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Ahrens C, Beatrice L, Meier V, Rohrer Bley C. Radiation toxicity grading after chemoradiotherapy of canine urinary tract carcinomas: Comparing VRTOG to VRTOG_v2.0. Vet Comp Oncol 2024; 22:255-264. [PMID: 38544415 DOI: 10.1111/vco.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
Radiation toxicities may be underestimated after treatment of transitional cell carcinoma in dogs' lower urinary tract. Assessing acute and late toxicities and differentiating them from progressive disease (PD) impacts further therapeutic approach. We retrospectively assessed dogs treated with definitive-intent chemoradiotherapy (12 × 3.8 Gy, various first-line chemotherapeutics). Local tumour control, radiation toxicities and survival were evaluated. We classified radiation toxicities according to the previously published radiation toxicity scheme "VRTOG" as well as the updated version, "VRTOG_v2.0". Fourteen dogs with transitional cell carcinoma of bladder ± urethra (n = 8), +prostate (n = 3) or solely urethra (n = 3), were included. Median follow-up was 298 days (range 185-1798 days), median overall survival 305 days (95%CI = 209;402) and 28.6% deaths were tumour-progression-related. Acute radiation toxicity was mild and self-limiting with both classification systems: In VRTOG, 5 dogs showed grade 1, and 1 dog grade 2 toxicity. In VRTOG_v2.0, 2 dogs showed grade 1, 3 dogs grade 2, and 3 dogs grade 3 toxicity. Late toxicity was noted in 14.2% of dogs (2/14) with the VRTOG, both with grade 3 toxicity. With VRTOG_v2.0, a larger proportion of 42.9% of dogs (6/14) showed late toxicities: Four dogs grade 3 (persistent incontinence), 2 dogs grade 5 (urethral obstructions without PD resulting in euthanasia). At time of death, 5 dogs underwent further workup and only 3 were confirmed to have PD. With the updated VRTOG_v2.0 classification system, more dogs with probable late toxicity are registered, but it is ultimately difficult to distinguish these from disease progression as restaging remains to be the most robust determinant.
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Affiliation(s)
- Carlotta Ahrens
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Laura Beatrice
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Valeria Meier
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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Hasterok M, Szołtysik M, Nowicka Z, Goc B, Gräupner D, Majewski W, Rasławski K, Rajwa P, Jabłońska I, Magrowski Ł, Przydacz M, Krajewski W, Masri O, Miszczyk M. Rectum and Bladder Toxicity in Postoperative Prostate Bed Irradiation: Dose-Volume Parameters Analysis. Cancers (Basel) 2023; 15:5334. [PMID: 38001594 PMCID: PMC10670737 DOI: 10.3390/cancers15225334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 (p < 0.001 and p < 0.001) and rectum wall V46 (p = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 (p = 0.019 and p = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall (p = 0.004) and bladder (p = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.
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Affiliation(s)
- Maja Hasterok
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Monika Szołtysik
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15, 92-215 Lodz, Poland;
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Donata Gräupner
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Wojciech Majewski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Konrad Rasławski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Department of Urology, Medical University of Silesia, 3-go Maja 13-15, 41-800 Zabrze, Poland
| | - Iwona Jabłońska
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland;
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Oliwia Masri
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
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Cousins MM, Heckman P, Short E, Narayana V, Bryant AK, Evans C, Hixson G, Hurley P, McLaughlin PW. Rectal sparing in prostate radiotherapy with combination-brachytherapy and hydrogel spacer. Brachytherapy 2022; 21:300-307. [DOI: 10.1016/j.brachy.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/11/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
