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Shah S, Saravanakumar S, Conroy D, Sowmiyanarayanan S, Singh R, Pepin A, Rashid H, Danner MT, Krishnan P, Lei S, Rashid A, Suy S, Kataria S, Aghdam N, Collins S. Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Men With Hip Prostheses: A Cautionary Note. Cureus 2024; 16:e61432. [PMID: 38947568 PMCID: PMC11214744 DOI: 10.7759/cureus.61432] [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] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. SBRT requires high accuracy to reduce treatment margins. Metal hip prostheses create artifacts that distort pelvic imaging and potentially decrease the accuracy of target/organ at risk (OAR) identification and radiation dose calculations. Data on the safety and efficacy of SBRT after hip replacement is limited. This single-institution study sought to evaluate the safety and local control following SBRT for prostate cancer in men with hip replacements. METHODS 23 patients treated with localized prostate cancer and a history of pre-treatment hip replacement, treated with SBRT from 2007 to 2017 at MedStar Georgetown University Hospital were included in this retrospective analysis. Treatment was administered with the CyberKnife® (Accuray Incorporated, Sunnyvale, CA) at doses of 35 Gy or 36.25 Gy in 5 fractions. The targets and OARs were identified and contoured by a single experienced Radiation Oncologist (SPC). The adequacy of the CT and T2W MRI images for treatment planning was assessed with a three-point scale (good, adequate, or suboptimal). During treatment planning, care was taken to avoid treatment beams that directly traversed the hip prosthesis. Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). Local recurrence was confirmed by magnetic resonance imaging and/or prostate biopsy. RESULTS The median follow-up was seven years. The patients were elderly (median age = 71 years) with a high rate of comorbidities (Charlson Comorbidity Index > 2 in 25%). Four patients had bilateral hip replacements. The majority of patients were low to intermediate risk per the D'Amico classification. Around 13% received upfront ADT. In total, 13 patients were treated with 35 Gy, and 10 were treated with 36.25 Gy. The rates of late > Grade 3 GU toxicity and > Grade 2 GI toxicity were 8.6% and 4.3%, respectively. There were no Grade 4 or 5 toxicities. Six patients (26%) developed a local recurrence at a median time of 7.5 years. Of these six patients, four had unilateral hip replacements and two had bilateral. Three underwent salvage cryotherapy and three received salvage ADT. CONCLUSIONS In the general population, high-grade toxicities and local recurrences are uncommon following prostate SBRT. However, in this cohort of patients with prior hip replacements, prostate SBRT had higher than expected rates of late toxicity and local recurrence. In the opinion of the authors, such patients should be counseled regarding an elevated risk of late toxicity and local recurrence with prostate SBRT. With its ultrasound guidance, brachytherapy would have the advantage of circumventing the need for MRI/CT-based imaging and thus may represent a preferable radiation alternative in this patient population. If these patients are treated with SBRT, they should be monitored closely for local recurrence so early salvage can be performed. We hope that recent advances in metal artifact reduction techniques and dose-calculation algorithms will improve future outcomes.
