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Abdel-Wahab M, Giammarile F, Carrara M, Paez D, Hricak H, Ayati N, Li JJ, Mueller M, Aggarwal A, Al-Ibraheem A, Alkhatib S, Atun R, Bello A, Berger D, Delgado Bolton RC, Buatti JM, Burt G, Bjelac OC, Cordero-Mendez L, Dosanjh M, Eichler T, Fidarova E, Gondhowiardjo S, Gospodarowicz M, Grover S, Hande V, Harsdorf-Enderndorf E, Herrmann K, Hofman MS, Holmberg O, Jaffray D, Knoll P, Kunikowska J, Lewis JS, Lievens Y, Mikhail-Lette M, Ostwald D, Palta JR, Peristeris P, Rosa AA, Salem SA, Dos Santos MA, Sathekge MM, Shrivastava SK, Titovich E, Urbain JL, Vanderpuye V, Wahl RL, Yu JS, Zaghloul MS, Zhu H, Scott AM. Radiotherapy and theranostics: a Lancet Oncology Commission. Lancet Oncol 2024:S1470-2045(24)00407-8. [PMID: 39362232 DOI: 10.1016/s1470-2045(24)00407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 10/05/2024]
Abstract
Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy-other than 131I-was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives-such as the International Atomic Energy Agency's Rays of Hope programme-and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
| | - Francesco Giammarile
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Mauro Carrara
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA; Gerstner Sloan Kettering Graduate School of Biomedical Sciences, New York, NY, USA
| | - Nayyereh Ayati
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Jing Jing Li
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | | | - Ajay Aggarwal
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Sondos Alkhatib
- Department of Radiation Oncology, Henry Ford Health, Detroit, MI, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Abubakar Bello
- National Hospital, Abuja and Federal University of Health Sciences, Azare, Nigeria
| | - Daniel Berger
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, Spain; Servicio Cántabro de Salud, Santander, Spain
| | - John M Buatti
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Olivera Ciraj Bjelac
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Lisbeth Cordero-Mendez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Manjit Dosanjh
- University of Oxford, Oxford, UK; European Organization for Nuclear Research, Geneva, Switzerland
| | - Thomas Eichler
- Department of Radiation Oncology, Massey Cancer Center Virginia Commonwealth University, Richmond, VA, USA
| | - Elena Fidarova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Mary Gospodarowicz
- Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Varsha Hande
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Ekaterina Harsdorf-Enderndorf
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Ola Holmberg
- Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - David Jaffray
- Department of Radiation Physics and Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Knoll
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA; Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Miriam Mikhail-Lette
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Dennis Ostwald
- WifOR Institute, Darmstadt, Germany; Steinbeis School of International Business and Entrepreneurship, Herrenberg, Germany
| | - Jatinder R Palta
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Arthur A Rosa
- Radiation Oncology, Grupo Oncoclinicas, Salvador, Brazil
| | - Soha Ahmed Salem
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Steve Biko Academic Hospital, Pretoria, South Africa; Nuclear Medicine Research Infrastructure, Pretoria, South Africa
| | | | - Egor Titovich
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Jean-Luc Urbain
- Department of Radiology, Division of Nuclear Medicine, Branford General Hospital, Ontario, Canada
| | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine Department of the Korlebu Teaching Hospital, Accra, Ghana
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Department of Radiology, and Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jennifer S Yu
- Department of Radiation Oncology and Department of Cancer Biology, Cleveland Clinic, Cleveland, OH USA
| | - Mohamed Saad Zaghloul
- Radiation Oncology Department, National Cancer Institute, Cairo University & Children's Cancer Hospital, Cairo, Egypt
| | - Hongcheng Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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2
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Kohjimoto Y, Uemura H, Yoshida M, Hinotsu S, Takahashi S, Takeuchi T, Suzuki K, Shinmoto H, Tamada T, Inoue T, Sugimoto M, Takenaka A, Habuchi T, Ishikawa H, Mizowaki T, Saito S, Miyake H, Matsubara N, Nonomura N, Sakai H, Ito A, Ukimura O, Matsuyama H, Hara I. Japanese clinical practice guidelines for prostate cancer 2023. Int J Urol 2024. [PMID: 39078210 DOI: 10.1111/iju.15545] [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: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.
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Affiliation(s)
- Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of EBM and Guidelines, Japan Council for Quality Health Care (Minds), Tokyo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- NPO Prostate Cancer Patients Association, Takarazuka, Hyogo, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Tochigi, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Saito
- Department of Urology, Prostate Cancer Center Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
- Department of Urology, JA Yamaguchi Kouseiren Nagato General Hospital, Yamaguchi, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Millot JC, Arenas-Gallo C, Silver E, Goldman M, Picciotto S, Jia AY, Zaorsky NG, Spratt DE, Fredman ET, Shoag JE. Major Complications and Adverse Events Related to Use of SpaceOAR Hydrogel for Prostate Cancer Radiotherapy. Urology 2024; 188:94-100. [PMID: 38458325 DOI: 10.1016/j.urology.2023.12.034] [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: 10/19/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To determine the prevalence and severity of SpaceOAR-related adverse events using the Manufacturer and User Facility Device Experience (MAUDE) database. METHODS We analyzed SpaceOAR-related adverse event reports in the Manufacturer and User Facility Device Experience (MAUDE) database from January 2015 to May 2023. For each report, the event type, associated device and patient problems, event description, event timing, and event severity stratified by the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE) grading system were recorded. RESULTS From 2015 to 2022, 206,619 SpaceOAR devices were sold. From January 2015 to May 2023, we identified 981 reports describing 990 SpaceOAR-related adverse events. Malfunctions were the most common event type (N = 626), followed by patient injuries (N = 350) with few reported deaths (N = 5). Device positioning problems were the most frequent device issue (N = 686). Pain was the most reported patient problem (N = 216). Abscesses and fistulas related to the device were each reported in 91 events. A noteworthy portion of relevant adverse events occurred before the initiation of radiation (N = 35, 22.4%), suggesting the device, rather than the radiation, was responsible. In total, 470 (50.2%) and 344 (36.7%) of the adverse events were CTCAE grade 1 and 2, respectively. There were 123 (13.1%) events that were CTCAE grade ≥3. CONCLUSION We identified multiple reports of SpaceOAR-related adverse events, many of which are more serious than have been reported in clinical trials. While SpaceOAR use is common, suggesting these events are rare, these data highlight the need for continued postmarket surveillance.
