Unif orm Sc anning Prot on Therapy f or Prostat e Cancer: The Pr oCur e Oklahoma Experience Sameer Keole (1), Omar Zeidan (2), Rossio Rodriguez (3), Doug Smidebush (3), Kim Hahn (3), Elaine Nordhues (1), Gary La rson (1), Bryan Barriger (4), , Lucius Doh (1), Y uanshui Zheng (2), Carlos Vargas(5) (1) Radiaon Oncology, Radiaon Medicine Associates - ProCure Proton Therapy Center OK C, United States of America, (2) Physics, ProCure Proton Therapy Center Oklahoma, United States of , (3) Management, Proton Collaborave Group, United States of America , (4) Radiaon Oncology, Indiana University, United States of America (5) Radiaon Oncology, Proton Collaborave Group, United States of America INTRODUCTION Prot on therapy (PT) is a method of e xt ernal beam r adiaon therapy which can be used f or the definive tr eatment of pros tat e cancer (PC). The most common PT deliv ery method is double scaering (DS), but mor e r ecent delivery methods include scanning t echniques, both pencil beam scanning (PBS) and uniform scanning (US). US, v er sus DS, offer s sharper lat er al penumbra and, in theory, improved r ect al and bladder dosimetry . Our cent er was the 1st in the world to offer an e x clusiv ely US backbone f or tr eatment delivery . This r eport r epr esen ts the inial out comes f or paents with PC tr eat ed at our cent er who have a minimum of one y ear f ollow up. MATERIALS & METHODS 76 paents with PC consent ed to the out comes tr acking protocol RE G001-09 sponsor ed by the Proton Collaborave Gr oup (PCG) and met the r equir ement of a minimum of one y ear of f ollow up with complet ed Expanded Pros tat e cancer Inde x Composit e (EPIC) survey s. Adv er se events wer e r ecor ded using CT C scoring crit eria pr ospecv ely on all pa ents, pr e-tr eatment, during weekly tr eatment visits, and all f ollow-ups. The median age of the paent cohort was 65 (range 43 t o 84). Paents wer e tr eat ed to a target dose of 79.2 GY (RBE) in 44 daily fr acons, unless dose cons tr aints t o crical structur es (r ectum, bladder , or f emor al heads) wer e violat ed. 35 paents had low risk disease (st age I), 28 paents had int ermediat e risk disease (s tage IIA), and 13 paents had high risk disease (s tage IIB), as defined by AJCC 7th edion s t aging. 11 paents r eceiv ed androgen deprivaon therapy (ADT). Paents wer e asked to complet e the Expanded (EPIC) and A UA pr e-tr ea tment, at 3 months, 6 months, 12 months, 18 months and 24 months pos t-tr eatment. EPIC f orms wer e not collect ed at the conclusion of RT . RESULTS Genit ourinary (GU) and gas tr oint esnal (GI) funcon appear ed t o be stable in paents pos t-tr ea tment s t arng as early as 3 months pos t-tr eatment, as measur ed by the EPIC scor es. Ther e was no decline seen up to 2 y ear s pos t-RT . Ther e appear ed t o be a slight decline in se x ual scor e in men who did not r eceiv e ADT . Ther e wer e a small number of men who did r eceiv e ADT . Aﬅer disconnuaon of ADT , they did not see a further decline in se x ual funcon at 1 y ear pos t-tr eatment and bey ond. By CT C AE 4.0 to xicity scoring crit eria, ther e wer e no gr ade 3 or higher events in these 76 paents in an y measur ed domain. The most common gr ade 1 to xicity was derma s, seen in 58/76 paents. Gr ade 1/2GU urgency was seen in 66/76 paents, of which 49 wer e gr ade 1, 17 wer e gr ade 2. Diarrhea was seen in 13/76 paents. All diarrhea was gr ade 1. CONCLUSIONS E arly to xicity r esults from US PT f or PC demons trat es that the use of this modality is well-t olerat ed. Further f ollow up connues to be collect ed and will be r eport ed in futur e r eports.

