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Dabic-Stankovic K, Rajkovic K, Stankovic J, Marosevic G, Kolarevic G, Pavicar B. High-dose-rate Brachytherapy Monotherapy in Patients With Localised Prostate Cancer: Dose Modelling and Optimisation Using Computer Algorithms. Clin Oncol (R Coll Radiol) 2024; 36:378-389. [PMID: 38584072 DOI: 10.1016/j.clon.2024.03.009] [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: 06/09/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS Interstitial high-dose-rate brachytherapy (HDR-BT) is an effective therapy modality for patients with localized prostate carcinoma. The objectives of the study were to optimise the therapy regime variables using two models: response surface methodology (RSM) and artificial neural network (ANN). MATERIALS AND METHODS Thirty-one studies with 5651 patients were included (2078 patients presented as low-risk, 3077 patients with intermediate-risk, and 496 patients with high-risk). A comparison of these therapy schedules was carried out using an effective biologically effective dose (BEDef) that was calculated assuming the number of treatment days and dose (D) per day. The modelling and optimization of therapy parameters (BEDef and risk level) in order to obtain the maximum biochemical free survival (BFS) were carried out by the RSM and ANN models. RESULTS An optimal treatment schedule (BFS = 97%) for patients presented with low-risk biochemical recurrence would be D = 26 Gy applied in one application, 2 fractions at least 6 h apart, within an overall treatment time of 1 day (BEDef = 251 Gy) by the RSM and ANN model. For patients presented with intermediate- or high-risk an optimal treatment regime (BFS = 94% and 90%, respectively) would be D = 38 Gy applied in one application, 4 fractions at least 6 h apart, with an overall treatment time of 2 days (BEDef = 279 Gy) by the RSM and ANN models. CONCLUSIONS The RSM and ANN models determine almost the same optimal values for the set of predicted therapy parameters that make a feasible selection of an optimal treatment regime.
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Affiliation(s)
- K Dabic-Stankovic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - K Rajkovic
- Academy of Applied Preschool Teaching and Health Studies, Krusevac, Serbia; Bijeljina University, Republic of Srpska, Bosnia and Herzegovina.
| | - J Stankovic
- Bijeljina University, Republic of Srpska, Bosnia and Herzegovina; Academy for Applied Studies Belgrade, The College of Health Sciences, Zemun, Serbia.
| | - G Marosevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - G Kolarevic
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - B Pavicar
- IMC Affidea, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
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Zeng H, Dai J, Cao D, Wang M, Zhao J, Zeng Y, Xu N, Xie Y, Liu H, Zeng H, Sun G, Shen P. Safety and efficacy associated with single-fraction high-dose-rate brachytherapy in localized prostate cancer: a systematic review and meta-analysis. Strahlenther Onkol 2023; 199:525-535. [PMID: 37093230 DOI: 10.1007/s00066-023-02063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/19/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Although single-fraction high-dose-rate brachytherapy (SFHDR) for localized prostate cancer has been tried in clinical trials, relevant medical evidence is currently lacking. It is necessary to systematically analyze the safety and efficacy of SFHDR. METHODS Comprehensive and systematic searches for eligible studies were performed in PubMed, Embase, and the Cochrane Library databases. The primary endpoints included safety and efficacy, represented by toxic effects and biochemical recurrence-free survival (bRFS), respectively. The proportion rates were used as the effect measure for each study and were presented with corresponding 95% confidence intervals (CI) and related 95% prediction interval (PI). Restricted maximum-likelihood estimator (REML) and the Hartung-Knapp method were used in the meta-analysis. RESULTS Twenty-five studies met the inclusion criteria for quantitative analysis, including 1440 patients. The median age of patients was 66.9 years old (62-73 years old) and the median follow-up was 47.5 months (12-75 months). The estimates of cumulative occurrence for severe gastrointestinal (GI) and genitourinary (GU) toxic effects were 0.1% (95% CI 0-0.2%) and 0.4% (95% CI 0-1.2%), and for grade 2 toxic effects were 1.6% (95% CI 0.1-4.7%) and 17.1% (95% CI 5.4-33.5%), respectively. The estimate of 3‑year bRFS was 87.5% (95% CI 84.4-90.3%) and 71.0% (95% CI 63.0-78.3%) for 5‑year bRFS. The pooled bRFS rates for low-risk patients were 99.0% (95% CI 85.2-100.0%) at 3 years and 80.9% (95% CI 75.4-85.9%) at 5 years, and the risk group was found to be statistically correlated with bRFS (3-year bRFS, P < 0.01; 5‑year bRFS, P = 0.04). CONCLUSION SFHDR is associated with favorable tolerability and suboptimal clinical benefit in patients with localized prostate cancer. Ongoing and planned high-quality prospective studies are necessary to verify its safety and efficacy.
