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Nakai Y, Tanaka N, Inoue T, Onishi K, Morizawa Y, Hori S, Gotoh D, Miyake M, Torimoto K, Fujimoto K. Quality of life after non-nerve-sparing, robot-assisted radical prostatectomy. Asia Pac J Clin Oncol 2023. [PMID: 37850378 DOI: 10.1111/ajco.14031] [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: 06/16/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To evaluate quality of life (QOL) after non-nerve-sparing, robot-assisted radical prostatectomy (RARP) and factors associated with worsened QOL. METHODS Patients who underwent non-nerve-sparing RARP (n = 115) were enrolled. The Expanded Prostate Cancer Index Composite and 8-item Short Form Health Survey were used to evaluate QOL at baseline and postoperative 1, 3, 6, 12, and 24 months. Preoperative factors were evaluated by multivariate analysis for worsened QOL. RESULTS Postoperative 24-month urinary QOL worsened in 68 of 115 (59%) patients. In multivariate analysis, membranous urethral length ≥10.8 mm [odds ratio (OR): .26, 95% confidence interval (CI): .07-.96] and intravesical prostatic protrusion ≥12 mm (OR: .14, 95% CI .06-.35) were significantly associated with maintaining postoperative 24-month urinary QOL. Significantly more patients with intravesical prostatic protrusion ≥12 mm than < 12 mm had improved urinary QOL. At postoperative 24 months, 43 of 115 (38%) patients had worsened sexual QOL. In multivariate analysis, higher Sexual Health Inventory for Men score (OR: 8.39, 95% CI 2.28-30.9), sexual activity (OR: 6.94, 95% CI: 2.27-21.2), and intercourse activity (OR: 6.81, 95% CI: 1.64-28.3) preoperatively were significantly associated with worsened postoperative 24-month sexual QOL. More patients with high preoperative intercourse activity (12/23,53%) had significantly worsened (p = .009) QOL regarding sexual bother than those who had no preoperative intercourse activity (21/92, 23%). CONCLUSION After non-nerve-sparing RARP, patients with long membranous urethral length and/or intravesical prostatic protrusion maintain urinary QOL. Patients with high intercourse activity presented with impairment of sexual QOL after non-nerve-sparing RARP.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
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Chilukuri S, Mallick I, Agrawal A, Maitre P, Arunsingh M, James FV, Kataria T, Narang K, Gurram BC, Anand AK, Utreja N, Dutta D, Pavamani S, Mitra S, Mallik S, Mahale N, Chandra M, Chinnachamy AN, Shahid T, Raghunathan MS, Kannan V, Mohanty SK, Basu T, Hotwani C, Panigrahi G, Murthy V. Multi-Institutional Clinical Outcomes of Biopsy Gleason Grade Group 5 Prostate Cancers Treated With Contemporary High-Dose Radiation and Long-Term Androgen Deprivation Therapy. Clin Oncol (R Coll Radiol) 2023; 35:454-462. [PMID: 37061457 DOI: 10.1016/j.clon.2023.03.018] [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: 01/18/2023] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT). MATERIALS AND METHODS Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses. RESULTS Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities. CONCLUSION Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.
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Affiliation(s)
- S Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - F V James
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - T Kataria
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - K Narang
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - B C Gurram
- Department of Radiation Oncology, Yashoda Cancer Institute, Somajiguda, Hyderabad, India
| | - A K Anand
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - N Utreja
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
| | - S Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - S Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Mallik
- Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, India
| | - N Mahale
- Nirali Memorial Radiation Centre and Bharat Cancer Hospital, Surat, India
| | - M Chandra
- Department of Radiation Oncology, Jupiter Hospital, Thane, India
| | - A N Chinnachamy
- Department of Radiation Oncology, VN Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - T Shahid
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India
| | - M S Raghunathan
- Department of Radiotherapy, Kovai Medical Centre and Hospital, Coimbatore, India
| | - V Kannan
- Department of Radiation Oncology, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S K Mohanty
- Department of Radiation Oncology, Sterling Cancer Hospital, Rajkot, Gujrat, India
| | - T Basu
- Department of Radiation Oncology, HCG Cancer Centre, Mumbai, India
| | - C Hotwani
- Department of Radiation Oncology, Alexis Multi-Speciality Hospital, Nagpur, India
| | - G Panigrahi
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India.
