Genitourinary Cancer

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SU_33_2338 - Intensity-modulated radiation therapy for elderly patients with prostate cancer: Evaluation of outcomes and safety

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

Intensity-modulated radiation therapy for elderly patients with prostate cancer: Evaluation of outcomes and safety
H. Tanaka1, M. Ito1, T. Yamaguchi1, K. Hachiya1, F. Hyodo2, and M. Matsuo1; 1Gifu University, Department of Radiology, Gifu, Japan, 2Gifu University, Department of Frontier Science for Imaging, Gifu, Japan

Purpose/Objective(s): According to the data collected in 2016, the life expectancies of 75- and 80-year-old Japanese individuals are 12.14 and 8.92 years, respectively. This study aimed at evaluating the safety and tolerability of intensity-modulated radiation therapy (IMRT) for elderly prostate cancer patients.

Materials/Methods: A total of 1091 patients with localized prostate cancer were treated between March 2006 and July 2014 at our institute. Among them, 238 patients were 75 years old or older. The median prostate-specific antigen (PSA) level at diagnosis was 9.59 ng/ml (range, 4.10-356.00 ng/ml). A total of 76 (31.9%), 69 (29.0%), 12 (9.7%), 33 (13.9%), 41 (17.2%), 4 (1.7%), and 3 (1.3%) patients had stage cT1c, T2a, T2b, T2c, T3a, T3b, and T4 cancers, respectively. The patients had a Gleason score (GS) of ≤ 6 (n = 56 [23.5%]), 7 (n = 111 [46.6%]), 8 (n = 36 [15.1%]), 9 (n = 30 [12.6%]), and 5 (n = 14 [5.9%]). The patients were stratified into the low (n = 31 [13.0%]), intermediate (n = 78 [32.8%]), high (n = 129 [54.3%]) groups according to the D’Amico classification. All patients were irradiated via IMRT at a dose of 70-78 Gy (median: 76 Gy) with or without androgen-deprivation therapy. The median follow-up period was 42 months (range, 2-108 months).

Results: The biochemical failure-free rate (BFFR), clinical failure-free rate, and overall survival (OS) rate at the 5-year follow-up for all patients were 89.2%, 96.2%, and 99.1%, respectively. The BFFR at the 5-year follow-up for patients with initial PSA levels < 10 ng/ml was significantly higher than that for patients with PSA levels ≥ 10 ng/ml (96.3% vs. 85.1%, p = 0.0172). There was no significant difference in BFFR between patients with T1c-T2a and those with T2b-T4 (p = 0.5611). The BFFRs at the 5-year follow-up for patients with GS ≤ 6 and ≥ 7 were 97.9% and 88.2%, respectively. A trend toward higher BFFR was noted in patients with a GS ≤ 6 than in those with a GS ≥ 7 (p = 0.1093). The BFFR in this study did not show a significant difference in comparison with the BFFR in patients < 75 years of age. The OS rate in this study was significantly lower than that in patients <75 years of age. The cumulative incidence rates of gastrointestinal and genitourinary toxicity (≥grade 2) at the 5-year follow-up were 11.4% and 4.3%, respectively. The rates of adverse events (≥grade 2) were not significantly different in comparison with those in patients < 75 years old.

Conclusion: The findings of this study indicate that IMRT is well tolerated and is associated with good long-term tumor control in elderly patients with localized prostate cancer.

Author Disclosure: H. Tanaka: None. M. Ito: None. T. Yamaguchi: None. K. Hachiya: None. F. Hyodo: None.

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