Genitourinary Cancer

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SU_24_2249 - Stereotactic Body Radiation Therapy for Prostate Cancer: Systematic Review and Meta-Analysis

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Stereotactic Body Radiation Therapy for Prostate Cancer: Systematic Review and Meta-Analysis
T. R. Cushman1, V. Verma2, J. Levy3, C. B. Simone II4, and M. V. Mishra5; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 3University of Maryland, Baltimore, MD, 4Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 5University of Maryland School of Medicine, Baltimore, MD

Hypothesis: Stereotactic body radiation therapy (SBRT) is safe and efficacious in the treatment of localized prostate cancer.

Purpose/Objective(s): SBRT is a safe, convenient, and efficacious modality for multiple neoplasms. There have been several recent reports of SBRT for prostate cancer. The existing prospective data indicate safety and efficacy of prostate SBRT, but concerns remain about late genitourinary and gastrointestinal toxicity. To evaluate the summative data on outcomes and toxicities in patients with localized prostate cancer, we conducted a PRISMA-guided systematic review and meta-analysis of prospective prostate SBRT.

Materials/Methods: We queried PubMed and Google Scholar using search terms “stereotactic” and “prostate.” All prospective studies with survival and/or toxicity endpoints that did not overlap with other papers were included. If overlap existed, the most recent data was included. RT was classified as stereotactic if it was delivered in 5 or fewer fractions. Searches were performed by two independent investigators in parallel. Pooled rates of freedom from biochemical failure (FFBF) and late grades ≥3 gastrointestinal and genitourinary toxicities were assessed. Meta-analysis of proportions was logit transformed and pooled using generalized linear mixed models (both fixed and random effects) and subsequently back transformed to standard proportions.

Results: Of the 24 initially screened prospective studies, 14 met inclusion criteria. 2288 patients were included in analysis; 1174 (51%) were low risk, 731 (32%) were intermediate risk, 292 (13%) were high risk, and 91 were unknown risk. Doses ranged from 33-50 Gy most typically in 5 fractions (93%), with nearly all studies delivering nondaily regimens with image guidance. Following meta-analyses of proportions, actuarial FFBF was 94% [95% confidence interval (CI), 90-97%]. Late grade ≥3 GI toxicity was 2% [95% CI, 1-5%], and late grade ≥3 GU toxicity was 3% [95% CI, 1-8%]. Conclusion: SBRT is safe and effective in the management of prostate cancer. Construction of phase III trials addressing this question are underway.

Author Disclosure: T.R. Cushman: None. V. Verma: None. J. Levy: None. C.B. Simone: Employee; Nemours/Alfred I. duPont Hospital for Children. Chair, Executive Council; Chair, Lung Committee; Proton Collaborative Group (PCG). Editor-in-Chief; Annals of Palliative Medicine. M.V. Mishra: Employee; Orthofix. Research Grant; ASTRO, Keep Punching. Advisory Board; Patient Centers Outcomes Research Institute (PCORI. Travel Expenses; Patient Centers Outcomes Research Institute (PCORI.

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