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Affiliation(s)
- Sarthak Shah
- Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | | | - Dylan Conroy
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | | | - Rahul Singh
- College of Arts and Sciences, Case Western Reserve University, Cleveland, USA
| | - Abigail Pepin
- Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, USA
| | - Harris Rashid
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Malika T Danner
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Pranay Krishnan
- Radiology, MedStar Georgetown University Hospital, Washington, USA
| | - Siyuan Lei
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Abdul Rashid
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Simeng Suy
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Shaan Kataria
- Radiation Oncology, Arlington Radiation Oncology, Reston, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sean Collins
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
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Kim S, Kong JH, Lee Y, Lee JY, Kang TW, Kong TH, Kim MH, You SH. Dose-escalated radiotherapy for clinically localized and locally advanced prostate cancer. Cochrane Database Syst Rev 2023; 3:CD012817. [PMID: 36884035 PMCID: PMC9994460 DOI: 10.1002/14651858.cd012817.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Treatments for clinically localized prostate cancer include radical prostatectomy, external beam radiation therapy, brachytherapy, active surveillance, hormonal therapy, and watchful waiting. For external beam radiation therapy, oncological outcomes may be expected to improve as the dose of radiotherapy (RT) increases. However, radiation-mediated side effects on surrounding critical organs may also increase. OBJECTIVES To assess the effects of dose-escalated RT in comparison with conventional dose RT for curative treatment of clinically localized and locally advanced prostate cancer. SEARCH METHODS We performed a comprehensive search using multiple databases including trial registries and other sources of grey literature, up until 20 July 2022. We applied no restrictions on publication language or status. SELECTION CRITERIA We included parallel-arm randomized controlled trials (RCTs) of definitive RT in men with clinically localized and locally advanced prostate adenocarcinoma. RT was dose-escalated RT (equivalent dose in 2 Gy [EQD2] ≥ 74 Gy, lesser than 2.5 Gy per fraction) versus conventional RT (EQD2 < 74 Gy, 1.8 Gy or 2.0 Gy per fraction). Two review authors independently classified studies for inclusion or exclusion. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of the evidence of RCTs. MAIN RESULTS We included nine studies with 5437 men in an analysis comparing dose-escalated RT versus conventional dose RT for the treatment of prostate cancer. The mean participant age ranged from 67 to 71 years. Almost all men had localized prostate cancer (cT1-3N0M0). Primary outcomes Dose-escalated RT probably results in little to no difference in time to death from prostate cancer (hazard ratio [HR] 0.83, 95% CI 0.66 to 1.04; I2 = 0%; 8 studies; 5231 participants; moderate-certainty evidence). Assuming a risk of death from prostate cancer of 4 per 1000 at 10 years in the conventional dose RT group, this corresponds to 1 fewer men per 1000 (1 fewer to 0 more) dying of prostate cancer in the dose-escalated RT group. Dose-escalated RT probably results in little to no difference in severe RT toxicity of grade 3 or higher late gastrointestinal (GI) toxicity (RR 1.72, 95% CI 1.32 to 2.25; I2 = 0%; 8 studies; 4992 participants; moderate-certainty evidence); 23 more men per 1000 (10 more to 40 more) in the dose-escalated RT group assuming severe late GI toxicity as 32 per 1000 in the conventional dose RT group. Dose-escalated RT probably results in little to no difference in severe late genitourinary (GU) toxicity (RR 1.25, 95% CI 0.95 to 1.63; I2 = 0%; 8 studies; 4962 participants; moderate-certainty evidence); 9 more men per 1000 (2 fewer to 23 more) in the dose-escalated RT group assuming severe late GU toxicity as 37 per 1000 in the conventional dose RT group. Secondary outcomes Dose-escalated RT probably results in little to no difference in time to death from any cause (HR 0.98, 95% CI 0.89 to 1.09; I2 = 0%; 9 studies; 5437 participants; moderate-certainty evidence). Assuming a risk of death from any cause of 101 per 1000 at 10 years in the conventional dose RT group, this corresponds to 2 fewer men per 1000 (11 fewer to 9 more) in the dose-escalated RT group dying of any cause. Dose-escalated RT probably results in little to no difference in time to distant metastasis (HR 0.83, 95% CI 0.57 to 1.22; I2 = 45%; 7 studies; 3499 participants; moderate-certainty evidence). Assuming a risk of distant metastasis of 29 per 1000 in the conventional dose RT group at 10 years, this corresponds to 5 fewer men per 1000 (12 fewer to 6 more) in the dose-escalated RT group developing distant metastases. Dose-escalated RT may increase overall late GI toxicity (RR 1.27, 95% CI 1.04 to 1.55; I2 = 85%; 7 studies; 4328 participants; low-certainty evidence); 92 more men per 1000 (14 more to 188 more) in the dose-escalated RT group assuming overall late GI toxicity as 342 per 1000 in the conventional dose RT group. However, dose-escalated RT may result in little to no difference in overall late GU toxicity (RR 1.12, 95% CI 0.97 to 1.29; I2 = 51%; 7 studies; 4298 participants; low-certainty evidence); 34 more men per 1000 (9 fewer to 82 more) in the dose-escalated RT group assuming overall late GU toxicity as 283 per 1000 in the conventional dose RT group. Based on long-term follow-up (up to 36 months), dose-escalated RT may result or probably results in little to no difference in the quality of life using 36-Item Short Form Survey; physical health (MD -3.9, 95% CI -12.78 to 4.98; 1 study; 300 participants; moderate-certainty evidence) and mental health (MD -3.6, 95% CI -83.85 to 76.65; 1 study; 300 participants; low-certainty evidence), respectively. AUTHORS' CONCLUSIONS Compared to conventional dose RT, dose-escalated RT probably results in little to no difference in time to death from prostate cancer, time to death from any cause, time to distant metastasis, and RT toxicities (except overall late GI toxicity). While dose-escalated RT may increase overall late GI toxicity, it may result, or probably results, in little to no difference in physical and mental quality of life, respectively.
