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Schröder C, Tang H, Lenffer B, Buchali A, Zwahlen DR, Förster R, Windisch P. Re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after initial definitive radiotherapy - A systematic review and meta-analysis of recent trials. Clin Transl Radiat Oncol 2024; 48:100806. [PMID: 39044780 PMCID: PMC11263509 DOI: 10.1016/j.ctro.2024.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 07/25/2024] Open
Abstract
Background There is increasing data on re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after definitive radiotherapy for prostate cancer, with increasing evidence on prostate re-irradiation using a C-arm LINAC or an MR LINAC in recent years. We therefore conducted this systematic review and meta-analysis on prostate re-irradiation including studies published from 2020 to 2023, to serve as an update on existing meta-analysis. Methods We searched the PubMed and Embase databases in October 2023 with queries including combinations of "repeat", "radiotherapy", "prostate", "re-irradiation", "reirradiation", "re treatment", "SBRT", "retreatment". Publication date was set to be from 2020 to 2023. There was no limitation regarding language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. After data extraction, heterogeneity testing was done by calculating the I2. A random effects model with a restricted maximum likelihood estimator was used to estimate the combined effect. Funnel plot asymmetry was assessed visually and using Egger's test to estimate the presence of publication and/or small study bias. Results 14 publications were included in the systematic review. The rates of acute ≥ grade 2 (G2) genitourinary (GU) and gastrointestinal (GI) toxicities reported in the included studies ranged from 0.0-30.0 % and 0.0-25.0 % respectively. For late ≥ G2 GU and GI toxicity, the ranges are 4.0-51.8 % and 0.0-25.0 %. The pooled rate of acute GU and GI toxicity ≥ G2 were 13 % (95 % CI: 7-18 %) and 2 % (95 % CI: 0-4 %). For late GU and GI toxicity ≥ G2 the pooled rates were 25 % (95 % CI: 14-35 %) and 5 % (95 % CI: 1-9 %). The pooled 2-year biochemical recurrence-free survival was 72 % (95 % CI: 64-92 %). Conclusions SBRT in the re-irradiation of radiorecurrent prostate cancer is safe and effective. Further prospective data are warranted.
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Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Hongjian Tang
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Bianca Lenffer
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
- Department of Radiation Oncology, Inselspital (Bern University Hospital), University of Bern, 3010 Bern, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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Patel KR, Rydzewski NR, Schott E, Cooley-Zgela T, Ning H, Cheng J, Salerno K, Huang EP, Lindenberg L, Mena E, Choyke P, Turkbey B, Citrin DE. A Phase 1 Trial of Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer After Brachytherapy. Int J Radiat Oncol Biol Phys 2024; 119:1471-1480. [PMID: 38428681 PMCID: PMC11262986 DOI: 10.1016/j.ijrobp.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE NCT03253744 is a phase 1 trial with the primary objective to identify the maximum tolerated dose (MTD) of salvage stereotactic body radiation therapy (SBRT) in patients with local prostate cancer recurrence after brachytherapy. Additional objectives included biochemical control and imaging response. METHODS AND MATERIALS This trial was initially designed to test 3 therapeutic dose levels (DLs): 40 Gy (DL1), 42.5 Gy (DL2), and 45 Gy (DL3) in 5 fractions. Intensity modulation was used to deliver the prescription dose to the magnetic resonance imaging and prostate-specific membrane antigen-based positron emission tomography imaging-defined gross tumor volume while simultaneously delivering 30 Gy to an elective volume defined by the prostate gland. This phase 1 trial followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities were scored until trial completion at 2 years post-SBRT using Common Terminology Criteria for Adverse Events version 5.0. Escalation was halted if 2 dose limiting toxicities occurred, defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT or any grade ≥3 genitourinary (GU) or grade 4 gastrointestinal toxicity thereafter. RESULTS Between August 2018 and January 2023, 9 patients underwent salvage SBRT and were observed for a median of 22 months (Q1-Q3, 20-43 months). No grade 3 to 5 adverse events related to study treatment were observed; thus, no dose limiting toxicities occurred during the observation period. Escalation was halted by amendment given excellent biochemical control in DL1 and DL2 in the setting of a high incidence of clinically significant late grade 2 GU toxicity. Therefore, the MTD was considered 42.5 Gy in 5 fractions (DL2). One- and 2-year biochemical progression-free survival were 100% and 86%, representing a single patient in the trial cohort with biochemical failure (prostate-specific antigen [PSA] nadir + 2.0) at 20 months posttreatment. CONCLUSIONS The MTD of salvage SBRT for the treatment of intraprostatic radiorecurrence after brachytherapy was 42.5 Gy in 5 fractions producing an 86% 2-year biochemical progression-free survival rate, with 1 poststudy failure at 20 months. The most frequent clinically significant toxicity was late grade 2 GU toxicity.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Nicholas R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason Cheng
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Erich P Huang
- Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Marvaso G, Jereczek-Fossa BA, Zaffaroni M, Vincini MG, Corrao G, Andratschke N, Balagamwala EH, Bedke J, Blanck O, Capitanio U, Correa RJM, De Meerleer G, Franzese C, Gaeta A, Gandini S, Garibaldi C, Gerszten PC, Gillessen S, Grubb WR, Guckenberger M, Hannan R, Jhaveri PM, Josipovic M, Kerkmeijer LGW, Lehrer EJ, Lindskog M, Louie AV, Nguyen QN, Ost P, Palma DA, Procopio G, Rossi M, Staehler M, Tree AC, Tsang YM, Van As N, Zaorsky NG, Zilli T, Pasquier D, Siva S. Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma-a European Society for Radiotherapy and Oncology study endorsed by the European Association of Urology. Lancet Oncol 2024; 25:e193-e204. [PMID: 38697165 DOI: 10.1016/s1470-2045(24)00023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 05/04/2024]
Abstract
The purpose of this European Society for Radiotherapy and Oncology (ESTRO) project, endorsed by the European Association of Urology, is to explore expert opinion on the management of patients with oligometastatic and oligoprogressive renal cell carcinoma by means of stereotactic ablative radiotherapy (SABR) on extracranial metastases, with the aim of developing consensus recommendations for patient selection, treatment doses, and concurrent systemic therapy. A questionnaire on SABR in oligometastatic renal cell carcinoma was prepared by a core group and reviewed by a panel of ten prominent experts in the field. The Delphi consensus methodology was applied, sending three rounds of questionnaires to clinicians identified as key opinion leaders in the field. At the end of the third round, participants were able to find consensus on eight of the 37 questions. Specifically, panellists agreed to apply no restrictions regarding age (25 [100%) of 25) and primary renal cell carcinoma histology (23 [92%] of 25) for SABR candidates, on the upper threshold of three lesions to offer ablative treatment in patients with oligoprogression, and on the concomitant administration of immune checkpoint inhibitor. SABR was indicated as the treatment modality of choice for renal cell carcinoma bone oligometatasis (20 [80%] of 25) and for adrenal oligometastases 22 (88%). No consensus or major agreement was reached regarding the appropriate schedule, but the majority of the poll (54%-58%) retained the every-other-day schedule as the optimal choice for all the investigated sites. The current ESTRO Delphi consensus might provide useful direction for the application of SABR in oligometastatic renal cell carcinoma and highlight the key areas of ongoing debate, perhaps directing future research efforts to close knowledge gaps.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ehsan H Balagamwala
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jens Bedke
- Department of Urology and Transplantation surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig Holstein, Kiel, Germany
| | - Umberto Capitanio
- IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Rohann J M Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Gert De Meerleer
- Department of Radiation Oncology, Leuven University Hospitals, Leuven, Belgium
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Cristina Garibaldi
- Unit of Radiation Research, European Institute of Oncology, IRCCS, Milan, Italy
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - William R Grubb
- Department of Radiation Oncology, Augusta University Medical Center, Augusta, GA, USA
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pavan M Jhaveri
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Mirjana Josipovic
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Eric J Lehrer
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Pelvic Cancer, Section of Genitourinary Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Quynh-Nhu Nguyen
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium and Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Giuseppe Procopio
- Dipartimento Di Oncologia Medica, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maddalena Rossi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Staehler
- Interdisciplinary Centre on Renal Tumours, University of Munich, Munich, Germany
| | - Alison C Tree
- Department of Urology, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Yat Man Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nicholas Van As
- Department of Urology, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; The Institute of Cancer Research, London, UK
| | - Nicholas G Zaorsky
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Thomas Zilli
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre O Lambret, Lille, France; University of Lille, Centrale Lille, CNRS, UMR 9189-CRIStAL, Lille, France
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Department of Radiation Oncology, University of Melbourne, Parkville, VIC, Australia; Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia
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Yang J, Xiong X, Liao X, Zheng W, Xu H, Wei Q, Yang L. Nonsurgical salvage options for locally recurrent prostate cancer after primary definitive radiotherapy: a systematic review and meta-analysis. Int J Surg 2024; 110:3008-3020. [PMID: 38348896 DOI: 10.1097/js9.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/26/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To conduct a meta-analysis to provide the latest evidence of nonsurgical local salvage options in the first-line radiotherapy (RT) failure setting for localized prostate cancer patients. BACKGROUND Recurrence of localized prostate cancer after primary RT remains a clinical challenge. There is no consensus on optimal nonsurgical local salvage therapies, which mainly consist of cryotherapy (CRYO), high-intensity focused ultrasound (HIFU), high/low-dose-rate brachytherapy (HDR/LDR), and stereotactic body radiotherapy (SBRT). METHODS Our study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The authors systematically searched PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov up to September 2023 to identify potentially relevant studies. The risk of bias was assessed using the European Association of Urology (EAU) items. Biochemical recurrence-free survival (bRFS) and genitourinary/gastrointestinal toxicities were the outcomes of interest. Pooled rates with 95% CIs were evaluated. RESULTS A total of 99 studies comprising 8440 patients were included. The pooled rate of 1-year biochemical control (BC) was highest for LDR (0.88, 95% CI: 0.72-0.95) and lowest for SBRT (0.68, 95% CI: 0.49-0.83). The pooled rate of 5-year BC was highest for CRYO (0.52, 95% CI: 0.33-0.69) and lowest for HDR (0.23, 95% CI: 0.08-0.51). HIFU presented the worst outcome of grade ≥3 genitourinary toxicities (GU3), with a rate of 0.22 (95% CI: 0.12-0.3). Conversely, CRYO (0.09, 95% CI: 0.04-0.14), HDR (0.05, 95% CI: 0.02-0.07), LDR (0.10, 95% CI: 0.06-0.14), and SBRT (0.06, 95% CI: 0.03-0.09) presented low rates of GU3. All subgroups induced a quite low incidence of grade ≥3 gastrointestinal toxicities (GI3). CONCLUSIONS Nonsurgical salvage therapies are promising modalities for prostate cancer in the local radiorecurrence setting. Based on the preliminary evidence from this study, CRYO and SBRT might present a relatively steady efficacy of BC with acceptable treatment-related toxicities.
