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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2310856. [PMID: 38771628 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV, 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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Guo B, Stephans K, Godley A, Kolar M, Magnelli A, Tendulkar R, Mian O, Majkszak D, Xia P. Transperineal ultrasound is a good alternative for intra-fraction motion monitoring for prostate stereotactic body radiotherapy. J Appl Clin Med Phys 2023; 24:e14021. [PMID: 37144947 PMCID: PMC10562017 DOI: 10.1002/acm2.14021] [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: 10/18/2022] [Revised: 01/27/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSES To report our experience in a prospective study of implementing a transperineal ultrasound system to monitor intra-fractional prostate motion for prostate stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS This IRB-approved prospective study included 23 prostate SBRT patients treated between 04/2016 and 11/2019 at our institution. The prescription doses were 36.25 Gy to the Low-Dose planning target volume (LD-PTV) and 40 Gy to the High-Dose PTV (HD-PTV) in five fractions with 3 mm planning margins. The transperineal ultrasound system was successfully used in 110 of the 115 fractions. For intra-fraction prostate motion, the real-time prostate displacements measured by ultrasound were exported for analysis. The percentage of time prostate movement exceeded a 2 mm threshold was calculated for each fraction of all patients. T-test was used for all statistical comparisons. RESULTS Ultrasound image quality was adequate for prostate delineation and prostate motion tracking. The setup time for each fraction under ultrasound-guided prostate SBRT was 15.0 ± 4.9 min and the total treatment time per fraction was 31.8 ± 10.5 min. The presence of an ultrasound probe did not compromise the contouring of targets or critical structures. For intra-fraction motion, prostate movement exceeded 2 mm tolerance in 23 of 110 fractions for 11 of 23 patients. For all fractions, the mean percentage of time when the prostate moved more than 2 mm in any direction during each fraction was 7%, ranging from 0% to 62% of a fraction. CONCLUSION Ultrasound-guided prostate SBRT is a good option for intra-fraction motion monitoring with clinically acceptable efficiency.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Kevin Stephans
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Andrew Godley
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Matt Kolar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Anthony Magnelli
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Rahul Tendulkar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Omar Mian
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - David Majkszak
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Ping Xia
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
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Targeting Education as a Barrier to Implement Hypofractionation: Results of a Country-Wide Training Program. Adv Radiat Oncol 2022; 8:101165. [PMID: 36760343 PMCID: PMC9905934 DOI: 10.1016/j.adro.2022.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Access to radiation therapy in low- and middle-income countries (LMICs) could be improved with modern hypofractionated radiation therapy schedules, although their adoption remains limited. We aimed to evaluate perceptions regarding hypofractionation and the effect of a dedicated curriculum in an LMIC. Methods and Materials We developed a pilot e-learning hypofractionation curriculum focused on breast, prostate, rectal cancer, and high-grade glioma in Colombia. International educators taught 13 weekly, 90-minute sessions. Participants completed pre- and postcurriculum questionnaires regarding hypofractionation attitudes, 1 to 5 Likert-scale self-confidence, and practices for 12 clinical scenarios. Physicians' responses were categorically scored "1" (for hypofractionation or ultrahypofractionation) or "0" (for conventional fractionation). We used the paired t test to measure pre- versus postcurriculum differences in self-confidence and the McNemar test to detect differences in hypofractionation selection. Results Across 19 cities in Colombia, 147 clinicians enrolled: 61 radiation oncologists, 6 radiation oncology residents, 59 medical physicists, 18 physics residents, and 3 other staff. Among physicians, education was the greatest barrier to select hypofractionation, common in ultrahypofractionation for prostate (77.6%) and breast cancer (74.6%) and less common for moderate hypofractionation of prostate (61.2%) and breast cancer (52.2%). Additional perceived barriers included unfamiliarity with clinic protocols (7%-22%), clinical experience (5%-15%), personal preference (3%-16%), and lack of technology (3%-20%), with variation across different clinical settings. After the curriculum, paired (n = 38) physicians' selection of hypofractionation increased across all disease sites (mean aggregate score 6.2/12 vs 8.2/12, P <.001). Self-confidence among paired clinicians (n = 87) increased for prostate ultrahypofractionation (+0.45), rectal ultrahypofractionation (+0.43), breast hypofractionation (+0.38), and prostate hypofractionation (+0.23) (P ≤ .03). Conclusions In an LMIC with a bundled payment system, lack of education and training was a perceived barrier for implementation of hypofractionation and ultrahypofractionation. A targeted e-learning hypofractionation curriculum increased participant confidence and selection of hypofractionated schedules.