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Affiliation(s)
- Jack C Millot
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Esther Silver
- Department of Neuroscience, Ohio State University, Columbus, OH
| | | | - Shany Picciotto
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Angela Y Jia
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Elisha T Fredman
- Department of Radiation Oncology, Davidoff Cancer Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
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4
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Morris BA, Holmes EE, Anger NJ, Cooley G, Schuster JM, Hurst N, Baschnagel AM, Bassetti MF, Blitzer GC, Chappell RJ, Bayliss RA, Morris ZS, Ritter MA, Floberg JM. Toxicity and Patient-Reported Quality-of-Life Outcomes After Prostate Stereotactic Body Radiation Therapy With Focal Boost to Magnetic Resonance Imaging-Identified Prostate Cancer Lesions: Results of a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2023; 117:613-623. [PMID: 37179035 DOI: 10.1016/j.ijrobp.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE In this prospective phase 2 trial, we investigated the toxicity and patient-reported quality-of-life outcomes in patients treated with stereotactic body radiation therapy (SBRT) to the prostate gland and a simultaneous focal boost to magnetic resonance imaging (MRI)-identified intraprostatic lesions while also de-escalating dose to the adjacent organs at risk. METHODS AND MATERIALS Eligible patients included low- or intermediate-risk prostate cancer (Gleason score ≤7, prostate specific antigen ≤20, T stage ≤2b). SBRT was prescribed to 40 Gy in 5 fractions delivered every other day to the prostate, with any areas of high disease burden (MRI-identified prostate imaging reporting and data system 4 or 5 lesions) simultaneously escalated to 42.5 to 45 Gy and areas overlapping organs at risk (within 2 mm of urethra, rectum, and bladder) constrained to 36.25 Gy (n = 100). Patients without a pretreatment MRI or without MRI-identified lesions were treated to dose of 37.5 Gy with no focal boost (n = 14). RESULTS From 2015 to 2022, a total of 114 patients were enrolled with a median follow-up of 42 months. No acute or late grade 3+ gastrointestinal (GI) toxicity was observed. One patient developed late grade 3 genitourinary (GU) toxicity at 16 months. In patients treated with focal boost (n = 100), acute grade 2 GU and GI toxicity was seen in 38% and 4% of patients, respectively. Cumulative late grade 2+ GU and GI toxicities at 24 months were 13% and 5% respectively. Patient-reported outcomes showed no significant long-term change from baseline in urinary, bowel, hormonal, or sexual quality-of-life scores after treatment. CONCLUSIONS SBRT to a dose of 40 Gy to the prostate gland with a simultaneous focal boost up to 45 Gy is well tolerated with similar rates of acute and late grade 2+ GI and GU toxicity as seen in other SBRT regimens without intraprostatic boost. Moreover, no significant long-term changes were seen in patient-reported urinary, bowel, or sexual outcomes from pretreatment baseline.
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Affiliation(s)
| | - Emma E Holmes
- Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | | | | | | | | | - Richard J Chappell
- Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Beckett M, Goethals L, Kraus RD, Denysenko K, Barone Mussalem Gentiles MF, Pynda Y, Abdel-Wahab M. Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States. JCO Glob Oncol 2023; 9:e2300130. [PMID: 37769217 PMCID: PMC10581634 DOI: 10.1200/go.23.00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality. METHODS This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis. RESULTS Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001). CONCLUSION This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.
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Affiliation(s)
| | - Luc Goethals
- International Atomic Energy Agency, Vienna, Austria
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6
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Alleyne-Mike K. Gauging radiotherapy resources in South America and the Caribbean. Lancet Oncol 2023; 24:951-952. [PMID: 37657468 DOI: 10.1016/s1470-2045(23)00343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Kellie Alleyne-Mike
- Cancer Centre of Trinidad and Tobago, St James Medical Complex, Trinidad and Tobago.
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7
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Monticelli D, Castriconi R, Tudda A, Fodor A, Deantoni C, Gisella Di Muzio N, Mangili P, Del Vecchio A, Fiorino C, Broggi S. Knowledge-based plan optimization for prostate SBRT delivered with CyberKnife according to RTOG0938 protocol. Phys Med 2023; 110:102606. [PMID: 37196603 DOI: 10.1016/j.ejmp.2023.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To extend the knowledge-based (KB) automatic planning approach to CyberKnife in the case of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer. METHODS Seventy-two clinical plans of patients treated according to the RTOG0938 protocol (36.25 Gy/5fr) with CyberKnife were exported from the CyberKnife system to Eclipse to train a KB-model using the Rapid Plan tool. The KB approach provided dose-volume objectives for specific OARs only and not PTV. Bladder, rectum and femoral heads were considered in the model. The KB-model was successfully trained on 51 plans and then validated on 20 new patients. A KB-based template was tuned in the Precision system for both sequential optimization (SO) and VOLO optimization algorithms. Plans of the validation group were re-optimized (KB-TP) using both algorithms without any operator intervention and compared against the original plans (TP) in terms of OARs/PTV dose-volume parameters. Paired Wilcoxon signed-rank tests were performed to assess statistically significant differences (p < 0.05). RESULTS Regarding SO, automatic KB-TP plans were generally better than or equivalent to TP plans. PTVs V95% was slightly worse while OARs sparing for KB-TP was significantly improved. Regarding VOLO optimization, the PTVs coverage was significantly better for KB-TP while there was a limited worsening in the rectum. A significant improvement was observed in the bladder in the range of low-intermediate doses. CONCLUSIONS An extension of the KB optimization approach to the CyberKnife system has been successfully developed and validated in the case of SBRT prostate cancer.
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Affiliation(s)
- Davide Monticelli
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Roberta Castriconi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Nadia Gisella Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
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8
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Beaudry M, Carignan D, Foster W, Lavallee M, Aubin S, Lacroix F, Poulin E, Lachance B, Després P, Beaulieu L, Vigneault E, Martin A. Comparison of four-year toxicities and local control of ultra-hypofractionated vs moderate-hypofractionated image guided prostate radiation with HDR brachytherapy boost: A phase I-II single institution trial. Clin Transl Radiat Oncol 2023; 40:100593. [PMID: 36875870 PMCID: PMC9974413 DOI: 10.1016/j.ctro.2023.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose/Objectives To analyze the long term efficacy and safety of an ultra-hypofractionated (UHF) radiation therapy prostate treatment regimen with HDR brachytherapy boost (BB) and compare it to moderate-hypofractionated regimens (MHF). Materials/Methods In this single arm, prospective monocentric study, 28 patients with intermediate risk prostate cancer were recruited in an experimental treatment arm of 25 Gy in 5 fractions plus a 15 Gy HDR BB. They were then compared to two historical control groups, treated with either 36 Gy in 12 fractions or 37.5 Gy in 15 fractions with a similar HDR BB. The control groups included 151 and 311 patients respectively. Patient outcomes were reported using the International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC-26) questionnaires at baseline and at each follow-up visit. Results Median follow-up for the experimental arm was 48.5 months compared to 47 months and 60 months compared to the 36/12 and 37,5/15 groups respectively. The IPSS and EPIC scores did not demonstrate any significant differences in the gastrointestinal or genitourinary domains between the three groups over time. No biochemical recurrence occurred in the UHF arm as defined by the Phoenix criterion. Conclusion The UHF treatment scheme with HDR BB seems equivalent to standard treatment arms in terms of toxicities and local control. Randomized control trials with larger cohorts are ongoing and needed to further confirm our findings.