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Affiliation(s)
- Jie Yang
- Department of Urology, Institute of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Majewski W, Miszczyk M, Graupner D, Goc B, Goldner G, Napieralska A. Stereotactic body radiotherapy (SBRT) re-irradiation for local failures following radical prostatectomy and post-operative radiotherapy. Strahlenther Onkol 2024; 200:230-238. [PMID: 38157016 PMCID: PMC10876733 DOI: 10.1007/s00066-023-02187-2] [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: 08/09/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Local recurrences after radical prostatectomy (RP) and postoperative radiotherapy (RT) are challenging for salvage treatment. Retrospective analysis of own experiences with salvage re-irradiation was performed. METHODS The study included all consecutive patients treated with salvage stereotactic body radiotherapy (sSBRT) for prostate bed recurrence following RP and postoperative RT at a single tertiary center between 2014 and 2021. Treatment toxicity defined as the occurrence of CTCAE grade ≥ 2 genito-urinary (GU) or gastro-intestinal (GI) adverse events (AEs) was assessed. A PSA response, biochemical control (BC) and overall survival (OS) were also evaluated. RESULTS The study group included 32 patients with a median age of 68 years and a median follow-up of 41 months, treated with CyberKnife (53%) or Linac (47%) sSBRT. Total dose of 33.75-36.25 Gy in five fractions (72%) was applied in the majority of them. Approximately 19% patients reported grade ≥ 2 GU AEs both at baseline and at three months, and grade ≥ 2 GI toxicity increased from 0% at baseline to 6% at three months after sSBRT. There was some clinically relevant increase in late toxicity with 31% patients reporting late ≥ 2 GU, and 12.5% late ≥ 2 GI AEs. Two grade 3 AEs were recorded: recto-urinary fistulas. The majority of patients showed a PSA response (91% at one year post-sSBRT). The 3‑year BC was 40% and 3‑year OS was 87%. CONCLUSIONS Manageable toxicity profile and satisfactory biochemical response suggest that SBRT in patients with local recurrence following RP and postoperative RT might be a salvage option for selected patients.
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Affiliation(s)
- Wojciech Majewski
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland.
| | - Marcin Miszczyk
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Donata Graupner
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Aleksandra Napieralska
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
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Grivas N, Zampaftis C, Ermidis D, Leotsakos I, Katafigiotis I, Karavitakis M. Re: David Pasquier, Thomas Lacornerie, Stéphane Supiot, et al. The Safety and Efficacy of Salvage Stereotactic Radiation Therapy in Patients with Intraprostatic Tumor Recurrence After Previous External Radiation Therapy: Phase 1 Results from the GETUG-AFU 31 Study. Eur Urol Oncol. Eur Urol Oncol. 2023;6:399-405. Eur Urol Oncol 2023; 6:640. [PMID: 37003860 DOI: 10.1016/j.euo.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece.
| | - Christos Zampaftis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece
| | - Dimitris Ermidis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece
| | - Ioannis Leotsakos
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece
| | - Ioannis Katafigiotis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece
| | - Markos Karavitakis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros Clinic, Athens, Greece
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7
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Francolini G, Carnevale MG, Di Cataldo V, Loi M, Detti B, Orsatti C, Caprara L, Bertini N, Lorenzetti V, Olmetto E, Becherini C, Visani L, Salvestrini V, Simontacchi G, Greto D, Bonomo P, Doro R, Masi L, Desideri I, Meattini I, Serni S, Livi L. Stereotactic reirradiation with Cyberknife R for locally recurrent prostate cancer, long-term toxicity and clinical outcomes from a monocentric cohort. LA RADIOLOGIA MEDICA 2023; 128:1580-1588. [PMID: 37728816 DOI: 10.1007/s11547-023-01721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Up to 47% of patients with localized prostate cancer (PCa) treated with radiotherapy (EBRT) eventually develop local recurrence. To date, no clear consensus exists on optimal management. A growing body of interest supports the use of stereotaxic re-irradiation (rSBRT), with promising oncological outcomes and low toxicity profile. We collected a single-center case series of locally recurrent PCa who underwent re-irradiation after a previous course of postoperative or definitive radiotherapy. METHODS AND MATERIALS Data from 101 patients treated at our institution for locally recurrent PCa from June 2012 to June 2021 were retrospectively collected. Patients underwent rSBRT with CyberKnife system (Accuray Inc., Sunnyvale, CA, USA), delivered to intraprostatic or macroscopic recurrences within the prostate bed, for a total dose of 30 Gy in 5 fractions. RESULTS All patients received prior EBRT. The median EQD2 total dose was 75.0 Gy (range, 60-80 Gy). Thirty-two (32%) patients were receiving androgen deprivation therapy (ADT) after prior biochemical recurrence. After a median follow-up of 57.8 months, BR occurred in 55 patients (54.5%), with a median BR-free survival (BRFS) of 40.4 months (95% C.I. 34.3-58.3). Thirty-two patients (31.7%) developed metastatic disease, with a median metastasis-free survival (MFS) not reached. PSA ≥ 2.5 ng/ml and ADT were associated with worst BRFS (26.06 vs. 39.3 months, p = 0.03 and 22.7 vs. 27 months, p = 0.01, respectively). Castration-resistant status and ADT were found to be predictive of worst MFS (34.1 vs. 50.5 months, p = 0.02 and 33.5 vs. 53.1 months, p = 0.002, respectively). Concomitant ADT was confirmed as an independent factor for MFS (HR 4.8, 95% CI 1.5-10.6, p = 0.007). No grade > /2 adverse were recorded. CONCLUSIONS After almost 5 years of follow-up, with a median BRFS of 40.4 months and no grade ≥ 2 AEs, CyberknifeR rSBRT proved effective and safe in a cohort of 101 patients affected by locally recurrent PCa.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Mauro Loi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carolina Orsatti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Luisa Caprara
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Victoria Lorenzetti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Daniela Greto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50100, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
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8
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Willmann J, Appelt AL, Balermpas P, Baumert BG, de Ruysscher D, Hoyer M, Hurkmans C, Kaidar-Person O, Meattini I, Niyazi M, Poortmans P, Reynaert N, Tandini-Lang S, van der Linden Y, Nieder C, Andratschke N. Re-irradiation in clinical practice: Results of an international patterns of care survey within the framework of the ESTRO-EORTC E 2-RADIatE platform. Radiother Oncol 2023; 189:109947. [PMID: 37806559 DOI: 10.1016/j.radonc.2023.109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/17/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Re-irradiation is an increasingly utilized treatment for recurrent, metastatic or new malignancies after previous radiotherapy. It is unclear how re-irradiation is applied in clinical practice. We aimed to investigate the patterns of care of re-irradiation internationally. MATERIAL/METHODS A cross-sectional survey conducted between March and September 2022. The survey was structured into six sections, each corresponding to a specific anatomical region. Participants were instructed to complete the sections of their clinical expertise. A total of 15 multiple-choice questions were included in each section, addressing various aspects of the re-irradiation process. The online survey targeted radiation and clinical oncologists and was endorsed by the European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC). RESULTS 371 physicians from 55 countries across six continents participated. Participants had a median professional experience of 16 years, and the majority (60%) were affiliated with an academic hospital. The brain region was the most common site for re-irradiation (77%), followed by the pelvis (65%) and head and neck (63%). Prolonging local control was the most common goal (90-96% across anatomical regions). The most common minimum interval between previous radiotherapy and re-irradiation was 6-12 months (45-55%). Persistent grade 3 or greater radiation-induced toxicity (77-80%) was the leading contraindication. Variability in organs at risk dose constraints for re-irradiation was observed. Advanced imaging modalities and conformal radiotherapy techniques were predominantly used. A scarcity of institutional guidelines for re-irradiation was reported (16-19%). Participants from European centers more frequently applied thoracic and abdominal re-irradiation. Indications did not differ between academic and non-academic hospitals. CONCLUSION This study highlights the heterogeneity in re-irradiation practices across anatomical regions and emphasizes the need for high-quality evidence from prospective studies to guide treatment decisions and derive safe cumulative dose constraints.
