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Meraouna Y, Blanchard P, Losa S, Labib A, Krhili S, Pommier P, Crehange G, Flam T, Cosset JM, Kissel M. Salvage low-dose-rate brachytherapy for locally recurrent prostate cancer after definitive irradiation. Clin Transl Radiat Oncol 2024; 48:100809. [PMID: 39027689 PMCID: PMC11254530 DOI: 10.1016/j.ctro.2024.100809] [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: 10/23/2023] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center. Patients and methods A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively.No significant difference in toxicity or efficacy was observed between the three implant volume groups. Conclusion The efficacy and toxicity results are consistent with those in the LDR group of the MASTER meta-analysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.
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Affiliation(s)
- Y. Meraouna
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Faculté de médecine Sorbonne Université, 91-105 Boulevard de l’Hôpital, 75013 Paris, France
| | - P. Blanchard
- Radiotherapy Department, Gustave Roussy, 114 Boulevard Edouard Vaillant, 94220 Villejuif, France
| | - S. Losa
- Physics Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - A. Labib
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - S. Krhili
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - P. Pommier
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - G. Crehange
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - T. Flam
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Urology Department, Clinique Saint Jean de Dieu, 2 rue Rousselet, 75007 Paris, France
| | - J-M. Cosset
- Radiotherapy Department, Centre Charlebourg – La Défense – Amethyst Radiothérapie, 65 Avenue Foch, 92250 La Garenne-Colombes, France
| | - M. Kissel
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
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Shen B, Liu J, Wu D, Guo J. Evaluation of the safety and efficacy of high-dose rate brachytherapy for radiorecurrent prostate cancer: a systematic review and meta-analysis. Strahlenther Onkol 2024; 200:655-670. [PMID: 38386054 DOI: 10.1007/s00066-024-02205-x] [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: 10/16/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND High-dose-rate brachytherapy (HDR-BT) plays an important role in the treatment of locally recurrent prostate cancer after definitive treatment. The objective of this study is to summarize the efficacy and toxicity of HDR-BT in these patients. METHODS We performed a systematic review of PubMed and EMBASE from inception to July 2023. The primary endpoint was relapse-free survival (RFS) in different subgroups, and the secondary endpoint was gastrointestinal (GI) and genitourinary (GU) toxicity. A semi-automated tool (WebPlotDigitizer) and a new Shiny application combined with R software (R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; https://www.R-project.org/ ) helped to reconstruct survival curves. RESULTS Twenty-six studies met the inclusion criteria for quantitative analysis, including 1447 patients. A total of 761 patients from 13 studies were included in survival reconstruction, and the median RFS time was 61.2 months (57.6-72.0 months). The estimated 2‑, 3‑, and 5‑year rates were 75.9% (95% confidence interval [CI] 72.8 ~ 79.2%), 66.7% (95% CI 63.0 ~ 70.5%), and 52.3% (95% CI 47.5 ~ 57.4%), respectively. Whole-gland irradiation with multiple fractions (≥ 2 F) resulted in better RFS compared with focal gland irradiation with fewer fractions (1 F mostly; hazard ratio [HR]: 0.60, 95% CI 0.47-0.77, p < 0.0001). According to the different median time from primary treatment to salvage therapy (TRS) and median age at recurrence, short median TRS (56-67.2 months vs. 70-120 months; HR 0.52, 95% CI 0.68-0.40; p < 0.0001) and younger median age (60-70 years vs. 71-75 years; HR 0.58, 95% CI 0.46-0.74; p < 0.0001) were positive factors for RFS. The cumulative incidences estimated for grade ≥ 3 acute and late GU toxicities were 1% (95% CI 0 ~ 1%) and 5% (95% CI 4 ~ 7%), respectively. Three patients (3/992) experienced grade ≥ 3 late GI toxicity, and no cases of grade ≥ 3 acute GI toxicity were reported. CONCLUSION HDR-BT has a high safety profile and good RFS benefit for salvage treatment of radiorecurrent prostate cancer. In terms of RFS, whole-gland irradiation with multiple fractions seems to be better than focal gland irradiation with fewer fractions, while short TRS and younger age are good prognostic factors. In view of the low level of evidence in the included studies and the large heterogeneity of each study, these conclusions still need to be confirmed by randomized controlled trials.
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Affiliation(s)
- Bin Shen
- Urology Department, Shaoxing People's Hospital, 312000, Shaoxing, Zhejiang, China
| | - Jianjiang Liu
- Department of Radiotherapy, Shaoxing People's Hospital, 312000, Shaoxing, Zhejiang, China
| | - Dongping Wu
- Department of Radiotherapy, Shaoxing People's Hospital, 312000, Shaoxing, Zhejiang, China.
| | - Jiayi Guo
- School of Medicine, Shaoxing University, No.568 Zhongxing North Road, Yuecheng District, 312000, Shaoxing, Zhejiang, China.
