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Corrao G, Marvaso G, Mastroleo F, Biffi A, Pellegrini G, Minari S, Vincini MG, Zaffaroni M, Zerini D, Volpe S, Gaito S, Mazzola GC, Bergamaschi L, Cattani F, Petralia G, Musi G, Ceci F, De Cobelli O, Orecchia R, Alterio D, Jereczek-Fossa BA. Photon vs proton hypofractionation in prostate cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 195:110264. [PMID: 38561122 DOI: 10.1016/j.radonc.2024.110264] [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: 12/14/2023] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND High-level evidence on hypofractionated proton therapy (PT) for localized and locally advanced prostate cancer (PCa) patients is currently missing. The aim of this study is to provide a systematic literature review to compare the toxicity and effectiveness of curative radiotherapy with photon therapy (XRT) or PT in PCa. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched up to April 2022. Men with a diagnosis of PCa who underwent curative hypofractionated RT treatment (PT or XRT) were included. Risk of grade (G) ≥ 2 acute and late genitourinary (GU) OR gastrointestinal (GI) toxicity were the primary outcomes of interest. Secondary outcomes were five-year biochemical relapse-free survival (b-RFS), clinical relapse-free, distant metastasis-free, and prostate cancer-specific survival. Heterogeneity between study-specific estimates was assessed using Chi-square statistics and measured with the I2 index (heterogeneity measure across studies). RESULTS A total of 230 studies matched inclusion criteria and, due to overlapped populations, 160 were included in the present analysis. Significant lower rates of G ≥ 2 acute GI incidence (2 % vs 7 %) and improved 5-year biochemical relapse-free survival (95 % vs 91 %) were observed in the PT arm compared to XRT. PT benefits in 5-year biochemical relapse-free survival were maintained for the moderate hypofractionated arm (p-value 0.0122) and among patients in intermediate and low-risk classes (p-values < 0.0001 and 0.0368, respectively). No statistically relevant differences were found for the other considered outcomes. CONCLUSION The present study supports that PT is safe and effective for localized PCa treatment, however, more data from RCTs are needed to draw solid evidence in this setting and further effort must be made to identify the patient subgroups that could benefit the most from PT.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Annalisa Biffi
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Samuele Minari
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Simona Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Clinical Cancer Science, School of Medical Sciences, The University of Manchester, Manchester, UK
| | | | - Luca Bergamaschi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Glicksman RM, Loblaw A, Morton G, Vesprini D, Szumacher E, Chung HT, Chu W, Liu SK, Tseng CL, Correa R, Deabreu A, Mamedov A, Zhang L, Cheung P. Randomized Trial of Concomitant Hypofractionated Intensity Modulated Radiation Therapy Boost Versus Conventionally Fractionated Intensity Modulated Radiation Therapy Boost for Localized High-Risk Prostate Cancer (pHART2-RCT). Int J Radiat Oncol Biol Phys 2024; 119:100-109. [PMID: 37979707 DOI: 10.1016/j.ijrobp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/15/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE The aim of this work is to report on the results of a phase 2 randomized trial of moderately hypofractionated (MH) versus conventionally fractionated (CF) radiation therapy to the prostate with elective nodal irradiation. METHODS AND MATERIALS This was a single-center, prospective, phase 2 randomized study. Patients with high-risk disease (cT3, prostate-specific antigen level >20 ng/mL, or Gleason score 8-10) were eligible. Patients were randomized to either MH using a simultaneous integrated boost (68 Gy in 25 fractions to prostate; 48 Gy to pelvis) or CF (46 Gy in 23 fractions with a sequential boost to the prostate of 32 Gy in 16 fractions), with long-term androgen deprivation therapy. The primary endpoint was grade ≥2 acute gastrointestinal (GI) and genitourinary (GU) toxicity (Common Terminology Criteria for Adverse Events version 3.0). Secondary endpoints included late GI and GU toxicity, quality of life, and oncologic outcomes. RESULTS One-hundred eighty patients were enrolled; 90 were randomized to and received MH and 90 to CF. The median follow-up was 67.4 months. Seventy-five patients (41.7%) experienced a grade ≥2 acute GI and/or GU toxicity, including 34 (37.8%) in the MH and 41 (45.6%) in the CF arms, respectively (P = .29). Late grade ≥2 GI (P = .07) and GU (P = .25) toxicity was not significantly different between arms; however, late grade ≥3 GI toxicity was worse in the MH group (P = .01). There were no statistically significant quality-of-life differences between the 2 treatments. There were no statistically significant differences observed in cumulative incidence of biochemical failure (P = .71) or distant metastasis (P = .31) and overall survival (P = .46). CONCLUSIONS MH to the prostate and pelvis with androgen deprivation therapy for men with high-risk localized prostate cancer was not significantly different than CF with regard to acute toxicity, quality of life, and oncologic efficacy. However, late grade ≥3 GI toxicity was more common in the MH arm.