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Biopolymer and Biomaterial Conjugated Iron Oxide Nanomaterials as Prostate Cancer Theranostic Agents: A Comprehensive Review. Symmetry (Basel) 2021. [DOI: 10.3390/sym13060974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in men and the leading cause of death for men all over the world. Early diagnosis is the key to start treatment at an early stage of PCa and to reduce the death toll. Generally, PCa expresses characteristic morphologic features and serum biomarkers; however, early diagnosis is challenging due to its heterogeneity and long-term indolent phase in the early stage. Following positive diagnosis, PCa patients receive conventional treatments including surgery, radiation therapy, androgen deprivation therapy, focal therapy, and chemotherapy to enhance survival time and alleviate PCa-related complications. However, these treatment strategies have both short and long-term side effects, notably impotence, urinary incontinence, erectile dysfunctions, and recurrence of cancer. These limitations warrant the quest for novel PCa theranostic agents with robust diagnostic and therapeutic potentials to lessen the burden of PCa-related suffering. Iron oxide nanoparticles (IONPs) have recently drawn attention for their symmetrical usage in the diagnosis and treatment of several cancer types. Here, we performed a systematic search in four popular online databases (PubMed, Google Scholar, Scopus, and Web of Science) for the articles regarding PCa and IONPs. Published literature confirmed that the surface modification of IONPs with biopolymers and diagnostic biomarkers improved the early diagnosis of PCa, even in the metastatic stage with reliable accuracy and sensitivity. Furthermore, fine-tuning of IONPs with biopolymers, nucleic acids, anticancer drugs, and bioactive compounds can improve the therapeutic efficacy of these anticancer agents against PCa. This review covers the symmetrical use of IONPs in the diagnosis and treatment of PCa, investigates their biocompatibility, and examines their potential as PCa theranostic agents.
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Onderdonk BE, Dorn PL, Martinez C, Arif F, Cloutier D, Antic T, Golden DW, Karrison T, Pitroda SP, Szmulewitz RZ, Liauw SL. A prospective clinical and transcriptomic feasibility study of oral-only hormonal therapy with radiation for unfavorable prostate cancer in men 70 years of age and older or with comorbidity. Cancer 2021; 127:2631-2640. [PMID: 33882144 DOI: 10.1002/cncr.33556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/05/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) improves outcomes in unfavorable-risk prostate cancer (PCa) treated with radiation therapy (RT). It was hypothesized that replacing luteinizing hormone-releasing hormone (LHRH) agonists with a 5-α-reductase inhibitor (5-ARI) would improve hormonal health-related quality of life (HRQOL) without differentially suppressing androgen-responsive (AR) gene expression. METHODS Patients with localized unfavorable-risk PCa, aged ≥70 years or Charlson Comorbidity Index score ≥2 were treated with oral ADT (oADT), consisting of 4 months of bicalutamide, a 5-ARI, and RT at 78 Gy. The primary end point was Expanded Prostate Cancer Index Composite HRQOL at 6 months ≤30%, and improvement compared with a synchronous standard of care (SOC) cohort receiving 4 months of bicalutamide and long-term LHRH agonist with RT. RNA sequencing was performed from matched pre-/post-ADT prostate tumor biopsies in a subset of men. Differential gene and pathway expressional changes were examined using gene set enrichment. RESULTS Between 2011 and 2018, 40 and 30 men were enrolled in the oADT and SOC cohorts, respectively. Median follow-up was 40 months. Those with ≤30% decline in hormonal HRQOL at 6 months was 97% (oADT) and 93% (SOC). The average 6-month hormonal decline was 1% (oADT) versus 12% (SOC; P = .04). The 4-year freedom from biochemical failure was 88% (oADT) versus 81% (SOC; P = .48). RNA sequencing (n = 9) showed similar numbers of downregulated and upregulated genes between the treatment groups (fold-change = 2; false-discovery rate-adjusted P ≤ .05). Both treatments comparably decreased the expression of 20 genes in canonical androgen receptor signaling. CONCLUSIONS For men with PCa undergoing RT, oral versus standard ADT may improve 6-month QOL and appears to have a similar impact on androgen-responsive gene expression.