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Weiner AB, Kakani P, Armstrong AJ, Bossi A, Cornford P, Feng F, Kanabur P, Karnes RJ, Mckay RR, Morgan TM, Schaeffer EM, Shore N, Tree AC, Spratt DE. Risk Stratification of Patients with Recurrence After Primary Treatment for Prostate Cancer: A Systematic Review. Eur Urol 2024:S0302-2838(24)02375-3. [PMID: 38782697 DOI: 10.1016/j.eururo.2024.04.034] [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: 02/12/2024] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Biochemical recurrence (BCR) after primary definitive treatment for prostate cancer (PCa) is a heterogeneous disease state. While BCR is associated with worse oncologic outcomes, risk factors that impact outcomes can vary significantly, necessitating avenues for risk stratification. We sought to identify prognostic risk factors at the time of recurrence after primary radical prostatectomy or radiotherapy, and prior to salvage treatment(s), associated with adverse oncologic outcomes. METHODS We performed a systematic review of prospective studies in EMBASE, MEDLINE, and ClinicalTrials.gov (from January 1, 2000 to October 16, 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42023466330). We reviewed the factors associated with oncologic outcomes among patients with BCR after primary definitive treatment. KEY FINDINGS AND LIMITATIONS A total of 37 studies were included (total n = 10 632), 25 after prostatectomy (total n = 9010) and 12 after radiotherapy (total n = 1622). Following recurrence after prostatectomy, factors associated with adverse outcomes include higher pathologic T stage and grade group, negative surgical margins, shorter prostate-specific antigen doubling time (PSADT), higher prostate-specific antigen (PSA) prior to salvage treatment, shorter time to recurrence, the 22-gene tumor RNA signature, and recurrence location on molecular imaging. After recurrence following radiotherapy, factors associated with adverse outcomes include a shorter time to recurrence, and shorter PSADT or higher PSA velocity. Grade group, T stage, and prior short-term hormone therapy (4-6 mo) were not clearly associated with adverse outcomes, although sample size and follow-up were generally limited compared with postprostatectomy data. CONCLUSIONS AND CLINICAL IMPLICATIONS This work highlights the recommendations and level of evidence for risk stratifying patients with PCa recurrence, and can be used as a benchmark for personalizing salvage treatment based on prognostics. PATIENT SUMMARY We summarize the data from previously reported clinical trials on the topic of which factors predict worse cancer outcomes for patients who recur with prostate cancer after their initial treatment.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Preeti Kakani
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA
| | - Alberto Bossi
- Amethyst Radiotherapy Group, La Garenne Colombes, France
| | | | - Felix Feng
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
| | - Pratik Kanabur
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rana R Mckay
- Department of Medicine, Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Todd M Morgan
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Alison C Tree
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
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Li X, Zhou H, Mou K, Zheng Y, Li H, Ren P, Ye H, Lin S, Pang H, Wu J, Xiang L. Risk Factors for Operation Complications of High Dose Rate 3-Dimensional Interstitial Brachytherapy for Lung Cancer. Clin Lung Cancer 2023:S1525-7304(23)00059-1. [PMID: 37149479 DOI: 10.1016/j.cllc.2023.04.003] [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: 12/10/2022] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The risk factors for operation complications of high-dose-rate dimensional (3D) interstitial brachytherapy for lung malignant tumors are still unclear. We aimed to provide a reliable reference for the preoperative safety assessment of interstitial brachytherapy. PATIENTS AND METHODS We analyzed the degree and incidence of operational complications in 120 eligible patients with lung carcinoma who underwent computed tomography (CT)-guided HDR interstitial brachytherapy. Univariate and multivariate analyses were used to study the relationships between patient-related factors, tumor-related factors, operation-related factors, and operational complications. RESULTS The most frequent complications of CT-guided HDR interstitial brachytherapy were pneumothorax and hemorrhage. In univariate analysis, smoking, emphysema, distance of implanted needles through the normal lung tissue, number of implanted needle adjustments, and distance of the lesion from the pleura were the risk factors for pneumothorax; the tumor size, distance of the tumor from the pleura, number of implanted needle adjustments, and distance of the implanted needle through the normal lung tissue were risk factors for hemorrhage. In multivariate analysis, the depth of the implanted needle through the normal lung tissue and distance of the lesion from the pleura were independent risk factors for pneumothorax. Tumor size, number of implanted needle adjustments, and distance through normal lung tissue were independent risk factors for hemorrhage. CONCLUSION This study provides a reference for the clinical treatment of lung cancer by analyzing the risk factors for complications of interstitial brachytherapy.