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Affiliation(s)
- Hong Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Minghao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Nanwei Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yandong Xie
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Haolin Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
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A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy. Cancers (Basel) 2022; 14:cancers14061425. [PMID: 35326574 PMCID: PMC8946271 DOI: 10.3390/cancers14061425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.
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Corkum MT, Achard V, Morton G, Zilli T. Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go? Clin Oncol (R Coll Radiol) 2021; 34:340-349. [PMID: 34961659 DOI: 10.1016/j.clon.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 01/23/2023]
Abstract
Following adoption of moderately hypofractionated radiotherapy as a standard for localised prostate cancer, ultrahypofractioned radiotherapy delivered in five to seven fractions is rapidly being embraced by clinical practice and international guidelines. However, the question remains: how low can we go? Can radiotherapy for prostate cancer be delivered in fewer than five fractions? The current review summarises the evidence that radiotherapy for localised prostate cancer can be safely and effectively delivered in fewer than five fractions using high dose rate brachytherapy or stereotactic body radiotherapy. We also discuss important lessons learned from the single-fraction high dose rate brachytherapy experience.
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Affiliation(s)
- M T Corkum
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - V Achard
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - G Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Zilli
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva University, Geneva, Switzerland.
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Martell K, Kollmeier MA. Complications and side effects of high-dose-rate prostate brachytherapy. Brachytherapy 2021; 20:966-975. [PMID: 33612395 DOI: 10.1016/j.brachy.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe technical challenges and complications encountered during and after high-dose-rate prostate brachytherapy (HDR-BT) and review management of these complications. METHODS AND MATERIALS The authors performed a systematic review of the literature on toxicities encountered after prostate HDR-BT +/- external beam radiotherapy. A total of 397 studies were identified, of which 64 were included. A focused review of literature regarding the management of acute and late toxicities also performed. RESULTS Most acute toxicities include grade 0-2 genitourinary and gastrointestinal toxicity. Overall, Grade 3+ Common Terminology Criteria for Adverse Events toxicity after HDR-BT was low [genitourinary: 0-1%; gastrointestinal 0-3%]. Rates of fistula formation were <1%, and radiation cystitis/proctitis were <14% and more commonly reported in cohorts treated with HDR-BT boost and external beam radiotherapy. CONCLUSIONS HDR-BT both as monotherapy or combined with external beam radiotherapy for prostate cancer is well tolerated. Serious complications are rare.