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Novikov SN, Novikov RV, Merezhko YO, Gotovchikova MY, Ilin ND, Melnik YS, Kanaev SV. A comparison between high dose rate brachytherapy and stereotactic body radiotherapy boost after elective pelvic irradiation for high and very high-risk prostate cancer. Radiat Oncol J 2022; 40:200-207. [PMID: 36200309 PMCID: PMC9535414 DOI: 10.3857/roj.2022.00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022] Open
Abstract
Purpose: To compare biochemical recurrence-free survival (BRFS) and toxicity outcomes of high dose rate brachytherapy (HDRB) and stereotactic body radiotherapy (SBRT) boost after elective nodal irradiation for high/very high-risk prostate cancer.Materials and Methods: a retrospective analysis was performed in 149 male. In 98 patients, the boost to the prostate was delivered by HDRB as 2 fractions of 10 Gy (EQD2 for α/β = 1.5; 66 Gy) or 1 fraction of 15 Gy (EQD2 for α/β = 1.5; 71 Gy). In 51 male, SBRT was used for the boost delivery (3 fractions of 7 Gy; EQD2Gy for α/β = 1.5; 51 Gy) because brachytherapy equipment was out of order.Results: In 98 patients that received HDRB boost, 3- and 5-year BRFS were 74.6% and 66.8%. Late grade-II genitourinary toxicity was detected in 27, grade-III in 1 case. Grade-II (maximum) rectal toxicity was diagnosed in nine patients. For 51 male patients that received SBRT boost, 3- and 5-year BRFS was 76.5% and 67.7%. Late grade-II (maximum) genitourinary toxicity was detected in five cases, late grade-II rectal toxicity in four cases. Other three patients developed late grade-III–IV rectal toxicity that required diverting colostomy. SBRT boost was associated with higher maximum dose to 2 cm3 of anterior rectal wall (D2cm³rectum) compared to HDRB: 92% versus 55% of dose to prostate. Severe rectal toxicity was negligible at EQD2 D2cm³rectum <85 Gy and EQD2 D5cm³ rectum <75 Gy.Conclusion: Our results indicate similar 3- and 5-year BRFS in patients with high/very high-risk prostate cancer who received HDRB or SBRT boost, but SBRT boost is associated with higher rate of severe late rectal toxicity.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
- Correspondence: Sergey Nikolaevich Novikov Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, Leningradskaya, 68, St Petersburg, 197758, Russia. Tel: +79500437996 Fax +78125968609 E-mail:
| | - Roman Vladimirovich Novikov
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Yurii Olegovich Merezhko
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Mariya Yurevna Gotovchikova
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Nikolai Dmitrievich Ilin
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Yulia Sergeevna Melnik
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
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Extreme Hypofractionation with SBRT in Localized Prostate Cancer. Curr Oncol 2021; 28:2933-2949. [PMID: 34436023 PMCID: PMC8395496 DOI: 10.3390/curroncol28040257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer among men around the world. Radiotherapy is a standard of care treatment option for men with localized prostate cancer. Over the years, radiation delivery modalities have contributed to increased precision of treatment, employing radiobiological insights to shorten the overall treatment time, improving the control of the disease without increasing toxicities. Stereotactic body radiation therapy (SBRT) represents an extreme form of hypofractionated radiotherapy in which treatment is usually delivered in 1–5 fractions. This review assesses the main efficacy and toxicity data of SBRT in non-metastatic prostate cancer and discusses the potential to implement this scheme in routine clinical practice.
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Foerster R, Zwahlen DR, Buchali A, Tang H, Schroeder C, Windisch P, Vu E, Akbaba S, Bostel T, Sprave T, Zamboglou C, Zilli T, Stelmes JJ, Telkhade T, Murthy V. Stereotactic Body Radiotherapy for High-Risk Prostate Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13040759. [PMID: 33673077 PMCID: PMC7918664 DOI: 10.3390/cancers13040759] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is an established, potentially curative treatment option for all risk constellations of localized prostate cancer (PCA). Androgen deprivation therapy (ADT) and dose-escalated RT can further improve outcome in high-risk (HR) PCA. In recent years, shorter RT schedules based on hypofractionated RT have shown equal outcome. Stereotactic body radiotherapy (SBRT) is a highly conformal RT technique enabling ultra-hypofractionation which has been shown to be safe and efficient in patients with low- and intermediate-risk PCA. There is a paucity of data on the role of SBRT in HR PCA. In particular, the need for pelvic elective nodal irradiation (ENI) needs to be addressed. Therefore, we conducted a systematic review to analyze the available data on observed toxicities, ADT prescription practice, and oncological outcome to shed more light on the value of SBRT in HR PCA. METHODS We searched the PubMed and Embase electronic databases for the terms "prostate cancer" AND "stereotactic" AND "radiotherapy" in June 2020. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. RESULTS After a rigorous selection process, we identified 18 individual studies meeting all selection criteria for further analyses. Five additional studies were included because their content was judged as relevant. Three trials have reported on prostate SBRT including pelvic nodes; 2 with ENI and 1 with positive pelvic nodes only. The remaining studies investigated SBRT of the prostate only. Grade 2+ acute genitourinary (GU) toxicity was between 12% and 46.7% in the studies investigating pelvic nodes irradiation and ranged from 0% to 89% in the prostate only studies. Grade 2+ chronic GU toxicity was between 7% and 60% vs. 2% and 56.7%. Acute gastrointestinal (GI) grade 2+ toxicity was between 0% to 4% and 0% to 18% for studies with and without pelvic nodes irradiation, respectively. Chronic GI grade 2+ toxicity rates were between 4% and 50.1% vs. 0% and 40%. SBRT of prostate and positive pelvic nodes only showed similar toxicity rates as SBRT for the prostate only. Among the trials that reported on ADT use, the majority of HR PCA patients underwent ADT for at least 2 months; mostly neoadjuvant and concurrent. Biochemical control rates ranged from 82% to 100% after 2 years and 56% to 100% after 3 years. Only a few studies reported longer follow-up data. CONCLUSION At this point, SBRT with or without pelvic ENI cannot be considered the standard of care in HR PCA, due to missing level 1 evidence. Treatment may be offered to selected patients at specialized centers with access to high-precision RT. While concomitant ADT is the current standard of care, the necessary duration of ADT in combination with SBRT remains unclear. Ideally, all eligible patients should be enrolled in clinical trials.