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Affiliation(s)
- Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Paige L Dorn
- Rose Medical Center Radiation Oncology, Denver, Colorado
| | - Carlos Martinez
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Fauzia Arif
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Denise Cloutier
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Theodore Karrison
- Department of Biostatistics, University of Chicago Medicine, Chicago, Illinois
| | - Sean P Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | | | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
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Turchan WT, Gutiontov SI, Spiotto MT, Liauw SL. Prostate Cancer Radiotherapy: Increased Biochemical Control and Late Toxicity in Men With Medication Allergies. JNCI Cancer Spectr 2020; 4:pkaa081. [PMID: 33409456 PMCID: PMC7771007 DOI: 10.1093/jncics/pkaa081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Given similarities in the mediators of medication allergy (MA) and tissue response to radiotherapy, we assessed whether outcomes following prostate radiotherapy differ in patients with MAs.
Methods
A total 587 men with known MA history and nonmetastatic prostate cancer underwent radiotherapy from 1989 to 2006. Clinicopathologic and treatment variables were analyzed for association with freedom from biochemical failure (FFBF) and late treatment–related, physician-defined Radiation Therapy Oncology Group gastrointestinal (GI) and genitourinary (GU) toxicity. Covariates identified on univariate analysis for toxicity and disease control were examined on multivariable analysis. All statistical tests were 2-sided, and a P less than .05 was considered statistically significant.
Results
A total of 155 of 587 men (26.4%) had 1 or more MAs, most commonly to penicillin (n = 71), sulfa (n = 35), and aspirin or nonsteroidal antiinflammatory drugs (n = 28). On univariate analysis, men with MAs had superior 10-y FFBF (71.5% vs 63.5%, P = .02) and higher incidence of late GI grade 2 or higher (G2+; 20.6% vs 13.2%, P = .04) and grade 3 or higher (G3+; 7.5% vs 3.9%, P = .08) as well as late GU G2+ (42.5% vs 33.2%, P = .04) and G3+ (7.5% vs 3.0%, P = .02) toxicity than men without MAs. On multivariable analysis, MA history remained a statistically significant predictor of FFBF (hazard ratio [HR] = 0.64, 95% confidence interval [CI] = 0.43 to 0.93, P = .02), late G2+ GI (HR = 1.76, 95% CI = 1.06 to 2.90, P=.03), and G3+ GU (HR = 2.69, 95% CI = 1.16 to 6.27, P = .02) toxicity after controlling for corresponding covariates in each model.
Conclusions
Men with MAs had improved FFBF and increased treatment-related toxicity following radiotherapy for prostate cancer. MA history could be a relevant consideration in the management of men with localized prostate cancer.
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Affiliation(s)
- William Tyler Turchan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Michael T Spiotto
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy. Sci Rep 2020; 10:114. [PMID: 31924839 PMCID: PMC6954263 DOI: 10.1038/s41598-019-57056-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022] Open
Abstract
The safety and efficacy of dose-escalated radiotherapy with intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) remain unclear in salvage radiotherapy (SRT) after radical prostatectomy. We examined the impact of these advanced radiotherapy techniques and dose intensification on the toxicity of SRT. This multi-institutional retrospective study included 421 patients who underwent SRT at the median dose of 66 Gy in 2-Gy fractions. IMRT and IGRT were used for 225 (53%) and 321 (76%) patients, respectively. At the median follow-up of 50 months, the cumulative incidence of late grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities was 4.8% and 24%, respectively. Multivariate analysis revealed that the non-use of either IMRT or IGRT, or both (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.8-5.4, p < 0.001) and use of whole-pelvic radiotherapy (HR 7.6, CI 1.0-56, p = 0.048) were associated with late GI toxicity, whereas a higher dose ≥68 Gy was the only factor associated with GU toxicities (HR 3.1, CI 1.3-7.4, p = 0.012). This study suggested that the incidence of GI toxicities can be reduced by IMRT and IGRT in SRT, whereas dose intensification may increase GU toxicity even with these advanced techniques.