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Affiliation(s)
- Xiaoyue Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Huan Zhou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kelin Mou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zheng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongxia Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peirong Ren
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hua Ye
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingbo Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Li Xiang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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5
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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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6
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King MT, Yang DD, D’Amico AV, Buzurovic I, Harris TC, Guthier CV, Steele GS, Kathrins MN, Choudhury AD. Risk-adaptive paradigm for focal versus whole-gland salvage treatment for radio-recurrent prostate cancer. Front Oncol 2022; 12:998390. [PMID: 36249064 PMCID: PMC9554650 DOI: 10.3389/fonc.2022.998390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Martin T. King
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- *Correspondence: Martin T. King,
| | - David D. Yang
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Anthony V. D’Amico
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ivan Buzurovic
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Thomas C. Harris
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Christian V. Guthier
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Graeme S. Steele
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Martin N. Kathrins
- Department of Urology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Atish D. Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Ménard C, Navarro-Domenech I, Liu Z(A, Joseph L, Barkati M, Berlin A, Delouya G, Taussky D, Beauchemin MC, Nicolas B, Kadoury S, Rink A, Raman S, Sundaramurthy A, Weersink R, Beliveau-Nadeau D, Helou J, Chung P. MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer. Front Oncol 2022; 12:971344. [PMID: 36091157 PMCID: PMC9459480 DOI: 10.3389/fonc.2022.971344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Locally recurrent prostate cancer after radiotherapy merits an effective salvage strategy that mitigates the risk of adverse events. We report outcomes of a cohort enrolled across two institutions investigating MRI-guided tumor-targeted salvage high dose rate brachytherapy (HDR-BT). Materials and methods Analysis of a prospective cohort of 88 patients treated across two institutions with MRI-guided salvage HDR-BT to visible local recurrence after radiotherapy (RT). Tumor target dose ranged from 22-26 Gy, using either an integrated boost (ibBT) or focal technique (fBT), delivered in two implants over a median of 7 days. Outcome metrics included cancer control and toxicity (CTCAE). Quality of life (QoL-EPIC) was analyzed in a subset. Results At a median follow-up of 35 months (6 -134), 3 and 5-year failure-free survival (FFS) outcomes were 67% and 49%, respectively. At 5 years, fBT was associated with a 17% cumulative incidence of local failure (LF) outside the GTV (vs. 7.8% ibBT, p=0.14), while LF within the GTV occurred in 13% (vs. 16% ibBT, p=0.81). Predictors of LF outside fBT volumes included pre-salvage PSA>7 ng/mL (p=0.03) and interval since RT less than 5 years (p=0.04). No attributable grade 3 events occurred, and ibBT was associated with a higher rate of grade 2 toxicity (p<0.001), and trend towards a larger reduction in QoL sexual domain score (p=0.07), compared to fBT. Conclusion A tumor-targeted HDR-BT salvage approach achieved favorable cancer control outcomes. While a fBT was associated with less toxicity, it may be best suited to a subgroup with lower PSA at later recurrence. Tumor targeted dose escalation may be warranted.
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Affiliation(s)
- Cynthia Ménard
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
- *Correspondence: Cynthia Ménard,
| | | | - Zhihu (Amy) Liu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Lisa Joseph
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Maroie Barkati
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Guila Delouya
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Daniel Taussky
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Claude Beauchemin
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Benedicte Nicolas
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Samuel Kadoury
- Radiation Oncology, Polytechnique Montreal, Montreal, QC, Canada
| | - Alexandra Rink
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Srinivas Raman
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Robert Weersink
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Dominic Beliveau-Nadeau
- Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Joelle Helou
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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A Prospective Study of MR-Guided Focal Salvage High Dose-Rate Brachytherapy for Radiorecurrent Prostate Cancer: Updated Results of 30 Patients. Pract Radiat Oncol 2022; 12:e531-e537. [PMID: 35718075 DOI: 10.1016/j.prro.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Limited prospective data on focal salvage high dose-rate (HDR) prostate brachytherapy are available. We sought to explore the toxicities, health related quality of life (HRQOL) and efficacy of focal salvage HDR brachytherapy in a prospective clinical trial. This report represents updated results of previously published data. MATERIALS AND METHODS Patients with locally recurrent prostate cancer after previous external beam radiotherapy and/or brachytherapy were enrolled. Patients received MRI-guided, ultrasound-based focal HDR brachytherapy delivered over two fractions of 13.5 Gy delivered 1-2 weeks apart. Androgen deprivation therapy (ADT) was not used. RESULTS Thirty patients were treated between 2012-2019. At a median follow-up of 39 months, the three-year biochemical failure-free rate was 61.8% (95% CI 44.0-86.6%), and three-year ADT/salvage therapy-free rate was 86.0% (95% CI 74.1-99.8%). Seventeen patients experienced subsequent biochemical failure, 9 have received ADT and/or further local salvage, and no patients have died from prostate cancer. Of the 28 patients who had a post-treatment MRI, 26 had a local treatment response. No acute grade ≥ 3 GU/GI toxicity was observed. One temporary late grade 3 GU toxicity event occurred, and no late grade ≥ 3 GI toxicity was seen. No significant decline in urinary or bowel HRQOL was observed. CONCLUSIONS Focal salvage HDR brachytherapy has a favourable side effect profile, no significant decline in HRQOL and 3-year biochemical control rates in line with other salvage options. While early MRI response at the treated site is common, this does not preclude subsequent biochemical failure.