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Affiliation(s)
- Robert Foerster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-52-266-31-40
| | - Daniel Rudolf Zwahlen
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Andre Buchali
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
| | - Hongjian Tang
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Christina Schroeder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
- Center for Proton Therapy, Paul Scherrer Institute (PSI), ETH Domain, 5232 Villingen, Switzerland
| | - Paul Windisch
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen (KSSG), 9007 St. Gallen, Switzerland;
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Thomas Zilli
- Department of Radiation Oncology, University Hospital Geneva (HUG), 1205 Geneva, Switzerland;
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland (IOSI), Cantonal Hospitals (EOC), 6500 Bellinzona, Switzerland;
| | - Tejshri Telkhade
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
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Blacksburg SR, Fuller DB, Haas JA. Editorial: The Evolving Landscape of Stereotactic Body Radiation Therapy for the Management of Prostate Cancer. Front Oncol 2021; 10:627686. [PMID: 33384965 PMCID: PMC7770153 DOI: 10.3389/fonc.2020.627686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seth R Blacksburg
- Department of Radiation Oncology, Perlmutter Cancer Center at NYU Long Island Hospital, Mineola, NY, United States
| | - Donald B Fuller
- Department of Radiation Oncology, Genesis Healthcare Partners, San Diego, CA, United States
| | - Jonathan A Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at NYU Long Island Hospital, Mineola, NY, United States
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Stereotactic body radiation therapy use for high risk prostate cancer in the United States. Prostate Cancer Prostatic Dis 2020; 24:578-581. [PMID: 33188271 PMCID: PMC8116349 DOI: 10.1038/s41391-020-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
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Ricco A, Barbera G, Lanciano R, Feng J, Hanlon A, Lozano A, Good M, Arrigo S, Lamond J, Yang J. Favorable Biochemical Freedom From Recurrence With Stereotactic Body Radiation Therapy for Intermediate and High-Risk Prostate Cancer: A Single Institutional Experience With Long-Term Follow-Up. Front Oncol 2020; 10:1505. [PMID: 33102201 PMCID: PMC7545336 DOI: 10.3389/fonc.2020.01505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose/Objective(s): The current study reports long-term overall survival (OS) and biochemical freedom from recurrence (BFFR) after stereotactic body radiation therapy (SBRT) for men with intermediate and high-risk prostate cancer in a single community hospital setting with early adoption. Materials/Methods: Ninety-seven consecutive men with intermediate and high-risk prostate cancer treated with SBRT between 2007 and 2015 were retrospectively studied. Categorical variables for analysis included National Comprehensive Cancer Network risk group, race, Gleason grade group, T stage, use of androgen deprivation therapy, and planning target volume dose. Continuous variables for analysis included pretreatment prostate-specific antigen (PSA), percent cores positive, age at diagnosis, PSA nadir, prostate volume, percent prostate that received 40 Gy, and minimum dose to 0.03 cc of prostate (Dmin). BFFR was assessed using the Phoenix nadir +2 definition. OS and BFFR were estimated using Kaplan–Meier (KM) methodology with comparisons accomplished using log-rank statistics. Multivariable analysis (MVA) was accomplished with a backwards selection Cox proportional-hazards model with statistical significance taken at the p < 0.05 level. Results: Median FU is 78.4 months. Five- and ten-year OS KM estimates are 90.9 and 73.2%, respectively, with 19 deaths recorded. MVA reveals pretreatment PSA (p = 0.032), percent prostate 40 Gy (p = 0.003), and race (p = 0.031) were predictive of OS. Five- and nine-year BFFR KM estimates are 92.1 and 87.5%, respectively, with 10 biochemical failures recorded. MVA revealed PSA nadir (p < 0.001) was the only factor predictive of BFFR. Specifically, for every one-unit increase in PSA nadir, there was a 4.2-fold increased odds of biochemical failure (HR = 4.248). No significant differences in BFFR were found between favorable intermediate, unfavorable intermediate, and high-risk prostate cancer (p = 0.054) with 7-year KM estimates of 96.6, 81.0, and 85.7%, respectively. Conclusions: Favorable OS and BFFR can be expected after SBRT for intermediate and high-risk prostate cancer with non-significant differences seen for BFFR between favorable intermediate, unfavorable intermediate, and high-risk groups. Our 5-year BFFR compares favorably with the HYPO-RT-PC trial of 84%. PSA nadir was predictive of biochemical failure. This study is ultimately limited by the small absolute number of high-risk patients included.
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Affiliation(s)
- Anthony Ricco
- Virginia Commonwealth University Health System, Richmond, VA, United States
| | - Gabrielle Barbera
- College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Rachelle Lanciano
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States.,Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Jing Feng
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Alexandra Hanlon
- Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Alicia Lozano
- Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Michael Good
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Stephen Arrigo
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States.,Philadelphia CyberKnife Center, Havertown, PA, United States
| | - John Lamond
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States.,Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Jun Yang
- Philadelphia CyberKnife Center, Havertown, PA, United States
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Odei B, Bae S, Diaz DA. Challenges influencing the utilization of prostate brachytherapy in the United States. Radiother Oncol 2020; 154:123-124. [PMID: 32976872 DOI: 10.1016/j.radonc.2020.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Bismarck Odei
- Ohio State University, Department of Radiation Oncology, United States.
| | - Sonu Bae
- Ohio State University, School of Medicine, United States.
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Royce TJ, Mavroidis P, Wang K, Falchook AD, Sheets NC, Fuller DB, Collins SP, El Naqa I, Song DY, Ding GX, Nahum AE, Jackson A, Grimm J, Yorke E, Chen RC. Tumor Control Probability Modeling and Systematic Review of the Literature of Stereotactic Body Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 110:227-236. [PMID: 32900561 DOI: 10.1016/j.ijrobp.2020.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation. The evolving treatment approach of ultrahypofractionation with stereotactic body radiation therapy (SBRT) allows possible further biological dose escalation (biologically equivalent dose [BED]) and shortened treatment time. METHODS AND MATERIALS The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiation Therapy/SBRT included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse. Results were stratified by prostate cancer risk group. RESULTS Twenty-five published cohorts were identified for inclusion, with a total of 4821 patients (2235 with low-risk, 1894 with intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up of more than 5 years. Dosing regimens ranged from 32 to 50 Gy in 4 to 5 fractions, with total BED (α/β = 1.5 Gy) between 183.1 and 383.3 Gy. At 5 years, we found that in patients with low-intermediate risk disease, an equivalent doses of 2 Gy per fraction (EQD2) of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of 97 Gy (37.6 Gy in 5 fractions) can achieve a TCP of 90% and an EQD2 of 102 Gy (38.7 Gy in 5 fractions) can achieve a TCP of 95%. CONCLUSIONS We found significant variation in the published literature on target delineation, margins used, dose/fractionation, and treatment schedule. Despite this variation, TCP was excellent. Most prescription doses range from 35 to 40 Gy, delivered in 4 to 5 fractions. The literature did not provide detailed dose-volume data, and our dosimetric analysis was constrained to prescription doses. There are many areas in need of continued research as SBRT continues to evolve as a treatment modality for prostate cancer, including the durability of local control with longer follow-up across risk groups, the efficacy and safety of SBRT as a boost to intensity modulated radiation therapy (IMRT), and the impact of incorporating novel imaging techniques into treatment planning.