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Takemoto S, Shibamoto Y, Sugie C, Manabe Y, Yanagi T, Iwata H, Murai T, Ishikura S. Long-term results of intensity-modulated radiotherapy with three dose-fractionation regimens for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2019; 60:221-227. [PMID: 30566649 PMCID: PMC6430249 DOI: 10.1093/jrr/rry089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/18/2018] [Indexed: 06/09/2023]
Abstract
We evaluated long-term outcomes of three protocols of intensity-modulated radiation therapy (IMRT) for localized prostate cancer. Between 2005 and 2014, 348 patients were treated with 5-field IMRT. The first 74 patients were treated with a daily fraction of 2.0 Gy to 74 Gy (low-risk prostate cancer) or 78 Gy (intermediate- or high-risk prostate cancer); then 101 patients were treated with 2.1-Gy daily fractions to 73.5 or 77.7 Gy. More recently, 173 patients were treated with 2.2-Gy fractions to 72.6 or 74.8 Gy. The median age of all patients was 70 years and the median follow-up period was 82 months. The median follow-up periods were 124 months in the 2.0-Gy group, 98 months in the 2.1-Gy group, and 69 months in the 2.2-Gy group. The overall and prostate-specific antigen (PSA) failure-free survival (PSA-FFS) rates were, respectively, 89 and 68% at 10 years for the 2.0-Gy group, 91 and 84% at 8 years for the 2.1-Gy group, and 93 and 92% at 6 years for the 2.2-Gy group. The PSA-FFS rate for high-risk patients in all groups was 80% at 7 years. The cumulative incidences of Grade ≥2 late genitourinary (GU) and gastrointestinal (GI) toxicity were, respectively, 7.2 and 12.4% at 10 years for the 2.0-Gy group, 7.4 and 14.1% at 8 years for the 2.1-Gy group, and 7.1 and 7.9% at 6 years for the 2.2-Gy group. All three fractionation schedules yielded good tumor control with acceptable toxicities.
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Affiliation(s)
- Shinya Takemoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
- Department of Radiology, Fujieda Heisei Memorial Hospital, 123-1 Mizukami, Fujieda, Shizuoka, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Yoshihiko Manabe
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Shimajiri-gun, Okinawa, Japan
| | - Takeshi Yanagi
- Department of Radiology, Narita Memorial Hospital, 134 Haneihonmachi, Toyohashi, Aichi, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1–1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
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Detti B, Baki M, Becherini C, Saieva C, Scartoni D, Giacomelli I, Trombetta L, Muntoni C, Olmetto E, Francolini G, Turkaj A, Topulli J, Ciabatti C, Carta G, Poggesi L, Delli Paoli C, Terziani F, Grassi R, Livi L. High-dose intensity-modulated radiation therapy as primary treatment of prostate cancer: genitourinary/gastrointestinal toxicity and outcomes, a single-institution experience. Radiol Med 2019; 124:422-431. [PMID: 30607866 DOI: 10.1007/s11547-018-0977-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/05/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Prostatectomy, radiotherapy and watchful waiting are the main therapeutic options available for local stage of prostate cancer (PCa). We report our experience on 394 patients affected by prostate cancer primarily treated with high-dose, image-guided, IMRT, focusing on gastrointestinal, genitourinary toxicities and biochemical control. METHODS From July 2003 to August 2014, 394 patients were treated with radical high-dose radiotherapy (HDRT) for prostate cancer; the mean total radiation dose was 79 Gy in standard fractions. Hormonal therapy (HT) was administered to 7.6% of low-risk patients, to 20.3% of intermediate-risk patients and to 72% of high-risk patients. Patients were evaluated for biochemical failure, local recurrence (LR) and metastases. RESULTS Ninety-seven patients (26.65%) developed acute GU toxicity at the medium dose of 25.4 Gy, grade 1 (G1) or grade 2 (G2) in 94 cases. Only 16 patients (4.06%) reported chronic GU toxicity (G1 or G2), and one case developed G3 cystitis. No G3 GI acute and late toxicity were detected. Fifty-six (14.2%) patients experienced LR, 26 (6.6%) developed metastases and 70 patients (17.8%) were deceased. Gleason sum score > 7 was predictive for worse overall survival (GS = 7 was borderline) and for metastasis. No factors resulted predictive for local relapse. HT pre-RT had been demonstrated as a negative predictor for OS and DFS-DM. CONCLUSIONS Data confirm the safety of HDRT for PCa. Treatment was efficient with low toxicity profile. Moreover, continued technologic advancements, as image-guided radiotherapy, could lead to further reduction in toxicity, thus increasing the therapeutic index.
