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Maggio A, Rancati T, Gatti M, Cante D, Avuzzi B, Bianconi C, Badenchini F, Farina B, Ferrari P, Giandini T, Girelli G, Landoni V, Magli A, Moretti E, Petrucci E, Salmoiraghi P, Sanguineti G, Villa E, Waskiewicz JM, Guarneri A, Valdagni R, Fiorino C, Cozzarini C. Quality of Life Longitudinal Evaluation in Prostate Cancer Patients from Radiotherapy Start to 5 Years after IMRT-IGRT. Curr Oncol 2024; 31:839-848. [PMID: 38392056 PMCID: PMC10887595 DOI: 10.3390/curroncol31020062] [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: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. MATERIAL AND METHODS Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74-80 Gy, 1.8-2 Gy/fr) or moderately hypofractionated IMRT (65-75.2 Gy, 2.2-2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. RESULTS A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. CONCLUSIONS In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses.
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Affiliation(s)
- Angelo Maggio
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Marco Gatti
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Domenico Cante
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Cinzia Bianconi
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Bruno Farina
- Ospedale degli Infermi, 13875 Biella, Italy; (B.F.); (G.G.)
| | - Paolo Ferrari
- Comprensorio Sanitario di Bolzano, 39100 Bolzano, Italy; (P.F.); (J.M.W.)
| | - Tommaso Giandini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | | | - Valeria Landoni
- IRCCS Istituto Tumori Regina Elena, 00144 Roma, Italy; (V.L.); (G.S.)
| | | | | | - Edoardo Petrucci
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | | | | | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, 24121 Bergamo, Italy; (P.S.); (E.V.)
| | | | - Alessia Guarneri
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milano, Italy
| | - Claudio Fiorino
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Cesare Cozzarini
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
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Moradi S, Hashemi B, Bakhshandeh M, Banaei A, Mofid B. Introducing new plan evaluation indices for prostate dose painting IMRT plans based on apparent diffusion coefficient images. Radiat Oncol 2022; 17:193. [PMID: 36419067 PMCID: PMC9685857 DOI: 10.1186/s13014-022-02163-7] [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: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dose painting planning would be more complicated due to different levels of prescribed doses and more complex evaluation with conventional plan quality indices considering uniform dose prescription. Therefore, we tried to introduce new indices for evaluating the dose distribution conformity and homogeneity of treatment volumes based on the tumoral cell density and relative volumes of each lesion in prostate IMRT. METHODS CT and MRI scans of 20 male patients having local prostate cancer were used for IMRT DP planning. Apparent diffusion coefficient (ADC) images were imported to a MATLAB program to identify lesion regions based on ADC values automatically. Regions with ADC values lower than 750 mm2/s and regions with ADC values higher than 750 and less than 1500 mm2/s were considered CTV70Gy (clinical tumor volume with 70 Gy prescribed dose), and CTV60Gy, respectively. Other regions of the prostate were considered as CTV53Gy. New plan evaluation indices based on evaluating the homogeneity (IOE(H)), and conformity (IOE(C)) were introduced, considering the relative volume of each lesion and cellular density obtained from ADC images. These indices were compared with conventional homogeneity and conformity indices and IOEs without considering cellular density. Furthermore, tumor control probability (TCP) was calculated for each patient, and the relationship of the assessed indices were evaluated with TCP values. RESULTS IOE (H) and IOE (C) with considering cellular density had significantly lower values compared to conventional indices and IOEs without considering cellular density. (P < 0.05). TCP values had a stronger relationship with IOE(H) considering cell density (R2 = -0.415), and IOE(C) without considering cell density (R2 = 0.624). CONCLUSION IOE plan evaluation indices proposed in this study can be used for evaluating prostate IMRT dose painting plans. We suggested to consider cell densities in the IOE(H) calculation formula and it's appropriate to calculate IOE(C) without considering cell density values.