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Affiliation(s)
- Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald B Fuller
- Division of Genesis Healthcare Partners Inc, Genesis CyberKnife, San Diego, California
| | - Sean P Collins
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Issam El Naqa
- Machine Learning Department, Moffitt Cancer Center, Tampa, Florida
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alan E Nahum
- Department of Physics, University of Liverpool, United Kingdom and Henley-on-Thames, United Kingdom
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas
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12
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Faria S, Ruo R, Perna M, Cury F, Duclos M, Sarshoghi A, Souhami L. Long-Term Results of Moderate Hypofractionation to Prostate and Pelvic Nodes Plus Androgen Suppression in High-Risk Prostate Cancer. Pract Radiat Oncol 2020; 10:e514-e520. [PMID: 32738465 DOI: 10.1016/j.prro.2020.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/06/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE Moderate hypofractionated radiation therapy (HypoRT) is an attractive alternative to conventionally fractionated radiation therapy for prostate cancer. However, most studies using HypoRT only included the prostate as the target volume. We report long-term outcomes of patients with high-risk prostate cancer treated with androgen deprivation therapy (ADT) and HypoRT to the prostate and nodal areas with a simultaneous integrated boost technique. METHODS AND MATERIALS Patients with localized, high-risk prostate cancer entered a prospective phase I/II study with a HypoRT regimen of 60 Gy/20 fractions (4 weeks) to the prostate volume while the nodal areas received 44 Gy in the same 20 fractions delivered with intensity modulated radiation therapy with a simultaneous integrated boost technique. ADT started 2 to 3 months before HypoRT. Toxicity was prospectively assessed according to the Common Terminology Criteria for Adverse Events v3. Outcomes rates were calculated by the actuarial method of Kaplan-Meier from the date of last radiation treatment until date of event. RESULTS We report on the first 105 patients treated between October 2010 and February 2014. Median follow-up was 74 months, with 97% of patients followed for more than 36 months. Median ADT duration was 18 months. The worst grade 2 or higher late gastrointestinal or genitourinary toxicity was seen in 7% and 9%, respectively. There was no grade 4 or 5 toxicity. At the last follow-up, the rates of grade ≥2 gastrointestinal or genitourinary toxicity were 2% and 3%, respectively, with no residual grade ≥3 toxicity. The 5- and 7-year actuarial overall survival and relapse free survival were 91% and 85% and 87% and 81%, respectively. CONCLUSIONS The longest follow-up report of moderate HypoRT (plus ADT) to the prostate and pelvic nodes shows that this approach is feasible, well tolerated, and effective. It is convenient for patients and the health system. A larger randomized trial using this approach is warranted.
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Affiliation(s)
- Sergio Faria
- Department of Radiation Oncology, McGill University, Quebec, Canada.
| | - Russel Ruo
- Department of Medical Physics, McGill University, Quebec, Canada
| | - Marianna Perna
- Department of Radiation Oncology, McGill University, Quebec, Canada
| | - Fabio Cury
- Department of Radiation Oncology, McGill University, Quebec, Canada
| | - Marie Duclos
- Department of Radiation Oncology, McGill University, Quebec, Canada
| | - Arash Sarshoghi
- Student of Health Sciences, Collège Jean de Brébeuf, Montreal, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University, Quebec, Canada
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13
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Vuolukka K, Auvinen P, Tiainen E, Palmgren JE, Heikkilä J, Seppälä J, Aaltomaa S, Kataja V. Stereotactic body radiotherapy for localized prostate cancer - 5-year efficacy results. Radiat Oncol 2020; 15:173. [PMID: 32664981 PMCID: PMC7362647 DOI: 10.1186/s13014-020-01608-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of stereotactic body radiotherapy (SBRT) as the primary treatment modality in clinically localized prostate cancer (PCa) is emerging. The aim of the study was to analyze the long-term results of PCa patients treated with SBRT. METHODS This non-selected, real-life patient cohort included 213 patients with localized PCa treated with a robotic SBRT device during 2012-2015. RESULTS The median follow-up was 64 months (range, 10-85 months), and all risk-groups were represented as 47 (22.1%), 56 (26.3%) and 110 (51.6%) patients were classified into D'Amico risk stratification of low, intermediate and high-risk groups, respectively. Androgen deprivation therapy (ADT) was administered to 64.3% of the patients. At cut-off, the biochemical relapse-free survival (bRFS) was 100, 87.5 and 80.0% for patients at low, intermediate and high-risk (p = 0.004), and 92.5, 84.2 and 66.7% for patients with Gleason score ≤ 6, 7 and ≥ 8, respectively (p = 0.001). The actuarial 5-year overall survival (OS) rates were 97.9, 96.4 and 88.6% in the low, intermediate and high-risk groups, respectively, and at the cut-off, the disease-specific survival (DSS) rate of the whole cohort was high (99.1%), as only two high-risk patients died due to PCa. CONCLUSION Our present results of SBRT delivered with CyberKnife produced excellent long-term bRFS, OS and DSS outcomes among patients with localized PCa. We conclude that SBRT provides an efficient and convenient treatment option for patients with localized PCa, irrespective of the risk-group.
