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Faria S, Duclos M, Cury F, Patrocinio H, Souhami L. Acute toxicity in patients with high-risk prostate cancer treated with stereotactic body radiation, with irradiation to the prostate and pelvic nodes. Cancer Radiother 2024; 28:159-163. [PMID: 38548531 DOI: 10.1016/j.canrad.2023.07.014] [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: 03/09/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 04/22/2024]
Abstract
PURPOSE Stereotactic body radiation therapy has been used for prostate cancer. However, the bulk of published studies on stereotactic body radiation therapy for prostate cancer has involved the irradiation of the prostate alone, without irradiation of the pelvic lymph nodes. We report our preliminary experience with this approach. MATERIAL AND METHODS The files of patients with biopsy-proven prostate cancer treated with stereotactic body radiation therapy in our institution were reviewed. Stereotactic body radiation was delivered with intensity modulated-volumetric arctherapy with daily image-guidance. The prostate planning target volume included the prostate plus a margin of 5mm in all directions. The pelvic planning target volume included pelvic nodes plus an expansion of 6 to 7mm in all directions. The prostate planning target volume received a total dose of 36.25Gy delivered in five fractions on alternate days. The nodal planning target volume received a dose of 25Gy in the same five fractions. Patients were followed during treatment, after 1, and 3 months and every 6 months thereafter. Gastrointestinal and genitourinary toxicity was prospectively graded according to Common Terminology Criteria for Adverse Events. RESULTS Among the 188 patients, 80 received stereotactic body radiation to the prostate and the pelvic nodes, while 108 received stereotactic body radiation to the prostate target only. Grade 2 acute gastrointestinal toxicity was 4% in both groups, and grade 2 acute genitourinary toxicity was 27% and 20% (P=0.9) for prostate only versus prostate and pelvis respectively. There was no grade 3 or higher acute gastrointestinal or genitourinary toxicity. CONCLUSION Stereotactic body radiation therapy in five fractions including the prostate and pelvic nodes, in patients with high-risk prostate cancer, has been feasible and safe in terms of acute toxicity.
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Affiliation(s)
- S Faria
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, PQ H4A3J1, Canada.
| | - M Duclos
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, PQ H4A3J1, Canada
| | - F Cury
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, PQ H4A3J1, Canada
| | - H Patrocinio
- Medical Physics Unit, McGill University, Montreal, Canada
| | - L Souhami
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, PQ H4A3J1, Canada
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Ho CH, Cheng KC, Chao CM, Lai CC, Chiang SR, Chen CM, Liao KM, Wang JJ, Lee PH, Hung CM, Tai CM, Chiu CC. Does radiotherapy increase the risk of colorectal cancer among prostate cancer patients? A large population-based study. J Cancer 2020; 11:6204-6212. [PMID: 33033503 PMCID: PMC7532509 DOI: 10.7150/jca.44726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
Objective: The survival of prostate cancer (PC) patients after radiotherapy (RT) has improved over time, but it raises the debate of increased risk of secondary colorectal cancer (SCRC). This study aimed to assess whether RT for PC treatment increases the risk of SCRC in comparison with radical prostatectomy (RP). Methods: A population-based cohort of PC patients treated only with RT or only with RP between January 2007 and December 2015 was identified from the Taiwan Cancer Registry. The incidence rate of SCRC development was estimated using Cox regression model. Results: In this study, total 8,797 PC patients treated with either RT (n = 3,219) or RP (n =5,578). Patients subjected to RT were elder (higher percentage of 70≧years, p < 0.0001) and more advanced clinically (stage III: 22.90% vs. 11.87%; stage IV: 22.15% vs. 13.80%, p < 0.0001), compared to those subjected to RP. More patients subjected to RT had a much higher percentage of autoimmune disease (22.34% vs. 18.75%, p < 0.0001) and osteoarthritis and allied disorders (16.31% vs. 12.98%, p < 0.0001). Besides, RT patients had a higher percentage of underlying Crohn's disease (0.25% vs. 0.05%, p = 0.0230). Although almost all selected factors were not statistically significant, they presented the positive risk of SCRC for those under RP compared with those among RT. Besides, for PC patients in clinical stage I and II, patients with RP may have borderline significantly protective effects of SCRC compared with those under RT (stage I, HR: 0.14; 95% C.I.:0.01-1.39; p = 0.0929; stage II, HR: 1.92; 95% C.I.:0.93-3.95; p = 0.0775). Kaplan-Meier curves for a 3-year-period, which demonstrated no statistical difference in the risk of SCRC free between PC patients undergoing RT and RP (p = 0.9766). Conclusion: Whether or not pelvic RT for PC is associated with an increased risk for SCRC on a population-based level remains a matter of considerable debate. From a clinical perspective, these PC survivors should be counseled accordingly and received continued cancer surveillance with regular colonoscopy follow-up.