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Affiliation(s)
- Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Brigitta G Baumert
- Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht and Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Morten Hoyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel And Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium
| | - Stephanie Tandini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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9
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Patel KR, Rydzewski NR, Schott E, Cooley-Zgela T, Ning H, Cheng J, Salerno K, Huang EP, Pinto PA, Lindenberg L, Mena E, Choyke P, Turkbey B, Citrin DE. A Phase 1 Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer. Pract Radiat Oncol 2023; 13:540-550. [PMID: 37442430 PMCID: PMC10782822 DOI: 10.1016/j.prro.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE NCT03253744 was a phase 1 trial to identify the maximum tolerated dose (MTD) of image-guided, focal, salvage stereotactic body radiation therapy (SBRT) for patients with locally radiorecurrent prostate cancer. Additional objectives included biochemical control and imaging response. METHODS AND MATERIALS The trial design included 3 dose levels (DLs): 40 Gy (DL1), 42.5 Gy (DL2), and 45 Gy (DL3) in 5 fractions delivered ≥48 hours apart. The prescription dose was delivered to the magnetic resonance- and prostate-specific membrane antigen imaging-defined tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities were scored until 2 years after completion of SBRT using Common Terminology Criteria for Adverse Events, version 5.0, criteria. Escalation was halted if 2 dose-limiting toxicities occurred, defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT and any grade 3 genitourinary (GU) or grade 4 gastrointestinal (GI) toxicity thereafter. RESULTS Between August 2018 and May 2022, 8 patients underwent salvage focal SBRT, with a median follow-up of 35 months. No dose-limiting toxic effects were observed on DL1. Two patients were enrolled in DL2 and experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) at the MTD (DL1). The most common toxicities observed were grade ≥2 GU toxicities, with only a single grade 2 GI toxicity and no grade ≥3 GI toxicities. One patient experienced biochemical failure (prostate-specific antigen nadir + 2.0) at 33 months. CONCLUSIONS The MTD for focal salvage SBRT for isolated intraprostatic radiorecurrence was 40 Gy in 5 fractions, producing a 100% 24-month biochemical progression free survival, with 1 poststudy failure at 33 months. The most frequent clinically significant toxicity was late grade ≥2 GU toxicity.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland.
| | - Nicholas R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Jason Cheng
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Erich P Huang
- Biometric Research Branch, National Cancer Institute, NIH, Rockville, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
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10
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Baty M, Pasquier D, Gnep K, Castelli J, Delaby N, Lacornerie T, de Crevoisier R. Achievable Dosimetric Constraints in Stereotactic Reirradiation for Recurrent Prostate Cancer. Pract Radiat Oncol 2023; 13:e515-e529. [PMID: 37295723 DOI: 10.1016/j.prro.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Stereotactic body radiation therapy has been proposed as a salvage treatment for recurrent prostate cancer after irradiation. One crucial issue is choosing appropriate dose-volume constraints (DVCs) during planning. The objectives of this study were to (1) quantify the proportion of patients respecting the DVCs according to the Urogenital Tumor Study Group GETUG-31 trial, testing 36 Gy in six fractions, (2) explain geometrically why the DVCs could not be respected, and (3) propose the most suitable DVCs. METHODS AND MATERIALS This retrospective dosimetric analysis included 141 patients treated for recurrent prostate cancer with Cyberknife (Accuray), according to GETUG-31 DVCs: V95% ≥ 95% for the planning target volume (PTV), V12Gy < 20% and V27Gy < 2 cc for the rectum, and V12Gy < 15% and V27Gy < 5 cc for the bladder. The percentage of patients not respecting the DVCs was quantified. Correlations between the DVCs and anatomic structures were examined. New DVCs were proposed. RESULTS Only 19% of patients respected all DVCs, with a mean PTV of 18.5 cc (range, 3-48 cc), although the mean PTV was 40.5 cc (range, 3-174 cc) in the whole series. A total of 98% of the patients with a clinical target volume (CTV)/prostate ratio >0.5 could not respect the DVCs in the organs at risk. The target coverage and organ-at-risk sparing decreased significantly with increase in the values of PTV, CTV, CTV/prostate ratio, the overlapping volume between the PTV and bladder wall and between the PTV and rectal wall. Threshold values of PTV, >20 cc and 40 cc, allowed for the PTV and bladder DVCs, respectively. To improve DVC respect in case of large target volume, we proposed the following new DVCs: V12Gy < 25% and 25% and V27Gy < 2 cc and 5 cc for the rectum and bladder, respectively. CONCLUSIONS GETUG-31 DVCs are achievable only for small target volumes (CTV more than half of the prostate). For a larger target volume, new DVCs have been proposed.
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Affiliation(s)
- Manon Baty
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France.
| | - David Pasquier
- Department of Radiation Oncology, Center Oscar Lambret, Lille University, France
| | - Khemara Gnep
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France
| | - Joel Castelli
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Rennes, France
| | - Nolwenn Delaby
- Department of Medical Physics, Center Eugène Marquis, Rennes, France
| | - Thomas Lacornerie
- Department of Radiation Oncology, Center Oscar Lambret, Lille, France
| | - Renaud de Crevoisier
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Rennes, France; Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
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11
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Nieder C, Willmann J, Andratschke NH. Prospective randomized clinical studies involving reirradiation: update of a systematic review. Strahlenther Onkol 2023; 199:787-797. [PMID: 37500926 PMCID: PMC10449695 DOI: 10.1007/s00066-023-02118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Reirradiation is a potentially useful option for many patients with recurrent cancer, aiming at cure or symptom palliation, depending on disease/recurrence type and stage. The purpose of this follow-up study to a previous review from 2016 was to summarize all recently published randomized trials. Points of interest again included identifcation of methodological strengths and weaknesses, practice-changing results, and open questions. MATERIAL AND METHODS Systematic review of trials published between 2015 and February 2023. RESULTS We reviewed 7 additional trials, most of which addressed reirradiation of head and neck or brain tumours. The median number of patients was 60. Mirroring the previous review, trial design, primary endpoints and statistical hypotheses varied widely. The updated results only impact on decision making for reirradiation of nasopharynx cancer and glioma. Patients with one of these diseases, as well as other head and neck cancers, may benefit from reirradiation-induced local control, e.g. in terms of progression-free survival. For the first time, hyperfractionated radiotherapy emerged as preferred option for recurrent, inoperable nasopharynx cancer. Despite better therapeutic ratio with hyperfractionation, serious toxicity remains a concern after high cumulative total doses. Randomized trials are still lacking for prostate cancer and other sites. CONCLUSION Multicentric randomized trials on reirradiation are feasible and continue to refine the current standard of care for recurrent disease after previous radiotherapy. Ongoing prospective studies such as the European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer (ESTRO-EORTC) observational cohort ReCare (NCT: NCT03818503) will further shape the clinical practice of reirradiation.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9038, Tromsø, Norway.
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zürich, 8091, Zurich, Switzerland
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12
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Pasquier D, Lacornerie T, Supiot S, Pommier P, Quivrin M, Simon JM, Loos G, Meyer E, Calais G, Peiffert D, Vandendorpe B, Aymes E, Leguillette C, Brihoum M, Nenan S, Cormier L, Le Deley MC, Lartigau EF. The Safety and Efficacy of Salvage Stereotactic Radiation Therapy in Patients with Intraprostatic Tumor Recurrence After Previous External Radiation Therapy: Phase 1 Results from the GETUG-AFU 31 Study. Eur Urol Oncol 2023; 6:399-405. [PMID: 36754722 DOI: 10.1016/j.euo.2023.01.009] [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: 08/19/2022] [Revised: 12/11/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is no consensus on the best local salvage treatment for prostate cancer recurrence after primary external beam radiotherapy. Prospective data on stereotactic body radiation therapy (SBRT) are very scarce. OBJECTIVE To determine the optimal dose regimen for salvage SBRT. DESIGN, SETTING, AND PARTICIPANTS The present report concerns the phase 1 part of the GETUG-AFU 31 multicenter open-label study. The main inclusion criteria were histologically proven biochemical recurrence, clinical stage T1-T2 upon relapse, multiparametric magnetic resonance imaging data, prostate-specific antigen (PSA) level ≤10 ng/ml prior to salvage SBRT, PSA doubling time >10 mo, and an International Prostate Symptom Score of ≤12. INTERVENTION Five or six fractions of 6 Gy were delivered using focal SBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Dose-limiting toxicity (DLT) was defined as grade ≥3 gastrointestinal or genitourinary tract toxicity, or any grade 4 toxicity (according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03) occurring in the first 18 wk following treatment initiation. A time-to-event continual reassessment method was used to select the dose regimen. RESULTS AND LIMITATIONS Twenty-one patients were treated (median [interquartile range] age: 76.8 yr [72.2-80.8]), including 12 at 6 × 6 dose level. No DLT was observed. The acute grade 2 genitourinary tract toxicity rate was 19%. With a median follow-up of 12.3 mo, the estimated cumulative incidence of late grade 2 genitourinary toxicity was 41.2% (95% confidence interval: 18.1-63.1%). No grade >2 genitourinary toxicity and no grade ≥2 gastrointestinal toxicity were reported. All treated patients were alive and relapse free at the last follow-up. CONCLUSIONS A 6 × 6 Gy dose regimen was selected for our phase 2 study of salvage SBRT. With a short follow-up period, the level of toxicity appears to be acceptable. PATIENT SUMMARY There is no consensus on the best local treatment for patients with local relapse after radiotherapy for prostate cancer. Prospective data are very scarce. Our early phase trial allowed us to recommend six fractions of 6 Gy using high-precision radiotherapy for further studies.