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Affiliation(s)
- Saman Moradi
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Bijan Hashemi
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Mohsen Bakhshandeh
- grid.411600.2Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443 Iran
| | - Amin Banaei
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Bahram Mofid
- grid.411600.2Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443 Iran
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Taneja SS. Re: Hypofractionated Postoperative IMRT in Prostate Carcinoma: A Phase I/II Study. J Urol 2018. [DOI: 10.1016/j.juro.2018.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
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Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Di Franco R, Borzillo V, Ravo V, Ametrano G, Falivene S, Cammarota F, Rossetti S, Romano FJ, D'Aniello C, Cavaliere C, Iovane G, Piscitelli R, Berretta M, Muto P, Facchini G. Rectal/urinary toxicity after hypofractionated vs conventional radiotherapy in low/intermediate risk localized prostate cancer: systematic review and meta analysis. Oncotarget 2017; 8:17383-17395. [PMID: 28129649 PMCID: PMC5370048 DOI: 10.18632/oncotarget.14798] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this review was to compare radiation toxicity in Localized Prostate Cancer (LPC) patients who underwent conventional fractionation (CV), hypofractionated (HYPO) or extreme hypofractionated (eHYPO) radiotherapy. We analyzed the impact of technological innovation on the management of prostate cancer, attempting to make a meta-analysis of randomized trials. Methods PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in low/intermediate risk LPC patients after receiving radiotherapy. Studies were then gathered into 5 groups: detected acute and chronic toxicity data from phase II non randomized trials were analyzed and Odds Ratio (OR) was calculated by comparing the number of patients with G0-1 toxicity and those with toxicity > G2 in the studied groups. A meta-analysis of prospective randomized trials was also carried out. Results The initial search yielded 575 results, but only 32 manuscripts met all eligibility requirements: in terms of radiation-induced side effects, such as gastrointestinal and genitourinary acute and late toxicity, hypofractionated 3DCRT seemed to be more advantageous than 3DCRT with conventional fractionation as well as IMRT with conventional fractionation compared to 3DCRT with conventional fractionation; furthermore, IMRT hypofractionated technique appeared more advantageous than IMRT with conventional fractionation in late toxicities. Randomized trials meta-analysis disclosed an advantage in terms of acute gastrointestinal and late genitourinary toxicity for Hypofractionated schemes. Conclusions Although our analysis pointed out a more favorable toxicity profile in terms of gastrointestinal acute side effects of conventional radiotherapy schemes compared to hypofractionated ones, prospective randomized trials are needed to better understand the real incidence of rectal and urinary toxicity in patients receiving radiotherapy for localized prostate cancer.
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Affiliation(s)
- Rossella Di Franco
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Valentina Borzillo
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Vincenzo Ravo
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Gianluca Ametrano
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Sara Falivene
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Fabrizio Cammarota
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Sabrina Rossetti
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Francesco Jacopo Romano
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Carmine D'Aniello
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, A.O.R.N. dei COLLI "Ospedali Monaldi-Cotugno-CTO", Napoli
| | - Carla Cavaliere
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy
| | - Gelsomina Iovane
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
| | - Raffaele Piscitelli
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, Aviano, Italy
| | - Paolo Muto
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Gaetano Facchini
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
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Salami SS, Obedian E, Zimberg S, Olsson CA. Urinary quality of life outcomes in men who were treated with image-guided intensity-modulated radiation therapy for prostate cancer. Adv Radiat Oncol 2017; 1:310-316. [PMID: 28740902 PMCID: PMC5514226 DOI: 10.1016/j.adro.2016.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Quality of life (QoL) outcomes play a major role in the treatment selection for prostate cancer (CaP). We evaluated the urinary QoL outcomes in men who were treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for CaP. METHODS AND MATERIALS We enrolled men who were diagnosed with CaP and underwent IG-IMRT in a large urological group practice into a prospectively maintained database. The typical radiation treatment dosage to prostates and seminal vesicles was 8100 cGy in 45 fractions. Urinary QoL was self-assessed using the standardized incontinence grade and International Prostate Symptom Score (IPSS) at baseline and at each follow-up visit. We evaluated the cumulative incidence of urinary incontinence and changes in both continence and IPSS over time. RESULTS Of the 3602 men who were eligible for analysis, 3086 (85.7%) had no urinary incontinence; 479 (13.3 %) had minimal incontinence (no requirement for pads), and 37 (1.0 %) had significant urinary incontinence that required the use of pads or interfered with activities of daily living, at baseline. After a median follow-up of 24 months (range: 12.0-41.0 months), these numbers were 80.6%, 17.4%, and 2.0%, respectively. Radiation therapy appeared to have a beneficial effect on some men: 54.1% of men with minimal incontinence became completely continent of urine during follow-up. Of those with significant urinary incontinence, 29.7% reported resolution and 27.0% reported improved symptoms with no requirement for pads. Of the 1276 men with moderate IPSS, the mean IPSS decreased from 12 to 9.8 at the time of the last follow-up (P < .001). Similarly, of the 233 men with severe IPSS, the mean IPSS decreased from 24 to 13 at the time of the last follow-up (P < .001). CONCLUSION IG-IMRT for clinically localized CaP is associated with a relatively low incidence of urinary incontinence. Although unexplained, IG-IMRT seems to improve symptoms in some men with baseline urinary incontinence and moderate-to-severe IPSS.
