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Publications

Journal Article Ahead of print

PubMed: 42435987 DOI: 10.1016/j.prro.2026.06.015

"Cumulative incidence of toxicity between 2 and 5 years following SBRT to the prostate and pelvis nodes in patients with high-risk prostate cancer ".

Pract Radiat Oncol

Authors: Constanza Martinez, Fabio Cury, Marie Duclos, James Man Git Tsui, Ackeem Joseph, Horacio Patrocinio, Luis Souhami, Sergio Faria

Affiliations

  • Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada.
  • Department of Medical Physics, McGill University Health Centre, Montreal, Canada.
  • Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada.

Abstract

BACKGROUND AND PURPOSE

Stereotactic body radiotherapy (SBRT) is increasingly used for localized prostate cancer, but data on SBRT with pelvic nodal irradiation in patients with high-risk disease remain limited. We report late genitourinary (GU) and gastrointestinal (GI) toxicities and clinical outcomes in patients with high-risk prostate cancer treated with SBRT in 5 fractions to the prostate and pelvic lymph nodes.

MATERIALS AND METHODS

We reviewed 101 patients with high-risk prostate cancer treated with SBRT between August 2019 and May 2023. Treatment consisted of 36.25 Gy in 5 fractions to the prostate with a simultaneous dose of 25 Gy to the pelvic lymph nodes. Patients received 6 to 18 months of androgen deprivation therapy. Toxicity was prospectively assessed according to CTCAE version 4.0. Late toxicity was defined as events occurring ≥ 3 months after SBRT. Survival outcomes were estimated using Kaplan-Meier methods.

RESULTS

All patients had a minimum follow-up of 24 months. With a median follow-up of 43.8 months (range 26-70 months), late grade 1 and 2 GI toxicity occurred in 4 patients (4%), including three cases of rectal bleeding and one case of fecal incontinence. Late grade 1 and 2 GU toxicity occurred in 13 patients (13%), including 5 grade 2 events (5%). No grade ≥ 3 GI or GU toxicity was observed. The 5-year actuarial biochemical recurrence-free survival was 89.5%, with distant metastasis-free survival of 96.2% and overall survival of 98.8%.

CONCLUSION

SBRT delivered in five fractions with pelvic nodal irradiation appears feasible and associated with low rates of late GU and GI toxicity in patients with high-risk prostate cancer. Ongoing randomized trials will provide definitive evidence regarding the role of SBRT with pelvic nodal irradiation in this population.

MeSH

Radiation Oncology, Lymph Nodes, Incidence, Neoplasms, Prostate, Lymph, Prostatic Neoplasms, Therapeutics