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Affiliation(s)
- Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Viani GA, Arruda CV, Assis Pellizzon AC, De Fendi LI. HDR brachytherapy as monotherapy for prostate cancer: A systematic review with meta-analysis. Brachytherapy 2021; 20:307-314. [PMID: 33461894 DOI: 10.1016/j.brachy.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The effectiveness and safety of high dose brachytherapy as monotherapy (HDR-BRT-M) in prostate cancer is limited to retrospective studies. We performed a meta-analysis to summarize existing data and identify trends in biochemical recurrence-free survival (bRFS) and toxicity after HDR-BRT-M in patients with prostate cancer. METHODS AND MATERIALS Retrospective, prospective, or randomized clinical trials were identified on electronical databases through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-regression analysis was performed to assess if there is a relationship between moderator variables and bRFS. A p-value < 0.05 was considered significant. RESULTS Fourteen studies with a total of 3534 patients treated were included. The cumulative size of the bRFS at 5 years was 0.92 (95% confidence interval (CI) 0.48-0.61). The five-year bRFS for low, intermediate, and high risk was 97.5% (95% CI 96-98%), 93.5% (95% CI 91-96%), and 91% (95% CI 88-93%), respectively. The total biological effective dose (BED) (p = 0.02), the BED per fraction (p = 0.001), androgen deprivation therapy usage (p = 0.04), and the number of fractions of HDR-BRT-M (p = 0.024) were significantly associated with bRFS rate. The rate of late Grade 2/3 or > genitourinary and gastrointestinal toxicity was 22.4% (95% CI 9-35,2%)/1.4% (95% CI 0.8-2.1%) and 2.7% (95% CI 0-6.8%) and 0.2% (95% CI 0.1%-0.4%), respectively. CONCLUSIONS HDR-BRT-M is safe with excellent rates of bRFS for all risk groups. The total BED, the BED per fraction, and number of fractions were the key factors associated with the biochemical control. These data can be useful to choose the size and number of BRT fractionation.
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Affiliation(s)
| | - Caio Viani Arruda
- Bioscience Institute of University of State from Sao Paulo (UNESP), Botucatu, Sau Paulo, Brazil
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Prostate high dose-rate brachytherapy as monotherapy for prostate cancer: Late toxicity and patient reported outcomes from a randomized phase II clinical trial. Radiother Oncol 2020; 156:160-165. [PMID: 33359269 DOI: 10.1016/j.radonc.2020.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Long-term toxicity of high dose-rate brachytherapy as monotherapy for prostate cancer is not well defined. We report late toxicity and health related quality of life (HRQOL) changes from a randomized phase II clinical trial of two different fractionation schemes. MATERIALS AND METHODS Eligible patients had NCCN low or intermediate risk prostate cancer. 170 patients were randomized to receive either a single 19 Gy or two-fractions of 13.5 Gy one week apart. Toxicity was measured using Common Terminology for Adverse Events (CTCAE) v4.0, and HRQOL was measured using the Expanded Prostate Index Composite (EPIC). RESULTS Median follow-up was 63 months. The 5-year cumulative incidence of Grade 2 or higher genitourinary (GU) and gastrointestinal (GI) toxicity was 62% and 12% in the single-fraction arm, and 47% and 9% in the two-fraction arm, respectively. Grade 3 GU toxicity was only seen in the single fraction arm with a cumulative incidence of 2%. The 5-year prevalence of Grade 2 GU toxicity was 29% and 21%, in the single- and two-fraction arms, respectively, with Grade 2 GI toxicity of 1% and 2%. Beyond the first year, no significant differences in mean urinary HRQOL were seen compared to baseline in the two-fraction arm, in contrast to the single-fraction arm where a decline in urinary HRQOL was seen at 4 and 5 years. Sexual HRQOL was significantly reduced in both treatment arms at all timepoints, with no changes in the bowel domain. CONCLUSIONS HDR monotherapy is well tolerated with minimal impact on HRQOL.