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Affiliation(s)
- Kristiina Vuolukka
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.
| | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland
| | | | - Jan-Erik Palmgren
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Janne Heikkilä
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Jan Seppälä
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Vesa Kataja
- University of Eastern Finland, Kuopio, Finland.,Central Finland Health Care District, Adm Bldg 6/2, FI-40620, Jyväskylä, Finland
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14
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Shinde A, Li R, Han C, Frankel P, Sampath S. Dosimetric Predictors of Genitourinary Toxicity From a Phase I Trial of Prostate Bed Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2020; 11:e90-e97. [PMID: 32562789 DOI: 10.1016/j.prro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Our purpose was to analyze dose-volume parameters associated with genitourinary (GU) toxicity from a phase I clinical trial of prostate bed stereotactic body radiation therapy. METHODS AND MATERIALS Patients were treated in escalating dose levels of 35, 40, and 45 Gy, over 5 fractions. Data from all 26 patients enrolled in the protocol were analyzed using multiple dose-volume cut points for multiple GU organs at risk. Univariate logistical regression and Fisher exact test were used to assess statistical significance associated with incidence of toxicity. RESULTS The median follow-up was 36 months for all patients. Acute GU toxicity was mild and resolved spontaneously. Eight out of 26 patients (30.7%) developed late GU toxicity of grade 2 or higher. Two patients developed grade 3 ureteral stenosis, 1 in the 35 Gy arm and the other in the 45 Gy arm. Three patients developed grade 2 or higher hematuria/cystitis, and 3 developed grade 2 or higher incontinence. Incidence of grade 3 ureteral stenosis was related to the absolute volume of bladder wall receiving greater than 20, 25, and 30 Gy (P < .01). Grade 2 cystitis and hematuria were related to the volume of bladder wall receiving 20 Gy less than 34% and 35 Gy less than 25% (18.8% vs 60% and 23.8% vs 80%, respectively, P < .05). Incontinence was related to mean urethral dose less than 35 Gy and 25 Gy (4.3% vs 66.7% and 0% vs 37.5%, respectively, P < .05) and volume of urethra receiving 35 Gy less than 24% (8.3% vs 50%, P < .05). CONCLUSIONS This is the first analysis to report dose-volume thresholds associated with late GU toxicity in patients receiving prostate bed stereotactic body radiation therapy. We recommend limiting the bladder wall receiving 25 Gy to less than 18 cubic centimeters to reduce the risk for late grade 3 ureteral stenosis.
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Affiliation(s)
- Ashwin Shinde
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Paul Frankel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
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15
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Adorno Febles VR, Blacksburg S, Haas JA, Wise DR. Translating the Immunobiology of SBRT to Novel Therapeutic Combinations for Advanced Prostate Cancer. Front Oncol 2020; 10:830. [PMID: 32670868 PMCID: PMC7326115 DOI: 10.3389/fonc.2020.00830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/28/2020] [Indexed: 12/30/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an increasingly used radiation modality for the treatment of both localized and metastatic prostate cancer. Substantial data suggests that prostate cancer may be more sensitive to higher doses of radiation per fraction due to its low α/β ratio. This increased sensitivity raises important questions as to how SBRT should be combined with systemic therapy for clinically significant prostate cancer, including whether androgen deprivation therapy retains its beneficial effects when combined with SBRT. Furthermore, pre-clinical and clinical data suggest pronounced immunomodulatory effects of SBRT, including observed improvements in T cell priming and trafficking. These data support investigational strategies combining SBRT with immunotherapy. Here we aim to review the data for the use of SBRT in both the local and metastatic disease settings as well as ongoing translational and clinical research examining combinations with ADT, immunotherapy and other targeted agents.
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Affiliation(s)
- Victor R Adorno Febles
- Perlmutter Cancer Center, Langone Medical Center, New York University, New York, NY, United States
| | - Seth Blacksburg
- New York University Winthrop Hospital, Mineola, NY, United States
| | - Jonathan A Haas
- New York University Winthrop Hospital, Mineola, NY, United States
| | - David R Wise
- Perlmutter Cancer Center, Langone Medical Center, New York University, New York, NY, United States
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16
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Macias VA, Barrera‐Mellado I. Ultra-hypofractionated radiation therapy for unfavourable intermediate-risk and high-risk prostate cancer is safe and effective: 5-year outcomes of a phase II trial. BJU Int 2020; 125:215-225. [PMID: 31614071 PMCID: PMC7003804 DOI: 10.1111/bju.14925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To report toxicity (primary endpoint) and biochemical disease-free survival (BDFS) outcomes of a phase II trial evaluating ultra-hypofractionated radiation therapy (UHRT), focusing on patients with unfavourable intermediate-risk and high-risk prostate cancer (PCa). PATIENTS AND METHODS From 2012 to 2017, 154 patients (92 with unfavourable intermediate-risk or high-risk PCa) were treated with helical TomoTherapy delivering 43.8-45.2 Gy in eight fractions over 3 weeks. Of these, 73% received hormonotherapy (51% neoadjuvant). RESULTS The median (range) follow-up was 48 (19-84) months. For the whole series, crude BDFS and 5-year BDFS rates were 97.4% and 94.3%, respectively. The corresponding figures for unfavourable intermediate-risk and high-risk PCa were 96.7% and 90%, respectively. The crude metastasis-free survival rate was 98% for the unfavourable intermediate-risk and high-risk group. For the whole series, the 5-year cumulative urinary/intestinal grade 2+ late toxicity was 17.8/7.4%. No grade 4-5 toxicity was observed. One patient experienced late grade 3 toxicity (urinary). CONCLUSION This eight-fraction UHRT regimen can be safely delivered to patients with unfavourable intermediate-risk/high-risk PCa. Its relapse rates are similar to those reported for the combination of external beam radiotherapy plus brachytherapy, however, the observed toxicity profile is milder. The disease survival rates compare favourably with historical controls in some other forms of radiotherapy, with similar side effects. Since the low rate of biochemical/metastasis relapse is encouraging, further research to confirm these results is justified.