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Affiliation(s)
- Sunghyun Kim
- Department of Radation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Division of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - YoHan Lee
- Department of Radation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Jun Young Lee
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Tae Wook Kang
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Tae Hoon Kong
- Department of Otorhinolaryngology Head and neck surgery, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Sei Hwan You
- Department of Radation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
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Sasamura K, Soyano T, Kozuka T, Yuasa T, Yamamoto S, Yonese J, Oguchi M, Yoshimura R, Yoshioka Y. Outcomes of intensity-modulated radiation therapy for intermediate- or high-risk prostate cancer: a single-institutional study. Jpn J Clin Oncol 2022; 52:170-178. [PMID: 34689189 DOI: 10.1093/jjco/hyab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are few reports from Japan about the outcomes of intensity-modulated radiation therapy for localized prostate cancer. This study was aimed at assessing the efficacy and toxicity of intensity-modulated radiation therapy in patients with intermediate- or high-risk prostate cancer. METHODS We conducted a review of the data, retrieved from our institutional database, of patients who had received intensity-modulated radiation therapy for localized prostate cancer at a radiation dose of 78 Gy in 39 fractions. Data of 201 patients with intermediate-risk prostate cancer and 311 patients with high-risk prostate cancer were analyzed. RESULTS The median follow-up period after the completion of intensity-modulated radiation therapy was 100 months (range, 24-154). The rates of cause-specific survival, overall survival, metastasis-free survival and biochemical recurrence-free survival in the intermediate-risk patients were 99, 95, 95 and 94% at 5 years and 99, 91, 90 and 86% at 8 years, respectively; the corresponding rates in the high-risk patients were 100, 97, 91 and 84% at 5 years and 96, 92, 84 and 76% at 8 years, respectively. The crude incidence of late grade 2-3 genitourinary toxicity was 28.1%, and that of late grade 3 genitourinary toxicity was 2.0%. The crude incidence of late grade 2 gastrointestinal toxicity was 5.1%, and there were no cases of late grade 3 gastrointestinal toxicity. CONCLUSIONS Our data demonstrated that intensity-modulated radiation therapy is effective for patients with localized intermediate-risk or high-risk prostate cancer while having minimal toxicity.
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Affiliation(s)
- Kazuma Sasamura
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Soyano
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Takuyo Kozuka
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Oguchi
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Yoshioka
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Takeda K, Umezawa R, Ishikawa Y, Yamamoto T, Takahashi N, Takeda K, Kadoya N, Matsushita H, Kawasaki Y, Mitsuzuka K, Ito A, Arai Y, Takai Y, Jingu K. Clinical predictors of severe late urinary toxicity after curative intensity-modulated radiation therapy for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2021:rrab074. [PMID: 34467400 DOI: 10.1093/jrr/rrab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Intractable late urinary toxicity is a serious complication after radiotherapy for patients with localized prostate cancer (LPC). We assessed clinical factors correlated with severe late urinary toxicity in LPC treated with curative image-guided intensity-modulated radiation therapy (IMRT). A total of 452 patients with LPC treated with IMRT between 2002 and 2016 were retrospectively analyzed. Among them, 432 patients received androgen deprivation therapy (ADT). The median total irradiated doses were 80 (range, 76-80) Gy. Each daily dose was 2 Gy per fraction. The median follow-up was 83 (range, 4-210) months. Late urinary toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.03. Grade 3 late urinary toxicity was observed in 27 patients. No cases with grade ≥ 4 late urinary toxicity were observed. The 5-, 10-, and 12.5-year grade 3 late urinary toxicity-free survival rates were 97%, 91.8% and 88.1%, respectively. Age, risk classification, total irradiated dose, ADT duration, antithrombotic therapy (AT), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), dyslipidemia (DL), prior transurethral resection of the prostate (TURP) and prior high-intensity focused ultrasound (HIFU) were investigated for correlations with grade 3 late urinary toxicity. In univariate analysis, AT and prior HIFU and no other studied factors, were correlated with grade 3 late urinary toxicity. AT and prior HIFU appear to be predictive of grade 3 late urinary toxicity. Patients with LPC with these relevant clinical factors should be carefully followed up by sharing detailed information with the urology department.