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3
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Qiu J, Cai D, Wang Z, Zhou J, Gong Y, Cai L, Gong K. Prognostic Models for Patients With Gleason Score 9 Prostate Cancer: A Population-Based Study. Front Oncol 2021; 11:633312. [PMID: 33981602 PMCID: PMC8107690 DOI: 10.3389/fonc.2021.633312] [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: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Gleason score (GS) system is one of the most widely used histological grading methods for prostate cancer (PCa) all over the world. GS can be obtained by adding the primary Gleason pattern (GP) and secondary GP. Different proportions of GP 4 and GP 5 in prostate specimens can both lead to GS 9. In this study, we explored whether GP 5 + 4 or GP 4 + 5 was associated with different prognoses among patients with GS 9 PCa. Materials and methods: A retrospective population-based study was conducted on 10,124 subjects diagnosed with GS 9 PCa between 2004 and 2009 from the Surveillance, Epidemiology, and End Results program. A 1:1 propensity-score matching (PSM) was performed to balance the baseline characteristics between the GP 4 + 5 and 5 + 4 groups and to compare the prognoses between the two groups. Cox regression analysis and Fine-Gray competing risk regression models were adopted to screen the covariates significantly associated with all-cause mortality (ACM) and cancer-specific mortality (CAM). Results: GP 5 + 4 was associated with higher risks of ACM and CSM before or after PSM than GP 4 + 5. In the original cohort, there were eight independent predictors for ACM, which were age at diagnosis, race, AJCC NM stage, PSA levels, treatments, GP, and marital status, confirmed by the Cox analysis; and nine independent predictors for CSM, which were age at diagnosis, race, AJCC TNM stage, PSA levels, treatments, GP, and marital status, confirmed by the competing-risk model. Conclusion: GP 5 + 4 was associated with a poorer overall survival and cancer-specific survival compared with GP 4 + 5.
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Affiliation(s)
- Jianhui Qiu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Desheng Cai
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Zixin Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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4
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Nemirovsky A, Huang H, Al Kibria GM, Naslund M, Siddiqui MM. Surgery associated with increased survival compared to radiation in clinically localized Gleason 9-10 prostate cancer: a SEER analysis. World J Urol 2021; 39:415-423. [PMID: 32350585 PMCID: PMC7606264 DOI: 10.1007/s00345-020-03215-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Men with Gleason score 9-10 prostate cancer have worse outcomes compared to those with Gleason 8 disease. Upfront treatments remain controversial for these patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, we evaluated the impact of initial treatment with external beam radiation therapy (EBRT), external beam radiation therapy with brachytherapy (EBRT + BT), or surgery on prostate cancer-specific mortality (PCSM) and overall mortality (OM) in Gleason 9-10 disease. METHODS The SEER database was queried for men diagnosed with biopsy Gleason 9-10 prostate cancer from 2005 to 2014. Gathered data included demographic, pathologic, therapy received, and survival outcomes. Kaplan-Meier survival curves and crude and multivariate analyses were generated for initial therapy with EBRT, EBRT + BT, or surgery. RESULTS A total of 7877 men were included, 4465 (56.7%) who underwent upfront treatment with EBRT alone, 623 (7.9%) with EBRT + BT, and 2789 (35.4%) with surgery. The 7 year PCSM rates were 29.2, 15.0, and 14.6% for EBRT, EBRT + BT, and surgery respectively (p < 0.001). The 7 year OM rates were 43.8, 27.2, and 20.0% for EBRT, EBRT + BT, and surgery, respectively (p < 0.001).When controlling for age, year of diagnosis, Gleason score, clinical T stage, and PSA level on multivariate analysis, EBRT had greater PCSM and OM than surgery (HR 0.41, 95% CI 0.28-0.61, p < 0.001 and HR 0.44, 95% CI 0.34-0.57, p < 0.001 respectively), but the mortality differences was not statistically significant between EBRT and EBRT + BT. CONCLUSION Among men with localized Gleason 9-10 disease, surgery was associated with statistically significant improved survival outcomes compared to EBRT alone.
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Affiliation(s)
- Amy Nemirovsky
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Hubert Huang
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland Medical Center, Baltimore, MD, USA
| | - Michael Naslund
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Mohummad Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA.
