AUTHOR=Paydar Ima , Kim Brian S. , Cyr Robyn A. , Rashid Harriss , Anjum Amna , Yung Thomas M. , Lei Siyuan , Collins Brian T. , Suy Simeng , Dritschilo Anatoly , Lynch John H. , Collins Sean P. TITLE=Urethrogram-Directed Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Patients with Contraindications to Magnetic Resonance Imaging JOURNAL=Frontiers in Oncology VOLUME=5 YEAR=2015 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2015.00194 DOI=10.3389/fonc.2015.00194 ISSN=2234-943X ABSTRACT=Purpose

Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer.

Methods

Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram-directed SBRT with or without supplemental intensity-modulated radiation therapy (IMRT) at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35–36.25 Gy in five fractions or as a boost of 19.5 Gy in three fractions followed by supplemental conventionally fractionated IMRT (45–50.4 Gy). Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0).

Results

The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70), and comorbidities were common (Carlson comorbidity index ≥2 in 36%). Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.

Conclusion

Magnetic resonance imaging is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram-directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.