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Affiliation(s)
- Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshihide Kawasaki
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoichi Arai
- Department of Urology, Miyagi Cancer Center, 47-1, Medeshimashiotenodayama, Natori, 981-1293, Japan
| | - Yoshihiro Takai
- Southern Tohoku BNCT Research Center, 7-10, Yatsuyamada, Koriyama, 963-8052, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Bolt M, Clark CH, Nisbet A, Chen T. Quantification of the uncertainties within the radiotherapy dosimetry chain and their impact on tumour control. Phys Imaging Radiat Oncol 2021; 19:33-38. [PMID: 34307916 PMCID: PMC8295844 DOI: 10.1016/j.phro.2021.06.004] [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: 11/14/2020] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Dose delivered during radiotherapy has uncertainty arising from a number of sources including machine calibration, treatment planning and delivery and can impact outcomes. Any systematic uncertainties will impact all patients and can continue for extended periods. The impact on tumour control probability (TCP) of the uncertainties within the radiotherapy calibration process has been assessed. MATERIALS AND METHODS The linear-quadratic model was used to simulate the TCP from two prostate cancer and a head and neck (H&N) clinical trial. The uncertainty was separated into four components; 1) initial calibration, 2) systematic shift due to output drift, 3) drift during treatment and 4) daily fluctuations. Simulations were performed for each clinical case to model the variation in TCP present at the end of treatment arising from the different components. RESULTS Overall uncertainty in delivered dose was +/-2.1% (95% confidence interval (CI)), consisting of uncertainty standard deviations of 0.7% in initial calibration, 0.8% due to subsequent calibration shift due to output drift, 0.1% due to drift during treatment, and 0.2% from daily variations. The overall uncertainty of TCP (95% CI) for a population of patients treated on different machines was +/-3%, +/-5%, and +/-3% for simulations based on the two prostate trials and H&N trial respectively. CONCLUSION The greatest variation in delivered target volume dose arose from calibration shift due to output drift. Careful monitoring of beam output following initial calibration remains vital and may have a significant impact on clinical outcomes.
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Affiliation(s)
- Matthew Bolt
- Department of Medical Physics, St Luke’s Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- National Physical Laboratory, Teddington, UK
- Department of Chemical and Process Engineering, University of Surrey, Guildford, UK
| | - Catharine H. Clark
- National Physical Laboratory, Teddington, UK
- Radiotherapy Physics, University College London Hospital NHS Foundation Trust, London, UK
| | - Andrew Nisbet
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tao Chen
- Department of Chemical and Process Engineering, University of Surrey, Guildford, UK
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Huang SY, Wu CT, Liu DW, Wang TH, Liao YH, Chen YW, Hsu WL. Dose escalation (81 Gy) with image-guided radiation therapy and volumetric-modulated arc therapy for localized prostate cancer: A retrospective preliminary result. Tzu Chi Med J 2020; 32:75-81. [PMID: 32110525 PMCID: PMC7015011 DOI: 10.4103/tcmj.tcmj_2_19] [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: 01/02/2019] [Revised: 01/29/2019] [Accepted: 04/11/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives: The objective of the study is to report the acute and late toxicity and preliminary results of localized prostate cancer treated with high-dose radiation therapy (RT). Materials and Methods: Between March 2010 and October 2018, a total of 53 patients with clinically localized prostate cancer were treated with definitive RT at our institution. All patients were planned to receive a total dose of 81 Gy with the volumetric-modulated arc therapy technique. Patients were stratified by prognostic risk groups based on the National Comprehensive Cancer Network risk classification criteria. Acute and late toxicities were scored by the Radiation Therapy Oncology Group morbidity grading scales. The definition of biochemical failure was using the 2005 ASTRO Phoenix consensus definition. Median follow-up time was 46.5 months (range: 4.7–81.0 months). Results: The 3-year biochemical failure-free survival rates for low-, intermediate-, and high-risk group patients were 100%, 87.5%, and 84%, respectively. The 3- and 5-year overall survival rates were 83% and 62%, respectively. Three (5.6%) patients developed Grade II acute gastrointestinal (GI) toxicity. Four (7.5%) patients developed Grade II acute genitourinary (GU) toxicity, and none experienced Grade III or higher acute GI or GU