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Affiliation(s)
- Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
- Department of Safety, Health and Environment, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
- Department of Dental Laboratory Technology, Min-Hwei College of Health Care Management, Tainan 73657, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 71004, Taiwan
| | - Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
- Departments of General Education, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Chin-Ming Chen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali 72263, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan
- AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan
| | - Po-Huang Lee
- Department of Surgery, E-Da Hospital. I-Shou University, Kaohsiung 82400, Taiwan
| | - Chao-Ming Hung
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82400, Taiwan
| | - Chi-Ming Tai
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82400, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82400, Taiwan
- ✉ Corresponding author: Chong-Chi Chiu, MD, Professor, Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82400, Taiwan. Mail address: P. O. Box 174 Shanhua, Tainan City, 74199, Taiwan. E-mail: ; Telephone: +886-76150022-6046; Fax: +886-7615-0940
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Nightingale H, Conroy R, Elliott T, Coyle C, Wylie J, Choudhury A. A national survey of current practices of preparation and management of radical prostate radiotherapy patients during treatment. Radiography (Lond) 2017; 23:87-93. [DOI: 10.1016/j.radi.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/18/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
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Chin S, Hayden AJ, Gebski V, Cross S, Turner SL. Long Term Patient Reported Urinary Function Following External Beam Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:421-428. [PMID: 28202212 DOI: 10.1016/j.clon.2017.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 01/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study reports long-term patient reported urinary function and urinary-related quality of life (uQoL) after external beam radiotherapy (EBRT) for localized prostate cancer. METHODS 574 men underwent definitive prostate EBRT to 70-78 Gy±androgen deprivation therapy between 2000 and 2009. The median follow-up from EBRT was 44 months. Patients were evaluated at baseline (pre-EBRT) and at intervals post-treatment using the International Prostate Symptom Score (IPSS) instrument. RESULTS Patients with mild IPSS at baseline (total 0-7) reported median total scores of 3, 4 and 3 at baseline, 6 and 48 months respectively post-EBRT. For patients with moderate IPSS at baseline (total 8-19), median total IPSS was 12 at baseline and 9 at both 6 and 48 months. For the severe IPSS group at baseline (total 20-35), the median total IPSS was 24, 12 and 14 at baseline, 6 and 48 months post-EBRT. The cumulative risk of persistent IPSS increase (greater than 5 points above baseline) at 48 months was 16%, 10% and 6% for patients with mild, moderate and severe baseline IPSS respectively. 94%, 54% and 11% of patients with mild, moderate and severe baseline IPSS reported good uQoL at baseline respectively, with these proportions increasing to 95%, 83% and 69% at 48 months. CONCLUSION Urinary symptoms and uQoL as measured by the IPSS instrument remained stable or improved for the majority of men after definitive EBRT with or without ADT for prostate cancer. This was especially notable for the group of men with worse baseline symptoms or uQoL, with risk of persistent worsening of urinary symptoms decreasing with higher baseline IPSS category. Understanding the expected pattern of urinary symptoms and related uQoL in the months and years following EBRT taking into account baseline urinary function is highly valuable for counselling men as part of the therapeutic decision-making process.
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Affiliation(s)
- S Chin
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia.
| | - A J Hayden
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - V Gebski
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia
| | - S Cross
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - S L Turner
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
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Individual response to ionizing radiation. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 770:369-386. [PMID: 27919342 DOI: 10.1016/j.mrrev.2016.09.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022]
Abstract
The human response to ionizing radiation (IR) varies among individuals. The first evidence of the individual response to IR was reported in the beginning of the 20th century. Considering nearly one century of observations, we here propose three aspects of individual IR response: radiosensitivity for early or late adverse tissue events after radiotherapy on normal tissues (non-cancer effects attributable to cell death); radiosusceptibility for IR-induced cancers; and radiodegeneration for non-cancer effects that are often attributable to mechanisms other than cell death (e.g., cataracts and circulatory disease). All the molecular and cellular mechanisms behind IR-induced individual effects are not fully elucidated. However, some specific assays may help their quantification according to the dose and to the genetic status. Accumulated data on individual factors have suggested that the individual IR response cannot be ignored and raises some clinical and societal issues. The individual IR response therefore needs to be taken into account to better evaluate the risks related to IR exposure.