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Affiliation(s)
- Simpa S. Salami
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
- Corresponding author. University of Michigan Medical School, 1500 E Medical Center Drive, TC 3875, Ann Arbor, MI 48109University of Michigan Medical School1500 E Medical Center DriveTC 3875Ann ArborMI48109
| | - Edward Obedian
- Integrated Medical Professionals, Melville, New York
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shawn Zimberg
- Integrated Medical Professionals, Melville, New York
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carl A. Olsson
- Integrated Medical Professionals, Melville, New York
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Urology, Columbia University Medical Center, New York, New York
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Taneja SS. Re: Use, Complications, and Costs of Stereotactic Body Radiotherapy for Localized Prostate Cancer. J Urol 2016; 196:1676-1677. [PMID: 27845107 DOI: 10.1016/j.juro.2016.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/25/2022]
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8
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Patient-reported quality of life after stereotactic body radiation therapy versus moderate hypofractionation for clinically localized prostate cancer. Radiother Oncol 2016; 121:294-298. [DOI: 10.1016/j.radonc.2016.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/18/2022]
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9
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Taneja SS. Re: Hypofractionated Radiotherapy versus Conventionally Fractionated Radiotherapy for Patients with Intermediate-Risk Localised Prostate Cancer: 2-Year Patient-Reported Outcomes of the Randomised, Non-Inferiority, Phase 3 CHHiP Trial. J Urol 2016; 196:1445-1447. [DOI: 10.1016/j.juro.2016.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
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10
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Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer. Radiother Oncol 2016; 118:99-104. [PMID: 26755165 DOI: 10.1016/j.radonc.2015.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This multi-institutional phase I/II trial explored patient-assessed tolerance of increasingly hypofractionated (HPFX) radiation for low/intermediate risk prostate cancer. METHODS 347 patients enrolled from 2002 to 2010. Three increasing dose-per-fraction schedules of 64.7 Gy/22 fx, 58.08 Gy/16 fx and 51.6 Gy/12 fx were each designed to yield equivalent predicted late toxicity. Three quality of life (QoL) surveys were administered prior to treatment and annually upto 3 years. RESULTS Bowel QoL data at 3years revealed no significant difference among regimens (p=0.469). Bowel QoL for all regimens declined transiently, largely recovering by three years, with only the 22 fraction decrement reaching significance. Bladder outcomes at 3 years were comparable (p=0.343) although, for all patients combined, a significant decline was observed from the baseline (p=0.008). Spitzer quality of life data revealed similarly excellent, 3-year means (p=0.188). International erectile function data also revealed no significant differences at 3 years although all measures except intercourse satisfaction worsened post-treatment. CONCLUSIONS Three-year QoL changes for bowel, bladder and SQLI were modest and similar for 3 HPFX regimens spanning 2.94-4.3 Gy per fraction. These favorable patient-scored outcomes demonstrate the safety and tolerability of such regimens and may be leveraged to support further implementation of mild to moderately hypofractionated radiotherapy in the setting of low and intermediate-risk prostate cancer.