symptoms. One (1.8%) patient developed Grade II or higher late GI toxicity. Six (11.3%) patients experienced Grade II late GU toxicity. No Grade III or higher late GI and GU complications have been observed. Conclusions: Data from the current study demonstrated the feasibility of dose escalation with image-guided and volumetric-modulated arc therapy techniques for the treatment of localized prostate cancer. Minimal acute and late toxicities were observed from patients in this study. Long-term prostate-specific antigen controls are comparable to previously published results of high-dose intensity-modulated RT for localized prostate cancer. Based on this favorable outcome, dose escalation (81 Gy) has become the standard treatment for localized prostate cancer at our institution.
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Affiliation(s)
- Sheng-Yao Huang
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Ta Wu
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Dai-Wei Liu
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tzu-Hwei Wang
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yen-Hsiang Liao
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Wei Chen
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wen-Lin Hsu
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Marteinsdottir M, Paganetti H. Applying a variable relative biological effectiveness (RBE) might affect the analysis of clinical trials comparing photon and proton therapy for prostate cancer. ACTA ACUST UNITED AC 2019; 64:115027. [DOI: 10.1088/1361-6560/ab2144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hatano K, Tohyama N, Kodama T, Okabe N, Sakai M, Konoeda K. Current status of intensity‐modulated radiation therapy for prostate cancer: History, clinical results and future directions. Int J Urol 2019; 26:775-784. [DOI: 10.1111/iju.14011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/07/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Kazuo Hatano
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
| | - Naoki Tohyama
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
| | - Takashi Kodama
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
| | - Naoyuki Okabe
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
| | - Mitsuhiro Sakai
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
| | - Koichi Konoeda
- Division of Radiation Oncology Tokyo‐Bay Advanced Imaging & Radiation Oncology Clinic/Makuhari Chiba Japan
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Ciabatti S, Ntreta M, Buwenge M, Gaudiano C, Sessagesimi E, Romani F, Angelini AL, Cammelli S, Macchia G, Deodato F, Zamagni A, Golfieri R, Morganti AG, Cilla S. Dominant intraprostatic lesion boosting in sexual-sparing radiotherapy of prostate cancer: A planning feasibility study. Med Dosim 2019; 44:356-364. [PMID: 30955990 DOI: 10.1016/j.meddos.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
AIM Radical radiotherapy of prostate cancer requires a relatively high dose to achieve an optimal tumor control probability and a reduced dose to the critical structures related to the sexual function (S_OARs) in order to avoid erectile dysfunction. The aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription with Simultaneous Integrated Boost (SIB) on the dominant intraprostatic lesion (DIL) and with S_OARs sparing. MATERIAL AND METHODS Twelve patients with clinically localized intermediate risk prostate cancer were included. The prostate, seminal vescicles, and DIL Clinical Target Volumes were delineated on rigid fused MRI-CT simulation images using mp-MRI as a separate guide. A 5 mm margin was added to define the PTVs. Penile bulb (PB), corpora cavernosa (CC), internal pudendal arteries (IPAs) and neurovascular bundles were contoured as S_OARs. The following doses were prescribed in 25 fractions: 56.25 Gy to PTVsv, 67.50 Gy to PTVp, and 75 Gy to PTVdil. Standard plans (SD-VMAT) were created to fulfil targets coverage and Quantec constraints for conventional OARs (SD_OARs: rectum, bladder, and femoral heads). For each patient, a new "sexual-sparing" plan (SS-VMAT) was created adding new objectives for S_OARs with priority to minimize mean doses to IPAs, CC, and PB. Dose-volume histogram end points were compared between the 2 plans using Wilcoxon test. RESULTS D98% were >95% of prescribed doses for all targets and techniques. No significant differences were found in sparing SD_OARs for considered metrics. Regarding S_OARs, SS_VMAT plans provided a significant reduction of the dose. Mean dose reduction for IPAs, CC, PB, and neurovascular bundles was 32.4% (11.2 Gy, p = 0.002), 22.5% (4.1 Gy, p = 0.006), 10.0% (4.6 Gy, p = 0.010), and 2.6% (1.8 Gy, p = 0.020), respectively. CONCLUSIONS We showed that a significant dose sparing for S_OARs using VMAT-SIB strategy is feasible allowing "sexual-sparing" and highly conformal plans with dose escalation to the DIL.