Uniform Scanning Proton Therap for Prostate Cancer: The …Proton therapy (PT) is a method of external beam radiation therapy which can be used for the deﬁnitive treatment of prostate

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Page 1: Uniform Scanning Proton Therap for Prostate Cancer: The …Proton therapy (PT) is a method of external beam radiation therapy which can be used for the deﬁnitive treatment of prostate

Uniform Scanning Proton Therapy for Prostate Cancer: The ProCure Oklahoma Experience

Sameer Keole (1), Omar Zeidan (2), Rossio Rodriguez (3), Doug Smidebush (3), Kim Hahn (3), Elaine Nordhues (1), Gary Larson (1), Bryan Barriger (4), , Lucius Doh (1), Yuanshui Zheng (2), Carlos Vargas(5)

(1) Radiation Oncology, Radiation Medicine Associates - ProCure Proton Therapy Center OKC, United States of America, (2) Physics, ProCure Proton Therapy Center Oklahoma, United States of , (3) Management, Proton Collaborative Group, United States of America , (4) Radiation Oncology, Indiana University, United States of America (5) Radiation Oncology, Proton Collaborative Group, United States of America

INTRODUCTION Proton therapy (PT) is a method of external beam radiation therapy which can be used for the definitive treatment of prostate cancer (PC). The most common PT delivery method is double scattering (DS), but more recent delivery methods include scanning techniques, both pencil beam scanning (PBS) and uniform scanning (US). US, versus DS, offers sharper lateral penumbra and, in theory, improved rectal and bladder dosimetry. Our center was the 1st in the world to offer an exclusively US backbone for treatment delivery. This report represents the initial outcomes for patients with PC treated at our center who have a minimum of one year follow up.

MATERIALS & METHODS 76 patients with PC consented to the outcomes tracking protocol REG001-09 sponsored by the Proton Collaborative Group (PCG) and met the requirement of a minimum of one year of follow up with completed Expanded Prostate cancer Index Composite (EPIC) surveys. Adverse events were recorded using CTC scoring criteria prospectively on all patients, pre-treatment, during weekly treatment visits, and all follow-ups. The median age of the patient cohort was 65 (range 43 to 84). Patients were treated to a target dose of 79.2 GY (RBE) in 44 daily fractions, unless dose constraints to critical structures (rectum, bladder, or femoral heads) were violated. 35 patients had low risk disease (stage I), 28 patients had intermediate risk disease (stage IIA), and 13 patients had high risk disease (stage IIB), as defined by AJCC 7th edition staging. 11 patients received androgen deprivation therapy (ADT). Patients were asked to complete the Expanded (EPIC) and AUA pre-treatment, at 3 months, 6 months, 12 months, 18 months and 24 months post-treatment. EPIC forms were not collected at the conclusion of RT.

RESULTS Genitourinary (GU) and gastrointestinal (GI) function appeared to be stable in patients post-treatment starting as early as 3 months post-treatment, as measured by the EPIC scores. There was no decline seen up to 2 years post-RT. There appeared to be a slight decline in sexual score in men who did not receive ADT. There were a small number of men who did receive ADT. After discontinuation of ADT, they did not see a further decline in sexual function at 1 year post-treatment and beyond. By CTC AE 4.0 toxicity scoring criteria, there were no grade 3 or higher events in these 76 patients in any measured domain. The most common grade 1 toxicity was dermatitis, seen in 58/76 patients. Grade 1/2GU urgency was seen in 66/76 patients, of which 49 were grade 1, 17 were grade 2. Diarrhea was seen in 13/76 patients. All diarrhea was grade 1.

CONCLUSIONS Early toxicity results from US PT for PC demonstrates that the use of this modality is well-tolerated. Further follow up continues to

be collected and will be reported in future reports.