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Affiliation(s)
- Victor A. Macias
- Radiation Oncology DepartmentHospital Universitario y Politécnico La FeValenciaSpain
- Hospital Universitario de SalamancaSalamancaSpain
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17
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Isfahanian N, Lukka H, Dayes I, Quan K, Schnarr KL, Douvi G, Goldberg M, Wright J, Swaminath A, Chow T, Diamond K, Cutz JC, Kavsak P, Thabane L, Tsakiridis T. A Randomized Phase II Trial of Prostate Boost Irradiation With Stereotactic Body Radiotherapy (SBRT) or Conventional Fractionation (CF) External Beam Radiotherapy (EBRT) in Locally Advanced Prostate Cancer: The PBS Trial (NCT03380806). Clin Genitourin Cancer 2020; 18:e410-e415. [PMID: 32265129 DOI: 10.1016/j.clgc.2019.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 01/24/2023]
Abstract
Standard therapy for high-risk (HR) prostate cancer (PrCa) involves androgen deprivation therapy (ADT) and pelvic conventional fractionation (CF) external beam radiotherapy (EBRT) followed by boost CF-EBRT treatment to prostate for a total of 78 to 80 Gy in 39 to 40 fractions. This is a long and inconvenient treatment for patients. Brachytherapy boost treatment studies indicate that escalation of biological dose of radiotherapy (RT) can improve outcomes in HR-PrCa. However, brachytherapy is an invasive treatment associated with increased toxicity and requires specialized resources. Stereotactic body radiotherapy (SBRT) is a promising, non-invasive alternative to brachytherapy. However, its impact on patient quality of life (QoL) and RT-associated toxicity has not been investigated in a randomized setting. In this study, we investigate SBRT as a boost treatment, following pelvic CF-EBRT, in patients with HR-PrCa treated with ADT. One hundred patients with locally advanced PrCa will be randomized to receive daily CF-EBRT of 45 to 46 Gy in 23 to 25 fractions followed by either daily CF-EBRT of 32 to 33 Gy in 15 to 16 fractions (control arm) or SBRT boost treatment of 19.5 to 21 Gy in 3 fractions (1 fraction per week) (experimental arm). The primary objective of the PBS trial is early bowel and urinary QoL (expanded prostate index composite [EPIC], up to 6 months after RT). This phase II randomized study (PBS) provides an appropriate setting to investigate effectively the impact of SBRT boost on QoL and toxicity in patients with HR-PrCa, before this modality can be compared against the current standard of care in larger phase III protocols.
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Affiliation(s)
- Naghmeh Isfahanian
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Himanshu Lukka
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ian Dayes
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kimmen Quan
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kara Lynne Schnarr
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Georgia Douvi
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Mira Goldberg
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada
| | - Jim Wright
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Anand Swaminath
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tom Chow
- Medical Physics, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada
| | - Kevin Diamond
- Medical Physics, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada
| | - Jean Claude Cutz
- Departments of Oncology, Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Peter Kavsak
- Departments of Oncology, Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Theodoros Tsakiridis
- Radiation Oncology, Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada; Departments of Oncology, Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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18
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Zelefsky MJ, Pinitpatcharalert A, Kollmeier M, Goldman DA, McBride S, Gorovets D, Zhang Z, Varghese M, Happersett L, Tyagi N, Hunt M. Early Tolerance and Tumor Control Outcomes with High-dose Ultrahypofractionated Radiation Therapy for Prostate Cancer. Eur Urol Oncol 2019; 3:748-755. [PMID: 31668713 DOI: 10.1016/j.euo.2019.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies using stereotactic body radiotherapy (SBRT) dose escalation in in low- and intermediate-risk prostate cancer patients have indicated favorable outcomes. OBJECTIVE To evaluate tolerance and tumor control outcomes in low- and intermediate-risk prostate cancer patients treated with high-dose SBRT following our phase 1 trial. DESIGN, SETTING, AND PARTICIPANTS A total of 551 patients with low- or intermediate-risk prostate cancer were treated with SBRT. INTERVENTION Treatment with 37.5-40Gy SBRT in five fractions directed to the prostate and seminal vesicles. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome measurements included acute toxicities (<3 mo after radiotherapy [RT]) and late toxicities (>3 mo after RT) and tumor control evaluation (prostate-specific antigen [PSA] levels at 3-6-mo intervals and post-treatment prostate biopsy at 2yr). RESULTS AND LIMITATIONS Acute grade 2 gastrointestinal (GI) toxicities occurred in 1.8% of patients, and late grade 2 and 3 GI toxicities were observed in 3.4% and 0.4% of patients, respectively. Acute grade 2 genitourinary (GU) toxicities occurred in 10% of patients, and grade 3 acute GU toxicities were observed in 0.7% of patients. Late grade 2 and 3 GU toxicities were observed in 21.1% and 2.5% of patients, respectively. The use of a hydrogel rectal spacer was significantly associated with reduced late GI toxicity and lower odds of developing late GU toxicity. The median follow-up was 17 mo, and 53% of those with at least 2yr of follow-up (103/193) had a biopsy performed. The 5-yr cumulative incidence of PSA failure was 2.1%, and the incidence of a positive 2-yr treatment biopsy was 12%. Limitations to this report include its retrospective nature and short follow-up time. CONCLUSIONS Favorable short-term outcomes were achieved with high-dose SBRT for low- and intermediate-risk disease. Severe late toxicities were observed and favorable tumor control was found. PATIENT SUMMARY We utilized stereotactic body radiotherapy, a form of external beam radiotherapy that delivers highly targeted high-dose treatment to the prostate, to treat over 500 localized prostate cancer patients in five sessions over 1.5 wk. Treatments were well tolerated without significant urinary or rectal side effects. Nearly 90% of those who underwent biopsies after treatment did not demonstrate residual active disease.