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Affiliation(s)
- Selena Ciabatti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Ntreta
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Caterina Gaudiano
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Sessagesimi
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabrizio Romani
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna L Angelini
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
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Abstract
Radiation therapy (RT) is a curative treatment modality for localized prostate cancer. Over the past two decades, advances in technology and imaging have considerably changed RT in prostate cancer treatment. Treatment has evolved from 2-dimensional (2D) planning using X-ray fields based on pelvic bony landmarks to 3-dimensional (3D) conformal RT (CRT) which uses computed tomography (CT) based planning. Despite improvements with 3D-CRT, dose distributions often remained suboptimal with portions of the rectum and bladder receiving unacceptably high doses. In more recent years, intensity-modulated radiation therapy (IMRT) has become the standard of care to deliver external beam RT. IMRT uses multiple radiation beams of different shapes and intensities delivered from a wide range of angles to ‘paint’ the radiation dose onto the tumor. IMRT allows for a higher dose of radiation to be delivered to the prostate while reducing dose to surrounding organs. Multiple clinical trials have demonstrated improved cancer outcomes with dose escalation, but toxicities using 3D-CRT and escalated doses have been problematic. IMRT is a method to deliver dose escalated RT with more conformal dose distributions than 3D-CRT and has been associated with improved toxicity profiles. IMRT also appears to be the safest method to deliver hypofractionated RT and pelvic lymph node radiation. The purpose of this review is to summarize the technical aspects of IMRT planning and delivery, and to review the literature supporting the use of IMRT for prostate cancer.
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Affiliation(s)
- Ben W Fischer-Valuck
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
| | - Yuan James Rao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
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Daly T, Hickey BE, See AM, Francis DP. Dose-escalated radiotherapy for clinically localised and locally advanced prostate cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tiffany Daly
- Princess Alexandra Hospital; Radiation Oncology Mater Service; 31 Raymond Terrace Brisbane Queensland Australia 4101
| | - Brigid E Hickey
- Princess Alexandra Hospital; Radiation Oncology Mater Service; 31 Raymond Terrace Brisbane Queensland Australia 4101
- The University of Queensland; School of Medicine; Brisbane Australia
| | - Adrienne M See
- Princess Alexandra Hospital; Radiation Oncology Mater Service; 31 Raymond Terrace Brisbane Queensland Australia 4101
| | - Daniel P Francis
- Queensland University of Technology; School of Public Health and Social Work; Victoria Park Road Brisbane Queensland Australia 4059
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12
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Marvaso G, Jereczek-Fossa BA, Riva G, Bassi C, Fodor C, Ciardo D, Cambria R, Pansini F, Zerini D, De Marco P, Cattani F, De Cobelli O, Orecchia R. High-Risk Prostate Cancer and Radiotherapy: The Past and the Future. A Benchmark for a New Mixed Beam Radiotherapy Approach. Clin Genitourin Cancer 2017; 15:376-383. [DOI: 10.1016/j.clgc.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
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13