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9
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Wong OL, Poon DM, Kam MK, Lo GG, Fung WW, Man SY, Xue C, Yu SK, Cheung KY, Yuan J. 3D‐T2W‐TSE radiotherapy treatment planning MRI using compressed sensing acceleration for prostate cancer: Image quality and delineation value. Asia Pac J Clin Oncol 2022; 18:e369-e377. [DOI: 10.1111/ajco.13752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Oi Lei Wong
- Research Department Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Darren M.C. Poon
- Comprehensive Oncology Centre Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Miachael K.M. Kam
- Comprehensive Oncology Centre Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Gladys G. Lo
- Department of Diagnostic and Interventional Radiology Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Winky W.K. Fung
- Department of Radiotherapy Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Shei Yee Man
- Department of Radiotherapy Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Cindy Xue
- Research Department Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Siu Ki Yu
- Medical Physics Department Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Kin Yin Cheung
- Medical Physics Department Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
| | - Jing Yuan
- Research Department Hong Kong Sanatorium and Hospital Hong Kong Hong Kong SAR
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10
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Liu W, Fakir H, Randhawa G, Alfano R, Corkum M, Kassam Z, Rachinsky I, Chung HT, Chung P, Loblaw A, Morton G, Sexton T, Kapoor A, Ward A, Zukotynski K, Emmett L, Bauman G. Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI. Clin Transl Radiat Oncol 2022; 32:41-47. [PMID: 34841094 PMCID: PMC8606298 DOI: 10.1016/j.ctro.2021.11.006] [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: 09/13/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022] Open
Abstract
PURPOSE Our purpose was to evaluate intra-prostatic cancer volumes for salvage radiotherapy in men with recurrent prostate cancer confined to the prostate post-primary radiotherapy using mpMRI and 18F-DCFPyL PET/CT (PET). METHODS Men with biochemical failure post-primary radiotherapy were enrolled in a multi-centre trial investigating mpMRI and PET. All men with isolated intra-prostatic recurrence are included in this secondary analysis. The intra-prostatic gross tumour volume (GTV) was manually delineated on mpMRI and was also delineated on PET using three methods: 1. manually, 2. using a 30% threshold of maximum intra-prostatic standard uptake value (SUVmax), and 3. using a 67% threshold of this SUVmax. Clinical target volumes (CTV) including expansions on each GTV were generated. Conformity indices were performed between the mpMRI CTV and each PET CTV. Correlation with biopsy and clinical outcomes were performed. RESULTS Of the 36 men included, 30 (83%) had disease in two quadrants or less using the combination of mpMRI and PET. Mean target volume (union of CTV on mpMRI and CTV manually delineated on PET) was 12.2 cc (49% of prostate gland volume). 12/36 (33%) men had a biopsy. Per-patient sensitivity was 91% for mpMRI and 82% for PET. CONCLUSIONS mpMRI and PET provide complementary information for delineation of intra-prostatic recurrent disease. Union of CTV on mpMRI and PET is often less than 50% of the prostate, suggesting this imaging could help define a target for focal salvage therapy.