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Ferrera G, Mortellaro G, Mannino M, Caminiti G, Spera A, Figlia V, Iacoviello G, Di Paola G, Mazzola R, Lo Casto A, Alongi F, Pappalardo MP, Lagalla R. Moderate hypofractionation and simultaneous integrated boost by helical tomotherapy in prostate cancer: monoinstitutional report of acute tolerability assessment with different toxicity scales. Radiol Med 2015; 120:1170-6. [PMID: 26002724 DOI: 10.1007/s11547-015-0555-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Based on radiobiology evidence, hypofractionated radiotherapy has the potential of improving treatment outcome in prostate cancer patients. In this study, we evaluated the safety, in terms of acutetoxicity, of using moderate hypofractionated radiotherapy delivered with Helical Tomotherapy (HT) to treat prostate cancer patients. MATERIALS AND METHODS Between December 2012 and April 2014, 42 consecutive patients were treated with hypofractionated radiotherapy using HT. All patients received 70 Gy in 28 fractions to PTV1, which included the prostate. In the intermediate risk group, 61.6 Gy were delivered to PTV2, which included the seminal vesicles. In high risk patients, the pelvic nodes were added (PTV3) and received 50.4 Gy. Acute toxicity was recorded prospectively with RTOG and Common Terminology Criteria for Adverse Events 3.0, retrospectively with CTCAE 4.0. Expanded Prostate Cancer Index Composite (EPIC) was measured at baseline and 3 months after end of treatment, to investigate health related quality of life with regards to bladder and gastrointestinal function. RESULTS Acute toxicity was acceptable, independently from the system used to score side effects. Moderate genitourinary toxicity was more frequent than gastrointestinal toxicity. No correlation between acute side effects and patients' characteristics or physical dose parameters was registered. EPIC evaluation showed a negligible difference in urinary and bowel function post-treatment, that did not reach statistical significance. CONCLUSIONS Our experience confirms the safety of moderate hypofractionation delivered with HT in prostate cancer patients with low, intermediate and high risk.
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Affiliation(s)
| | | | | | | | - Antonio Spera
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Vanessa Figlia
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | | | | | - Rosario Mazzola
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Filippo Alongi
- RadiationOncology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Roberto Lagalla
- Radiation Oncology School, University of Palermo, Palermo, Italy
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12
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Nguyen NP, Davis R, Bose SR, Dutta S, Vinh-Hung V, Chi A, Godinez J, Desai A, Woods W, Altdorfer G, D'Andrea M, Karlsson U, Vo RA, Sroka T. Potential applications of image-guided radiotherapy for radiation dose escalation in patients with early stage high-risk prostate cancer. Front Oncol 2015; 5:18. [PMID: 25699239 PMCID: PMC4313771 DOI: 10.3389/fonc.2015.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/15/2015] [Indexed: 01/21/2023] Open
Abstract
Patients with early stage high-risk prostate cancer (prostate specific antigen > 20, Gleason score > 7) are at high risk of recurrence following prostate cancer irradiation. Radiation dose escalation to the prostate may improve biochemical-free survival for these patients. However, high rectal and bladder dose with conventional three-dimensional conformal radiotherapy may lead to excessive gastrointestinal and genitourinary toxicity. Image-guided radiotherapy (IGRT), by virtue of combining the steep dose gradient of intensity-modulated radiotherapy and daily pretreatment imaging, may allow for radiation dose escalation and decreased treatment morbidity. Reduced treatment time is feasible with hypo-fractionated IGRT and it may improve patient quality of life.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Rick Davis
- Department of Radiation Oncology, Michael D. Wachtel Cancer Center , Oskosh, WI , USA
| | - Satya R Bose
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Suresh Dutta
- Department of Radiation Oncology, Medicine and Radiation Oncology PA , San Antonio, TX , USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Martinique University Hospital , Martinique , France
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Juan Godinez
- Department of Radiation Oncology, Rochester Radiation Oncology Group , Rochester, NY , USA
| | - Anand Desai
- Department of Radiation Oncology, Akron City Hospital , Akron, OH , USA
| | - William Woods
- Department of Radiation Oncology, Richard A. Henson Institute , Salisbury, ML , USA
| | - Gabor Altdorfer
- Department of Radiation Oncology, Camden Clark Cancer Center , Parkersburg, WV , USA
| | - Mark D'Andrea
- Department of Radiation Oncology, University Cancer Centers , Houston, TX , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Richard A Vo
- University of Galveston School of Medicine , Galveston, TX , USA
| | - Thomas Sroka
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Dartmouth College , Hanover, NH , USA
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13
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Hegemann NS, Guckenberger M, Belka C, Ganswindt U, Manapov F, Li M. Hypofractionated radiotherapy for prostate cancer. Radiat Oncol 2014; 9:275. [PMID: 25480014 PMCID: PMC4273481 DOI: 10.1186/s13014-014-0275-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 12/01/2022] Open
Abstract
In the last few years, hypofractionated external beam radiotherapy has gained increasing popularity for prostate cancer treatment, since sufficient evidence exists that prostate cancer has a low α/β ratio, lower than the one of the surrounding organs at risk and thus there is a potential therapeutic benefit of using larger fractionated single doses. Apart from the therapeutic rationale there are advantages such as saving treatment time and medical resources and thereby improving patient’s convenience. While older trials showed unsatisfactory results in both standard and hypofractionated arm due to insufficient radiation doses and non-standard contouring of target volumes, contemporary randomized studies have reported on encouraging results of tumor control mostly without an increase of relevant side effects, especially late toxicity. Aim of this review is to give a detailed analysis of relevant, recently published clinical trials with special focus on rationale for hypofractionation and different therapy settings.