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Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol 2016; 17:464-474. [DOI: 10.1016/s1470-2045(15)00567-7] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022]
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Barbosa Neto O, Souhami L, Faria S. Hypofractionated radiation therapy for prostate cancer: The McGill University Health Center experience. Cancer Radiother 2015; 19:431-6. [DOI: 10.1016/j.canrad.2015.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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Supiot S, Créhange G, Latorzeff I, Pommier P, Paumier A, Rio E, Delaroche G, Guérif S, Catton C, Martin J, Lisbona A. [Hypofractionated radiotherapy in prostate cancer]. Cancer Radiother 2013; 17:349-54. [PMID: 23973460 DOI: 10.1016/j.canrad.2013.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 04/26/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022]
Abstract
Radiotherapy plays a central role in the management of localized prostate cancer, but the total duration of treatment of nearly 2 months poses not only problems of fatigue related to repetitive transports, especially for older patients, but also increases the overall cost of treatment including linear accelerators occupancy and patient transportation. To address this problem, various teams have developed hypofractionated radiotherapy protocols seeking to maintain the same efficacy and toxicity while reducing the total duration of treatment. These hypofractionated protocols require recent techniques such as image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Single centre series have validated the feasibility of "light" hypofractionation schemes at doses per fraction less than 6 Gy Similarly, different teams have shown the possibility of stereotactic irradiation for delivering "severe" hypofractionation schemes at doses greater than 6 Gy per fraction. Whatever the dose per fraction, the current clinical data support the conclusion that hypofractionated radiotherapy does not increase mid-term toxicity and could even improve biochemical control. Studies with the objective of demonstrating non-inferiority are expected to definitively validate the role of hypofractionated irradiation in the treatment of prostate cancer.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
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Patel N, Faria S, Cury F, David M, Duclos M, Shenouda G, Ruo R, Souhami L. Hypofractionated Radiation Therapy (66 Gy in 22 Fractions at 3 Gy per Fraction) for Favorable-Risk Prostate Cancer: Long-term Outcomes. Int J Radiat Oncol Biol Phys 2013; 86:534-9. [DOI: 10.1016/j.ijrobp.2013.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/03/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Prostate Hypofractionated Radiation Therapy: Injection of Hyaluronic Acid to Better Preserve The Rectal Wall. Int J Radiat Oncol Biol Phys 2013; 86:72-6. [DOI: 10.1016/j.ijrobp.2012.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/03/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity. JOURNAL OF RADIOTHERAPY IN PRACTICE 2012. [DOI: 10.1017/s1460396911000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurpose: To evaluate the toxicity of hypofractionated helical intensity-modulated radiotherapy (IMRT) for men with intermediate- and high-risk prostate cancer.Methods and Materials: A retrospective toxicity analysis was performed in 22 patients treated definitively with hypofractionated helical IMRT. The helical IMRT were designed to deliver 75 Gy in 2.5 Gy/fraction to the prostate gland, 63 Gy in 2.1 Gy/fraction to seminal vesicle, and 54 Gy in 1.8 Gy/fraction to pelvic lymph nodes. No patient received hormonal therapy. Toxicity was graded by the Radiation Therapy Oncology Group (RTOG) scales.Results: All patients tolerated the treatment well without treatment interruption, and there was no Grade 3 or more acute toxicity. With a median follow-up of 24.5 months, there was no Grade 3 or more late toxicity. The late Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity for total 22 patients were 9.1% and 18.2%, respectively, and the late Grade 1 GI and GU toxicity were 18.2% and 50%, respectively. Late GU toxicity was associated with greater bladder volume irradiated ≥70 Gy. Late GI toxicity did not correlate with any of the dosimetric parameters.Conclusions: This study demonstrate that hypofractionated helical IMRT with high biologic effective dose (BED) is well tolerated with favourable toxicity rate. If longer follow-up periods and larger cohorts confirm the favourable biochemical control rate and our favourable toxicity assessment results, the hypofractionated IMRT (total 75 Gy, 2.5 Gy/fraction) might be implemented in clinical field for treatment of prostate cancer.
