%0 Journal Article
%T Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer
%A Silvia Johansson
%A Lennart £żstr£żm
%A Fredrik Sandin
%A Ulf Isacsson
%A Anders Montelius
%A Ingela Turesson
%J Prostate Cancer
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/654861
%X Proton boost of 20£żGy in daily 5£żGy fractions followed by external beam radiotherapy (EBRT) of 50£żGy in daily 2£żGy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity. 1. Introduction One of the first-line curative treatment options of prostate carcinoma is radiotherapy (RT), which can be considered for organ-confined disease as well as for locally advanced tumors. The message of the potential benefit of dose escalation for disease-free survival announced by Hanks [1] and Perez et al. [2] from retrospective studies became a milestone for the current successful outcome in the use of radiotherapy for curative intent. Since then, several mature randomized trials have proven that dose escalation up to 79£żGy to the prostate is advantageous with regards to clinical disease control [3¨C14]. Further dose escalation to 81£żGy delivered in a phase II study using intensity modulated radiotherapy (IMRT) resulted in excellent 8-to-10-year tumors control and acceptable late toxicity [15, 16]. A feasibility study of proton beam therapy (PBT) suggested that daily proton fractions of 2£żGy to 82£żGy might be the maximal dose that can be delivered with acceptable late morbidity [17]. It is noteworthy that in phase II studies, to 81 and 82£żGy the dose was prescribed to the planning target volume (PTV). That means a 5 to 10% higher dose if prescribed
%U http://www.hindawi.com/journals/pc/2012/654861/