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Affiliation(s)
- Beatrice Detti
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Muhammed Baki
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), University of Florence, Florence, Italy
| | - Daniele Scartoni
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Irene Giacomelli
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Laura Trombetta
- Department of Radiation Oncology, University of Florence, Florence, Italy.
| | - Cristina Muntoni
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Ana Turkaj
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Juliana Topulli
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Cinzia Ciabatti
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Giulio Carta
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Linda Poggesi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | | | - Francesca Terziani
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Roberta Grassi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, University of Florence, Florence, Italy
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10
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Haekal M, Arimura H, Hirose TA, Shibayama Y, Ohga S, Fukunaga J, Umezu Y, Honda H, Sasaki T. Computational analysis of interfractional anisotropic shape variations of the rectum in prostate cancer radiation therapy. Phys Med 2018. [PMID: 29519405 DOI: 10.1016/j.ejmp.2017.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To analyze the uncertainties of the rectum due to anisotropic shape variations by using a statistical point distribution model (PDM). MATERIALS AND METHODS The PDM was applied to the rectum contours that were delineated on planning computed tomography (CT) and cone-beam CT (CBCT) at 80 fractions of 11 patients. The standard deviations (SDs) of systematic and random errors of the shape variations of the whole rectum and the region in which the rectum overlapped with the PTV (ROP regions) were derived from the PDMs at all fractions of each patient. The systematic error was derived by using the PDMs of planning and average rectum surface determined from rectum surfaces at all fractions, while the random error was derived by using a PDM-based covariance matrix at all fractions of each patient. RESULTS Regarding whole rectum, the population SDs were larger than 1.0 mm along all directions for random error, and along the anterior, superior, and inferior directions for systematic error. The deviation is largest along the superior and inferior directions for systematic and random errors, respectively. For ROP regions, the population SDs of systematic error were larger than 1.0 mm along the superior and inferior directions. The population SDs of random error for the ROP regions were larger than 1.0 mm except along the right and posterior directions. CONCLUSIONS The anisotropic shape variations of the rectum, especially in the ROP regions, should be considered when determining a planning risk volume (PRV) margins for the rectum associated with the acute toxicities.
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Affiliation(s)
- Mohammad Haekal
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetaka Arimura
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Taka-Aki Hirose
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yusuke Shibayama
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Saiji Ohga
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Junichi Fukunaga
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshiyuki Umezu
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Honda
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomonari Sasaki
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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11
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Dijkstra S, Govers TM, Hendriks RJ, Schalken JA, Van Criekinge W, Van Neste L, Grutters JPC, Sedelaar JPM, van Oort IM. Cost-effectiveness of a new urinary biomarker-based risk score compared to standard of care in prostate cancer diagnostics - a decision analytical model. BJU Int 2017; 120:659-665. [PMID: 28370948 DOI: 10.1111/bju.13861] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx; MDxHealth, Inc., Irvine, CA, USA) to identify patients for transrectal ultrasonography (TRUS)-guided biopsy and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUS-guided biopsy. MATERIALS AND METHODS A decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test vs SOC in men with a PSA level of >3 ng/mL. Transition probabilities, utilities and costs were derived from the literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions. RESULTS A diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade prostate cancer resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses showed that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUS-guided biopsy only slightly influenced the outcome of the model. CONCLUSION Based on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the SelectMDx test in men with PSA levels of >3 ng/mL may lead to a reduction in total costs per patient and a gain in QALYs.
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Affiliation(s)
- Siebren Dijkstra
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne J Hendriks
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Van Criekinge
- Department of Mathematical Modelling, Statistics and Bioinformatics, Ghent University, Ghent, Belgium
| | - Leander Van Neste
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Janneke P C Grutters
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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12
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Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion. AJR Am J Roentgenol 2017; 208:1058-1063. [PMID: 28225639 DOI: 10.2214/ajr.16.17322] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective. MATERIALS AND METHODS A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed. RESULTS The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective. CONCLUSION Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.
