CyberKnifeTM for the Treatment of Non-Metastatic Prostate Cancer

Seung Joon Lee; Kanghyon Song; Jong Wook Park; Myung Cheol Gil; Moon Ki Jo

doi:10.4111/kju.2009.50.8.744

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Lee, Song, Park, Gil, and Jo: CyberKnifeTM for the Treatment of Non-Metastatic Prostate Cancer

Original Article

Korean J Urol 2009;50(8):744-750.

Published online: 17 August 2009

DOI: https://doi.org/10.4111/kju.2009.50.8.744

CyberKnife^TM for the Treatment of Non-Metastatic Prostate Cancer

Seung Joon Lee, Kanghyon Song, Jong Wook Park, Myung Cheol Gil, Moon Ki Jo

Department of Urology, Korea Cancer Center Hospital, Seoul, Korea

Correspondence to: Moon Ki Jo, Department of Urology, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea TEL: 02-970-1299 FAX: 02-978-2005 E-mail: andrea@kcch.re.kr

Received 23 June 2009 Accepted 27 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The radiobiology of prostate cancer favors a hypofractionated dose regimen. We report here our experience with the CyberKnife^TM, demonstrating its efficacy, safety, and feasibility as a treatment modality for non-metastatic prostate cancer.

Materials and Methods

Between October 2002 and April 2006, 20 patients with biopsy-proven prostate cancer were treated with the CyberKnife^TM. The distribution of clinical risks, as assessed by using D'Amico's definition for risk grouping, was as follows: low (4), intermediate (5), and high (11). Three patients received 32 Gy, 7 patients received 34 Gy, and 10 patients received 36 Gy. All patients received the radiation doses in 4 fractions. The rectal and bladder toxicities were graded by using the criteria set forth by the Radiation Therapy Oncology Group (RTOG).

Results

The mean patient age was 71.4 years (range, 52-79 years), and the mean followup period was 35.5 months (range, 8-74 months). There were 2 acute and 1 late grade 2 gastrointestinal toxicities, and 1 acute and 2 late grade 2 urinary toxicities. The 5-year overall survival rate was 100%, respectively. The 5-year biochemical failure-free rate of the low-risk, intermediate-risk, and high-risk patients was 100%, 100%, and 90.9%, respectively.

Conclusions

CyberKnife^TM is a safe, well-tolerated, and rather effective treatment for non-metastatic prostate cancer. We obtained a 100% 5-year biochemical failure-free rate in low-risk and intermediate-risk patients. CyberKnife^TM is a viable option for the treatment of non-metastatic prostate cancer.

Keywords: Prostatic neoplasms, Radiation, Radiosurgery

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Fig. 1.

CyberKnife^TM treatment planning for prostate and critical organs in the Accuray multiplan system.

Fig. 2.

Prostate-specific antigen (PSA) response plotted as mean PSA as a function of time after CyberKnife^TM treatment. The error bar indicates ±1 SD from the mean. SD: standard deviation, CK: CyberKnife^TM.

Fig. 3.

Kaplan-Meier actuarial probability of the biochemical failure-free survival rate according to risk group. CK: CyberKnife^TM.

Table 1.

Clinical characteristics of the 20 consecutive prostate cancer patients treated with the CyberKnife^TM

Case number	Age (years)	Pre-treatment PSA	Gleason score	Clinical stage	Prognostic groups^a
Non-hormonal treatment group
1	70	7.5	3+3	2a	Low
2	79	5.4	3+3	1c	Low
3	68	7.7	2+2	1c	Low
4	78	1.7	3+3	2a	Low
5	73	14.9	2+2	2a	Intermediate
6	74	11.9	2+2	2a	Intermediate
7	65	11.0	3+3	1c	Intermediate
8	77	19.6	4+3	1c	Intermediate
9	75	10.5	4+3	1c	Intermediate
Hormonal treatment group
10	76	4.0	4+4	2a	High
11	76	29.9	1+1	2a	High
12	77	19.6	4+5	3a	High
13	70	115.0	4+4	3a	High
14	66	40.9	2+2	2c	High
15	75	78.6	4+3	1c	High
16	69	38.0	3+3	2b	High
17	75	20.6	4+4	3b	High
18	65	7.5	4+3	2c	High
19	67	62.7	4+4	2c	High
20	52	32.5	4+4	1c	High

PSA: prostate-specific antigen

^a low-risk: PSA level≤10 ng/ml and Gleason score≤6, stage T1c, T2a, intermediate-risk: PSA level >10 and ≤20 ng/ml or Gleason score 7 or stage T2b, high-risk: PSA level >20 ng/ml or Gleason score ≥8 or stage ≥T2c

Table 2.

Number of patients achieving a given PSA nadir threshold as a function of time after CyberKnife^TMtreatment

PSA nadir	No. of patients achieving PSA nadir by followup time
PSA nadir	At 1 year (10 patients)	At 2 year (5 patients)	At 3 year (5 patients)
0-0.2 ng/ml	7	2	3
0.2-0.5 ng/ml	3	2	1
0.5-1.0 ng/ml	0	1	0
>1.0 ng/ml	0	0	1

PSA: prostate-specific antigen

Table 3.

Acute and late lower gastrointestinal and urinary toxicity on the RTOG scale after CyberKnife^TM treatment

		RTOG grade
		0	1	2	3	4	+5
Lower gastrointestinal toxicity % (no. of patients)	Acute	65% (13)	25% (5)	10% (2)	-	-	-
	Late	85% (17)	10% (2)	5% (1)	-	-	-
Urinary toxicity % (no. of patients)	Acute	80% (16)	15% (3)	5% (1)	-	-	-
	Late	65% (13)	25% (5)	10% (2)	-	-	-

RTOG: radiation therapy oncology group

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