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8
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Ablative Radiotherapy in Prostate Cancer: Stereotactic Body Radiotherapy and High Dose Rate Brachytherapy. Cancers (Basel) 2020; 12:cancers12123606. [PMID: 33276562 PMCID: PMC7761604 DOI: 10.3390/cancers12123606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Radiation therapy is a standard of care treatment option for men with localized prostate cancer. Over the years, various radiation delivery modalities have contributed to the increased precision of radiation, employing radiobiological insights to shorten the overall treatment time with hypofractionation, while improving oncological control without increasing toxicities. Here, we discuss and compare two ablative radiation modalities, stereotactic body radiation therapy (SBRT) and high-dose-rate brachytherapy (HDRBT), in terms of oncological control, dose/fractionation and toxicities in men with localized prostate cancer. This review will highlight the levels of evidence available to support either modality as a monotherapy, will summarize safety and efficacy, help clinicians gain a deeper understanding of the safety and efficacy profiles of these two modalities, and highlight ongoing research efforts to address many unanswered questions regarding ablative prostate radiation. Abstract Prostate cancer (PCa) is the most common noncutaneous solid organ malignancy among men worldwide. Radiation therapy is a standard of care treatment option that has historically been delivered in the form of small daily doses of radiation over the span of multiple weeks. PCa appears to have a unique sensitivity to higher doses of radiation per fraction, rendering it susceptible to abbreviated forms of treatment. Stereotactic body radiation therapy (SBRT) and high-dose-rate brachytherapy (HDRBT) are both modern radiation modalities that allow the precise delivery of ablative doses of radiation to the prostate while maximally sparing sensitive surrounding normal structures. In this review, we highlight the evidence regarding the radiobiology, oncological outcomes, toxicity and dose/fractionation schemes of SBRT and HDRBT monotherapy in men with low-and intermediate-risk PCa.
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A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer. J Contemp Brachytherapy 2020; 12:193-200. [PMID: 32395145 PMCID: PMC7207227 DOI: 10.5114/jcb.2020.94492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/23/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. Material and methods Published HDR-BT clinical results for low- and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. Results We obtained a value of α/β = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. Conclusions The α/β obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/β explains reasonably well the data available in the region of high doses per fraction considered.
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Gomez-Iturriaga A, Buchser D, Mayrata E, San Miguel I, Gonzalez A, Suarez F, Martinez-Indart L, Minguez P, Espinosa J, Perez F, Cacicedo J, Casquero F. Pattern of relapse and dosimetric analysis of a single dose 19 Gy HDR-brachytherapy phase II trial. Radiother Oncol 2020; 146:16-20. [PMID: 32086047 DOI: 10.1016/j.radonc.2020.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the pattern of relapse within the prostate with reference to the initial site of disease in patients treated with single fraction 19-Gy. METHODS AND MATERIALS Forty-four patients were treated according to a prospective study of single-fraction HDR-brachytherapy. Treatment was delivered using 192Ir to a dose of 19 Gy prescribed to the prostate. Patients who experienced a biochemical failure underwent a re-staging multiparametric MRI (mpMRI) and MRI-TRUS fusion biopsy to rule-out local recurrence. In patients with visible Dominant intraprostatic lesions (DIL) on pretreatment mpMRI, the site of local relapse was compared with the initial site of disease. The dose received by the site of recurrence was investigated. RESULTS The median follow-up period was 48 months (range 29-63). The PSA nadir was reached at 24 months follow-up, with a median value of 1.07 ng/mL. To date, 14 patients (32%) have experienced biochemical failure (4 patients low-risk and 10 intermediate-risk; p = 0.013). Re-staging mpMRI was performed in 11/14 patients. Eleven patients underwent MRI-TRUS fusion biopsy confirming local relapse in all patients. The analysis of DVH of all 44 patients revealed that patients with biochemical failure had received significantly lower doses in terms of V100, V125 and D90 (p = 0.032, p = 0.018 and p = 0.018 respectively). In patients with DILs on diagnostic mpMRI, the mean D90 and D98 on DIL were lower for patients with biochemical failure. CONCLUSIONS This dosimetric analysis demonstrates a dose-response relationship in patients treated with single fraction 19 Gy. Patients with intermediate risk disease, with visible DIL on mpMRI and patients treated with cooler implants have higher incidence of biochemical and local failure.