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5
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Kasahara T, Ishizaki F, Kazama A, Yuki E, Yamana K, Maruyama R, Oshikane T, Kaidu M, Aoyama H, Bilim V, Nishiyama T, Tomita Y. High‐dose‐rate brachytherapy and hypofractionated external beam radiotherapy combined with long‐term androgen deprivation therapy for very high‐risk prostate cancer. Int J Urol 2020; 27:800-806. [DOI: 10.1111/iju.14305] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Takashi Kasahara
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Fumio Ishizaki
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Akira Kazama
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Eri Yuki
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Kazutoshi Yamana
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Ryo Maruyama
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Tomoya Oshikane
- Department of Radiology and Radiation Oncology Niigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology Niigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Hidefumi Aoyama
- Department of Radiology and Radiation Oncology Niigata University Graduate School of Medical and Dental Sciences NiigataJapan
| | - Vladimir Bilim
- Department of Urology Kameda Daiichi Hospital NiigataJapan
| | | | - Yoshihiko Tomita
- Division of Molecular Oncology Department of UrologyNiigata University Graduate School of Medical and Dental Sciences NiigataJapan
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6
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Stone NN, Skouteris V, Stock RG. Long-term biochemical control and cause-specific survival in men with Gleason grade Group 4 and 5 prostate cancer treated with brachytherapy and external beam irradiation. Brachytherapy 2020; 19:275-281. [PMID: 32217039 DOI: 10.1016/j.brachy.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Men with Gleason grade Group (GG) 4 and 5 prostate cancer have high failure rates when treated by conventional therapy. We investigated the effect of higher radiation doses on freedom from biochemical failure (FBF) and prostate cancer mortality (cause-specific survival [CSS]) in men treated with a combination of permanent implant and external beam irradiation (EBRT). METHODS AND MATERIALS Three hundred twenty men with GG4 (n = 186) and 5 (n = 134) prostate cancer were treated with I-125 or Pd-103 implant followed by 45 Gy of EBRT. Radiation doses were converted to the biological equivalent dose (BED). The median age, prostate-specific antigen (PSA), time on hormone therapy, BED, and followup were 69 years, 9.0 ng/mL, 9 months, 210 Gy, and 6.5 years, respectively. FBF and CSS were calculated by Kaplan-Meier method with associations determined by log rank and Cox regression. RESULTS Ten-year FBF for GG4 vs. 5 was 77.8 vs. 61.3% (p = 0.015), and CSS was 94 vs. 79.3% (p = 0.001). Men with lower PSA had improved FBF and CSS (p < 0.001). Thirty-one of 320 died of prostate cancer of which 10/186 (5.4%) had GG4 and 21/134 (15.7%) GG5 (OR 3.3, p = 0.002). BED <200 Gy was associated with a 2.2× greater BF (p = 0.004) and 2.4× prostate cancer mortality (p = 0.020). Significant covariates on regression analysis for FBF and CSS were PSA (p = 0.014), GG (p = 0.007), BED (p = 0.009), and GG (p = 0.001). CONCLUSIONS Survival rates for high-grade prostate cancer are favorable when diagnosed in men with lower PSA and treated with doses of BED > 200 Gy. Higher BED is achieved with a combination of I-125 (110 Gy) or Pd-103 (100 Gy) and 45 Gy EBRT.
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Affiliation(s)
- Nelson N Stone
- Departments of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | - Richard G Stock
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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7
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Polish Brachytherapy Society - Presidential opening: Chasing Brachytherapy. J Contemp Brachytherapy 2019; 11:38446. [PMID: 31749846 PMCID: PMC6854867 DOI: 10.5114/jcb.2019.89381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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8
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Ozyigit G, Onal C, Igdem S, Alicikus ZA, Iribas A, Akin M, Yalman D, Cetin I, Aksu MG, Atalar B, Dincbas F, Hurmuz P, Guler OC, Aydin B, Sert F, Yildirim C, Gorken IB, Agaoglu FY, Korcum AF, Yuce D, Ozkok S, Darendeliler E, Akyol F. Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy : TROD 09-001 multi-institutional study. Strahlenther Onkol 2019; 195:882-893. [PMID: 31143994 DOI: 10.1007/s00066-019-01476-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era. METHODS Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. RESULTS The median follow-up time was 5.9 years (range 0.4-18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10. CONCLUSIONS Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
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Affiliation(s)
- Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey.