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Affiliation(s)
- Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hans T Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William Chu
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stanley K Liu
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Andrea Deabreu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Lee TH, Pyo H, Yoo GS, Jeon SS, Seo SI, Jeong BC, Jeon HG, Sung HH, Kang M, Song W, Chung JH, Bae BK, Park W. Hypofractionated radiation therapy combined with androgen deprivation therapy for high-risk localized prostate cancer. J Med Imaging Radiat Oncol 2024; 68:333-341. [PMID: 38477380 DOI: 10.1111/1754-9485.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION This study aimed to analyse the treatment outcomes of moderately hypofractionated radiation therapy (RT) combined with androgen deprivation therapy (ADT) and the prognostic implications of prostate-specific antigen (PSA) kinetics in high-risk localized prostate cancer. METHODS The medical records of 140 patients who underwent definitive RT (70 Gy in 28 fractions) combined with ADT were retrospectively reviewed. ADT consists of a gonadotropin-releasing hormone agonist and an anti-androgen. Clinical outcomes included the biochemical failure rate (BFR), clinical failure rate (CFR), overall survival (OS) and prostate cancer-specific survival (PCSS). The BFR and CFR were stratified by the PSA nadir and the time to the PSA nadir, respectively. Acute and late genitourinary and gastrointestinal adverse events were also recorded. RESULTS The 5-year BFR, CFR, OS and PCSS rates were 9.8%, 4.5%, 90.2% and 98.7%, respectively. Ninety-five (67.9%) patients achieved a PSA nadir of 0.01 ng/mL. Patients with a PSA nadir >0.01 ng/mL had a significantly higher BFR and CFR (BFR, P = 0.001; CFR, P = 0.027), even after adjusting for other prognostic factors [per 0.1 ng/mL; BFR, hazard ratio (HR) 4.440, P < 0.001; CFR, HR 4.338, P = 0.001]. However, the time to the PSA nadir and pre-RT PSA were not significantly associated with the BFR and CFR. Six patients (4.3%) reported grade 3 late adverse events, mostly haematuria and haematochezia. CONCLUSION Definitive RT with moderate hypofractionation combined with long-term ADT showed good efficacy for high-risk localized prostate cancer. The lowest PSA nadir was significantly associated with a low recurrence rate, indicating the importance of PSA follow-up.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bong Kyung Bae
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Morgan SC, Hu C, Dess RT. A New Pos-SIB-ility for Prostate and Pelvic Nodal Radiation Therapy in High-Risk Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2024; 118:63-65. [PMID: 38049229 DOI: 10.1016/j.ijrobp.2023.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Scott C Morgan
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Department of Oncology, Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Hu
- Department of Oncology, Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert T Dess
- Department of Oncology, Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Masson I, Larriviere L, Mahé MA, Azria D, Pommier P, Mesgouez-Nebout N, Giraud P, Peiffert D, Chauvet B, Dudouet P, Salem N, Noël G, Khalifa J, Latorzeff I, Guérin-Charbonnel C, Supiot S. Prospective results for 5-year survival and toxicity of moderately hypofractionated radiotherapy with simultaneous integrated boost (SIB) in (very) high-risk prostate cancer. Clin Transl Radiat Oncol 2024; 44:100702. [PMID: 38111609 PMCID: PMC10726239 DOI: 10.1016/j.ctro.2023.100702] [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: 09/10/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose High-risk (HR) prostate cancer patients usually receive high-dose radiotherapy (RT) using a two-phase sequential technique, but data on a simultaneous integrated boost (SIB) technique are lacking. We prospectively evaluated the long-term results of urinary (GU) and digestive (GI) toxicity and survival data for high-dose RT using a SIB technique in HR and very high-risk (VHR) prostate cancer. Methods Patients were treated using an SIB technique in 34 fractions, at a dose of 54.4 Gy to the pelvis and seminal vesicles and 74.8 Gy to the prostate, combined with 36 months of androgen-depriving therapy in a prospective multicenter study. Acute and late GU and GI toxicity data were collected. Overall survival (OS), biochemical-relapse-free survival (bRFS), loco-regional-relapse-free survival (LRRFS), metastasis-free-survival (MFS) and disease-free-survival (DFS) were assessed. Results We recruited 114 patients. After a median follow-up of 62 months, very few patients experienced acute (M0-M3) (G3-4 GU = 3.7 %; G3-4 GI = 0.9 %) or late (M6-M60) severe toxicity (G3-4 GU = 5.6 %; G3-4 GI = 2.8 %). The occurrence of acute G2 + GU or GI toxicity was significantly related to the consequential late G2 + toxicity (p < 0.01 for both GU and GI). Medians of OS, bRFS, LRRFS, MFS and DFS were not reached. At 60 months, OS, bRFS, LRRFS, MFS and DFS were 88.2 % [82.1; 94.7], 86.0 % [79.4 %;93.2 %], 95.8 % [91.8 %;99.9 %], 87.2 % [80.9 %;94.0 %] and 84.1 % [77.2 %;91.6 %] respectively. Conclusion SIB RT at a dose of 54.4 Gy to the pelvis and 74.8 Gy to the prostate is feasible, leading to satisfying tumor control and reasonable toxicity in HR and VHR prostate cancer.