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13
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Chin S, Hayden AJ, Gebski V, Cross S, Turner SL. Long Term Patient Reported Urinary Function Following External Beam Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:421-428. [PMID: 28202212 DOI: 10.1016/j.clon.2017.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 01/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study reports long-term patient reported urinary function and urinary-related quality of life (uQoL) after external beam radiotherapy (EBRT) for localized prostate cancer. METHODS 574 men underwent definitive prostate EBRT to 70-78 Gy±androgen deprivation therapy between 2000 and 2009. The median follow-up from EBRT was 44 months. Patients were evaluated at baseline (pre-EBRT) and at intervals post-treatment using the International Prostate Symptom Score (IPSS) instrument. RESULTS Patients with mild IPSS at baseline (total 0-7) reported median total scores of 3, 4 and 3 at baseline, 6 and 48 months respectively post-EBRT. For patients with moderate IPSS at baseline (total 8-19), median total IPSS was 12 at baseline and 9 at both 6 and 48 months. For the severe IPSS group at baseline (total 20-35), the median total IPSS was 24, 12 and 14 at baseline, 6 and 48 months post-EBRT. The cumulative risk of persistent IPSS increase (greater than 5 points above baseline) at 48 months was 16%, 10% and 6% for patients with mild, moderate and severe baseline IPSS respectively. 94%, 54% and 11% of patients with mild, moderate and severe baseline IPSS reported good uQoL at baseline respectively, with these proportions increasing to 95%, 83% and 69% at 48 months. CONCLUSION Urinary symptoms and uQoL as measured by the IPSS instrument remained stable or improved for the majority of men after definitive EBRT with or without ADT for prostate cancer. This was especially notable for the group of men with worse baseline symptoms or uQoL, with risk of persistent worsening of urinary symptoms decreasing with higher baseline IPSS category. Understanding the expected pattern of urinary symptoms and related uQoL in the months and years following EBRT taking into account baseline urinary function is highly valuable for counselling men as part of the therapeutic decision-making process.
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Affiliation(s)
- S Chin
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia.
| | - A J Hayden
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - V Gebski
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia
| | - S Cross
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - S L Turner
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
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14
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Zaorsky NG, Showalter TN, Ezzell GA, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Taira AV, Vapiwala N, Davis BJ. ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II. Adv Radiat Oncol 2016; 2:62-84. [PMID: 28740916 PMCID: PMC5514238 DOI: 10.1016/j.adro.2016.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | - Gary A Ezzell
- Mayo Clinic, Phoenix, Arizona (research author, contributing)
| | - Paul L Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (panel vice-chair)
| | - Dean G Assimos
- University of Alabama School of Medicine, Birmingham, Alabama (American Urological Association)
| | - Anthony V D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (American Society of Clinical Oncology)
| | | | | | | | | | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | | | | | - Al V Taira
- Mills Peninsula Hospital, San Mateo, California
| | - Neha Vapiwala
- University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Ariyaratne H, Chesham H, Pettingell J, Alonzi R. Image-guided radiotherapy for prostate cancer with cone beam CT: dosimetric effects of imaging frequency and PTV margin. Radiother Oncol 2016; 121:103-108. [PMID: 27576431 DOI: 10.1016/j.radonc.2016.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/11/2016] [Accepted: 07/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE This study assesses the effect of frequency of cone beam CT (CBCT) verification imaging on dose-volume parameters during image-guided radiotherapy (IGRT) for prostate cancer. It also investigates the dosimetric impact of reducing the planning target volume (PTV) margin, when daily imaging is used. MATERIAL AND METHODS 844 CBCT images from 20 patients undergoing radical prostate radiotherapy were included. Patients received a dose of 74Gy in 37 fractions using 7-field intensity-modulated radiotherapy (IMRT). Clinical target volume (CTV) and organs at risk were contoured manually on each slice of every CBCT image. A daily online CBCT verification schedule was compared with a protocol of verification on days 1-3 followed by weekly online imaging. PTV margins of 3mm, 5mm, and 7mm were compared for the daily imaging protocol. RESULTS 90% of patients had improved target coverage with daily online in comparison to weekly online imaging. A median of 37 fractions per treatment course achieved CTV coverage with daily imaging compared to 34 fractions with a weekly online protocol. 80% of patients had a reduction in rectal dose with the daily protocol. PTV margin reduction to 5mm with adequate target coverage was feasible with daily imaging. CONCLUSIONS Daily online CBCT verification improves CTV coverage and reduces rectal dose during IGRT for prostate cancer. Tighter PTV margins could be considered with daily CBCT use.