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Affiliation(s)
- Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Marisa Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatatistics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatatistics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Melissa Varghese
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer, New York, NY, USA
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19
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Reichard CA, Kukreja J, Gregg JR, Bathala TK, Achim MF, Wang X, Davis JW, Nguyen QN, Chapin BF. Prediction of Organ-confined Disease in High- and Very-high-risk Prostate Cancer Patients Staged with Magnetic Resonance Imaging: Implications for Clinical Trial Design. Eur Urol Focus 2019; 7:71-77. [PMID: 31076357 DOI: 10.1016/j.euf.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/21/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND High-risk (HR) prostate cancer (PCa) is a heterogeneous disease leading to difficulties in designing appropriate inclusion criteria for clinical trials. OBJECTIVE To describe clinical predictors of organ-confined disease in HR or very-high-risk (VHR) PCa patients staged with multiparametric magnetic resonance imaging with endorectal coil (mp-MRI-ER). DESIGN, SETTING, AND PARTICIPANTS We reviewed 366 HR/VHR PCa patients who had preoperative mp-MRI-ER, and underwent radical prostatectomy and extended pelvic lymph node dissection between 2006 and 2015. INTERVENTION Radical prostatectomy with preoperative mp-MRI-ER. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used multivariable logistic regression modeling to assess for associations with ≤ pT2N0 stage and multivariable cox modeling to assess for associations with biochemical failure. RESULTS AND LIMITATIONS Of 366 patients, 132 had ≤ pT2N0 disease. For the entire cohort, negative staging mp-MRI-ER (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.06-2.83, p = 0.03), lower prostate-specific antigen (PSA; OR 0.98, 95% CI 0.97-1.00, p = 0.02), and fewer cores of Gleason ≥8 cancer (OR 0.86, 95% CI 0.79-0.93, p = 0.0002) were associated with ≤pT2N0 disease. In HR patients only, negative mp-MRI-ER (OR 3.41, 95% CI 1.73-6.72, p = 0.0004) and fewer than four cores of Gleason ≥8 disease (OR 3.38, 95% CI 1.20-9.56, p = 0.02) were still associated with ≤pT2N0 disease. Lack of non-organ-confined disease on MRI was associated with superior biochemical recurrence-free survival (p = 0.02). Limitations of this study include lack of a central review or quality control of the MRI reporting. CONCLUSIONS In HR PCa, negative staging mp-MRI-ER, fewer positive cores of Gleason >8, and lower PSA were significant predictors of pathologic organ-confined disease. Improved prediction of organ-confined disease in HR patients may allow for their inclusion into studies evaluating treatments from which they would otherwise be excluded based solely on their HR status. PATIENT SUMMARY In patients with high-risk prostate cancer, prostate magnetic resonance imaging along with other clinical parameters may help determine which patients are likely to have disease confined to the prostate and thus be eligible for clinical trials that they otherwise might be excluded from based on their high-risk status alone.
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Affiliation(s)
- Chad A Reichard
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Janet Kukreja
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justin R Gregg
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tharakeswala K Bathala
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary F Achim
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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20
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Wirth M, Fossati N, Albers P, Bangma C, Brausi M, Comperat E, Faithfull S, Gillessen S, Jereczek-Fossa BA, Mastris K, Mottet N, Müller SC, Pieters B, Ribal MJ, Sangar V, Schoots IG, Smelov V, Travado L, Valdagni R, Wesselmann S, Wiegel T, van Poppel H. The European Prostate Cancer Centres of Excellence: A Novel Proposal from the European Association of Urology Prostate Cancer Centre Consensus Meeting. Eur Urol 2019; 76:179-186. [PMID: 30799188 DOI: 10.1016/j.eururo.2019.01.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND High-quality management of prostate cancer is needed in the fields of clinics, research, and education. OBJECTIVE The objective of this project was to develop the concept of "European Prostate Cancer Centres of Excellence" (EPCCE), with the specific aim of identifying European centres characterised by high-quality cancer care, research, and education. DESIGN, SETTING, AND PARTICIPANTS A task force of experts aimed at identifying the general criteria to define the EPCCE. Discussion took place in conference calls and by e-mail from March 2017 to November 2017, and the final consensus meeting named "European Association of Urology (EAU) Prostate Cancer Centre Consensus Meeting" was held in Barcelona on November 16, 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The required criteria were grouped into three main steps: (1) clinics, (2) research, and (3) education. A quality control approach for the three steps was defined. RESULTS AND LIMITATIONS The definition of EPCCE consisted of the following steps: (1) clinical step-five items were identified and classified as core team, associated services, multidisciplinary approach, diagnostic pathway, and therapeutic pathway; (2) research step-internal monitoring of outcomes was required; clinical data had to be collected through a prespecified database, clinical outcomes had to be periodically assessed, and prospective trials had to be conducted; (3) educational step-it consists of structured fellowship programmes of 1yr, including 6mo of research and 6mo of clinics; and (4) quality assurance and quality control procedures, related to the quality assessment of the previous three steps. A limitation of this project was that the definition of standards and items was mainly based on a consensus among experts rather than being an evidence-based process. CONCLUSIONS The EAU Prostate Cancer Centre Consensus Meeting defined the criteria for the identification of the EPCCE in the fields of clinics, research, and education. The inclusion of a quality control approach represents the novelty that supports the excellence of these centres. PATIENT SUMMARY A task force of experts defined the criteria for the identification of European Prostate Cancer Centres of Excellence, in order to certify the high-quality centres for prostate cancer management.