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Affiliation(s)
- M.M. Beaudry
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - D. Carignan
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - W. Foster
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - M.C. Lavallee
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - S. Aubin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - F. Lacroix
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - E. Poulin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - B. Lachance
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - P. Després
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - L. Beaulieu
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - E. Vigneault
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - A.G. Martin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
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9
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Romano C, Viola P, Craus M, Macchia G, Ferro M, Bonome P, Pierro A, Buwenge M, Arcelli A, Morganti AG, Deodato F, Cilla S. Feasibility-guided automated planning for stereotactic treatments of prostate cancer. Med Dosim 2023:S0958-3947(23)00020-1. [PMID: 36990847 DOI: 10.1016/j.meddos.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Significant improvements in plan quality using automated planning have been previously demonstrated. The aim of this study was to develop an optimal automated class solution for stereotactic radiotherapy (SBRT) planning of prostate cancer using the new Feasibility module implemented in the pinnacle evolution. Twelve patients were retrospectively enrolled in this planning study. Five plans were designed for each patient. Four plans were automatically generated using the 4 proposed templates for SBRT optimization implemented in the new pinnacle evolution treatment planning systems, differing for different settings of dose-fallout (low, medium, high and veryhigh). Based on the obtained results, the fifth plan (feas) was generated customizing the template with the optimal criteria obtained from the previous step and integrating in the template the "a-priori" knowledge of OARs sparing based on the Feasibility module, able to estimate the best possible dose-volume histograms of OARs before starting optimization. Prescribed dose was 35 Gy to the prostate in 5 fractions. All plans were generated with a full volumetric-modulated arc therapy arc and 6MV flattening filter-free beams, and optimized to ensure the same target coverage (95% of the prescription dose to 98% of the target). Plans were assessed according to dosimetric parameters and planning and delivery efficiency. Differences among the plans were evaluated using a Kruskal-Wallis 1-way analysis of variance. The requests for more aggressive objectives for dose falloff parameters (from low to veryhigh) translated in a statistically significant improvement of dose conformity, but at the expense of a dose homogeneity. The best automated plans in terms of best trade-off between target coverage and OARs sparing among the 4 plans automatically generated by the SBRT module were the high plans. The veryhigh plans reported a significant increase of high-doses to prostate, rectum, and bladder that was considered dosimetrically and clinically unacceptable. The feas plans were optimized on the basis on high plans, reporting significant reduction of rectum irradiation; Dmean, and V18 decreased by 19% to 23% (p = 0.031) and 4% to 7% (p = 0.059), respectively. No statistically significant differences were found in femoral heads and penile bulb irradiation for all dosimetric metrics. feas plans showed a significant increase of MU/Gy (mean: 368; p = 0.004), reflecting an increased level of fluence modulation. Thanks to the new efficient optimization engines implemented in pinnacle evolution (L-BFGS and layered graph), mean planning time was decreased to less than 10 minutes for all plans and all techniques. The integration of dose-volume histograms a-priori knowledge provided by the feasibility module in the automated planning process for SBRT planning has shown to significantly improve plan quality compared to generic protocol values as inputs.
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10
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Patel S, Olatunji E, Mallum A, Benjika BB, Joseph AO, Joseph S, Lasebikan N, Mahuna H, Ngoma M, Ngoma TA, Nnko G, Onwualu C, Vorster M, Ngwa W. Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation. Front Oncol 2023; 13:1136357. [PMID: 37143940 PMCID: PMC10151787 DOI: 10.3389/fonc.2023.1136357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region. Methods Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer. Results Patients in Nigeria (n=390) traveled a median distance of 23.1 km to NLCC and 86.7 km to UNTH, patients in Tanzania (n=23) traveled a median distance of 537.0 km to ORCI, and patients in South Africa (n=412) traveled a median distance of 18.0 km to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira, respectively and for prostate cancer patients were 25,329 and 14,276 Naira, respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings in transportation costs and 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand for breast cancer and 9,486 Rand for prostate cancer. Conclusion Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.
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Affiliation(s)
- Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Saloni Patel,
| | - Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - Adedayo O. Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Godwin Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Chinelo Onwualu
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Mariza Vorster
- College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Wilfred Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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11
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Soni A, Jadhav GK, Manocha S, Chauhan S, Goswami B, Verma M. Comparative evaluation of hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate and high risk prostate cancer. Rep Pract Oncol Radiother 2022; 27:1001-1009. [PMID: 36632300 PMCID: PMC9826658 DOI: 10.5603/rpor.a2022.0116] [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: 09/21/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to comparatively evaluate an efficacy and toxicity profile of hypofractionated radiotherapy (67.5 Gy in 25 fractions) to conventionally fractionated radiotherapy (78 Gy in 39 fractions) in prostate cancer patients with intermediate and high-risk disease. Materials and methods From January 2015 to December 2018, 168 patients were randomized to hypofractionated radiation treatment and conventional fractionated radiation treatment schedules of volumetric modulated arc therapy (VMAT) to the prostate and seminal vesicles. All the patients also received androgen deprivation therapy (ADT) and radiation therapy started after ADT. Results The median (range) follow-up was 51 (31-63) and 53 (33-64) months in the hypofractionated and conventionally fractionated regimes, respectively. The 3-year biochemical no evidence of disease (bNED) rates were 86.9% and 73.8% in the hypofractionated and conventionally fractionated groups, respectively (p = 0.032, significant). The 3-year bNED rates in patients at a high risk [i.e., pretreatment prostate-specific antigen (PSA) > 20 ng/mL, Gleason score ≥ 8, or T ≥ 2 c], were 87.9% and 73.5% (p = 0.007, significant) in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. No statistically significant difference was found for late toxicity between the two groups, with 3-year grade 2 gastrointestinal toxicity rates of 19% and 16.7% and 3-year grade 2 genitourinary toxicity rates of 15.5% and 11.9% in the hypofractionated and conventionally fractionated radiotherapy groups, respectively. Conclusion Hypofractionated schedule is superior to the conventional fractionation schedule of radiation treatment in terms of bNED in intermediate and high grade prostate cancer patients. Also, the late toxicity is found to be equivalent between the two treatment groups.