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Affiliation(s)
- Ingrid Masson
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest René Gauducheau, Saint-Herblain, France
- Department of Radiataion oncology, Centre Eugène Marquis, Rennes, France
| | - Laurène Larriviere
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest René Gauducheau, Saint-Herblain, France
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest René Gauducheau, Saint-Herblain, France
- Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France
| | - David Azria
- Fédération Universitaire d’Oncologie Radiothérapie FOROM, ICM, Institut régional du Cancer Montpellier, Université de Montpellier, IRCM, Montpellier, France
| | - Pascal Pommier
- Department of Radiation Oncology, Léon Bérard Center, Lyon, France
| | - Nathalie Mesgouez-Nebout
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest Paul Papin, Angers, France
| | - Philippe Giraud
- Department of Radiation Oncology, Georges Pompidou European Hospital, Paris, France
| | - Didier Peiffert
- Department of Radiation Oncology, Lorraine Cancer Institute, Vandœuvre-lès-Nancy, France
| | - Bruno Chauvet
- Department of Radiation Oncology, Sainte Catherine Institute, Avignon, France
| | - Philippe Dudouet
- Department of Radiation Oncology, Pont de chaume Clinic, Montauban, France
| | - Naji Salem
- Department of Radiation Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Georges Noël
- Department of Radiation Oncology, ICANS (Cancerology Institute of Strasbourg-Europe), Strasbourg, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - Igor Latorzeff
- Department of Radiation Oncology, Pasteur Clinic, Toulouse, France
| | - Catherine Guérin-Charbonnel
- Clinical Trial Sponsor Unit/Biometry, Institut de Cancérologie de l’Ouest René Gauducheau, Saint-Herblain, France
- Nantes Université, CNRS US2B, Nantes, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest René Gauducheau, Saint-Herblain, France
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Yap SZL, Armstrong S, Aherne N, Shakespeare TP. PSMA-PET-guided dose-escalated volumetric arc therapy for newly diagnosed lymph node-positive prostate cancer: 5 Year outcomes following the FROGG and EviQ node-positive guidelines. J Med Imaging Radiat Oncol 2023. [PMID: 37186452 DOI: 10.1111/1754-9485.13534] [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: 07/04/2022] [Accepted: 04/01/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology Genitourinary Group (FROGG) guidelines and online EviQ protocols incorporate prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-guided dose-escalated intensity-modulated radiation therapy (DE-IMRT) for newly diagnosed lymph node (LN) positive prostate cancer. We evaluated late toxicity and efficacy outcomes following the FROGG and EviQ approach. METHODS Patients with LN-positive-only metastases on PSMA-PET imaging were offered curative therapy with 3 months neoadjuvant androgen deprivation therapy (ADT) followed by DE-IMRT and 3 years adjuvant ADT. IMRT was delivered via volumetric arc therapy (VMAT). We aimed to deliver 81 Gy in 45 fractions (Fx) to the prostate and PET-positive LNs, and 60 Gy in 45 Fx to elective pelvic nodes, contoured using the PIVOTAL guidelines. RESULTS Forty-five patients were included. The median number of PET-positive nodes boosted was 2 (range 1-6) and median boost volume 1.16 cc (range 0.15-4.14). Seventeen (38%) patients had PET-positive nodes outside of PIVOTAL contouring guidelines. With 60 months median follow-up, disease-free, metastasis-free, prostate cancer-specific and overall survival were 88.1%, 95.3%, 100% and 91.5%. There were no in-field nodal failures. Late grade 1, 2 and 3 gastrointestinal toxicities occurred in 4%, 2% and 0% of patients, and genitourinary toxicity in 18%, 18% and 4%. Lower limb grade 2 lymphoedema occurred in three patients (7%). CONCLUSION Outcomes following FROGG guidelines and EviQ are promising, with high long-term disease control and low toxicity. Contouring guidelines require modification due to the high rate of PET-positive nodes demonstrated beyond recommended coverage.