| | - Cem Onal
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, İstanbul Bilim University, Faculty of Medicine, Istanbul, Turkey
| | - Zumre Arican Alicikus
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ayca Iribas
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | | | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ilknur Cetin
- Department of Radiation Oncology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Melek Gamze Aksu
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University, Faculty of Medicine, Istanbul, Turkey
| | - Fazilet Dincbas
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozan Cem Guler
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Barbaros Aydin
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fatma Sert
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Cumhur Yildirim
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilknur Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fulya Yaman Agaoglu
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Deniz Yuce
- Department of Prevantive Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
| | - Serdar Ozkok
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Emin Darendeliler
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
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9
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Espenel S, Limkin E, Garcia MA, Langrand-Escure J, Vallard A, Chargari C, Magné N. [Brachytherapy: When needs overtake care offer]. Bull Cancer 2019; 106:584-589. [PMID: 31084914 DOI: 10.1016/j.bulcan.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Brachytherapy has the unique characteristic of being able to deliver high doses to a very localized volume, and remains one of the radiotherapy techniques that has an unparalleled therapeutic index. However, its use has been declining in the past years. Globally, only 55 to 88 % of patients with locally advanced cervical cancer benefit from utero-vaginal brachytherapy, despite the fact that it is proven to enhance both progression-free and overall survival. A decline in the use of low dose rate brachytherapy has likewise been described in the treatment of low-risk and favorable intermediate-risk prostate cancers. Several factors could explain this. First, the radiation oncologists who have the proficiency to perform brachytherapy seems to be inadequate, as it is a technique that requires training and expertise for optimal applications. In many cancer care centers, the caseload is insufficient to provide this experience. Second, the increasing use of technically advanced external beam radiation therapy, such as intensity modulated radiation therapy, offers an easier substitute with more lucrative benefits, resulting in decreased utilization of brachytherapy. However, when brachytherapy is not delivered, a poorer survival rate is reported in locally advanced cervical cancer, and is suggested in intermediate and high-risk prostate cancer. The increasing level of evidence of treatment with brachytherapy necessitates an improvement in its accessibility by having more radiation oncologists as well as cancer centers equipped to perform the procedure.
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Affiliation(s)
- Sophie Espenel
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Elaine Limkin
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Max-Adrien Garcia
- Institut de cancérologie Lucien-Neuwirth, département de santé publique, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Cyrus Chargari
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
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10
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Moschini M, Sharma V, Soligo M, Psutka S, Rangel L, Boorjian SA, Frank I, Gettman MT, Thompson RH, Tollefson MK, Karnes RJ. Heterogeneity of risk within Gleason 4 + 4, 4 + 5 and 5 + 4 prostate cancer. Scand J Urol 2019; 52:340-348. [DOI: 10.1080/21681805.2018.1534886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Psutka
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Laureano Rangel
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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11
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Nagore G, Lopez Guerra JL, Krumina E, Lagos M, Ovalles B, Miró A, Beltran L, Gómez E, Praena-Fernandez JM, Del Campo ER, Azinovic I, Gomez-Iturriaga A. High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions. Radiother Oncol 2018; 127:219-224. [PMID: 29625808 DOI: 10.1016/j.radonc.2018.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE High dose-rate (HDR) brachytherapy (BT) provides a highly conformal method of dose delivery to the prostate. The purpose of this study is to prospectively determine the toxicity of the treatment protocol of 13.5 Gy × 2 fractions. MATERIALS AND METHODS From 2010 through 2017, 119 patients with low (71%) or intermediate-risk prostate cancer were prospectively treated in a single institute with HDR-BT at 13.5 Gy × 2 fractions within one day. Median follow-up time was 4.4 years. RESULTS Actuarial rates of no biochemical evidence of disease, overall survival and metastasis-free survival for all patients were 96%,98% and 98%, respectively. The cumulative incidence of acute grade 2 and 3 genitourinary (GU) toxicity was 9% and 2%, respectively. The corresponding incidences of late GU toxicity were 18% and 1%. No grade ≥4 of either type of toxicity was detected. Multivariate analysis showed that having higher international prostate symptom score (IPSS; P = 0.041) or higher V200 (P = 0.013) was associated with a higher risk of experiencing any grade of acute GU toxicity. In addition, patients having a higher IPSS (P = 0.019) or a higher V150 (P = 0.033) were associated with a higher grade >1 acute GU toxicity. CONCLUSIONS The findings of this study show that HDR-BT 13.5 Gy × 2 as monotherapy was safe and effective for prostate cancer patients with low-intermediate risk.
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Affiliation(s)
- Gorka Nagore
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | | | - Evita Krumina
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Mark Lagos
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Beatriz Ovalles
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Antonio Miró
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Lourdes Beltran
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Emilia Gómez
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | | | | | | | - Alfonso Gomez-Iturriaga
- Department of Radiation Oncology, Hospital Universitario Cruces-Biocruces Health Research Institute, Barakaldo, Spain
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