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Affiliation(s)
- Abhishek Soni
- Department of Radiation Oncology, PT Bhagwat Dayal Sharma, Rohtak, India
| | - Ganesh K Jadhav
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sapna Manocha
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sunil Chauhan
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Brijesh Goswami
- Department of Radiation Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Monica Verma
- Department of Radiation Oncology, PT Bhagwat Dayal Sharma, Rohtak, India
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12
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Kraus RD, Weil CR, Abdel-Wahab M. Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2200215. [PMID: 36525619 PMCID: PMC10166538 DOI: 10.1200/go.22.00215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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13
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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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14
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Hiroshima Y, Ishikawa H, Iwai Y, Wakatsuki M, Utsumi T, Suzuki H, Akakura K, Harada M, Sakurai H, Ichikawa T, Tsuji H. Safety and Efficacy of Carbon-Ion Radiotherapy for Elderly Patients with High-Risk Prostate Cancer. Cancers (Basel) 2022; 14:cancers14164015. [PMID: 36011007 PMCID: PMC9406609 DOI: 10.3390/cancers14164015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Carbon-ion radiotherapy (CIRT) is a high-dose intensive treatment, whose safety and efficacy have been proven for prostate cancer. This study aims to evaluate the outcomes of CIRT in elderly patients with prostate cancer. Patients aged 75 years or above at the initiation of CIRT were designated as the elderly group, and younger than 75 years as the young group. The overall survival (OS), disease-specific survival (DSS), biochemical control rate (BCR), biochemical relapse-free survival (BRFS), and adverse events were compared between the elderly and young patients with high-risk prostate cancer treated with CIRT. The elderly group comprised 173 of 927 patients treated for high-risk prostate cancer between April 2000 and May 2018. The overall median age was 69 (range: 45−92) years. The median follow-up period was 91.9 (range: 12.6−232.3) months. The 10-year OS, DSS, BCR, and BRFS rates in the young and elderly groups were 86.9%/71.5%, 96.6%/96.8%, 76.8%/88.1%, and 68.6%/64.3%, respectively. The OS (p < 0.001) was longer in the younger group and the BCR was better in the elderly group (p = 0.008). The DSS and BRFS did not differ significantly between the two groups. The rates of adverse events between the two groups did not differ significantly and no patient had an adverse event of Grade 4 or higher during the study period. CIRT may be as effective and safe in elderly patients as the treatment for high-risk prostate cancer.
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Affiliation(s)
- Yuichi Hiroshima
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
- Correspondence:
| | - Yuma Iwai
- Department of Radiology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, Chiba 285-8741, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba 285-8741, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan
| | - Masaoki Harada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
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15
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Higuchi D, Ono T, Kakino R, Aizawa R, Nakayasu N, Ito H, Sakamoto T. Evaluation of internal margins for prostate for step and shoot intensity-modulated radiation therapy and volumetric modulated arc therapy using different margin formulas. J Appl Clin Med Phys 2022; 23:e13707. [PMID: 35719051 PMCID: PMC9512338 DOI: 10.1002/acm2.13707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This feasibility study evaluated the intra-fractional prostate motion using an ultrasound image-guided system during step and shoot intensity-modulated radiation therapy (SS-IMRT) and volumetric modulated arc therapy (VMAT). Moreover, the internal margins (IMs) using different margin formulas were calculated. METHODS Fourteen consecutive patients with prostate cancer who underwent SS-IMRT (n = 5) or VMAT (n = 9) between March 2019 and April 2020 were considered. The intra-fractional prostate motion was observed in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions. The displacement of the prostate was defined as the displacement from the initial position at the scanning start time, which was evaluated using the mean ± standard deviation (SD). IMs were calculated using the van Herk and restricted maximum likelihood (REML) formulas for SS-IMRT and VMAT. RESULTS For SS-IMRT, the maximum displacements of the prostate motion were 0.17 ± 0.18, 0.56 ± 0.86, and 0.18 ± 0.59 mm in the SI, AP, and LR directions, respectively. For VMAT, the maximum displacements of the prostate motion were 0.19 ± 0.64, 0.22 ± 0.35, and 0.14 ± 0.37 mm in the SI, AP, and LR directions, respectively. The IMs obtained for SS-IMRT and VMAT were within 2.3 mm and 1.2 mm using the van Herk formula and within 1.2 mm and 0.8 mm using the REML formula. CONCLUSIONS This feasibility study confirmed that intra-fractional prostate motion was observed with SS-IMRT and VMAT using different margin formulas. The IMs should be determined according to each irradiation technique using the REML margin.
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Affiliation(s)
- Daiki Higuchi
- Department of Radiology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Tomohiro Ono
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Kakino
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Rihito Aizawa
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoki Nakayasu
- Department of Radiology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hitoshi Ito
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
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16
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SBRT for Localized Prostate Cancer: CyberKnife vs. VMAT-FFF, a Dosimetric Study. Life (Basel) 2022; 12:life12050711. [PMID: 35629378 PMCID: PMC9144859 DOI: 10.3390/life12050711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years, stereotactic body radiation therapy (SBRT) has gained popularity among clinical methods for the treatment of medium and low risk prostate cancer (PCa), mainly as an alternative to surgery. The hypo-fractionated regimen allows the administration of high doses of radiation in a small number of fractions; such a fractionation is possible by exploiting the different intrinsic prostate radiosensitivity compared with the surrounding healthy tissues. In addition, SBRT treatment guaranteed a better quality of life compared with surgery, avoiding risks, aftermaths, and possible complications. At present, most stereotactic prostate treatments are performed with the CyberKnife (CK) system, which is an accelerator exclusively dedicated for stereotaxis and it is not widely spread in every radiotherapy centre like a classic linear accelerator (LINAC). To be fair, a stereotactic treatment is achievable also by using a LINAC through Volumetric Modulated Arc Therapy (VMAT), but some precautions must be taken. The aim of this work is to carry out a dosimetric comparison between these two methodologies. In order to pursue such a goal, two groups of patients were selected at Instituto Nazionale Tumori—IRCCS Fondazione G. Pascale: the first group consisting of ten patients previously treated with a SBRT performed with CK; the second one was composed of ten patients who received a hypo-fractionated VMAT treatment and replanned in VMAT-SBRT flattening filter free mode (FFF). The two SBRT techniques were rescaled at the same target coverage and compared by normal tissue sparing, dose distribution parameters and delivery time. All organs at risk (OAR) constraints were achieved by both platforms. CK exhibits higher performances in terms of dose delivery; nevertheless, the general satisfying dosimetric results and the significantly shorter delivery time make VMAT-FFF an attractive and reasonable alternative SBRT technique for the treatment of localized prostate cancer.
