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Toesca DAS, Hartsell WF, DeWees TA, Chang J, Laughlin B, Voss MM, Mohammed N, Keole SR, McGee LA, Gondi V, Sweeney PJ, Dorn PL, Sinesi CC, Jr LSD, Rich TA, Vargas CE. Final Analysis of a Phase III Controlled Randomized Study of Stereotactic Body Proton Therapy or Conventionally Fractionated Proton Therapy for Early Prostate Cancer: PCG GU002. Int J Radiat Oncol Biol Phys 2023; 117:S24-S25. [PMID: 37784460 DOI: 10.1016/j.ijrobp.2023.06.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To determine if stereotactic body proton therapy (SBPT) is non-inferior to conventionally fractionated proton therapy (CFPT) in patients with early prostate cancer. MATERIALS/METHODS Multicenter, randomized, controlled, open-label, non-inferiority phase 3 trial that included patients with histologically confirmed low-risk prostate adenocarcinoma defined by Gleason score ≤6, PSA <10 ng/mL, and clinical stage T1-2a N0 M0 by AJCC 7th Ed. Eligible participants were randomly assigned (initially 1:1 and later 2:1 ratio) to CFPT (79.2 Gy in 44 fractions for 9 weeks) or SBPT (38 Gy in 5 fractions for 1 week). Concurrent or adjuvant androgen deprivation therapy was not allowed. The primary endpoint was freedom from failure (FFF) at 2 years, defined as the first occurrence of local, regional, or distant recurrence, biochemical failure by the Phoenix definition (increase of PSA ≥2 ng/mL over the nadir PSA), or the start of salvage therapy including ADT. Secondary endpoints included GI and GU grade ≥2 toxicity according to CTCAE v4 criteria, as well as health-related quality of life (HRQoL) metrics assessed by AUASI and EPIC scores. Non-inferiority would be declared if the 1-sided 95% confidence interval limit for the difference in 2-year FFF rate was below 4.2% between both groups by Clopper-Pearson exact method. RESULTS Between November 2010 and September 2020, 133 patients were enrolled and randomly assigned to CFPT (n = 45) or SBPT (n = 88). Median follow-up was 5 years (IQ 3.9-5.2), with the last patient enrolled followed for at least 2 years. The 2-year FFF was 100% for both groups, fulfilling the pre-specified criteria for non-inferiority of SBPT compared to CFPT. By KM estimates, 5-year FFF was 97.4% and 100% (P = 0.1), and the 5-year OS was 97.1% and 95.5% (P = 0.46) for patients treated with CFPT and SBPT, respectively. The cumulative incidence of any grade ≥3 toxicities at 5 years was 0% and 5.7% (P = 0.14) for patients treated with CFPT and SBPT, respectively. The frequency of GI grade ≥2 toxicity at 6 months was of 0% and 2.3% (P = 0.55), and at 2 years was of 6.7% and 3.4% (P = 0.69) for patients treated with CFPT and SBPT, respectively. The frequency of GU grade ≥2 toxicity at 6 months was of 2.2% and 5.7% (P = 0.42), and at 2 years was of 8.9% and 5.7% (P = 0.54) for patients treated with CFPT and SBPT, respectively. Changes in HRQoL scores at 2 years were similar between groups (Table). CONCLUSION SBPT is non-inferior to CFPT regarding FFF and associated with similar long-term toxicity rates and HRQoL metric scores.
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Affiliation(s)
- D A S Toesca
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | | | - T A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - J Chang
- The Oklahoma Proton Center and University of Oklahoma Health Science Center, Oklahoma City, OK
| | - B Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - M M Voss
- Department of Quantitative Health Sciences, Mayo Clinic, Arizona, Phoenix, AZ
| | - N Mohammed
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - S R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - V Gondi
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - P J Sweeney
- Northwestern Medicine Chicago Proton Center, Warrenville, IL
| | - P L Dorn
- Department of Radiation Oncology, Rocky Mountain Hospital for Children, Denver, CO
| | - C C Sinesi
- Hampton University Proton Therapy Institute, Hampton, VA
| | - L S Doh Jr
- Radiation Medicine Associates, Oklahoma City, OK
| | - T A Rich
- University of Virginia Medical Center, Charlottesville, VA
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
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