated in the randomized investigation for 215 patients with the stages T1-3N0-1M0. In the main group - 89 patients after combined proton-photon therapy, in the control group - 126 patients after the standard 8 - field photon irradiation with 44–46 Gy doses for the small pelvis and 70 Gy for the prostate, 2 Gy daily. The whole volume of the small pelvis was irradiated in 82,1% patients of the main group and in 87,3% of the control group. The radiation therapy was preceeded by the 3–6 months course of the hormone therapy in the maximal androgen blockade regime.

The treatment program modification was needed for 7.9% of the patients in the main group and for 23.1% of the patients in the control group (p<0.03).

The frequency of the 2 stage acute rectitis was significantly (from 69% to 54%, p<0.05) decreased in the main group, its percent being surely increased 1,5 and 2 times in the case of the proton irradiation 4 Gy with 3 or 5 fraction per week, correspondingly, comparing with common 3 Gy. No distinctions in the acute genitourinary change frequency were noted. No changes of the 3 and 4 stages were recorded.

The observation median is 43 months. Late genitourinary change were recorded for 15.7% in the main group and for 21.2% in the control group, including the 2 st. reaction for 7.2% and 8.4% correspondingly (p>0.1). Late rectitis ≥2 st. was significantly lower in the main group: 9.6% , 31.5% in the control one (p<0.05). The 3 years actuarial recurrence-free survival was 75.9% after proton-photon therapy and 76.8% for the control group. The absence of the local regional progress was registered for 97.6% and 97.2% correspondingly (everywhere p>0.05).

Conclusions. Method of the combined proton-photon radiation therapy of the prostate cancer allows to decrease the frequency of both acute and late post-irradiation damages preserving the high level of the anticancer efficacy. The escalation of daily dose proton boost from 3 to 4CoGy increased acute, but not late GU and GI damages.