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Clinical Evaluation of Prostate Cancer Patients with Metallic Hip Prosthesis Using Anterior-Oblique and Lateral Proton Beams

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S Rana

S Rana1*, Y Zheng2 , G Larson3 , J Bennouna1 , A Gutierrez1 , C Vargas4 , (1) Miami Cancer Institute , Miami, FL, (2) Atlantic Health System, Morristown, NJ, (3) ProCure Proton Therapy Center, Oklahoma City, Oklahoma, (4) Mayo Clinic, Phoenix, Arizona


SU-I-GPD-T-207 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: The purpose of this study is to (1) evaluate the feasibility of treating unilateral metallic hip prosthesis prostate cancer cases with a combination of two anterior-oblique and one lateral uniform scanning proton beams, and (2) present clinical results of these cases.

Methods: Three prostate cancer cases treated at a single institution were selected based on the following criteria (i)patient had undergone an unilateral metallic hip replacement prior to treatment,(ii)no lymph node included in the CTV,(iii)beam delivery using 2 fields/day(lateral:daily; anterior-oblique:every other day),(iv)total prescription dose of 79.2 Gy(RBE), and (v)participation in Proton Collaborative Group protocol REG001-09(NCT01255748) with at least 3 years follow-up

Results: The average follow-up was 40 months. The rectal V70 were 11.0,3.6, and 3.9% in cases 1,2 and 3,respectively. Cases 1 and 3 experienced acute Grade 1 gastrointestinal toxicity with rectal NTCPs of 0.7 and 0.1%, and rectal EUDs of 50.3 and 40.1 Gy(RBE),respectively. The rectal EUD and NTCP of case 2 were 41.4 Gy(RBE) and 0.1%,respectively. All three cases experienced acute Grade 2 urinary toxicity, with bladder NTCPs of 0.9,0.2, and 0.4%, the bladder V80 of 6.3,1.0, and 1.1 cc, and the bladder EUDs of 57.7,48.8, and 54.1 Gy(RBE) in the first,second, and third cases, respectively. All three cases developed Grade 1 hip toxicity (pain) with femoral NTCPs below 0.01%. Cases 1 and 3 experienced acute Grade 2 erectile dysfunction. None of the three cases evaluated in this study experienced Grade≥2 gastrointestinal toxicity, Grade≥3 urinary toxicity, or hip fracture. Furthermore, all three cases presented in this study are now considered free of disease.

Conclusion: A combination of one lateral and two anterior-oblique uniform scanning proton beams produced acceptable clinical results for prostate cancer patients who had undergone metallic hip replacement. Clinical studies utilizing anterior-oblique beams in pencil beam scanning proton therapy for prostate cancer cases is warranted.

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