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Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Hatim Fakir
- Department of Oncology and Department of Medical Biophysics, London Health Sciences Centre and Western University, London, Canada
| | | | - Ryan Alfano
- Department of Radiation Oncology, Windsor Regional Cancer Centre, Windsor Regional Hospital, Windsor, Canada
| | - Mark Corkum
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph’s Health Care and Western University, London, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Hans T. Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Institute of Health Care Policy and Evaluation, University of Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Canada
| | - Aaron Ward
- Department of Medical Biophysics, Lawson Health Research Institute and Western University, London, Canada
| | - Katherine Zukotynski
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
- Departments of Medicine and Radiology, McMaster University, Hamilton, Canada
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent’s Hospital and University of New South Wales, Sydney, Australia
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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11
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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: 17] [Impact Index Per Article: 5.7] [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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12
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Murgic J, Chung HT. In Regard to van Son et al. Int J Radiat Oncol Biol Phys 2021; 110:617-618. [PMID: 33989586 DOI: 10.1016/j.ijrobp.2021.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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13
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Yu N, Wang B, Ren J, Wu H, Gao Y, Liu A, Niu G. The clinical guiding value of a radiomics model for androgen deprivation therapy for prostate cancer. J Int Med Res 2021; 49:3000605211014301. [PMID: 34187217 PMCID: PMC8258766 DOI: 10.1177/03000605211014301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Three models were used to evaluate prostate cancer after androgen deprivation therapy (ADT) and to determine the value of detecting residual lesions after treatment. METHODS We retrospectively analysed patients with prostate cancer who received ADT from January 2018 to June 2019. Patients were divided into ADT responder and ADT non-responder groups, and clinical risk factors were determined. Regions of interest were manually contoured on each slice on fat-saturated-T2-weighted imaging, and radiomic features were extracted. Uni- and multivariate logistic regression were used to establish radiomics, clinical and combined models. RESULTS There were 23 ADT non-responders and 20 ADT responders. In the clinical model, total prostate-specific antigen concentration and T stage were independent predictors of efficacy (area under the curve (AUC) = 0.774). The characteristics, MinIntensity and Correlation_ angle135_offset4 indicated an effective clinical model (AUC = 0.807). GLCMEntropy_ AllDirection_offset1_SD was the best feature to differentiate residual lesions from the central gland (CG) (Lesion-CG model, AUC = 0.955). Correlation_angle135_offset4, GLCMEntropy_ AllDirection_offset4_SD and GLCMEntropy_AllDirection_offset7_SD differentiated residual lesions from the peripheral zone (PZ) (Lesion-PZ model, AUC = 0.855). The AUC for the combined model was 0.904. CONCLUSIONS Our models can guide the clinical treatment of patients with different ADT responses. Furthermore, the radiomics model can detect prostate cancer that is non-responsive to ADT.
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Affiliation(s)
- Na Yu
- Department of Imaging Diagnosis, The Fifth People's Hospital of Datong, Datong, Shanxi Province, China
| | - Baoping Wang
- Department of Imaging Diagnosis, The Fifth People's Hospital of Datong, Datong, Shanxi Province, China
| | - Jialiang Ren
- General Electric Pharmaceutical (Shanghai), Beijing, China
| | - Hui Wu
- Department of Imaging Diagnosis, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yang Gao
- Department of Imaging Diagnosis, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Aishi Liu
- Department of Imaging Diagnosis, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Guangming Niu
- Department of Imaging Diagnosis, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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14
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Willigenburg T, van Son MJ, van de Pol SMG, Eppinga WSC, Lagendijk JJW, de Boer HCJ, Moerland MA, van der Voort van Zyp JRN, Peters M. Development and internal validation of multivariable prediction models for biochemical failure after MRI-guided focal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer. Clin Transl Radiat Oncol 2021; 30:7-14. [PMID: 34278009 PMCID: PMC8261471 DOI: 10.1016/j.ctro.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background and purpose Magnetic resonance-guided focal salvage high-dose-rate brachytherapy (FS-HDR-BT) for radiorecurrent prostate cancer (PCa) shows low toxicity rates. However, biochemical failure (BF) after treatment occurs frequently. We developed two prediction models for BF (Phoenix definition) with the aim of enhancing patient counselling before FS-HDR-BT and during follow-up. Materials and methods A prospective cohort of 150 radiorecurrent PCa patients treated with FS-HDR-BT between 2013 and 2020 was used for model development and internal validation. Multivariable Cox Proportional Hazards regression was applied. For model 1, only pre-salvage variables were included as candidate predictors. For model 2, additional (post-)salvage characteristics were tested. After calibration, nomograms and webtools were constructed. Finally, three risk groups were identified. Results Sixty-one patients (41%) experienced BF. At baseline (model 1), age, gross tumour volume, pre-salvage PSA, and pre-salvage PSA doubling time (PSADT) were predictive of BF. During follow-up (model 2), age, pre-salvage PSA and PSADT, seminal vesicle involvement, post-salvage time to PSA nadir, and percentage PSA reduction were predictive of BF. The adjusted C-statistics were 0.73 (95% CI: 0.66-0.81) and 0.84 (95% CI: 0.78-0.90), respectively, with acceptable calibration. Estimated 2-year biochemical disease-free survival for the low-, intermediate-, and high-risk groups were 84%, 70%, and 31% (model 1), and 100%, 71%, and 5% (model 2). Conclusion Two models are provided for prediction of BF in patients with radiorecurrent PCa treated with FS-HDR-BT. Based on pre- and post-salvage characteristics, we are able to identify patients with a high risk of BF. These findings can aid patient counselling for FS-HDR-BT.