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Chen CY, Lee LM, Yu HW, Lee SP, Lee HL, Lin YW, Wen YC, Chen YJ, Chen CP, Tsai JT. Dosimetric and radiobiological comparison of Cyberknife and Tomotherapy in stereotactic body radiotherapy for localized prostate cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:465-477. [PMID: 28157113 DOI: 10.3233/xst-16169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND PURPOSE As recent studies have suggested relatively low α/β for prostate cancer, the interest in hypofractionated stereotactic body radiotherapy (SBRT) for prostate cancer is rising. The aim of this study is to compare dosimetric results of Cyberknife (CK) with Tomotherapy (HT) in SBRT for localized prostate cancer. Furthermore, the radiobiologic consequences of heterogeneous dose distribution are also analyzed. MATERIAL AND METHOD A total of 12 cases of localized prostate cancer previously treated with SBRT were collected. Treatments had been planned and delivered using CK. Then HT plans were generated for comparison afterwards. The prescribed dose was 37.5Gy in 5 fractions. Dosimetric indices for target volumes and organs at risk (OAR) were compared. For radiobiological evaluation, generalized equivalent uniform dose (gEUD) and normal tissue complication probability (NTCP) were calculated and compared. RESULT Both CK and HT achieved target coverage while meeting OAR constraints adequately. HT plans resulted in better dose homogeneity (Homogeneity index: 1.04±0.01 vs. 1.21±0.01; p = 0.0022), target coverage (97.74±0.86% vs. 96.56±1.17%; p = 0.0076) and conformity (new vonformity index: 1.16±0.05 vs. 1.21±0.04; p = 0.0096). HT was shown to predict lower late rectal toxicity as compared to CK. Integral dose to body was also significantly lower in HT plans (46.59±6.44 Gy'L vs 57.05±11.68 Gy'L; p = 0.0029). CONCLUSION Based on physical dosimetry and radiobiologic considerations, HT may have advantages over CK, specifically in rectal sparing which could translate into clinical benefit of decreased late toxicities.
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Affiliation(s)
- Chun-You Chen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Liang-Ming Lee
- Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Wei Yu
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Steve P Lee
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yung-Wei Lin
- Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ching Wen
- Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ju Chen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiu-Ping Chen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Phase II multi-institutional clinical trial on a new mixed beam RT scheme of IMRT on pelvis combined with a carbon ion boost for high-risk prostate cancer patients. TUMORI JOURNAL 2016; 103:314-318. [PMID: 28009421 DOI: 10.5301/tj.5000587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Definition of the optimal treatment schedule for high-risk prostate cancer is under debate. A combination of photon intensity modulated radiotherapy (IMRT) on pelvis with a carbon ion boost might be the optimal treatment scheme to escalate the dose on prostate and deliver curative dose with respect to normal tissue and quality of dose distributions. In fact, carbon ion beams offer the advantage to deliver hypofractionated radiotherapy (RT) using a significantly smaller number of fractions compared to conventional RT without increasing risks of late effects. METHODS This study is a prospective phase II clinical trial exploring safety and feasibility of a mixed beam scheme of carbon ion prostate boost followed by photon IMRT on pelvis. The study is designed to enroll 65 patients with localized high-risk prostate cancer at 3 different oncologic hospitals: Istituto Europeo di Oncologia, Fondazione IRCCS Istituto Nazionale dei Tumori, and Centro Nazionale di Adroterapia Oncologica. The primary endpoint is the evaluation of safety and feasibility with acute toxicity scored up to 1 month after the end of RT. Secondary endpoints are treatment early (3 months after the end of RT) and long-term tolerability, quality of life, and efficacy. RESULTS The study is not yet recruiting; in silico studies are ongoing and we expect to start recruitment by 2017. CONCLUSIONS The present clinical trial aims at improving the current treatment for high-risk prostate cancer, evaluating safety and feasibility of a new RT mixed-beam scheme including photons and carbon ions. Encouraging results are coming from carbon ion facilities worldwide on the treatment of different tumors including prostate cancers. Carbon ions combine physical properties allowing for high dose conformity and advantageous radiobiological characteristics. The proposed mixed beam treatment has the advantage to combine a photon high conformity standard of care IMRT phase with a hypofractionated carbon ion RT boost delivered in a short overall treatment time.
