Palliative Radiation May Ease Pelvic Tumor Symptoms in CRPC Patients

The treatment was most effective in relief of macroscopic hematuria.
The treatment was most effective in relief of macroscopic hematuria.

Palliative pelvic radiotherapy (PPRT) can alleviate symptoms in men with castration-resistant prostate cancer (CRPC) and symptomatic pelvic tumors, according to a Norwegian study.

Marte Grønlie Cameron, MD, of Sørlandet Hospital in Kristiansand, and colleagues prospectively studied 47 CRPC patients with a symptomatic pelvic mass who were prescribed PPRT with 30–39 Gy.  The most common target symptoms were lower urinary tract symptoms (LUTS, 45%), macroscopic hematuria (26%), and pain (19%). The study's primary endpoint was patient-reported improvement or complete resolution of target symptoms 12 weeks after PPRT.

Of the 40 patients evaluable for target symptom severity 12 weeks after PPRT, 18 reported complete resolution, 10 reported improvement, 10 reported unchanged severity, and 2 reported worsening target symptoms, Dr. Cameron's group reported online ahead of print in Radiotherapy and Oncology. Improvement or complete resolution of the target symptom was achieved in 62% of evaluable patients at the end of radiotherapy, 80% after 6 weeks, and 70% after 12 weeks. Based on an intent-to-treat analysis, the overall response rate for the 47 patients enrolled in the study was 60% after 12 weeks. For the patients with LUTS, hematuria, and pain, the response rates were 38%, 92%, and 78%, respectively.

The most frequent toxicity—occurring in 50% of patients—was transient mild to moderate diarrhea at the end of PPRT. No grade 4 toxicities were observed.

“This study demonstrates that in patients with CRPC, symptoms resulting from an advanced pelvic tumor are well-palliated with PPRT,” the authors wrote.

The investigators stated that, to their knowledge, their study is the first prospective investigation “exploring symptomatic effects of PPRT of CRPC, yielding information not only about the magnitude, but also the onset and duration of effects and toxicities.”

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