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Affiliation(s)
- Thomas Willigenburg
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J van Son
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandrine M G van de Pol
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wietse S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan J W Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans C J de Boer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marinus A Moerland
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Lucia F, Miranda O, Bourbonne V, Martin E, Pradier O, Schick U. Integration of functional imaging in brachytherapy. Cancer Radiother 2021; 26:517-525. [PMID: 34172398 DOI: 10.1016/j.canrad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/31/2022]
Abstract
Functional imaging allows the evaluation of numerous biological properties that could be considered at all steps of the therapeutic management of patients treated with brachytherapy. Indeed, it enables better initial staging of the disease, and some parameters may also be used as predictive biomarkers for treatment response, allowing better selection of patients eligible for brachytherapy. It may also improve the definition of target volumes with the aim of dose escalations by dose-painting. Finally, it could be useful during the follow-up to assess response to treatment. In this review, we report how functional imaging is integrated at the present time during the brachytherapy procedure, and what are its potential future contributions in the main tumour locations where brachytherapy is recommended. Functional imaging has great potential in the contact of brachytherapy, but still, several issues remain to be resolved before integrating it into clinical practice, especially as a biomarker or in dose painting strategies.
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Affiliation(s)
- F Lucia
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France.
| | - O Miranda
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - V Bourbonne
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - E Martin
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - O Pradier
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
| | - U Schick
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France
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16
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van Son MJ, Peters M, Moerland MA, van der Voort van Zyp JRN. In Reply to Murgic and Chung. Int J Radiat Oncol Biol Phys 2021; 110:618-619. [PMID: 33989587 DOI: 10.1016/j.ijrobp.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marinus A Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
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17
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Young S, Liu W, Zukotynski K, Bauman G. Prostate-specific membrane antigen targeted PET/CT for recurrent prostate cancer: a clinician's guide. Expert Rev Anticancer Ther 2021; 21:641-655. [PMID: 33476253 DOI: 10.1080/14737140.2021.1878883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION PSMA-targeted PET/CT is a 'Next Generation Imaging' technique with superior sensitivity and specificity for detecting recurrent prostate cancer compared with conventional imaging, allowing more accurate staging and re-staging. AREAS COVERED This article reviews the role of PSMA-targeted PET/CT in clinical management of men with recurrent prostate cancer. EXPERT OPINION Through enhanced spatial characterization of recurrent prostate cancer, PSMA-targeted PET/CT has shown significant impact on management decisions. In particular, by identifying men with recurrence confined to the prostate or pelvic nodes, PSMA-targeted PET/CT enables selective deployment of localized salvage therapies for management of biochemical failure after primary treatment with prostatectomy or radiotherapy. In oligometastatic disease, PSMA-targeted PET/CT may improve patient selection and treatment accuracy for metastasis-directed therapy and early phase II studies show encouraging results in delaying the need for systemic therapy. Further, quantitative PSMA-targeted PET/CT for monitoring response and therapeutic PSMA-targeted radiopharmaceuticals are emerging as encouraging treatment options in the setting of castrate-resistant disease.
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Affiliation(s)
- Sympascho Young
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Wei Liu
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | | | - Glenn Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
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18
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Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, Rachinsky I, Kapoor A, Metser U, Loblaw A, Morton G, Sexton T, Lock M, Helou J, Berlin A, Boylan C, Archer S, Pond GR, Bauman G. Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging. Adv Radiat Oncol 2021; 6:100553. [PMID: 33521396 PMCID: PMC7820022 DOI: 10.1016/j.adro.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy. Methods and Materials A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT. Results Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months. Conclusions Most patients had a major change in actual management compared with pre-PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.
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Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent’s Hospital and University of New South Wales, Sydney, Australia
| | - Hans T. Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Wolfson
- Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Canada
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Institute of Health Care Policy and Evaluation, University of Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Michael Lock
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Techna Institute, University Health Network, Toronto, Canada
| | - Colm Boylan
- Department of Diagnostic Imaging, St. Joseph’s Healthcare and McMaster University, Hamilton, Canada
| | - Susan Archer
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Gregory R. Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
- Corresponding author: Glenn Bauman, MD, FRCPC
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Focal salvage treatment for radiorecurrent prostate cancer: A magnetic resonance-guided stereotactic body radiotherapy versus high-dose-rate brachytherapy planning study. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 15:60-65. [PMID: 33458327 PMCID: PMC7807590 DOI: 10.1016/j.phro.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
SBRT may provide a non-invasive treatment option for recurrent prostate cancer. MR-Linac single fraction 19 Gy treatment of recurrent prostate cancer is feasible. MR-Linac dose distributions for the target were comparable to HDR-brachytherapy. Real-time intrafraction adaptation techniques are needed for clinical introduction.