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17
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Tumor draining lymph nodes, immune response, and radiotherapy: Towards a revisal of therapeutic principles. Biochim Biophys Acta Rev Cancer 2022; 1877:188704. [DOI: 10.1016/j.bbcan.2022.188704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/06/2022] [Accepted: 02/21/2022] [Indexed: 12/20/2022]
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18
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Faustino FDLC, Altei WF, Canton HP, Morato L, de Paula LLRJ, Salvador GB, Fonseca DDSL, Gonçalves TK, Kupelian PA, Zaparolli JC, Ercolin L, Marconi DG. RAdiotherapy for Prostate cancer using HYpofractionation Directed by UltraSound (RAPHYDUS): a Brazilian public health care system study. Pract Radiat Oncol 2022; 12:e286-e295. [DOI: 10.1016/j.prro.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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19
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Kishan AU, Sun Y, Hartman H, Pisansky TM, Bolla M, Neven A, Steigler A, Denham JW, Feng FY, Zapatero A, Armstrong JG, Nabid A, Carrier N, Souhami L, Dunne MT, Efstathiou JA, Sandler HM, Guerrero A, Joseph D, Maingon P, de Reijke TM, Maldonado X, Ma TM, Romero T, Wang X, Rettig MB, Reiter RE, Zaorsky NG, Steinberg ML, Nickols NG, Jia AY, Garcia JA, Spratt DE. Androgen deprivation therapy use and duration with definitive radiotherapy for localised prostate cancer: an individual patient data meta-analysis. Lancet Oncol 2022; 23:304-316. [DOI: 10.1016/s1470-2045(21)00705-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022]
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20
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Prospective Randomized Phase II Study of Stereotactic Body Radiotherapy (SBRT) vs. Conventional Fractionated Radiotherapy (CFRT) for Chinese Patients with Early-Stage Localized Prostate Cancer. Curr Oncol 2021; 29:27-37. [PMID: 35049677 PMCID: PMC8774487 DOI: 10.3390/curroncol29010003] [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: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Stereotactic body radiotherapy (SBRT) has potential radiobiologic and economic advantages over conventional fractionated radiotherapy (CFRT) in localized prostate cancer (PC). This study aimed to compare the effects of these two distinct fractionations on patient-reported quality of life (PRQOL) and tolerability. Methods: In this prospective phase II study, patients with low- and intermediate-risk localized PC were randomly assigned in a 1:1 ratio to the SBRT (36.25 Gy/5 fractions/2 weeks) or CFRT (76 Gy/38 fractions/7.5 weeks) treatment groups. The primary endpoint of variation in PRQOL at 1 year was assessed by changes in the Expanded Prostate Cancer Index Composite (EPIC) questionnaire scores and analysed by z-tests and t-tests. Results: Sixty-four eligible Chinese men were treated (SBRT, n = 31; CFRT, n = 33) with a median follow-up of 2.3 years. At 1 year, 40.0%/46.9% of SBRT/CFRT patients had a >5-point decrease in bowel score (p = 0.08/0.28), respectively, and 53.3%/46.9% had a >2-point decrease in urinary score (p = 0.21/0.07). There were no significant differences in EPIC score changes between the arms at 3, 6, 9 and 12 months, but SBRT was associated with significantly fewer grade ≥ 1 acute and 1-year late gastrointestinal toxicities (acute: 35% vs. 87%, p < 0.0001; 1-year late: 64% vs. 84%, p = 0.03), and grade ≥ 2 acute genitourinary toxicities (3% vs. 24%, p = 0.04) compared with CFRT. Conclusion: SBRT offered similar PRQOL and less toxicity compared with CFRT in Chinese men with localized PC.
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21
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Payne HA, Pinkawa M, Peedell C, Bhattacharyya SK, Woodward E, Miller LE. SpaceOAR hydrogel spacer injection prior to stereotactic body radiation therapy for men with localized prostate cancer: A systematic review. Medicine (Baltimore) 2021; 100:e28111. [PMID: 34889268 PMCID: PMC8663810 DOI: 10.1097/md.0000000000028111] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/14/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Conventionally fractionated radiotherapy is a common treatment for men with localized prostate cancer. A growing consensus suggests that stereotactic body radiation therapy (SBRT) is similarly effective but less costly and more convenient for patients. The SpaceOAR hydrogel rectal spacer placed between the prostate and rectum reduces radiation-induced rectal injury in patients receiving conventionally fractionated radiotherapy, but spacer efficacy with SBRT is unclear. The purpose of this research was to assess the clinical utility of the hydrogel rectal spacer in men receiving SBRT for prostate cancer. METHODS We performed systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies in men who received the SpaceOAR hydrogel spacer prior to SBRT (≥5.0 Gy fractions) for treatment of localized prostate center. Rectal irradiation results were compared to controls without spacer implant; all other outcomes were reported descriptively owing to lack of comparative data incuding perirectal separation distance, rectal irradiation on a dosimetric curve, gastrointestinal (GI) toxicity, and freedom from biochemical failure. GI toxicity was reported as the risk of a grade 2 or 3+ bowel complication in early (≤3 months) and late (>3 months) follow-up. RESULTS In 11 studies with 780 patients, SBRT protocols ranged from 7 to 10 Gy per fraction with total dose ranging from 19 to 45 Gy. Perirectal distance achieved with the rectal spacer ranged from 9.6 to 14.5 mm (median 10.8 mm). Compared to controls receiving no spacer, SpaceOAR placement reduced the radiation delivered to the rectum by 29% to 56% across a dosimetric profile curve. In early follow-up, grade 2 GI complications were reported in 7.0% of patients and no early grade 3+ GI complications were reported. In late follow-up, the corresponding rates were 2.3% for grade 2 and 0.3% for grade 3 GI toxicity. Over 16 months median follow-up, freedom from biochemical failure ranged from 96.4% to 100% (pooled mean 97.4%). CONCLUSIONS SpaceOAR hydrogel spacer placed between the prostate and rectum prior to SBRT is a promising preventative strategy that increases the distance between the prostate and rectum, reduces rectal radiation exposure, and may lower the risk of clinically important GI complications.