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16
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Liu J, Kaidu M, Sasamoto R, Ayukawa F, Yamana N, Sato H, Tanaka K, Kawaguchi G, Ohta A, Maruyama K, Abe E, Kasahara T, Nishiyama T, Tomita Y, Aoyama H. Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes. JOURNAL OF RADIATION RESEARCH 2016; 57:280-287. [PMID: 26983988 PMCID: PMC4915542 DOI: 10.1093/jrr/rrw003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/27/2015] [Accepted: 01/07/2016] [Indexed: 06/05/2023]
Abstract
We investigated the outcomes of treatment for patients with localized prostate cancer (PCa) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- ( N =: 5; 3.2%), intermediate- ( N =: 36; 23.1%) and high-risk ( N =: 115; 73.7%) groups (Stage T3 PCa patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year 'biochemical no evidence of disease (bNED)' rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary.
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Affiliation(s)
- Junyang Liu
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Ryuta Sasamoto
- School of Health Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Fumio Ayukawa
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Nobuko Yamana
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Hiraku Sato
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Kensuke Tanaka
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Gen Kawaguchi
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Atsushi Ohta
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Katsuya Maruyama
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Eisuke Abe
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takashi Kasahara
- Urology Department, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Tsutomu Nishiyama
- Urology Department, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Yoshihiko Tomita
- Urology Department, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Hidefumi Aoyama
- Department of Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
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Liauw SL, Kropp LM, Dess RT, Oto A. Endorectal MRI for risk classification of localized prostate cancer: Radiographic findings and influence on treatment decisions. Urol Oncol 2016; 34:416.e15-21. [PMID: 27241167 DOI: 10.1016/j.urolonc.2016.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To report the results of endorectal coil magnetic resonance imaging (eMRI) in patients with localized prostate cancer, and how these images influenced radiotherapeutic management. MATERIALS AND METHODS A total of 122 men with localized adenocarcinoma of the prostate referred to radiation oncology underwent 3-T eMRI between 2010 and 2014, to evaluate candidacy for active surveillance (n = 26) and brachytherapy as monotherapy (n = 47), or to further risk stratify intermediate-risk (n = 29) or high-risk (n = 20) men before external beam radiation therapy. By National Comprehensive Cancer Network classification, men had low-risk (28%), intermediate-risk (55%), or high-risk (17%) disease. Multiparametric MRI sequences included T2-weighted, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. Radiographic extracapsular extension, seminal vesicle invasion (rSVI), and pelvic lymph node involvement (LNI) were graded as negative, indeterminate, or positive. A dominant nodule was defined as a nodule≥1.5cm. Changes in management were identified comparing pre-MRI and post-MRI plan of care. RESULTS The rates of radiographic extracapsular extension, radiographic seminal vesicle invasion, lymph node involvement, and dominant nodule were 39%, 7%, 12%, and 28%, respectively. The eMRI identified measurable disease in most patients with an increasing burden of disease (sextants involved, median nodule size) according to risk category (P<0.01). Changes in management after eMRI occurred in 18%, including 9%, 18%, and 33% of men with low-risk, intermediate-risk, or high-risk disease (P = 0.08), and 12%, 17%, and 22% of men who were candidates for active surveillance, brachytherapy as monotherapy, or external beam radiation therapy (P = 0.48), respectively. CONCLUSION The eMRI influenced management in a risk-dependent fashion. Further study is required to determine the clinical importance of eMRI findings and to determine whether changes in management can lead to improved clinical outcome.
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Affiliation(s)
- Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL.
| | - Lauren M Kropp
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Robert T Dess
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Aytekin Oto
- Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL
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