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Vavassis P, Nguyen DHA, Bahary JP, Yassa M. Hypofractionated radiotherapy in prostate cancer. Expert Rev Anticancer Ther 2012; 12:965-72. [PMID: 22845411 DOI: 10.1586/era.12.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In regards to prostate cancer, the classic radiotherapy dose ranges from 70-80 Gy, administered in daily 2-Gy fractions. However, when taking into account the particular radiobiological model of prostate cancer cells, one realizes that there is a potential theoretical advantage to delivering a greater biological effective dose per treatment in a lower number of fractions. Both recent and older publications have attempted to explore this treatment option. This critical review comprehensively examines the current state of knowledge concerning hypofractionated radiotherapy in prostate cancer.
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Affiliation(s)
- Peter Vavassis
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada
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Evaluation of the respiratory prostate motion with four-dimensional computed tomography scan acquisitions using three implanted markers. Radiother Oncol 2012; 103:266-9. [DOI: 10.1016/j.radonc.2012.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/15/2012] [Accepted: 03/20/2012] [Indexed: 11/16/2022]
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Quon H, Cheung PC, Loblaw DA, Morton G, Pang G, Szumacher E, Danjoux C, Choo R, Thomas G, Kiss A, Mamedov A, Deabreu A. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity. Int J Radiat Oncol Biol Phys 2012; 82:898-905. [DOI: 10.1016/j.ijrobp.2010.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 11/25/2022]
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Faria S, Pra AD, Cury F, David M, Duclos M, Freeman CR, Souhami L. Treating intermediate-risk prostate cancer with hypofractionated external beam radiotherapy alone. Radiother Oncol 2011; 101:486-9. [DOI: 10.1016/j.radonc.2011.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/21/2011] [Accepted: 07/07/2011] [Indexed: 11/29/2022]
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Quon H, Cheung PCF, Loblaw DA, Morton G, Pang G, Szumacher E, Danjoux C, Choo R, Kiss A, Mamedov A, Deabreu A. Quality of life after hypofractionated concomitant intensity-modulated radiotherapy boost for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2011; 83:617-23. [PMID: 22079736 DOI: 10.1016/j.ijrobp.2011.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/29/2011] [Accepted: 07/06/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the change in health-related quality of life (QOL) of patients with high-risk prostate cancer treated using hypofractionated radiotherapy combined with long-term androgen deprivation therapy. METHODS AND MATERIALS A prospective Phase I-II study enrolled patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level ≥20 ng/mL, or Gleason score 8-10. Radiotherapy consisted of 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes with a concomitant 22.5 Gy intensity-modulated radiotherapy boost to the prostate, for a total of 67.5 Gy (2.7 Gy per fraction) in 25 fractions over 5 weeks. Daily image guidance was performed using three gold seed fiducials. Quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), a validated tool that assesses four primary domains (urinary, bowel, sexual, and hormonal). RESULTS From 2004 to 2007, 97 patients were treated. Median follow-up was 39 months. Compared with baseline, at 24 months there was no statistically significant change in the mean urinary domain score (p = 0.99), whereas there were decreases in the bowel (p < 0.01), sexual (p < 0.01), and hormonal (p < 0.01) domains. The proportion of patients reporting a clinically significant difference in EPIC urinary, bowel, sexual, and hormonal scores at 24 months was 27%, 31%, 55%, and 60%, respectively. However, moderate and severe distress related to these symptoms was minimal, with increases of only 3% and 5% in the urinary and bowel domains, respectively. CONCLUSIONS Hypofractionated radiotherapy combined with long-term androgen deprivation therapy was well tolerated. Although there were modest rates of clinically significant patient-reported urinary and bowel toxicity, most of this caused only mild distress, and moderate and severe effects on QOL were limited. Additional follow-up is ongoing to characterize long-term QOL.
