Authors (including presenting author) :
Wu PY(1), Hung HM(1), Wong KW(2), Li CM(2), Yu MH(2), Lui KL(2), Lai AYT(3), Kam TY(1), Liu TC(1), Chan K(1)
Affiliation :
(1) Department of Clinical Oncology, (2) Department of Surgery (3) Department of Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital
Introduction :
Prostate cancer is the fourth most common cancer in Hong Kong. Majority of patients present as localised disease and are amendable to curative treatment. Conventional external beam radiotherapy (EBRT) involves 38 treatment fractions delivered over eight weeks. Despite representing an effective radical treatment, survivors are at risk of developing long term toxicities including radiation proctitis. There is increasing demand for high quality radiotherapy techniques. With evolution of radiotherapy technology and image guidance to allow increased treatment precision, paradigm has shifted to the adoption of hypofractionated treatment schedules. Furthermore, stereotactic ablative body radiotherapy (SBRT) has demonstrated excellent clinical outcomes across clinical trials. The use of perirectal spacer device has also emerged as an attractive measure to mitigate rectal toxicity and improve quality of life. Implementation of SBRT for prostate cancer requires the coordination of professional input across a multidisciplinary team (MDT).
Objectives :
To describe the implementation of a multidisciplinary integrated Uro-Oncology service model to provide SBRT for prostate cancer in PYNEH, and report on early treatment outcomes.
Methodology :
A dedicated MDT of Clinical Oncologists, Urologists, Radiologists, Radiation Therapists, Medical Physicists and Specialist Nurse was formed in February 2022, and a service protocol was established. Patients with low or intermediate-risk prostate cancer were selected after MDT review. Streamlined workflow, consisting of consultations, procedures for fiducial marker and perirectal spacer placement, MR and CT simulation, radiotherapy planning, verification and delivery was followed. Patients were supported by dedicated Radiation Therapist and Nurse Specialists. Radiotherapy plan quality, and early treatment outcomes were retrospectively reviewed.
Result & Outcome :
Eight patients received SBRT from April to December 2022. Treatment consisted of 5 fractions delivered over two weeks, which commenced within two weeks of simulation. SBRT dosimetry objectives were fulfilled for all patients. The use of perirectal spacer successfully reduced the volume of high dose to rectum. Early PSA response was remarkable. The median PSA decline was 82% (from baseline median of 8.4ng/mL) in the first six months. No severe acute radiotherapy toxicity was noted. Conclusion: Implementation of SBRT for prostate cancer under an integrated MDT approach safeguards the quality and safety of radiotherapy planning and delivery. High treatment precision allows adoption of ultra-hypofractionation schedules with significant reduction in treatment attendance of 33 sessions per patient, favourable in public hospital setting.