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Affiliation(s)
- David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France.
| | - Thomas Lacornerie
- Département de Physique Médicale, Centre Oscar Lambret, Lille, France
| | - Stéphane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint-Herblain, France
| | - Pascal Pommier
- Département de Radiothérapie, Centre Léon Bérard, Lyon, France
| | - Magali Quivrin
- Département de Radiothérapie, Centre Georges François Leclerc, Dijon, France
| | - Jean-Marc Simon
- Service d'Oncologie Radiothérapie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Geneviève Loos
- Département de Radiothérapie, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emmanuel Meyer
- Département de Radiothérapie, Centre François Baclesse, Caen, France
| | - Gilles Calais
- Département d'Oncologie et de Radiothérapie, CHRU Tours, France
| | - Didier Peiffert
- Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Estelle Aymes
- Département de Biostatistiques, Centre Oscar Lambret, Lille, France
| | | | | | - Soazig Nenan
- Unicancer, Recherche et Développement, Paris, France
| | | | | | - Eric F Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France
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13
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Thompson C, Pagett C, Lilley J, Svensson S, Eriksson K, Bokrantz R, Ödén J, Nix M, Murray L, Appelt A. Brain Re-Irradiation Robustly Accounting for Previously Delivered Dose. Cancers (Basel) 2023; 15:3831. [PMID: 37568647 PMCID: PMC10417278 DOI: 10.3390/cancers15153831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The STRIDeR (Support Tool for Re-Irradiation Decisions guided by Radiobiology) planning pathway aims to facilitate anatomically appropriate and radiobiologically meaningful re-irradiation (reRT). This work evaluated the STRIDeR pathway for robustness compared to a more conservative manual pathway. (2) Methods: For ten high-grade glioma reRT patient cases, uncertainties were applied and cumulative doses re-summed. Geometric uncertainties of 3, 6 and 9 mm were applied to the background dose, and LQ model robustness was tested using α/β variations (values 1, 2 and 5 Gy) and the linear quadratic linear (LQL) model δ variations (values 0.1 and 0.2). STRIDeR robust optimised plans, incorporating the geometric and α/β uncertainties during optimisation, were also generated. (3) Results: The STRIDeR and manual pathways both achieved clinically acceptable plans in 8/10 cases but with statistically significant improvements in the PTV D98% (p < 0.01) for STRIDeR. Geometric and LQ robustness tests showed comparable robustness within both pathways. STRIDeR plans generated to incorporate uncertainties during optimisation resulted in a superior plan robustness with a minimal impact on PTV dose benefits. (4) Conclusions: Our results indicate that STRIDeR pathway plans achieved a similar robustness to manual pathways with improved PTV doses. Geometric and LQ model uncertainties can be incorporated into the STRIDeR pathway to facilitate robust optimisation.
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Affiliation(s)
- Christopher Thompson
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.T.)
| | - Christopher Pagett
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.T.)
| | - John Lilley
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.T.)
| | | | | | | | - Jakob Ödén
- RaySearch Laboratories, SE-104 30 Stockholm, Sweden
| | - Michael Nix
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.T.)
| | - Louise Murray
- Leeds Cancer Centre, Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK
| | - Ane Appelt
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.T.)
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK
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14
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McDonald F, Belka C, Hurkmans C, Alicja Jereczek-Fossa B, Poortmans P, van de Kamer JB, Azizaj E, Franco P. Introducing the ESTRO Guidelines Committee, driving force for the new generation of ESTRO guidelines. Radiother Oncol 2023:109724. [PMID: 37244357 DOI: 10.1016/j.radonc.2023.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich; German Cancer Consortium (DKTK), partner site Munich; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eralda Azizaj
- European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, Novara, Italy.
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15
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Corkum MT, Buyyounouski MK, Chang AJ, Chung HT, Chung P, Cox BW, Crook JM, Davis BJ, Frank SJ, Henriquez I, Horwitz EM, Hoskin P, Hsu IC, Keyes M, King MT, Kollmeier MA, Krauss DJ, Kukielka AM, Morton G, Orio PF, Pieters BR, Potters L, Rossi PJ, Showalter TN, Solanki AA, Song D, Vanneste B, Vigneault E, Wojcieszek PA, Zelefsky MJ, Kamrava M. Salvage Prostate Brachytherapy in Radiorecurrent Prostate Cancer: An International Delphi Consensus Study. Radiother Oncol 2023; 184:109672. [PMID: 37059334 DOI: 10.1016/j.radonc.2023.109672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Local recurrences after previous radiotherapy (RT) are increasingly being identified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT. MATERIALS AND METHODS International experts in salvage prostate BT were invited (n=34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient- and cancer-specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of ≥ 75% was set, with a majority opinion being ≥ 50%. RESULTS Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and systematic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion preferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. CONCLUSION Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.
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Affiliation(s)
- Mark T Corkum
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | | | - Albert J Chang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Brett W Cox
- Department of Radiation Oncology, Solaris Health, Chicago, IL
| | | | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ivan Henriquez
- Radiation Oncology Department. Hospital Universitari Sant Joan, Reus, Spain
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom, Northwood, United Kingdom
| | - I-Chow Hsu
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | | | - Martin T King
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI
| | - Andrzej M Kukielka
- NU-MED Cancer Diagnostics and Therapy Centre, Zamość, Poland; Department of Brachytherapy, University Hospital in Kraków, Kraków, Poland
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA
| | - Bradley R Pieters
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Peter J Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | | | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Daniel Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ben Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Vigneault
- CHU de Quebec-Centre intégré de cancérologie Hôpitl de L'Enfant-Jésus, Québec, QC, Canada
| | - Piotr A Wojcieszek
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Allali S, Loap P, Bibault JE, Krepps S, Deforge A, Moreau D, Durdux C, Giraud P. Salvage stereotactic reirradiation for intraprostatic cancer recurrence: A large retrospective study. Prostate 2023; 83:743-750. [PMID: 36911892 DOI: 10.1002/pros.24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Prostate cancer is the most common cancer in men. Thirty to forty-seven percent of patients treated with exclusive radiotherapy for prostate cancer will experience intraprostate recurrence. The use of radiotherapy in stereotactic conditions allows millimetric accuracy in irradiation to the target zone that minimizes the dose to organs at risk. In this study, we evaluated the clinical outcome of prostatic reirradiation with stereotactic body radiation therapy (SBRT) in patients with intraprostatic recurrence initially treated by radiotherapy. METHOD This single-center retrospective study included 41 patients diagnosed with exclusive local recurrence of prostate cancer after radiotherapy and treatedby stereotactic Cyberknife irradiation. The objective of this study was to assess the efficacy and the safety of stereotactic reirradiation for patients with intraprostatic recurrence initially treated with radiotherapy. RESULTS Median follow-up was 35 months. The 2-year biochemical relapse-free survival was 72.89%, the 2-year local recurrence free survival was 93.59%, the 2-year local regional recurrence-free survival was 85.24%, and the 2-year metastasis-free survival was to 91.49%. The analysis of toxicities showed a good tolerance of stereotactic irradiation. Urinary and gastro-intestinal adverse events was mostly of grades 1-2 (CTCAEv4). Grade 3 toxicity occurred in one to two patients. CONCLUSION Stereotactic reirradiation appears effective and well-tolerated for local recurrence of prostate cancer and might allow to delay the introduction of hormonal therapy and its side effects.
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Affiliation(s)
| | - Pierre Loap
- European Hospital Georges Pompidou, Paris, France
| | | | - Sarah Krepps
- European Hospital Georges Pompidou, Paris, France
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Gillessen S, Bossi A, Davis ID, de Bono J, Fizazi K, James ND, Mottet N, Shore N, Small E, Smith M, Sweeney C, Tombal B, Antonarakis ES, Aparicio AM, Armstrong AJ, Attard G, Beer TM, Beltran H, Bjartell A, Blanchard P, Briganti A, Bristow RG, Bulbul M, Caffo O, Castellano D, Castro E, Cheng HH, Chi KN, Chowdhury S, Clarke CS, Clarke N, Daugaard G, De Santis M, Duran I, Eeles R, Efstathiou E, Efstathiou J, Ngozi Ekeke O, Evans CP, Fanti S, Feng FY, Fonteyne V, Fossati N, Frydenberg M, George D, Gleave M, Gravis G, Halabi S, Heinrich D, Herrmann K, Higano C, Hofman MS, Horvath LG, Hussain M, Jereczek-Fossa BA, Jones R, Kanesvaran R, Kellokumpu-Lehtinen PL, Khauli RB, Klotz L, Kramer G, Leibowitz R, Logothetis CJ, Mahal BA, Maluf F, Mateo J, Matheson D, Mehra N, Merseburger A, Morgans AK, Morris MJ, Mrabti H, Mukherji D, Murphy DG, Murthy V, Nguyen PL, Oh WK, Ost P, O'Sullivan JM, Padhani AR, Pezaro C, Poon DMC, Pritchard CC, Rabah DM, Rathkopf D, Reiter RE, Rubin MA, Ryan CJ, Saad F, Pablo Sade J, Sartor OA, Scher HI, Sharifi N, Skoneczna I, Soule H, Spratt DE, Srinivas S, Sternberg CN, Steuber T, Suzuki H, Sydes MR, Taplin ME, Tilki D, Türkeri L, Turco F, Uemura H, Uemura H, Ürün Y, Vale CL, van Oort I, Vapiwala N, Walz J, Yamoah K, Ye D, Yu EY, Zapatero A, Zilli T, Omlin A. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022. Eur Urol 2023; 83:267-293. [PMID: 36494221 PMCID: PMC7614721 DOI: 10.1016/j.eururo.2022.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. OBJECTIVE To present consensus voting results for select questions from APCCC 2022. DESIGN, SETTING, AND PARTICIPANTS Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. RESULTS AND LIMITATIONS The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. CONCLUSIONS These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. PATIENT SUMMARY The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.
