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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024:S1879-8500(24)00148-6. [PMID: 39019208 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition. METHODS Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer. RESULTS Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes. CONCLUSION Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
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Hayek OE, Rais-Bahrami S, McDonald A, Galgano SJ. Stereotactic Body Radiation Therapy Salvage for Lymph Node Recurrent Prostate Cancer in the Era of PSMA PET Imaging. Curr Urol Rep 2023; 24:471-476. [PMID: 37395949 DOI: 10.1007/s11934-023-01174-5] [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] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW Our understanding of patterns of prostate cancer recurrence after primary treatment of localized disease has significantly evolved since the development of positron emission tomography (PET) agents targeting prostate cancer. Previously, most biochemical recurrences were not associated with imaging correlates when restaging with computed tomography (CT), magnetic resonance imaging (MRI), or bone scintigraphy and, hence, were typically assumed to represent occult metastases. A rising prostate specific antigen (PSA) after previous local therapy prompting a PET scan showing uptake limited to regional lymph nodes is an increasingly common clinical scenario as advanced prostate cancer imaging becomes more widely utilized. The optimal management strategy for patients who have lymph node recurrent prostate cancer is both unclear and evolving, particularly in terms of local and regionally directed therapies. Stereotactic body radiation therapy (SBRT) utilizes ablative radiation doses with steep gradients to achieve local tumor control while sparing nearby normal tissues. SBRT is an attractive therapeutic modality due to its efficacy, favorable toxicity profile, and flexibility to administer elective doses to areas of potential occult involvement. The purpose of this review is to briefly describe how SBRT is being implemented in the era of PSMA PET for the management of solely lymph node recurrent prostate cancer. RECENT FINDINGS SBRT has been shown to effectively control individual lymph node tumor deposits within the pelvis and retroperitoneum for prostate cancer and is well-tolerated with a favorable toxicity profile. However, a major limitation thus far has been the lack of prospective trials supporting the use of SBRT for oligometastatic nodal recurrent prostate cancer. As further trials are conducted, its exact role in the treatment paradigm of recurrent prostate cancer will be better established. Although PET-guided SBRT appears feasible and potentially beneficial, there is still considerable uncertainty about the use of elective nodal radiotherapy (ENRT) in patients with nodal recurrent oligometastatic prostate cancer. PSMA PET has undoubtedly advanced imaging of recurrent prostate cancer, revealing anatomic correlates for disease recurrence that previously went undetected. At the same time, SBRT continues to be explored in prostate cancer with feasibility, a favorable risk profile, and satisfactory oncologic outcomes. However, much of the existing literature comes from the pre-PSMA PET era and integration of this novel imaging approach has led to greater focus on new and ongoing clinical trials to rigorously evaluate this approach and compare to other established treatment modalities utilized for oligometastatic, nodal recurrence of prostate cancer.
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Affiliation(s)
- Omar E Hayek
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, AL, Birmingham, USA
| | - Andrew McDonald
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, AL, Birmingham, USA
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, AL, Birmingham, USA.
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Corkum MT, Buyyounouski MK, Chang AJ, Chung HT, Chung P, Cox BW, Crook JM, Davis BJ, Frank SJ, Henriquez I, Horwitz EM, Hoskin P, Hsu IC, Keyes M, King MT, Kollmeier MA, Krauss DJ, Kukielka AM, Morton G, Orio PF, Pieters BR, Potters L, Rossi PJ, Showalter TN, Solanki AA, Song D, Vanneste B, Vigneault E, Wojcieszek PA, Zelefsky MJ, Kamrava M. Salvage Prostate Brachytherapy in Radiorecurrent Prostate Cancer: An International Delphi Consensus Study. Radiother Oncol 2023; 184:109672. [PMID: 37059334 DOI: 10.1016/j.radonc.2023.109672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Local recurrences after previous radiotherapy (RT) are increasingly being identified in biochemically recurrent prostate cancer. Salvage prostate brachytherapy (BT) is an effective and well tolerated treatment option. We sought to generate international consensus statements on the use and preferred technical considerations for salvage prostate BT. MATERIALS AND METHODS International experts in salvage prostate BT were invited (n=34) to participate. A three-round modified Delphi technique was utilized, with questions focused on patient- and cancer-specific criteria, type and technique of BT, and follow-up. An a priori threshold for consensus of ≥ 75% was set, with a majority opinion being ≥ 50%. RESULTS Thirty international experts agreed to participate. Consensus was achieved for 56% (18/32) of statements. Consensus was achieved in several areas of patient selection: 1) A minimum of 2-3 years from initial RT to salvage BT; 2) MRI and PSMA PET should be obtained; and 3) Both targeted and systematic biopsies should be performed. Several areas did not reach consensus: 1) Maximum T stage/PSA at time of salvage; 2) Utilization/duration of ADT; 3) Appropriateness of combining local salvage with SABR for oligometastatic disease and 4) Repeating a second course of salvage BT. A majority opinion preferred High Dose-Rate salvage BT, and indicated that both focal and whole gland techniques could be appropriate. There was no single preferred dose/fractionation. CONCLUSION Areas of consensus within our Delphi study may serve as practical advice for salvage prostate BT. Future research in salvage BT should address areas of controversy identified in our study.
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Affiliation(s)
- Mark T Corkum
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | | | - Albert J Chang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Brett W Cox
- Department of Radiation Oncology, Solaris Health, Chicago, IL
| | | | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ivan Henriquez
- Radiation Oncology Department. Hospital Universitari Sant Joan, Reus, Spain
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom, Northwood, United Kingdom
| | - I-Chow Hsu
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | | | - Martin T King
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI
| | - Andrzej M Kukielka
- NU-MED Cancer Diagnostics and Therapy Centre, Zamość, Poland; Department of Brachytherapy, University Hospital in Kraków, Kraków, Poland
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA
| | - Bradley R Pieters
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Peter J Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | | | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Daniel Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ben Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Vigneault
- CHU de Quebec-Centre intégré de cancérologie Hôpitl de L'Enfant-Jésus, Québec, QC, Canada
| | - Piotr A Wojcieszek
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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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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