Background and Purpose Magnetic resonance imaging (MRI)-guided focal salvage high-dose-rate brachytherapy (FS-HDR-BT) is one of the treatment options for radiorecurrent localized prostate cancer. However, due to the invasive nature of the treatment, not all patients are eligible. Magnetic resonance linear accelerator (MR-Linac) systems open up new treatment possibilities and could potentially replace FS-HDR-BT treatment. We conducted a planning study to investigate the feasibility of delivering a single 19 Gy dose to the recurrent lesion using a 1.5 Tesla MR-Linac system. Materials and Methods Thirty patients who underwent FS-HDR-BT were included. The clinical target volume (CTV) encompassed the visible lesion plus a 5 mm margin. Treatment plans were created for a 1.5 Tesla MR-Linac system using a 1 mm planning target volume (PTV) margin. A dose of 19 Gy was prescribed to ≥ 95% of the PTV. In case this target could not be reached, i.e. when organs-at-risk (OAR) constraints were violated, a dose of ≥ 17 Gy to ≥ 90% of the PTV was accepted. MR-Linac plans were compared to clinical FS-HDR-BT plans. Results Target dose coverage was achieved in 14/30 (47%) FS-HDR-BT plans and 17/30 (57%) MR-Linac plans, with comparable median D95% and D90%. In FS-HDR-BT plans, a larger volume reached ≥ 150% of the prescribed dose. Urethra D10%, rectum D1cm3, and rectum D2cm3 were lower in the FS-HDR-BT plans, while bladder dose was comparable for both modalities. Conclusion Single fraction treatment of recurrent prostate cancer lesions may be feasible using stereotactic body radiotherapy (SBRT) on a MR-Linac system.
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Abufaraj M, Siyam A, Ali MR, Suarez-Ibarrola R, Yang L, Foerster B, Shariat SF. Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review. Cancers (Basel) 2021; 13:E244. [PMID: 33440752 PMCID: PMC7826752 DOI: 10.3390/cancers13020244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. METHODS This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. RESULTS The rates of severe urinary incontinence ranged from 28-88%, 4.5-42%, 0-6.5%, 2.4-8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5-3.4, 3.5-12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. CONCLUSIONS local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.
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Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Abdelmuez Siyam
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Mustafa Rami Ali
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79098 Freiburg, Germany;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming school of medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Beat Foerster
- Department of Urology, Kantonsspital Winterthur, 8401 Winterthur, Switzerland;
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
- Institute for Urology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119992 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10075, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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21
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van Son M, Peters M, Moerland M, van de Pol S, Eppinga W, Lagendijk J, van der Voort van Zyp J. Determining the safety of ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: A toxicity assessment of 150 patients. Clin Transl Radiat Oncol 2020; 27:1-7. [PMID: 33364450 PMCID: PMC7750686 DOI: 10.1016/j.ctro.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Severe toxicity is as low as 3% (GU), 0% (GI) and 15% (ED). Lower impact is predicted for patients with favorable function at baseline. Lower dose to the urethra (D10% <17 Gy) may prevent urinary symptoms.
Background and purpose Local re-treatment of radiorecurrent prostate cancer is potentially curative. However, the increased risk of severe toxicity may outweigh the opportunity of cancer control. This study aims to evaluate treatment-related toxicity from ultrafocal salvage high-dose-rate brachytherapy (HDR-BT) and to investigate potential risk factors. Materials and methods Toxicity data from 150 treated patients (July 2013–November 2019) was collected from a prospective registry. The treatment aim was to deliver a single dose of 19 Gy to the recurrent lesion as identified on multiparametric MRI and PET-CT. Treating physicians graded genitourinary (GU) and gastro-intestinal (GI) toxicity and erectile dysfunction (ED) using the Common Terminology Criteria for Adverse Events (CTCAE) 4.0, at baseline and during follow-up. Domains with substantial (≥10%) new-onset grade ≥ 2 toxicity were further evaluated using mixed effects logistic regression to find potential risk factors. Results Median follow-up time was 20 months (IQR 12–31). Over time, new-onset grade 2 and 3 toxicity was recorded in 41% and 3% (GU), 5% and 0% (GI) and 22% and 15% (ED). While GI toxicity remained stably low, grade ≥ 2 GU toxicity and ED were seen twice as frequent in the late phase (>3 months after treatment). Significant risk factors for grade ≥ 2 toxicity were baseline GU toxicity (grade ≥ 2), baseline ED (grade ≥ 2), IPSS (cut-off ≥ 14) and urethral dose (D10%, cut-off ≥ 17 Gy). Conclusion Ultrafocal salvage HDR-BT is a safe re-treatment option, especially in patients with a favorable symptom profile at baseline. Adherence to urethral dose constraints is important to avoid GU toxicity.
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Affiliation(s)
- Marieke van Son
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Marinus Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sandrine van de Pol
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Wietse Eppinga
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jochem van der Voort van Zyp
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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van Son M, Monninkhof E, Peters M, Lagendijk J, van der Voort van Zyp J. Health-related quality of life after ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: reporting the patient’s perspective. Clin Transl Radiat Oncol 2020; 25:81-87. [PMID: 33134565 PMCID: PMC7586050 DOI: 10.1016/j.ctro.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022] Open
Abstract
We analyzed patient-reported quality of life in 100 patients who underwent ultrafocal salvage HDR-brachytherapy. Patient-reported bowel symptoms were neglible. Urinary complaints increased and sexual functioning declined over time. Lower impact is predicted for patients with favorable function at baseline and lower dose to the urethra.