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Affiliation(s)
- Heather A. Payne
- Oncology Department, University College London Hospital, London, UK
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | | | | | | | - Larry E. Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN
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22
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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23
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Li Y, Chan Kong Ngai T, Zhou S, Yap Haw Hwong J, Pang Pei Ping E, Ong Li Kuan A, Wang Lian Chek M, Chua Lee Kiang M, Looi WS, Nei WL, Chua ET, On WLK, Tan Wee Kiat T, Yuen Shyi Peng J, Tuan Kit Loong J. A comparative analysis between low-dose-rate brachytherapy and external beam radiation therapy for low- and intermediate-risk prostate cancer in Asian men. Acta Oncol 2021; 60:1291-1295. [PMID: 34259123 DOI: 10.1080/0284186x.2021.1950921] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the long-term clinical outcomes of low-risk (LR) and intermediate-risk (IR) prostate cancer patients treated with low-dose-rate brachytherapy (LDR-BT) and external beam radiation therapy (EBRT). PATIENTS AND METHODS Men with biopsy-proven low- and intermediate-risk prostate cancer received EBRT and LDR-BT in an Asian academic center from 2000 to 2019 were reviewed. Kaplan-Meier survival analysis was performed to compare biochemical failure-free survival (bFFS) and overall survival (OS) between LDR and EBRT in the low- and intermediate-risk cohorts. RESULTS 642 patients (521 EBRT and 121 LDR-BT) with low- and intermediate-risk prostate cancer were included for analysis. In the intermediate-risk group, 5- and 10-year bFFS was 96%, 89% and 86%, 61% for LDR-BT and EBRT, respectively. LDR-BT was associated with a statistically significant improvement of bFFS in the intermediate-risk cohort (HR 2.7, p = 0.02). In the low-risk cohort, no difference of bFFS was found between LDR-BT and EBRT (HR 1.9, p = 0.08). Hormone therapy was more common in EBRT than LDR-BT for intermediate-risk group (71% versus 44%, p < 0.05). Prostate cancer-specific mortality was low in both EBRT (1%) and LDR-BT (2%) cohorts. No significant difference in OS was found between LDR-BT and EBRT in low- and intermediate-risk group (HR 2.1, p = 0.2 and HR = 1.7, p = 0.3). CONCLUSION In our retrospective study, LDR-BT is associated with superior bFFS compared with EBRT in Asian men with intermediate-risk prostate cancer.
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Affiliation(s)
- Youquan Li
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | | | - Siqin Zhou
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jerome Yap Haw Hwong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eric Pang Pei Ping
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ashley Ong Li Kuan
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Michael Wang Lian Chek
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Melvin Chua Lee Kiang
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wen Shen Looi
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wen Long Nei
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Eu Tiong Chua
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Weber Lau Kam On
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Urology Centre, Singapore General Hospital, Singapore, Singapore
| | - Terence Tan Wee Kiat
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - John Yuen Shyi Peng
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Urology Centre, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey Tuan Kit Loong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
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24
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Juarez JE, Romero T, Mantz CA, Pepin A, Aghdam N, Suy S, Steinberg ML, Levin-Epstein RG, Nickols NG, Kaplan ID, Meier RM, Pham HT, Linson PW, Hong RL, Buyyounouski MK, Bagshaw HP, Fuller DB, Katz AJ, Loblaw A, Collins SP, Kishan AU. Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series. Adv Radiat Oncol 2021; 6:100759. [PMID: 34585025 PMCID: PMC8453194 DOI: 10.1016/j.adro.2021.100759] [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: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To evaluate the safety of stereotactic body radiation therapy (SBRT) for prostate cancer in men with inflammatory bowel disease (IBD). Methods and Materials We queried a consortium database for patients with IBD receiving SBRT for prostate cancer between 2006 and 2012. Identified patients were matched with patients without a history of IBD in a 3:1 fashion based on dose, fractionation, use of androgen deprivation therapy, and age distribution. Logistic regression was used to evaluate the association between having IBD and experiencing acute and late gastrointestinal (GI) and genitourinary (GU) toxicities as scored on the Common Terminology Criteria for Adverse Events scale. Time to late toxicity was evaluated using proportional hazard Cox models. Our study was limited by absence of data on prostate size, baseline International Prostate Symptom Score, and rectal dose-volume histogram parameters. Results Thirty-nine patients with flare-free IBD at time of treatment (median follow-up 83.9 months) and 117 matched controls (median follow-up 88.7 months) were identified. A diagnosis of IBD was associated with increased odds of developing any late grade GI toxicity (odds ratio [OR] 6.11, P <.001) and GU toxicity (odds ratio 6.14, P < .001), but not odds of developing late grade ≥2 GI (P = .08) or GU toxicity (P = .069). Acute GI and GU toxicity, both overall and for grade ≥2 toxicities, were more frequent in men with IBD (P < .05). Time to late GI and GU toxicity of any grade was significantly shorter in patients with IBD (P < .001). Time to late grade ≥2 GU, but not grade ≥2 GI toxicity, was also shorter in patients with IBD (P = .044 for GU and P = .144 for GI). Conclusions Patients with IBD who received SBRT for PCa had a higher likelihood of developing acute GI and GU toxicity, in addition to experiencing lower grade late toxicities that occurred earlier. However, patients with IBD did not have a higher likelihood for late grade ≥2 GI or GU toxicity after SBRT compared with the control cohort. Interpretation of this data are limited by the small sample size. Thus, men with IBD in remission should be properly counseled about these risks when considering SBRT.
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Affiliation(s)
- Jesus E Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | - Tahmineh Romero
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.,Department of Radiation Oncology, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Michael L Steinberg
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | | | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, California
| | - Irving D Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess, Boston, Massachusetts
| | | | - Huong T Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Patrick W Linson
- Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, California
| | - Robert L Hong
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia
| | | | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Donald B Fuller
- Division of Genesis Health care Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | - Alan J Katz
- Flushing Radiation Oncology Services, New York
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Urology, University of California, Los Angeles, California
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25
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Eckl M, Sarria GR, Springer S, Willam M, Ruder AM, Steil V, Ehmann M, Wenz F, Fleckenstein J. Dosimetric benefits of daily treatment plan adaptation for prostate cancer stereotactic body radiotherapy. Radiat Oncol 2021; 16:145. [PMID: 34348765 PMCID: PMC8335467 DOI: 10.1186/s13014-021-01872-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hypofractionation is increasingly being applied in radiotherapy for prostate cancer, requiring higher accuracy of daily treatment deliveries than in conventional image-guided radiotherapy (IGRT). Different adaptive radiotherapy (ART) strategies were evaluated with regard to dosimetric benefits. METHODS Treatments plans for 32 patients were retrospectively generated and analyzed according to the PACE-C trial treatment scheme (40 Gy in 5 fractions). Using a previously trained cycle-generative adversarial network algorithm, synthetic CT (sCT) were generated out of five daily cone-beam CT. Dose calculation on sCT was performed for four different adaptation approaches: IGRT without adaptation, adaptation via segment aperture morphing (SAM) and segment weight optimization (ART1) or additional shape optimization (ART2) as well as a full re-optimization (ART3). Dose distributions were evaluated regarding dose-volume parameters and a penalty score. RESULTS Compared to the IGRT approach, the ART1, ART2 and ART3 approaches substantially reduced the V37Gy(bladder) and V36Gy(rectum) from a mean of 7.4cm3 and 2.0cm3 to (5.9cm3, 6.1cm3, 5.2cm3) as well as to (1.4cm3, 1.4cm3, 1.0cm3), respectively. Plan adaptation required on average 2.6 min for the ART1 approach and yielded doses to the rectum being insignificantly different from the ART2 approach. Based on an accumulation over the total patient collective, a penalty score revealed dosimetric violations reduced by 79.2%, 75.7% and 93.2% through adaptation. CONCLUSION Treatment plan adaptation was demonstrated to adequately restore relevant dose criteria on a daily basis. While for SAM adaptation approaches dosimetric benefits were realized through ensuring sufficient target coverage, a full re-optimization mainly improved OAR sparing which helps to guide the decision of when to apply which adaptation strategy.