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Affiliation(s)
- Nina-Sophie Hegemann
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
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14
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Taneja SS. Re: Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results from a Randomized Trial. J Urol 2014. [DOI: 10.1016/j.juro.2014.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Koontz BF, Bossi A, Cozzarini C, Wiegel T, D'Amico A. A systematic review of hypofractionation for primary management of prostate cancer. Eur Urol 2014; 68:683-91. [PMID: 25171903 DOI: 10.1016/j.eururo.2014.08.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Technological advances in radiation therapy delivery have permitted the use of high-dose-per-fraction radiation therapy (RT) for early-stage prostate cancer (PCa). Level 1 evidence supporting the safety and efficacy of hypofractionated RT is evolving as this modality becomes more widely utilized and refined. OBJECTIVE To perform a systematic review of the current evidence on the safety and efficacy of hypofractionated RT for early-stage PCa and to provide in-context recommendations for current application of this technology. EVIDENCE ACQUISITION Embase, PubMed, and Scopus electronic databases were queried for English-language articles from January 1990 through June 2014. Prospective studies with a minimum of 50 patients were included. Separate consideration was made for studies involving moderate hypofractionation (doses of 2.5-4Gy per fraction) and extreme hypofractionation (5-10Gy in 4-7 fractions). EVIDENCE SYNTHESIS Six relatively small superiority designed randomized trials of standard fractionation versus moderate hypofractionation in predominantly low- and intermediate-risk PCa have been published with follow-up ranging from 4 to 8 yr, noting similar biochemical control (5-yr freedom from biochemical failure in modern studies is >80% for low-risk and intermediate-risk patients) and late grade ≥2 genitourinary and gastrointestinal toxicities (between 2% and 20%). Noninferiority studies are pending. In prospective phase 2 studies, extreme hypofractionation has promising 2- to 5-yr biochemical control rates of >90% for low-risk patients. Results from a randomized trial are expected in 2015. CONCLUSIONS Moderate hypofractionation has 5-yr data to date establishing safety compared with standard fractionation, but 10-yr outcomes and longer follow-up are needed to establish noninferiority for clinical effectiveness. Extreme hypofractionation is promising but as yet requires reporting of randomized data prior to application outside of a clinical protocol. PATIENT SUMMARY Hypofractionation for prostate cancer delivers relatively high doses of radiation per treatment. Prospective studies support the safety of moderate hypofractionation, while extreme fractionation may have greater toxicity. Both show promising cancer control but long-term results of noninferiority studies of both methods are required before use in routine treatment outside of clinical protocols.
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Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology, Duke Cancer Institute, Durham, NC, USA.
| | - Alberto Bossi
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cesare Cozzarini
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Anthony D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
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16
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Jereczek-Fossa BA, Zerini D, Fodor C, Santoro L, Maucieri A, Gerardi MA, Vischioni B, Cambria R, Garibaldi C, Cattani F, Vavassori A, Matei DV, Musi G, De Cobelli O, Orecchia R. Reporting combined outcomes with Trifecta and survival, continence, and potency (SCP) classification in 337 patients with prostate cancer treated with image-guided hypofractionated radiotherapy. BJU Int 2014; 114:E3-E10. [DOI: 10.1111/bju.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Barbara A. Jereczek-Fossa
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Dario Zerini
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Cristiana Fodor
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Luigi Santoro
- Department of Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Andrea Maucieri
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Marianna A. Gerardi
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | | | - Raffaella Cambria
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Cristina Garibaldi
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Federica Cattani
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Andrea Vavassori
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Deliu V. Matei
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Gennaro Musi
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Ottavio De Cobelli
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Roberto Orecchia
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
- Centro Nazionale di Adroterapia Oncologica (CNAO); Pavia Italy
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