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Affiliation(s)
- Shaun Zheng Liang Yap
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Shreya Armstrong
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Noel Aherne
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Thomas Philip Shakespeare
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Choo R, Hillman DW, Mitchell C, Daniels T, Vargas C, Rwigema JC, Corbin K, Keole S, Vora S, Merrell K, Stish B, Pisansky T, Davis BJ, Amundson A, Wong W. Late Toxicity of Moderately Hypofractionated Intensity-Modulated Proton Therapy Treating the Prostate and Pelvic Lymph Nodes for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 115:1085-1094. [PMID: 36427645 DOI: 10.1016/j.ijrobp.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate late gastrointestinal (GI) and genitourinary (GU) toxicity of moderately hypofractionated intensity modulated proton therapy (IMPT) targeting the prostate and pelvic lymph nodes. METHODS AND MATERIALS A target accrual of 56 patients with high-risk or unfavorable intermediate risk prostate cancer were enrolled into a prospective study (ClinicalTrials.gov: NCT02874014) of moderately hypofractionated IMPT. IMPT with pencil beam scanning was used to deliver 6750 and 4500 cGy relative biological effectiveness in 25 daily fractions simultaneously to the prostate and pelvic lymph nodes, respectively. All received androgen deprivation therapy. Late GI and GU toxicity was prospectively assessed using Common Terminology Criteria for Adverse Events version 4.0, at baseline, weekly during radiation therapy, 3-month postradiation therapy, and then every 6 months. Actuarial rates of late GI and GU toxicity were estimated using Kaplan-Meier method. RESULTS Median age was 75.5 years. Fifty-four patients were available for late toxicity evaluation. Median follow-up was 43.9 months (range, 16-66). The actuarial rate of late grade ≥2 GI toxicity at both 2 and 3 years was 7.4% (95% confidence interval [CI], 0.2%-14.2%). The actuarial rate of late grade 3 GI toxicity at both 2 and 3 years was 1.9% (95% CI, 0%-5.4%). One patient experienced grade 3 GI toxicity with proctitis. The actuarial rate of late grade ≥2 GU toxicity was 20.5% (95% CI, 8.9%-30.6%) at 2 years, and 29.2 % (95% CI, 15.5%-40.7%) at 3 years. None had grade 3 GU toxicity. The presence of baseline GU symptoms was associated with a higher likelihood of experiencing late grade 2 GU toxicity. CONCLUSIONS A moderately hypofractionated IMPT targeting the prostate and regional pelvic lymph nodes was generally well tolerated. Patients with pre-existing GU symptoms had a higher rate of late grade 2 GU toxicity. A phase 3 study is needed to assess any therapeutic gain of IMPT, in comparison with photon-based radiation therapy.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - David W Hillman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Cecilia Mitchell
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Thomas Daniels
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Carlos Vargas
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Jean Claude Rwigema
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sameer Keole
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Sujay Vora
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Thomas Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Adam Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - William Wong
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
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Brand DH, Tree AC. Fractionation Choice for Elective Lymph Node Radiation Therapy in Prostate Cancer: Slightly More to CHIRP About. Int J Radiat Oncol Biol Phys 2022; 114:108-110. [PMID: 35843786 DOI: 10.1016/j.ijrobp.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Douglas H Brand
- Department of Medical Physics and Bioengineering, University College London, London, United Kingdom; Department of Clinical Oncology, University College London Hospitals, London, United Kingdom; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Alison C Tree
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.
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9
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Patient-Reported Outcomes in a Prostate Cancer Hypofractionation Trial. Int J Radiat Oncol Biol Phys 2022; 114:99-107. [DOI: 10.1016/j.ijrobp.2022.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/10/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
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Amdur RJ, Yu JB. PRO's Top 20 Downloads of 2021. Pract Radiat Oncol 2022. [PMID: 35512987 DOI: 10.1016/j.prro.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, Florida.