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Affiliation(s)
- Manfred Wirth
- European Association of Urology (EAU), Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
| | - Nicola Fossati
- European Association of Urology (EAU), Division of Oncology / Unit of Urology; IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Peter Albers
- European Association of Urology (EAU), Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany.
| | - Chris Bangma
- European Association of Urology (EAU), Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Maurizio Brausi
- EAU Section of Oncological Urology (ESOU)Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy.
| | - Eva Comperat
- Service d'anatomie et cytologie pathologiques, hôpital Tenon, HUEP, Sorbonne université, Paris, France.
| | - Sara Faithfull
- European Association of Urology Nurses (EAUN), School of Health Sciences, Faculty of Health & Medical Sciences, Duke of Kent Building, University of Surrey,Surrey, UK.
| | - Silke Gillessen
- European Organisation for Research and Treatment of Cancer (EORTC), Manchester Cancer Research Centre, Manchester, UK.
| | - Barbara Alicja Jereczek-Fossa
- European Society for Radiotherapy and Oncology (ESTRO), Department of Oncology and Hemato-oncology, University of Milan, Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | | | - Nicolas Mottet
- European Association of Urology (EAU), Department of Urology, University Hospital, St. Etienne, France.
| | | | - Bradley Pieters
- European Society for Radiotherapy and Oncology (ESTRO), Amsterdam University Medical Centers / University of Amsterdam, Amsterdam, The Netherlands.
| | - Maria J Ribal
- European Urological Scholarship Programme (EUSP), Uro-Oncology Unit. Hospital Clínic. University of Barcelona, Spain.
| | - Vijay Sangar
- European Association of Urology (EAU), The Christie NHS Foundation Trust & Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - Ivo G Schoots
- European Society of Uro Radiology (ESUR), Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Vitaly Smelov
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer (IARC), World Health Organization (WHO).
| | - Luzia Travado
- International Psycho-Oncology Society (IPOS), Psycho-oncology, Champalimaud Clinical and Research Center, Champalimaud Foundation, Lisbon, Portugal.
| | - Riccardo Valdagni
- European School of Oncology (ESO), University of Milan, Department of Oncology and Hemato-oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Radiation Oncology, Milano, Italy.
| | | | - Thomas Wiegel
- European Society for Radiotherapy and Oncology (ESTRO) Milan, Italy.
| | - Hendrik van Poppel
- European Association of Urology (EAU), Dept Urology, University Hospital KU Leuven, Belgium.
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Pinitpatcharalert A, Happersett L, Kollmeier M, McBride S, Gorovets D, Tyagi N, Varghese M, Zelefsky MJ. Early Tolerance Outcomes of Stereotactic Hypofractionated Accelerated Radiation Therapy Concomitant with Pelvic Node Irradiation in High-risk Prostate Cancer. Adv Radiat Oncol 2019; 4:337-344. [PMID: 31011679 PMCID: PMC6460324 DOI: 10.1016/j.adro.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose This study aimed to evaluate the toxicity of prostate and pelvic lymph node stereotactic body radiation therapy (SBRT) for high-risk prostate cancer. Methods and Materials Twenty-three patients with high-risk or lymph node-positive prostate cancer were treated with SBRT that delivered 37.5 to 40 Gy in 5 fractions to the prostate and seminal vesicles, with concomitant treatment of the pelvic nodes to 25 Gy. In general, patients received neoadjuvant, concurrent, and adjuvant androgen deprivation therapy for a duration of 18 months. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events, version 3.0. The median follow-up was 19 months (range, 3-48 months). Results Acute grade 1 gastrointestinal (GI) toxicities were noted in 2 patients (9.1%). No patient experienced acute grade ≥2 GI toxicity. Acute genitourinary (GU) grade 1, 2, and 3 toxicities were observed in 7 patients (31.8%), 8 patients (36.4%), and 1 patient (4.5%), respectively. Late grade 2 GI and GU toxicities were observed in 2 patients (9.1%) and 6 patients (27.3%), respectively. No late grade ≥3 GI toxicity was noted. Late grade ≥3 GU (hemorrhagic cystitis) was noted in 1 patient (4.5%), which responded to laser fulguration. Conclusions SBRT with pelvic lymph node radiation therapy was feasible and well tolerated. The incidence of grade ≥3 GU and GI toxicities was uncommon. Continued follow-up will be required to determine the long-term safety and efficacy of this approach for high-risk patients.
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Affiliation(s)
| | - Laura Happersett
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marisa Kollmeier
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Gorovets
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neelam Tyagi
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Varghese
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael J Zelefsky
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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Lazar AA, Schulte R, Faddegon B, Blakely EA, Roach M. Clinical trials involving carbon-ion radiation therapy and the path forward. Cancer 2018; 124:4467-4476. [PMID: 30307603 DOI: 10.1002/cncr.31662] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/22/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
To describe the international landscape of clinical trials in carbon-ion radiotherapy (CIRT), the authors reviewed the current status of 63 ongoing clinical trials (median, 47 participants) involving CIRT identified from the US clinicaltrials.gov trial registry and the World Health Organization International Clinical Trials Platform Registry. The objectives were to evaluate the potential for these trials to define the role of this modality in the treatment of specific cancer types and identify the major challenges and opportunities to advance this technology. A significant body of literature suggested the potential for advantageous dose distributions and, in preclinical biologic studies, the enhanced effectiveness for CIRT compared with photons and protons. In addition, clinical evidence from phase I/II trials, although limited, indicated the potential for CIRT to improve cancer outcomes. However, current high-level phase III randomized clinical trial evidence does not exist. Although there has been an increase in the number of trials investigating CIRT since 2010, and the number of countries and sites offering CIRT is slowly growing, this progress has excluded other countries. Several recommendations are proposed to study this modality to accelerate progress in the field, including: 1) increasing the number of multinational randomized clinical trials, 2) leveraging the existing CIRT facilities to launch larger multinational trials directed at common cancers combined with high-level quality assurance; and 3) developing more compact and less expensive next-generation treatment systems integrated with radiobiologic research and preclinical testing.
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Affiliation(s)
- Ann A Lazar
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco (UCSF), San Francisco, California.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | - Reinhard Schulte
- Department of Radiation Oncology, UCSF, San Francisco, California.,Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, California
| | - Bruce Faddegon
- Department of Radiation Oncology, UCSF, San Francisco, California
| | - Eleanor A Blakely
- Division of Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Mack Roach
- Department of Radiation Oncology, UCSF, San Francisco, California
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Royce TJ, Chen RC. Stereotactic body radiation therapy for high-riskprostate cancer: Not ready. Pract Radiat Oncol 2018; 8:203-205. [DOI: 10.1016/j.prro.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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