• Int. J. Radiat. Oncol. Biol. Phys. · Jan 2012

    Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer.

    • Nancy P Mendenhall, Zuofeng Li, Bradford S Hoppe, Robert B Marcus, William M Mendenhall, R Charles Nichols, Christopher G Morris, Christopher R Williams, Joseph Costa, and Randal Henderson.
    • University of Florida Proton Therapy Institute, Jacksonville, FL 32206, USA. menden@shands.ufl.edu
    • Int. J. Radiat. Oncol. Biol. Phys. 2012 Jan 1; 82 (1): 213-21.

    PurposeTo report early outcomes with image-guided proton therapy for prostate cancer.Methods And MaterialsWe accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years.ResultsOne intermediate-risk patient and 2 high-risk patients had disease progression. Pretreatment genitourinary (GU) symptom management was required in 38% of patients. A cumulative 88 (42%) patients required posttreatment GU symptom management. Four transient Grade 3 GU toxicities occurred, all among patients requiring pretreatment GU symptom management. Multivariate analysis showed correlation between posttreatment GU 2+ symptoms and pretreatment GU symptom management (p < 0.0001) and age (p = 0.0048). Only 1 Grade 3+ gastrointestinal (GI) symptom occurred. The prevalence of Grade 2+ GI symptoms was 0 (0%), 10 (5%), 12 (6%), and 8 (4%) at 6, 12, 18, and 24 months, with a cumulative incidence of 20 (10%) patients at 2 years after proton therapy. Univariate and multivariate analyses showed significant correlation between Grade 2+ rectal bleeding and proctitis and the percentage of rectal wall (rectum) receiving doses ranging from 40 CGE (10 CGE) to 80 CGE.ConclusionsEarly outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities.Copyright © 2012 Elsevier Inc. All rights reserved.

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