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Affiliation(s)
- Alfonso Gomez-Iturriaga
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
| | - David Buchser
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Esther Mayrata
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Iñigo San Miguel
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Alba Gonzalez
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Fernan Suarez
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Lorea Martinez-Indart
- Hospital Universitario Cruces/Biocruces Health Research Institute, Clinical Epidemiology Unit, Barakaldo, Spain
| | - Pablo Minguez
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Jose Espinosa
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Fernando Perez
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Jon Cacicedo
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
| | - Francisco Casquero
- Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain
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Kishan AU, Dang A, Katz AJ, Mantz CA, Collins SP, Aghdam N, Chu FI, Kaplan ID, Appelbaum L, Fuller DB, Meier RM, Loblaw DA, Cheung P, Pham HT, Shaverdian N, Jiang N, Yuan Y, Bagshaw H, Prionas N, Buyyounouski MK, Spratt DE, Linson PW, Hong RL, Nickols NG, Steinberg ML, Kupelian PA, King CR. Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer. JAMA Netw Open 2019; 2:e188006. [PMID: 30735235 PMCID: PMC6484596 DOI: 10.1001/jamanetworkopen.2018.8006] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/13/2018] [Indexed: 02/05/2023] Open
Abstract
Importance Stereotactic body radiotherapy harnesses improvements in technology to allow the completion of a course of external beam radiotherapy treatment for prostate cancer in the span of 4 to 5 treatment sessions. Although mounting short-term data support this approach, long-term outcomes have been sparsely reported. Objective To assess long-term outcomes after stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. Design, Setting, and Participants This cohort study analyzed individual patient data from 2142 men enrolled in 10 single-institution phase 2 trials and 2 multi-institutional phase 2 trials of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer between January 1, 2000, and December 31, 2012. Statistical analysis was performed based on follow-up from January 1, 2013, to May 1, 2018. Main Outcomes and Measures The cumulative incidence of biochemical recurrence was estimated using a competing risk framework. Physician-scored genitourinary and gastrointestinal toxic event outcomes were defined per each individual study, generally by Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. After central review, cumulative incidences of late grade 3 or higher toxic events were estimated using a Kaplan-Meier method. Results A total of 2142 men (mean [SD] age, 67.9 [9.5] years) were eligible for analysis, of whom 1185 (55.3%) had low-risk disease, 692 (32.3%) had favorable intermediate-risk disease, and 265 (12.4%) had unfavorable intermediate-risk disease. The median follow-up period was 6.9 years (interquartile range, 4.9-8.1 years). Seven-year cumulative rates of biochemical recurrence were 4.5% (95% CI, 3.2%-5.8%) for low-risk disease, 8.6% (95% CI, 6.2%-11.0%) for favorable intermediate-risk disease, 14.9% (95% CI, 9.5%-20.2%) for unfavorable intermediate-risk disease, and 10.2% (95% CI, 8.0%-12.5%) for all intermediate-risk disease. The crude incidence of acute grade 3 or higher genitourinary toxic events was 0.60% (n = 13) and of gastrointestinal toxic events was 0.09% (n = 2), and the 7-year cumulative incidence of late grade 3 or higher genitourinary toxic events was 2.4% (95% CI, 1.8%-3.2%) and of late grade 3 or higher gastrointestinal toxic events was 0.4% (95% CI, 0.2%-0.8%). Conclusions and Relevance In this study, stereotactic body radiotherapy for low-risk and intermediate-risk disease was associated with low rates of severe toxic events and high rates of biochemical control. These data suggest that stereotactic body radiotherapy is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.
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Affiliation(s)
- Amar U. Kishan
- Department of Urology, University of California, Los Angeles
- Department of Radiation Oncology, University of California, Los Angeles
| | - Audrey Dang
- Department of Radiation Oncology, University of California, Los Angeles
| | - Alan J. Katz
- Flushing Radiation Oncology Services, Flushing, New York
| | | | - Sean P. Collins
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Nima Aghdam
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Fang-I Chu
- Department of Radiation Oncology, University of California, Los Angeles
| | - Irving D. Kaplan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Limor Appelbaum
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Donald B. Fuller
- Division of Genesis Healthcare Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | | | - D. Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Huong T. Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles
- Now with Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naomi Jiang
- Department of Radiation Oncology, University of California, Los Angeles
| | - Ye Yuan
- Department of Radiation Oncology, University of California, Los Angeles
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nicolas Prionas
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Mark K. Buyyounouski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
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