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Affiliation(s)
- Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland.
| | - Alberto Bossi
- Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Johann de Bono
- The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA; Urology/Surgical Oncology, GenesisCare, Myrtle Beach, SC, USA
| | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mathew Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ana M Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | | | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Himisha Beltran
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Pierre Blanchard
- Département de Radiothérapie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rob G Bristow
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Daniel Castellano
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Castro
- Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Heather H Cheng
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Caroline S Clarke
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Noel Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Ros Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Onyeanunam Ngozi Ekeke
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Port Harcourt, Nigeria
| | | | - Stefano Fanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Felix Y Feng
- University of California San Francisco, San Francisco, CA, USA
| | - Valerie Fonteyne
- Department of Radiation-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Nicola Fossati
- Department of Urology, Ospedale Regionale di Lugano, Civico USI - Università della Svizzera Italiana, Lugano, Switzerland
| | - Mark Frydenberg
- Department of Surgery, Prostate Cancer Research Program, Monash University, Melbourne, Australia; Department of Anatomy & Developmental Biology, Faculty of Nursing, Medicine & Health Sciences, Monash University, Melbourne, Australia
| | - Daniel George
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Martin Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Daniel Heinrich
- Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Celestia Higano
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Robert Jones
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University and Tampere Cancer Center, Tampere, Finland; Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
| | - Raja B Khauli
- Department of Urology and the Naef K. Basile Cancer Institute (NKBCI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Raya Leibowitz
- Oncology Institute, Shamir Medical Center, Be'er Ya'akov, Israel; Faculty of Medicine, Tel-Aviv University, Israel
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; University of Athens Alexandra Hospital, Athens, Greece
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Sylvester Cancer Center, Miami, FL, USA
| | - Fernando Maluf
- Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brasil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Joaquin Mateo
- Department of Medical Oncology and Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Matheson
- Faculty of Education, Health and Wellbeing, Walsall Campus, Walsall, UK
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Alicia K Morgans
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hind Mrabti
- National Institute of Oncology, Mohamed V University, Rabat, Morocco
| | - Deborah Mukherji
- Clemenceau Medical Center, Dubai, United Arab Emirates; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - William K Oh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
| | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Carmel Pezaro
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong; The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Danny M Rabah
- Cancer Research Chair and Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Urology, KFSHRC, Riyadh, Saudi Arabia
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - Charles J Ryan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Fred Saad
- Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | | | | | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nima Sharifi
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA; Department of Cancer Biology, GU Malignancies Research Center, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Iwona Skoneczna
- Rafal Masztak Grochowski Hospital, Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Daniel E Spratt
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey
| | - Fabio Turco
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey
| | - Claire L Vale
- University College London, MRC Clinical Trials Unit at UCL, London, UK
| | - Inge van Oort
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Kosj Yamoah
- Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zurich, University of Zurich and Tumorzentrum Hirslanden Zurich, Switzerland
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Long-Term Outcomes of Stereotactic Body Radiotherapy (SBRT) for Intraprostatic Relapse after Definitive Radiotherapy for Prostate Cancer: Patterns of Failure and Association between Volume of Irradiation and Late Toxicity. Cancers (Basel) 2023; 15:cancers15041180. [PMID: 36831523 PMCID: PMC9954604 DOI: 10.3390/cancers15041180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
The aim of this retrospective study was to assess the adverse effects and outcomes of salvage re-irradiation with stereotactic body radiotherapy (sSBRT) for local recurrence of prostate cancer (PCa) after definitive radiotherapy (RT). The study was focused on the adverse effects and prognostic factors for treatment toxicity, followed by an analysis of patterns of failure and survival. Patients treated with sSBRT between 2012 and 2020 at a tertiary institution were included. The exclusion criteria were a primary or salvage radical prostatectomy or a palliative sSBRT dose. Patients with oligorecurrence were eligible if all metastatic lesions were treated locally with curative intent. The Kaplan-Meier method was used to estimate time to grade ≥ 3 toxicity, local control (LC), freedom from distant metastases (FFDM), progression-free survival (PFS), biochemical control (BC) and overall survival (OS). The differences between groups (focal vs. whole-gland sSBRT) were compared using the log-rank test. The Cox proportional hazards model was used to assess prognostic factors for the listed endpoints. A total of 56 patients with a median age of 70.9 years and a median follow-up of 38.6 months were included in the analysis. The majority of them received local sSBRT only (45; 80.4%), while the rest were simultaneously treated for oligometastases (11; 19.6%). Overall, 18 (32.1%) patients experienced any grade ≥ 3 toxicity, including 1 (6.7%) patient who received focal sSBRT, and 17 (41.5%) patients treated with whole-gland sSBRT. The Planning Target Volume (per cc; HR 1.01; 95% CI 1-1.02; p = 0.025) and use of ADT (yes vs. no; HR 0.35; 95%CI 0.13-0.93; p = 0.035) were independent prognostic factors for the risk of grade ≥ 3 toxicity. The estimated rate of grade ≥ 3 adverse events was significantly higher (43.8% vs. 7.1% at 2 years; p = 0.006), and there was no improvement in the LC (92.9% vs. 85.3% at 2 years; p = 0.759) in patients treated with whole-gland sSBRT compared to focal sSBRT. The 2- and 5-year LC were 87.6% and 47.9%, respectively; the 2- and 5-year FFDM were 72.7% and 42.8%, respectively; and the 2- and 5-year PFS were 67.9% and 28.7%, respectively. The primary pattern of failure was distant metastasis. The sSBRT for local recurrence of PCa after definitive RT was associated with a high risk of severe grade ≥ 3 toxicity, which significantly increased with the volume and extent of re-irradiation.
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Mäkelä L, Bergroth R, Taipale L, Tornberg S, Visapää H. Salvage HDR brachytherapy for prostate cancer: a high-volume center experience on 100 consecutive patients. Scand J Urol 2023; 57:36-40. [PMID: 36724186 DOI: 10.1080/21681805.2023.2168048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM This study aims to evaluate the safety and efficacy of salvage HDR brachytherapy in patients who have undergone a thorough diagnostic process. MATERIALS AND METHODS 100 prostate cancer patients - locally relapsed after previous radiotherapy - were treated with salvage HDR brachytherapy to a total dose of 24 Gy. Before treatment, the patients underwent PET imaging, prostate MRI, and prostate biopsies to confirm local relapse and exclude systemic disease. Concomitant ADT was applied in 69 patients. Toxicity and efficacy data were collected as a patient chart review. Toxicity was graded using Common Terminology Criteria for Adverse Events (CTCAE 5.0). RESULTS The 3-year bDFS and OS were 74% (confidence interval [CI] 95%: 60-87%) and 93% (CI 95%: 84-100%), respectively. Acute Grade 1-2 genitourinary toxicity was observed in 70 patients, 58 patients with Grade 1 and 12 patients with Grade 2, respectively. Acute Grade 1 gastrointestinal toxicity was observed in 8 patients. CONCLUSIONS This retrospective study shows that salvage HDR brachytherapy is a well-tolerated and effective treatment for histologically proven, local radio-recurrent disease.
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Affiliation(s)
- Lauri Mäkelä
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Robin Bergroth
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Taipale
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sara Tornberg
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Visapää
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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A Novel Concept of Transperineal Focused Ultrasound Transducer for Prostate Cancer Local Deep Hyperthermia Treatments. Cancers (Basel) 2022; 15:cancers15010163. [PMID: 36612159 PMCID: PMC9818476 DOI: 10.3390/cancers15010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Design, embodiment, and experimental study of a novel concept of extracorporeal phased array ultrasound transducer for prostate cancer regional deep hyperthermia treatments using a transperineal acoustic window is presented. An optimized design of hyperthermia applicator was derived from a modelling software where acoustic and thermal fields were computed based on anatomical data. Performance tests have been experimentally conducted on gel phantoms and tissues, under 3T MRI guidance using PRFS thermometry. Feedback controlled hyperthermia (ΔT = 5 °C during 20min) was performed on two ex vivo lamb carcasses with prostate mimicking pelvic tissue, to demonstrate capability of spatio-temporal temperature control and to assess potential risks and side effects. Our optimization approach yielded a therapeutic ultrasound transducer consisting of 192 elements of variable shape and surface, pseudo randomly distributed on 6 columns, using a frequency of 700 kHz. Radius of curvature was 140 mm and active water circulation was included for cooling. The measured focusing capabilities covered a volume of 24 × 50 × 60 mm3. Acoustic coupling of excellent quality was achieved. No interference was detected between sonication and MR acquisitions. On ex vivo experiments the target temperature elevation of 5 °C was reached after 5 min and maintained during another 15 min with the predictive temperature controller showing 0.2 °C accuracy. No significant temperature rise was observed on skin and bonny structures. Reported results represent a promising step toward the implementation of transperineal ultrasound hyperthermia in a pilot study of reirradiation in prostate cancer patients.
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21
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Nojima H, Kaida A, Harada H, Akiyama M, Miuraa M. Effect of Ablative Dose Irradiation on Redistribution and Radioresponse in a Mouse Xenograft Model. Radiat Res 2022; 198:632-638. [PMID: 36223173 DOI: 10.1667/rade-22-00096.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/22/2022] [Indexed: 12/05/2022]
Abstract
We investigated the effects of ablative dose irradiation on redistribution and radioresponse after the second irradiation in a mouse xenograft model, assuming stereotactic body radiotherapy (SBRT). A human tongue cancer cell line, SAS-Fucci, expressing the fluorescent ubiquitination-based cell cycle indicator (Fucci) that visualizes the cell cycle, was employed in this study. Tumor xenografts formed subcutaneously in nude mice (approximately 6 mm in diameter), with essentially no hypoxic regions, were irradiated at 10 Gy and G2 arrest kinetics were determined using histology sections and a real-time detection method. The second irradiation (10 Gy) was given at intervals of 0 h, 3 h, 1 day, and 4 days after the first irradiation, and tumor regrowth curves were obtained. It was revealed that the ratio of G2-arrested cells showed a much higher peak at 1 day postirradiation compared to 2 Gy, assuming conventional radiotherapy, and gradually decreased thereafter up to 4 days. Tumors irradiated at intervals of 0 h and 1 day demonstrated significantly higher radioresponses than other timings. We conclude that redistribution could contribute to the efficacy of SBRT.