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Affiliation(s)
- Miriam Eckl
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sandra Springer
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marvin Willam
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Arne M Ruder
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Volker Steil
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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26
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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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27
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Taillez A, Bimbai AM, Lacornerie T, Le Deley MC, Lartigau EF, Pasquier D. Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation. Front Oncol 2021; 11:690422. [PMID: 34336678 PMCID: PMC8316636 DOI: 10.3389/fonc.2021.690422] [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: 04/02/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022] Open
Abstract
Background Understanding intra-fractional prostate motions is crucial for stereotactic body radiation therapy (SBRT). No studies have focused on the intra-fractional prostate motions during re-irradiation with SBRT. The objective was to evaluate these translational and rotational motions in primary treated patients and in the context of re-irradiation. Methods From January 2011 to March 2020, 162 patients with histologically proven prostate cancer underwent prostate SBRT, including 58 as part of a re-irradiation treatment. We used the continuous coordinates of the fiducial markers collected by an orthogonal X-ray dual-image monitoring system. The translations and rotations of the prostate were calculated. Prostate deviations representing overall movement was defined as the length of the 3D-vectors. Results A total of 858 data files were analyzed. The deviations over time in the group of primary treated patients were significantly larger than that of the group of re-irradiation, leading to a mean deviation of 2.73 mm (SD =1.00) versus 1.90 mm (SD =0.79), P<0.001. In the re-irradiation group, we identified displacements of -0.05 mm (SD =1.53), 0.20 mm (SD =1.46); and 0.42 mm (SD =1.24) in the left-right, superior-inferior and anterior-posterior planes. Overall, we observed increasing deviations over the first 30 min followed by a stabilization related to movements in the three translational axes. Conclusion This is the first study to focus on intrafraction prostate motions in the context of re-irradiation. We observed that intra-fraction prostate motions persisted in the setting of re-irradiation, although they showed a significant reduction when compared with the first irradiation. These results will help to better estimate random errors during SBRT treatment of intra-prostatic recurrence after irradiation.
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Affiliation(s)
- Alexandre Taillez
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France
| | - Andre-Michel Bimbai
- Department of Biostatistics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Thomas Lacornerie
- Department of Medical Physics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Marie-Cecile Le Deley
- Department of Biostatistics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Eric F Lartigau
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France.,CRISTAL UMR CNRS 9189, University of Lille, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France.,CRISTAL UMR CNRS 9189, University of Lille, Lille, France
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28
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Hehakaya C, van der Voort van Zyp JRN, Vanneste BGL, Grutters JPC, Grobbee DE, Verkooijen HM, Frederix GWJ. Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling. Radiother Oncol 2021; 161:74-82. [PMID: 34089754 DOI: 10.1016/j.radonc.2021.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. MATERIALS AND METHODS A state transition model was developed for men with localized prostate cancer. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes. RESULTS At €6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression. CONCLUSIONS MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.
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Affiliation(s)
- Charisma Hehakaya
- Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands; Julius Clinical, Zeist, The Netherlands.
| | | | - Ben G L Vanneste
- Department of Radiation Oncology, MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Janneke P C Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Diederick E Grobbee
- Julius Clinical, Zeist, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands; Utrecht University, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands; Utrecht University, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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29
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Choi SH, Kim YS, Yu J, Nam TK, Kim JS, Jang BS, Kim JH, Kim Y, Jeong BK, Chang AR, Park YH, Lee SU, Cho KH, Kim JH, Kim H, Choi Y, Kim YJ, Lee DS, Shin YJ, Shim SJ, Park W, Cho J. Optimizing External Beam Radiotherapy as per the Risk Group of Localized Prostate Cancer: A Nationwide Multi-Institutional Study (KROG 18-15). Cancers (Basel) 2021; 13:cancers13112732. [PMID: 34073100 PMCID: PMC8198120 DOI: 10.3390/cancers13112732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/14/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary This multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer to identify the optimal EBRT strategy for each risk-stratified patient subgroup for clinical practice implementation. In 1573 patients from 17 institutions, EBRT treated prostate cancer effectively. Also, among various risk classification tools, NCCN classification revealed the highest predictive power. The modern RT techniques and dose escalation (≥179 Gy1.5) enhanced therapeutic effects of RT significantly, especially in the high-risk group. On the other hand, modest doses (≥170 Gy1.5) was a significant factor in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. IMRT+ ≥179 Gy1.5+ hypofractionation resulted in higher biochemical failure-free survival in all risk groups, and it translated into survival benefits in the high-risk group. Therefore, risk-adapted RT (more intense RT, high-risk patients; moderate-dose RT, low-risk patients) can be considered, although further prospective studies are warranted. Abstract Purpose: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. Methods and Materials: We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. Results: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524–0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy1.5 were significant factors in the high-risk group, whereas ≥170 Gy1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. Conclusions: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.
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Affiliation(s)
- Seo Hee Choi
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea;
- Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Seok Kim
- Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.S.K.); (J.Y.); (Y.J.K.)
| | - Jesang Yu
- Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.S.K.); (J.Y.); (Y.J.K.)
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju 61469, Korea;
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.-S.K.); (B.-S.J.)
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.-S.K.); (B.-S.J.)