Purpose For patients with a localized prostate cancer recurrence after radiotherapy, focal salvage treatment offers a less toxic alternative to whole-gland treatments, with the potential of preserving health-related quality of life (HR-QoL). With a focus on the patient’s perspective of treatment, this study aims to describe HR-QoL after ultrafocal salvage high-dose-rate brachytherapy (HDR-BT), and to explore predictive factors affecting HR-QoL. Material and methods We included 100 patients treated with ultrafocal salvage HDR-BT. Prostate cancer-related HR-QoL was assessed by the EORTC QLQ-PR25 questionnaire. Domains were urinary symptoms, bowel symptoms and sexual activity/functioning. For each domain, a mixed effects model was made to estimate HR-QoL trends over time. For domains showing clinically relevant change (≥10 points difference), the mixed effects model was used to explore potential predictors (age, baseline HR-QoL score, T-stage, tumor location, CTV size, dose to organs at risk and history of ADT). Results Median follow-up was 20 months (IQR 13–30). Mean questionnaire response rate was 86% (range 72–100%). Median baseline scores were 12 (urinary), 0 (bowel) and 67/50 (sexual activity/functioning). Urinary symptoms and sexual functioning showed clinically relevant deterioration over time (maximum difference of 11 and 12 points, respectively). Worse baseline score and higher administered dose to the urethra (≥16 Gy) were predictive of increased urinary symptoms (p < 0.01 and p = 0.03). Better baseline score was predictive of better sexual functioning (p < 0.01). Conclusion Ultrafocal salvage HDR-BT has negligible impact on bowel symptoms but does affect urinary symptoms and sexual functioning. Lower impact is predicted for patients with favorable urinary and sexual function at baseline. Urethral dose constraints should be closely monitored.
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Affiliation(s)
- Marieke van Son
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Corresponding author.
| | - Evelyn Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jochem van der Voort van Zyp
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Corkum MT, Mendez LC, Chin J, D’Souza D, Boldt RG, Bauman GS. A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis. Adv Radiat Oncol 2020; 5:965-977. [PMID: 33083660 PMCID: PMC7557139 DOI: 10.1016/j.adro.2020.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/11/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Reirradiation (re-RT) using external beam radiation therapy (EBRT) is a novel salvage strategy for local failure in prostate cancer. We performed a systematic review describing oncologic and toxicity outcomes for salvage EBRT/stereotactic radiation therapy (SBRT) re-RT. Methods and Materials A International Prospective Register of Systematic Reviews registered (#141466) systematic review, meta-analysis, and meta-regression was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed and EMBASE were searched from inception through September 2019. Outcome measures included local control (LC), biochemical relapse free survival (BRFS), and ≥grade 3 genitourinary (GU)/gastrointestinal (GI) toxicity. EBRT and SBRT data were collected separately. Meta-regression explored disease and toxicity outcomes as a function of equivalent dose in 2 Gy fractions (EQD2), length of follow-up, and partial versus whole prostate reirradiation. Results Nineteen studies representing 13 cohorts were included (428 patients). Weighted mean follow-up was 26.1 months. Median re-RT EQD2 was 77.1 Gy (α/β = 1.5), with 92% of patients receiving SBRT, 52.1% of patients receiving partial prostate re-RT, and 30.1% of patients receiving androgen deprivation therapy with re-RT. LC was 83.2% (95% confidence interval [CI], 75.5%-90.9%) and BRFS was 59.3% (47.9%-70.7%). Reported late toxicity ≥grade 3 was 3.4% (95% CI, 1.0%-5.8%) for GU and 2.0% (95% CI, 0.1%-4.0%) for GI. Meta-regression found higher LC, BRFS, and reported GU/GI toxicity with increasing EQD2, with partial prostate re-RT associated with less reported GU/GI toxicity and no detriment to LC and BRFS. Conclusions Salvage re-RT using EBRT, particularly with SBRT, is an emerging technique to treat isolated local failure of prostate cancer. With short-term follow-up, LC, BRFS, and reported toxicities appear reasonable, although further follow-up is required before definitive statements on late toxicities can be made. Our review is limited by incomplete reporting of androgen deprivation therapy use in the primary literature. Further prospective studies and longer follow-up are needed before considering re-RT as standard practice.
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Affiliation(s)
- Mark T. Corkum
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Joseph Chin
- Department of Urology, London Health Sciences Centre, London, Canada
| | - David D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - R. Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
- Corresponding author: Glenn S. Bauman, MD
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