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Affiliation(s)
| | | | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Masako Akiyama
- University Research Administration, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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22
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Pinkawa M, Hermani H, Bischoff P, Hanitzsch H, Heidrich A, Schäfer A, Kovács A, Haddad H. Focal injection of a radiopaque viscous spacer before focal brachytherapy as re-irradiation for locally recurrent prostate cancer. Brachytherapy 2022; 21:848-852. [PMID: 36055928 DOI: 10.1016/j.brachy.2022.07.009] [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: 02/22/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Close vicinity of the target volume and a sensitive organ may prevent an effective radiotherapy/brachytherapy. A liquid hydrogel spacer cannot be placed well focally in specific small areas or fatty tissue. The purpose of this study was to report the injection technique and results of a radiopaque viscous hydrogel spacer. METHODS The radiopaque viscous spacer was applied focally using transrectal ultrasound guidance before focal brachytherapy in re-irradiated areas in two patients. The technical feasibility of the injection between the recurrence and the rectum / bladder, the resulting distance, visibility in different imaging modalities, stability within several months, dose distribution, toxicity and tumor control up to 18 months after treatment was analyzed. RESULTS After hydrodissection, the needle was moved from the base towards the apex during injection of each syringe, respectively. The viscous spacer could be successfully injected focally and resulted in a planned distancing of the target volume (right lobe and seminal vesicle area) and the rectum of at least 1 cm and additional distancing to the bladder of at least 5 mm. Both brachytherapy treatments were performed without relevant toxicities. The PSA nadirs indicated a satisfactory short-term response to the treatment. CONCLUSIONS The viscous hydrogel spacer can be injected focally at a specific prostate lobe or seminal vesicles. A viscous spacer remains stable within fatty tissue in any areas that are accessible by an ultrasound guided needle injection to create a distance between the high brachytherapy dose within the target and the organ at risk.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany.
| | - Horst Hermani
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Peter Bischoff
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Herbert Hanitzsch
- Department of Urology, MediClin Robert Janker Klinik, Bonn, Germany; Urologic Centre Bonn, Bonn, Germany
| | - Albert Heidrich
- Department of Urology, MediClin Robert Janker Klinik, Bonn, Germany; Curos Urologic Centre, Wesseling, Germany
| | - Andreas Schäfer
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Attila Kovács
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Hathal Haddad
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
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23
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Andratschke N, Willmann J, Appelt AL, Alyamani N, Balermpas P, Baumert BG, Hurkmans C, Høyer M, Langendijk JA, Kaidar-Person O, van der Linden Y, Meattini I, Niyazi M, Reynaert N, De Ruysscher D, Tanadini-Lang S, Hoskin P, Poortmans P, Nieder C. European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making. Lancet Oncol 2022; 23:e469-e478. [PMID: 36174633 DOI: 10.1016/s1470-2045(22)00447-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Re-irradiation can be considered for local recurrence or new tumours adjacent to a previously irradiated site to achieve durable local control for patients with cancer who have otherwise few therapeutic options. With the use of new radiotherapy techniques, which allow for conformal treatment plans, image guidance, and short fractionation schemes, the use of re-irradiation for different sites is increasing in clinical settings. Yet, prospective evidence on re-irradiation is scarce and our understanding of the underlying radiobiology is poor. Our consensus on re-irradiation aims to assist in re-irradiation decision making, and to standardise the classification of different forms of re-irradiation and reporting. The consensus has been endorsed by the European Society for Radiotherapy and Oncology and the European Organisation for Research and Treatment of Cancer. The use of this classification in daily clinical practice and research will facilitate accurate understanding of the clinical implications of re-irradiation and allow for cross-study comparisons. Data gathered in a uniform manner could be used in the future to make recommendations for re-irradiation on the basis of clinical evidence. The consensus document is based on an adapted Delphi process and a systematic review of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
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Affiliation(s)
- Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Najlaa Alyamani
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Brigitta G Baumert
- Institute of Radiation-Oncology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Yvette van der Linden
- Department of Radiotherapy, University Medical Centre, Leiden, Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium; Laboratory of Medical Radiophysics, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Hoskin
- Mount Vernon Cancer Centre and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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24
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Cuccia F, Rigo M, Figlia V, Giaj-Levra N, Mazzola R, Nicosia L, Ricchetti F, Trapani G, De Simone A, Gurrera D, Naccarato S, Sicignano G, Ruggieri R, Alongi F. 1.5T MR-Guided Daily Adaptive Stereotactic Body Radiotherapy for Prostate Re-Irradiation: A Preliminary Report of Toxicity and Clinical Outcomes. Front Oncol 2022; 12:858740. [PMID: 35494082 PMCID: PMC9043550 DOI: 10.3389/fonc.2022.858740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Prostate re-irradiation is an attractive treatment option in the case of local relapse after previous radiotherapy, either in the definitive or in the post-operative setting. In this scenario, the introduction of MR-linacs may represent a helpful tool to improve the accuracy and precision of the treatment. Methods This study reports the preliminary data of a cohort of 22 patients treated with 1.5T MR-Linacs for prostate or prostate bed re-irradiation. Toxicity was prospectively assessed and collected according to CTCAE v5.0. Survival endpoints were measured using Kaplan-Meier method. Results From October 2019 to October 2021, 22 patients received 1.5T MR-guided stereotactic body radiotherapy for prostate or prostate-bed re-irradiation. In 12 cases SBRT was delivered to the prostate, in 10 to the prostate bed. The median time to re-RT was 72 months (range, 12-1460). SBRT was delivered concurrently with ADT in 4 cases. Acute toxicity was: for GU G1 in 11/22 and G2 in 4/22; for GI G1 in 7/22, G2 in 4/22. With a median follow-up of 8 months (3-21), late G1 and G2 GU events were respectively 11/22 and 4/22. Regarding GI toxicity, G1 were 6/22, while G2 3/22. No acute/late G≥3 GI/GU events occurred. All patients are alive. The median PSA-nadir was 0.49 ng/ml (0.08-5.26 ng/ml), for 1-year BRFS and DPFS rates of 85.9%. Twenty patients remained free from ADT with 1-year ADT-free survival rates of 91.3%. Conclusions Our experience supports the use of MR-linacs for prostate or prostate bed re-irradiation as a feasible and safe treatment option with minimal toxicity and encouraging results in terms of clinical outcomes.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Giovanna Trapani
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Antonio De Simone
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Davide Gurrera
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Stefania Naccarato
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Gianluisa Sicignano
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy.,University of Brescia, Brescia, Italy
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25
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Ryg U, Seierstad T, Nilsen LB, Hellebust TP, Djupvik LH, Gustafson H, Hydal J, Kishan AU, Hole KH, Lilleby W. A Prospective Study of High Dose-Rate Brachytherapy or Stereotactic Body Radiotherapy of Intra-Prostatic Recurrence: Toxicity and Long Term Clinical Outcome. Front Oncol 2022; 12:861127. [PMID: 35463376 PMCID: PMC9022104 DOI: 10.3389/fonc.2022.861127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Up to half of patients with localized prostate cancer experience biochemical relapse within 10 years after definitive radiotherapy. The aim of this prospective study was to investigate the toxicity, dose to the organs at risk (OARs), and efficacy of dose-intensified focal salvage radiotherapy. Methods and Material Thirty-three patients (median age 68.8 years) with histologically confirmed relapse after primary definitive radiotherapy were enrolled between 2012 and 2019. No patients had metastases at imaging or in bone marrow aspiration. Twenty-three patients were treated with high dose-rate brachytherapy to the recurrent tumor, defined at multiparametric MRI, with 3 fractions of 10 Gy with two weeks interval, and 10 patients by stereotactic body radiotherapy with 35 Gy to the local recurrence and 25 Gy to the whole prostate in 5 fractions. We used the RTOG-scoring system to grade genitourinary (GU) and gastrointestinal toxicity (GI) at three months (acute), and at 12, 24, and 36 months (late). Dose-volume histogram parameters to the local recurrence and the OARs were obtained and 2 Gy equivalent (EQD2) total dose was calculated using the linear-quadratic model with α/β = 3 Gy. Efficacy was assessed by the progression-free interval and overall survival. Results Median follow-up time was 81 months (range 21–115). The cumulative moderate to severe GI and GU toxicities were 3.0% (1/33) and 15.2% (5/33). Six patients had grade 1 acute GI toxicity, none had grade 2 or 3. One patient had grade 3 acute GU toxicity, two had grade 2, and fourteen had grade 1. One patient had late GI toxicity grade 2 and eight had grade 1. Four patients had late GU toxicity grade 2 and eight had grade 1. No patients had grade 3 late toxicity. The mean total D90 to the recurrent tumor was 77.7 ± 17.0 Gy. The mean total rectum D2cc was 17.0 ± 7.9 Gy and the mean total urethra D0.1cc was 29.1 ± 8.2 Gy. Twenty-eight patients had re-irradiation without androgen deprivation therapy (ADT). Nine of these are still relapse-free and 10 had a recurrence-free interval longer than 2 years. Conclusion The toxicity of salvage radiotherapy was mild to moderate. One-third of the patients achieved long-term stable disease without ADT and one-third had a recurrence-free interval longer than 2 years. Some patients progressed rapidly and probably did not benefit from re-irradiation.