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Affiliation(s)
- Harvey Quon
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Faria S, Joshua B, Patrocinio H, Dal Pra A, Cury F, Velly A, Souhami L. Searching for Optimal Dose–Volume Constraints to Reduce Rectal Toxicity after Hypofractionated Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2010; 22:810-7. [DOI: 10.1016/j.clon.2010.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 05/13/2010] [Accepted: 05/20/2010] [Indexed: 10/18/2022]
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Correlation Between Acute and Late Toxicity in 973 Prostate Cancer Patients Treated With Three-Dimensional Conformal External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:26-34. [DOI: 10.1016/j.ijrobp.2009.07.1742] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 07/11/2009] [Accepted: 07/16/2009] [Indexed: 11/18/2022]
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Rene N, Faria S, Cury F, David M, Duclos M, Shenouda G, Souhami L. Hypofractionated Radiotherapy for Favorable Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 77:805-10. [DOI: 10.1016/j.ijrobp.2009.05.047] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/25/2009] [Accepted: 05/27/2009] [Indexed: 11/24/2022]
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Bhojani N, Capitanio U, Suardi N, Jeldres C, Isbarn H, Shariat SF, Graefen M, Arjane P, Duclos A, Lattouf JB, Saad F, Valiquette L, Montorsi F, Perrotte P, Karakiewicz PI. The Rate of Secondary Malignancies After Radical Prostatectomy Versus External Beam Radiation Therapy for Localized Prostate Cancer: A Population-Based Study on 17,845 Patients. Int J Radiat Oncol Biol Phys 2010; 76:342-8. [DOI: 10.1016/j.ijrobp.2009.02.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 02/06/2009] [Accepted: 02/07/2009] [Indexed: 11/29/2022]
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Marzi S, Saracino B, Petrongari MG, Arcangeli S, Gomellini S, Arcangeli G, Benassi M, Landoni V. Modeling of alpha/beta for late rectal toxicity from a randomized phase II study: conventional versus hypofractionated scheme for localized prostate cancer. J Exp Clin Cancer Res 2009; 28:117. [PMID: 19689825 PMCID: PMC2733302 DOI: 10.1186/1756-9966-28-117] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 08/19/2009] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recently, the use of hypo-fractionated treatment schemes for the prostate cancer has been encouraged due to the fact that alpha/beta ratio for prostate cancer should be low. However a major concern on the use of hypofractionation is the late rectal toxicity, it is important to be able to predict the risk of toxicity for alternative treatment schemes, with the best accuracy. The main purpose of this study is to evaluate the response of rectum wall to changes in fractionation and to quantify the alpha/beta ratio for late rectal toxicity METHODS 162 patients with localized prostate cancer, treated with conformal radiotherapy, were enrolled in a phase II randomized trial. The patients were randomly assigned to 80 Gy in 40 fractions over 8 weeks (arm A) or 62 Gy in 20 fractions over 5 weeks (arm B). The median follow-up was 30 months. The late rectal toxicity was evaluated using the Radiation Therapy Oncology Group (RTOG) scale. It was assumed >or= Grade 2 (G2) toxicity incidence as primary end point. Fit of toxicity incidence by the Lyman-Burman-Kutcher (LKB) model was performed. RESULTS The crude incidence of late rectal toxicity >or= G2 was 14% and 12% for the standard arm and the hypofractionated arm, respectively. The crude incidence of late rectal toxicity >or= G2 was 14.0% and 12.3% for the arm A and B, respectively. For the arm A, volumes receiving >or= 50 Gy (V50) and 70 Gy (V70) were 38.3 +/- 7.5% and 23.4 +/- 5.5%; for arm B, V38 and V54 were 40.9 +/- 6.8% and 24.5 +/- 4.4%. An alpha/beta ratio for late rectal toxicity very close to 3 Gy was found. CONCLUSION The >or= G2 late toxicities in both arms were comparable, indicating the feasibility of hypofractionated regimes in prostate cancer. An alpha/beta ratio for late rectal toxicity very close to 3 Gy was found.
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Affiliation(s)
- Simona Marzi
- Laboratorio di Fisica Medica e Sistemi Esperti, Istituto Regina Elena, Rome, Italy
| | | | | | | | | | | | - Marcello Benassi
- Laboratorio di Fisica Medica e Sistemi Esperti, Istituto Regina Elena, Rome, Italy
| | - Valeria Landoni
- Laboratorio di Fisica Medica e Sistemi Esperti, Istituto Regina Elena, Rome, Italy
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