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Youngkyong Kim
- Department of Radiation Oncology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea;
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Korea;
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (A.R.C.); (Y.-H.P.)
| | - Young-Hee Park
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (A.R.C.); (Y.-H.P.)
| | - Sung Uk Lee
- The Proton Therapy Center, National Cancer Center, Research Institute and Hospital, Goyang 10408, Korea; (S.U.L.); (K.H.C.)
| | - Kwan Ho Cho
- The Proton Therapy Center, National Cancer Center, Research Institute and Hospital, Goyang 10408, Korea; (S.U.L.); (K.H.C.)
| | - Jin Hee Kim
- Keimyung University Dongsan Medical Center, Department of Radiation Oncology, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Hunjung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Korea;
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan 49201, Korea;
| | - Yeon Joo Kim
- Asan Medical Center, Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.S.K.); (J.Y.); (Y.J.K.)
- Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon 24289, Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Korea;
| | - Young Ju Shin
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul 04551, Korea;
| | - Su Jung Shim
- Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul 01830, Korea;
| | - Won Park
- Samsung Medical Center, Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: (W.P.); (J.C.); Tel.: +82-2-3410-2616 (W.P.); +82-2-2228-8095 (J.C.); Fax: +82-2-3410-2619 (W.P.); +82-2-2227-7823 (J.C.)
| | - Jaeho Cho
- Yonsei Cancer Center, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (W.P.); (J.C.); Tel.: +82-2-3410-2616 (W.P.); +82-2-2228-8095 (J.C.); Fax: +82-2-3410-2619 (W.P.); +82-2-2227-7823 (J.C.)
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Jones GP. "Physicians, not Technicians": Reflections on the Role of the Radiation Oncologist in an Era of Hypofractionation. Int J Radiat Oncol Biol Phys 2021; 109:830-831. [PMID: 33516440 DOI: 10.1016/j.ijrobp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Gavin P Jones
- University of Kentucky Chandler Hospital, Department of Radiation Medicine, Lexington, Kentucky.
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Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking. Radiother Oncol 2020; 156:145-152. [PMID: 33310011 DOI: 10.1016/j.radonc.2020.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To reconstruct the dose delivered during single-fraction urethra-sparing prostate stereotactic body radiotherapy (SBRT) accounting for intrafraction motion monitored by intraprostatic electromagnetic transponders (EMT). METHODS We analyzed data of 15 patients included in the phase I/II "ONE SHOT" trial and treated with a single fraction of 19 Gy to the planning target volume (PTV) and 17 Gy to the urethra planning risk volume. During delivery, prostate motion was tracked with implanted EMT. SBRT was interrupted when a 3-mm threshold was trespassed and corrected unless the offset was transient. Motion-encoded reconstructed (MER) plans were obtained by splitting the original plans into multiple sub-beams with isocenter shifts based on recorded EMT positions, mimicking prostate motion during treatment. We analyzed intrafraction motion and compared MER to planned doses. RESULTS The median EMT motion range (±SD) during delivery was 0.26 ± 0.09, 0.22 ± 0.14 and 0.18 ± 0.10 cm in the antero-posterior, supero-inferior, and left-right axes, respectively. Treatment interruptions were needed for 8 patients because of target motion beyond limits in the antero-posterior (n = 6) and/or supero-inferior directions (n = 4). Comparing MER vs. original plan there was a median relative dose difference of -1.9% (range, -7.9 to -1.0%) and of +0.5% (-0.3-1.7%) for PTV D98% and D2%, respectively. The clinical target volume remained sufficiently covered with a median D98% difference of -0.3% (-1.6-0.5%). Bladder and rectum dosimetric parameters showed significant differences between original and MER plans, but mostly remained within acceptable limits. CONCLUSIONS The dosimetric impact of intrafraction prostate motion was minimal for target coverage for single-fraction prostate SBRT with real-time electromagnetic tracking combined with beam gating.
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De Roover R, Hansen R, Crijns W, Muurholm CG, Poels K, Skouboe S, Haustermans K, Poulsen PR, Depuydt T. Dosimetric impact of intrafraction prostate rotation and accuracy of gating, multi-leaf collimator tracking and couch tracking to manage rotation: An end-to-end validation using volumetric film measurements. Radiother Oncol 2020; 156:10-18. [PMID: 33264640 DOI: 10.1016/j.radonc.2020.11.031] [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: 07/16/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Both gating and tracking can mitigate the deteriorating dosimetric impact of intrafraction translation during prostate stereotactic body radiotherapy (SBRT). However, their ability to manage intrafraction rotation has not yet been thoroughly investigated. The dosimetric accuracy of gating, MLC tracking and couch tracking to manage intrafraction prostate rotation was investigated. MATERIALS AND METHODS Treatment plans for end-to-end tests of prostate SBRT with focal boosting were generated for a dynamic anthropomorphic pelvis phantom. The phantom applied internal lateral rotation (up to 25°) and coupled vertical and longitudinal translation of a radiochromic film stack that was used for dose measurements. Dose was delivered for each plan while the phantom applied motion according to three typical prostate motion traces without compensation (i), with gating (ii), with MLC tracking (iii) or with couch tracking (iv). Measured doses for the four motion compensation strategies were compared with the planned dose in terms of γ-index analysis, target coverage and organs at risk (OAR) sparing. RESULTS Intrafraction rotation reduced the 3%(global)/2mm γ-index passing rate (γPR) for the prostate target volume by median (range) -33.2% (-68.6%, -4.1%) when no motion compensation was applied. The use of motion compensation improved the γPR by 13.2% (-0.4%, 32.9%) for gating, by 6.0% (-0.8%, 27.7%) for MLC tracking and by 11.1% (1.2%, 22.9%) for couch tracking. The three compensation techniques improved the target coverage in most cases. Gating showed better OAR sparing than MLC tracking or couch tracking. CONCLUSIONS Compensation of intrafraction prostate rotation with gating, MLC tracking and couch tracking was investigated experimentally for the first time. All three techniques improved the dosimetric accuracy, but residual motion-related dose errors remained due to the lack of rotation correction.
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Affiliation(s)
- Robin De Roover
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Denmark.
| | - Wouter Crijns
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | | | - Kenneth Poels
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Simon Skouboe
- Department of Oncology, Aarhus University Hospital, Denmark.
| | - Karin Haustermans
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
| | - Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Tom Depuydt
- Department of Oncology, KU Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
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Prostate Ultrahypofractionation - Rising to Challenges Presents Opportunities in the COVID-19 Era. Clin Oncol (R Coll Radiol) 2020; 33:e90. [PMID: 33158724 PMCID: PMC7610090 DOI: 10.1016/j.clon.2020.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/23/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
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Zaorsky NG. Prostate and Pelvis on Pause Pending a Pandemic. Int J Radiat Oncol Biol Phys 2020; 108:341-342. [PMID: 32890506 PMCID: PMC7463037 DOI: 10.1016/j.ijrobp.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
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