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Affiliation(s)
- Una Ryg
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Taran Paulsen Hellebust
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | | | - Hilde Gustafson
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jørgen Hydal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Urology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Knut Håkon Hole
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Michalet M, Riou O, Cottet-Moine J, Castan F, Gourgou S, Valdenaire S, Debuire P, Ailleres N, Draghici R, Charissoux M, Llacer Moscardo C, Farcy-Jacquet MP, Fenoglietto P, Azria D. Magnetic Resonance-Guided Reirradiation for Local Recurrence within the Prostate or in the Prostate Bed: One-Year Clinical Results of a Prospective Registry Study. Cancers (Basel) 2022; 14:cancers14081943. [PMID: 35454850 PMCID: PMC9030485 DOI: 10.3390/cancers14081943] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Around 33% of patients treated by EBRT or brachytherapy will present a biochemical recurrence. SBRT is a new option for the treatment of patients with local-only recurrence. MRgRT seems to be interesting for the treatment of these recurrences. This article presents the one-year late tolerance and biochemical recurrence-free survival results of a prospective registry study. Patients with intraprostatic (or in the prostate bed) recurrence were treated with 5 to 9 fractions (median dose of 30 Gy in 5 fractions) with the MRIdian® system. PSA level and toxicities were evaluated before treatment and at three, six and 12 months after treatment. Thirty-seven patients with a median age of 74.5 years old were treated between 21 October 2019 and 7 December 2020. Acute tolerance was excellent with no grade >2 toxicities. Twelve months after treatment, we observed an increase of grade 1−2 dysuria (46% vs. 13% before treatment) and grade 1 polyuria (73% vs. 7%). The six, nine and 12-months biochemical-recurrence free survival were 97.3%, 86.5% and 65.0%. Fifteen patients (40%) presented a biochemical recurrence. Nine of these 15 patients (60%) had a persistent disease within the treated volume. In conclusion, MRgRT is safe and has promising survival results.
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Affiliation(s)
- Morgan Michalet
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
- Correspondence:
| | - Olivier Riou
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Jeremy Cottet-Moine
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Florence Castan
- Biometrics Unit ICM, Montpellier Cancer Institute, University Montpellier, 34090 Montpellier, France; (F.C.); (S.G.)
| | - Sophie Gourgou
- Biometrics Unit ICM, Montpellier Cancer Institute, University Montpellier, 34090 Montpellier, France; (F.C.); (S.G.)
| | - Simon Valdenaire
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Pierre Debuire
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Norbert Ailleres
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Roxana Draghici
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Marie Charissoux
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Carmen Llacer Moscardo
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - Marie-Pierre Farcy-Jacquet
- Institut de Cancérologie du Gard, University Federation of Radiation Oncology of Mediterranean Occitanie, CHU Carémeau, 30900 Nîmes, France;
| | - Pascal Fenoglietto
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
| | - David Azria
- Montpellier Cancer Institute, University Federation of Radiation Oncology of Mediterranean Occitanie, University Montpellier, INSERM U1194 IRCM, 34298 Montpellier, France; (O.R.); (J.C.-M.); (S.V.); (P.D.); (N.A.); (R.D.); (M.C.); (C.L.M.); (P.F.); (D.A.)
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27
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Beddok A, Calugaru V, de Marzi L, Graff P, Dumas JL, Goudjil F, Dendale R, Minsat M, Verrelle P, Buvat I, Créhange G. Clinical and technical challenges of cancer reirradiation: Words of wisdom. Crit Rev Oncol Hematol 2022; 174:103655. [PMID: 35398521 DOI: 10.1016/j.critrevonc.2022.103655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 12/25/2022] Open
Abstract
Since the development of new radiotherapy techniques that have improved healthy tissue sparing, reirradiation (reRT) has become possible. The selection of patients eligible for reRT is complex given that it can induce severe or even fatal side effects. The first step should therefore be to assess, in the context of multidisciplinary staff meeting, the patient's physical status, the presence of sequelae resulting from the first irradiation and the best treatment option available. ReRT can be performed either curatively or palliatively to treat a cancer-related symptom that is detrimental to the patient's quality of life. The selected techniques for reRT should provide the best protection of healthy tissue. The construction of target volumes and the evaluation of constraints regarding the doses that can be used in this context have not yet been fully codified. These points raised in the literature suggest that randomized studies should be undertaken to answer pending questions.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie. Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France.
| | - Valentin Calugaru
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France
| | - Ludovic de Marzi
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie. Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France
| | - Pierre Graff
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France
| | - Jean-Luc Dumas
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France
| | - Farid Goudjil
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France
| | - Rémi Dendale
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France
| | - Mathieu Minsat
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France
| | - Pierre Verrelle
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France
| | - Irène Buvat
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie. Orsay. France
| | - Gilles Créhange
- Department of Radiation Oncology. Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay. France; Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie. Orsay. France; Proton Therapy Center. Institut Curie, PSL Research University, Orsay. France
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Kissel M, Pounou A, Ka K, Alexis A, Irani J, Jereczek-Fossa BA, Terlizzi M, Bossi A, Blanchard P. Efficacy and toxicity following salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy. Brachytherapy 2022; 21:424-434. [PMID: 35331666 DOI: 10.1016/j.brachy.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The management of local relapse after prostate cancer radiotherapy is frequently based on androgen deprivation therapy. The aim of the study was to report Gustave Roussy's experience with salvage prostate brachytherapy. PATIENTS AND METHODS All cases of localized prostate cancer presenting in an irradiated area who received salvage high dose rate (HDR) brachytherapy from 2013 to 2020 were retrospectively reviewed. RESULTS A total of 64 patients were included. Median follow up was 30.5 months. Median initial EBRT dose was 70 Gy [Q1-Q3: 70 - 74]. Median PSA at brachytherapy was 6.8 ng/mL [Q1-Q3: 4.4 - 8.7] with a median interval between first and salvage irradiation of 10 years [Q1-Q3: 6.9 - 12.6]. The modality of the first irradiation was an exclusive EBRT in 73% of the cases, mostly with a 3D technique (82%). Dose prescription was two fractions of 12 Gy or 13 Gy associated with androgen deprivation therapy for 63% of the patients. About 23% of the patients were castrate-resistant. Disease free survival at 2 years was 58% in the whole population and 66% in hormone sensitive patients. The only factors associated with disease free survival on multivariate analysis was a high-risk disease at initial diagnosis (HR = 3.59, IC95 [1.75; 7.39], p = 0.0005). Grade 3 urinary and rectal toxicities occurred in 1.5% and 1.5% of the patients, respectively. CONCLUSION HDR salvage brachytherapy seems to be a safe option for patients presenting with an isolated local relapse of prostate cancer.
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Affiliation(s)
- Manon Kissel
- Radiotherapy Department, Institut Curie, Paris, France
| | - Arthur Pounou
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Kanta Ka
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Anthony Alexis
- Radiophysics Department, Gustave Roussy, Villejuif, France
| | - Jacques Irani
- Urology Department, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Mario Terlizzi
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Alberto Bossi
- Radiotherapy Department, Gustave Roussy, Villejuif, France
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Augugliaro M, Marvaso G, Cambria R, Pepa M, Bagnardi V, Frassoni S, Pansini F, Patricia Rojas D, Colombo F, Iuliana Fodor C, Musi G, Petralia G, De Cobelli O, Cattani F, Orecchia R, Zerini D, Jereczek-Fossa BA. Finding safe dose-volume constraints for re-irradiation with SBRT of patients with prostate cancer relapse: The IEO experience. Phys Med 2021; 92:62-68. [PMID: 34871888 DOI: 10.1016/j.ejmp.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
AIM The primary aim of this study is to provide preliminary indications for safe constraints of rectum and bladder in patients re-irradiated with stereotactic body RT (SBRT). METHODS Data from patients treated for prostate cancer (PCa) and intraprostatic relapse, from 1998 to 2016, were retrospectively collected. First RT course was delivered with 3D conformal RT techniques, SBRT or volumetric modulated arc therapy (VMAT). All patients underwent re-irradiation with SBRT with heavy hypofractionated schedules. Cumulative dose-volume values to organs at risk (OARs) were computed and possible correlation with developed toxicities was investigated. RESULTS Twenty-six patients were included. Median age at re-irradiation was 75 years, mean interval between the two RT courses was 5.6 years and the median follow-up was 47.7 months (13.4-114.3 months). After re-irradiation, acute and late G ≥ 2 GU toxicity events were reported in 3 (12%) and 10 (38%) patients, respectively, while late G ≥ 2 GI events were reported in 4 (15%) patients. No acute G ≥ 2 GI side effects were registered. Patients receiving an equivalent uniform dose of the two RT treatments < 131 Gy appeared to be at higher risk of progression (4-yr b-PFS: 19% vs 33%, p = 0.145). Cumulative re-irradiation constraints that appear to be safe are D30% < 57.9 Gy for bladder and D30% < 66.0 Gy, D60% < 38.0 Gy and V122.1 Gy < 5% for rectum. CONCLUSION Preliminary re-irradiation constraints for bladder and rectum have been reported. Our preliminary investigation may serve to clear some grey areas of PCa re-irradiation.