| | - James B Yu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
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Viani GA, Gouveia AG, Moraes FY, Cury FL. "Meta-analysis of elective pelvic nodal irradiation using moderate hypofractionation for high-risk prostate cancer" (MENHYP-ENI). Int J Radiat Oncol Biol Phys 2022; 113:1044-1053. [PMID: 35430317 DOI: 10.1016/j.ijrobp.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/19/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite several advances in planning and delivery of radiotherapy (RT) for prostate cancer, the role of elective pelvic nodal irradiation (EPNI) remains controversial for high-risk disease. We performed a meta-analysis to evaluate the outcomes of patients treated with moderate hypofractionated RT (MHF-RT) with EPNI using modern radiotherapy techniques. METHODS Eligible studies were identified on Medline, Embase, the Cochrane Library, and proceedings of annual meetings through October 2021. We followed the PRISMA and MOOSE guidelines. A meta-regression analysis was performed to assess a possible correlation between selected variables and outcomes. A p-value <0.05 was considered significant. RESULTS Eighteen studies with a total of 1745 patients, median follow-up 61 months, treated with EPNI employing MHF-RT were included. The biochemical relapse-free survival (bRFS) at 5-, 7- and 10-year was 90% (95% CI 88-94%), 83% (95%CI 78-91%) and 78% (95%CI 68-88%). The 5-year prostate cancer-specific survival, disease-free survival, distant metastases-free survival and overall survival were 98% (95%CI 97-99%), 88.7% (95%CI 85-93%), 91.2% (95%CI 88-92%), and 93% (95%CI 90-96%), respectively. The rates of local, pelvic, and distant recurrence were 0.38% (95%CI 0-2%), 0.13% (95%CI 0-1.5%), and 7.35% (95%CI 2-12%), respectively. The rate of late GI and GU toxicity grade ≥ 2 were 6.7% (95%CI 4-9%), and 11.3% (95%CI 7.6-15%), with heterogeneity, but with rare cases of toxicity grade 3-5. CONCLUSION EPNI with concomitant MHF-RT provides satisfactory bRFS in the long-term follow-up, with low rates of GU and GI severe toxicities and minimal pelvic and local failure.
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Affiliation(s)
- Gustavo A Viani
- Ribeirao Preto Medical School, Department of Medical Imagings, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirao Preto, Brazil.
| | - Andre G Gouveia
- Radiation Oncology Department, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Canada
| | - Fabio L Cury
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Canada.
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Glicksman RM, Loblaw A, Morton G, Szumacher E, Chung HT, Vesprini D, Chu W, Liu SK, Choo R, Deabreu A, Mamedov A, Zhang L, Cheung P. Elective pelvic nodal irradiation with a simultaneous hypofractionated integrated prostate boost for localized high risk prostate cancer: Long term results from a prospective clinical trial. Radiother Oncol 2021; 163:21-31. [PMID: 34324914 DOI: 10.1016/j.radonc.2021.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND To report on long-term results of elective pelvic nodal irradiation (EPNI) and a simultaneous hypofractionated prostate boost for high-risk prostate cancer. MATERIALS AND METHODS This was a prospective single-arm study. Patients with high-risk disease (cT3, PSA >20 ng/mL, or Gleason score 8-10) were eligible. Patients received 45 Gy in 25 fractions to the prostate and pelvic lymph nodes with a simultaneous intensity-modulated radiotherapy boost of 22.5 Gy to the prostate (total dose 67.5 Gy in 25 fractions), with androgen deprivation therapy (ADT) for 2-3 years. The primary endpoint was biochemical failure. Secondary endpoints included distant metastases and overall survival. Multivariable analysis was performed to look for predictive factors. Late toxicity was assessed using CTCAE v3.0. RESULTS 230 patients enrolled. Median follow-up was 11.2 years (IQR 8.1-12.9). At 10 years, cumulative incidence of biochemical failure was 33.4%, distant metastasis was 16.5%, and overall survival was 76.3%. On multivariable analysis, PSA nadir ≥0.05 ng/mL was associated with biochemical failure (HR 6.8, 95% CI 4-11.8, p < 0.001) and distant metastases (HR 7.5, 95% CI 3.9-14.5, p < 0.0001). PSA nadir ≥0.1 ng/mL (HR 5.2, 95% 2.2-12, p = 0.0001) and ADT use ≤12 months (versus >24 months) (HR 2.3, 95% CI 1.3-3.9, p = 0.004) were associated with worse survival. The 5-year cumulative incidence of any late grade ≥3 gastrointestinal and genitourinary toxicity was 2.3% and 7.5%, respectively. CONCLUSION EPNI and a simultaneous hypofractionated prostate boost combined with long-term ADT for high-risk prostate cancer resulted in acceptable 10-year biochemical control and survival with low grade ≥3 toxicity.
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Affiliation(s)
| | - Andrew Loblaw
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hans T Chung
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William Chu
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stanley K Liu
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Andrea Deabreu
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexandre Mamedov
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Liying Zhang
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, University of Toronto, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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