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Affiliation(s)
- Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Francesca Colombo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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Francolini G, Loi M, Di Cataldo V, Detti B, Stocchi G, Masi L, Doro R, Scoccimarro E, Bellini C, Aquilano M, Allegra AG, Peruzzi A, Guerrieri B, Morelli I, Valzano M, Ciccone LP, Salvestrini V, Desideri I, Livi L. Stereotactic Re-irradiation in Recurrent Prostate Cancer after Previous Postoperative or Definitive Radiotherapy: Long-term Results after a Median Follow-up of 4 Years. Clin Oncol (R Coll Radiol) 2021; 34:50-56. [PMID: 34810069 DOI: 10.1016/j.clon.2021.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/07/2021] [Accepted: 11/02/2021] [Indexed: 12/26/2022]
Abstract
AIMS In 2018, we published early results from a cohort of patients treated with stereotactic body radiotherapy (SBRT) after previous radiotherapy with definitive or postoperative intent. We sought to provide extended follow-up of this cohort to confirm the safety and efficacy of this approach in a real-world scenario. MATERIALS AND METHODS Fifty patients affected by local relapse after previous definitive or postoperative radiotherapy were treated with SBRT. Treatment provided a total dose of 30 Gy in five fractions. Data about biochemical relapse-free survival (BRFS) and metastasis-free survival (MFS), together with adverse events, were analysed. Toxicity was reported according to Common Terminology Criteria for Adverse Events (CTCAE) score v.4.03. RESULTS After a median follow-up of 48.2 months, the median BRFS was 43 months. A Gleason score >7 and concomitant androgen deprivation therapy were shown to be predictors of the worst BRFS (hazard ratio 2.42, 95% confidence interval 1.09-5.41, P = 0.02; hazard ratio 2.83, 95% confidence interval 1.17-6.8, P = 0.02, respectively). The median MFS was not reached; concomitant androgen deprivation therapy was confirmed to be predictive of the worst MFS (hazard ratio 4.75, 95% confidence interval 1.52-14.8, P = 0.007). Late grade 1 and 2 rectal and bladder toxicity occurred in three (6%) and 13 (26%) patients, respectively. One patient experienced both grade 3 acute and chronic bladder toxicity. CONCLUSION Salvage SBRT re-irradiation after previous postoperative or definitive radiotherapy for local prostate cancer recurrence confirmed promising results in terms of oncological outcomes and the safety of this approach.
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Affiliation(s)
- G Francolini
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Italy.
| | - M Loi
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Italy
| | - V Di Cataldo
- CyberKnife Center, L'Istituto Fiorentino di Cura e Assistenza, Florence, Italy
| | - B Detti
- Azienda Ospedaliera Universitaria Careggi, Radiotherapy Unit, Florence, Italy
| | - G Stocchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L Masi
- Department of Medical Physics, Radiation Oncology L'Istituto Fiorentino di Cura e Assistenza, Florence, Italy
| | - R Doro
- Department of Medical Physics, Radiation Oncology L'Istituto Fiorentino di Cura e Assistenza, Florence, Italy
| | - E Scoccimarro
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - C Bellini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Aquilano
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A G Allegra
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A Peruzzi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - B Guerrieri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - I Morelli
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Valzano
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - I Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Slevin F, Aitken K, Alongi F, Arcangeli S, Chadwick E, Chang AR, Cheung P, Crane C, Guckenberger M, Jereczek-Fossa BA, Kamran SC, Kinj R, Loi M, Mahadevan A, Massaccesi M, Mendez LC, Muirhead R, Pasquier D, Pontoriero A, Spratt DE, Tsang YM, Zelefsky MJ, Lilley J, Dickinson P, Hawkins MA, Henry AM, Murray LJ. An international Delphi consensus for pelvic stereotactic ablative radiotherapy re-irradiation. Radiother Oncol 2021; 164:104-114. [PMID: 34560186 DOI: 10.1016/j.radonc.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stereotactic Ablative Radiotherapy (SABR) is increasingly used to treat metastatic oligorecurrence and locoregional recurrences but limited evidence/guidance exists in the setting of pelvic re-irradiation. An international Delphi study was performed to develop statements to guide practice regarding patient selection, pre-treatment investigations, treatment planning, delivery and cumulative organs at risk (OARs) constraints. MATERIALS AND METHODS Forty-one radiation oncologists were invited to participate in three online surveys. In Round 1, information and opinion was sought regarding participants' practice. Guidance statements were developed using this information and in Round 2 participants were asked to indicate their level of agreement with each statement. Consensus was defined as ≥75% agreement. In Round 3, any statements without consensus were re-presented unmodified, alongside a summary of comments from Round 2. RESULTS Twenty-three radiation oncologists participated in Round 1 and, of these, 21 (91%) and 22 (96%) completed Rounds 2 and 3 respectively. Twenty-nine of 44 statements (66%) achieved consensus in Round 2. The remaining 15 statements (34%) did not achieve further consensus in Round 3. Consensus was achieved for 10 of 17 statements (59%) regarding patient selection/pre-treatment investigations; 12 of 13 statements (92%) concerning treatment planning and delivery; and 7 of 14 statements (50%) relating to OARs. Lack of agreement remained regarding the minimum time interval between irradiation courses, the number/size of pelvic lesions that can be treated and the most appropriate cumulative OAR constraints. CONCLUSIONS This study has established consensus, where possible, in areas of patient selection, pre-treatment investigations, treatment planning and delivery for pelvic SABR re-irradiation for metastatic oligorecurrence and locoregional recurrences. Further research into this technique is required, especially regarding aspects of practice where consensus was not achieved.
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Affiliation(s)
- Finbar Slevin
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
| | - Katharine Aitken
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - Filippo Alongi
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy; University of Brescia, Italy.
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, Monza, Italy.
| | | | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | | | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloane Kettering Cancer Centre, New York, USA.
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Rémy Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Mauro Loi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
| | - Anand Mahadevan
- Geisinger Medical Center - Radiation Oncology, Danville, USA.
| | - Mariangela Massaccesi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Roma, Italy.
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, Canada.
| | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL, UMR 9181, Lille University, Lille, France.
| | - Antonio Pontoriero
- Department of BIOMORF, Radiation Oncology Unit, University of Messina, Italy.
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Centre, Cleveland, USA.
| | | | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloane Kettering Cancer Centre, New York, USA.
| | | | | | - Maria A Hawkins
- Medical Physics and Biochemical Engineering, University College London, UK.
| | - Ann M Henry
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
| | - Louise J Murray
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
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Zhong J, Slevin F, Scarsbrook AF, Serra M, Choudhury A, Hoskin PJ, Brown S, Henry AM. Salvage Reirradiation Options for Locally Recurrent Prostate Cancer: A Systematic Review. Front Oncol 2021; 11:681448. [PMID: 34568012 PMCID: PMC8459721 DOI: 10.3389/fonc.2021.681448] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/16/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Reirradiation using brachytherapy (BT) and external beam radiation therapy (EBRT) are salvage strategies with locally radiorecurrent prostate cancer. This systematic review describes the oncologic and toxicity outcomes for salvage BT and EBRT [including Stereotactic Body Radiation Therapy (SBRT)]. METHODS An International Prospective Register of Systematic Reviews (PROSPERO) registered (#211875) study was conducted using Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. EMBASE and MEDLINE databases were searched from inception to December 2020. For BT, both low dose rate (LDR) and high dose rate (HDR) BT techniques were included. Two authors independently assessed study quality using the 18-item Modified Delphi technique. RESULTS A total of 39 eligible studies comprising 1967 patients were included (28 BT and 11 SBRT). In 35 studies (90%), the design was single centre and/or retrospective and no randomised prospective studies were found. Twelve BT studies used LDR only, 11 HDR only, 4 LDR or HDR and 1 pulsed-dose rate only. All EBRT studies used SBRT exclusively, four with Cyberknife alone and 7 using both Cyberknife and conventional linear accelerator treatments. Median (range) modified Delphi quality score was 15 (6-18). Median (range) follow-up was 47.5 months (13-108) (BT) and 25.4 months (21-44) (SBRT). For the LDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 71% (48-89.5) and 52.5% (20-79). For the HDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 74% (63-89) and 51% (45-65). For the SBRT studies, the median (range) 2-year bRFS for the SBRT group was 54.9% (40-80). Mean (range) acute and late grade≥3 GU toxicity rates for LDR-BT/HDR-BT/SBRT were 7.4%(0-14)/2%(0-14)/2.7%(0-8.7) and 13.6%(0-30)/7.9%(0-21.3%)/2.7%(0-8%). Mean (range) acute and late grade≥3 GI toxicity rates for LDR-BT/HDR-BT/SBRT were 6.5%(0-19)/0%/0.5%(0-4%) and 6.4%(0-20)/0.1%(0-0.9)/0.2%(0-1.5). One third of studies included Patient Reported Outcome Measures (PROMs). CONCLUSIONS Salvage reirradiation of radiorecurrent prostate cancer using HDR-BT or SBRT provides similar biochemical control and acceptable late toxicity. Salvage LDR-BT is associated with higher late GU/GI toxicity. Challenges exist in comparing BT and SBRT from inconsistencies in reporting with missing data, and prospective randomised trials are needed.
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Affiliation(s)
- Jim Zhong
- Department of Diagnostic and Interventional Radiology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- Department of Clinical Oncology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Finbar Slevin
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- Department of Clinical Oncology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew F. Scarsbrook
- Department of Diagnostic and Interventional Radiology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Maria Serra
- Department of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
- The Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Peter J. Hoskin
- Department of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
- The Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Ann M. Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- Department of Clinical Oncology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Graff P, Crehange G. [Ultra-hypofractionated radiotherapy for the treatment of localized prostate cancer: Results, limits and prospects]. Cancer Radiother 2021; 25:684-691. [PMID: 34274223 DOI: 10.1016/j.canrad.2021.06.028] [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: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Still an emerging approach a few years ago, stereotactic body radiation therapy (SBRT) has ranked as a valid option for the treatment of localized prostate cancer. Inherent properties of prostatic adenocarcinoma (low α/β) make it the perfect candidate. We propose a critical review of the literature trying to put results into perspective to identify their strengths, limits and axes of development. Technically sophisticated, the stereotactic irradiation of the prostate is well tolerated. Despite the fact that median follow-up of published data is still limited, ultra-hypofractionated radiotherapy seems very efficient for the treatment of low and intermediate risk prostate cancers. Data seem satisfying for high-risk cancers as well. New developments are being studied with a main interest in treatment intensification for unfavorable intermediate risk and high-risk cancers. Advantage is taken of the sharp dose gradient of stereotactic radiotherapy to offer safe reirradiation to patients with local recurrence in a previously irradiated area.
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Affiliation(s)
- P Graff
- Département d'oncologie radiothérapie, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - G Crehange
- Département d'oncologie radiothérapie, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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