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15
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Jeang EH, Min S, Cho KH, Hwang UJ, Choi SH, Kwak J, Jeong JH, Kim H, Lee SB, Shin D, Park J, Kim JY, Kim DY, Lim YK. Two-dimensional in vivo rectal dosimetry using an endorectal balloon with unfoldable radiochromic film during prostate cancer radiotherapy. Radiother Oncol 2016; 120:327-32. [PMID: 27222297 DOI: 10.1016/j.radonc.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The present study aims to investigate the feasibility of two-dimensional (2D) in vivo rectal dosimetry using an endorectal balloon for the radiotherapy of prostate cancer. MATERIALS AND METHODS The endorectal balloon was equipped with an unfoldable radiochromic film. The film was unrolled as the balloon was inflated, and rolled as it was deflated. Its mechanical and imaging properties were tested, and the dosimetric effectiveness was evaluated in clinical photon and proton beams. RESULTS The size of the endorectal balloon including the film was linearly proportional to the volume of water filled in the balloon, and its position could be identified by X-ray radiography. The loss of dose information due to film cutting was within ±1mm from the cutting line. Applying linear interpolation on cut film, the gamma passing rate was more than 95% for 2%/2mm criteria. The measured dose profiles agreed with the plan within 3% and 4% for the photon and proton beams, respectively. A dose-volume histogram of the anterior rectal wall could be obtained from the measured dose distribution in the balloon, which also agreed well with the plan. CONCLUSIONS 2D in vivo rectal dosimetry is feasible using the endorectal balloon with a radiochromic film in the radiotherapy of prostate cancer.
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Affiliation(s)
- Eun Hee Jeang
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Soonki Min
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Kwan Ho Cho
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Ui-Jung Hwang
- Department of Radiation Oncology, National Medical Center, Seoul, Republic of Korea
| | - Sang Hyoun Choi
- Department of Radiation Oncology, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Hwi Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Haksoo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Se Byeong Lee
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Dongho Shin
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Jeonghoon Park
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Dae Yong Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea.
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16
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A patient-level data meta-analysis of standard-of-care treatments from eight prostate cancer clinical trials. Sci Data 2016; 3:160027. [PMID: 27163794 PMCID: PMC4862324 DOI: 10.1038/sdata.2016.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/06/2016] [Indexed: 12/23/2022] Open
Abstract
Open clinical trial data offer many opportunities for the scientific community to independently verify published results, evaluate new hypotheses and conduct meta-analyses. These data provide valuable opportunities for scientific advances in medical research. Herein we present the comparative meta-analysis of different standard of care treatments from newly available comparator arm data from several prostate cancer clinical trials. Comparison of survival rates following treatment with mitoxantrone or docetaxel in combination with prednisone as well as prednisone alone, validated the previously demonstrated superiority of treatment with docetaxel. Additionally, comparison of four testosterone suppression treatments in hormone-refractory prostate cancer revealed that subjects who had undergone surgical castration had significantly lower survival rates than those treated with LHRH, anti-androgen or LHRH plus anti-androgen, suggesting that this treatment option is less optimal. This study illustrates how the use of patient-level clinical trial data enables meta-analyses that can provide new insights into clinical outcomes of standard of care treatments and thus, once validated, has the potential to help optimize healthcare delivery.
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Kumabe A, Fukuhara N, Utsunomiya T, Kawase T, Iwata K, Okada Y, Sutani S, Ohashi T, Oya M, Shigematsu N. Three-dimensional conformal arc radiotherapy using a C-arm linear accelerator with a computed tomography on-rail system for prostate cancer: clinical outcomes. Radiat Oncol 2015; 10:208. [PMID: 26458948 PMCID: PMC4603912 DOI: 10.1186/s13014-015-0515-4] [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: 05/28/2015] [Accepted: 10/02/2015] [Indexed: 11/26/2022] Open
Abstract
Background We report the feasibility and treatment outcomes of image-guided three-dimensional conformal arc radiotherapy (3D-CART) using a C-arm linear accelerator with a computed tomography (CT) on-rail system for localized prostate cancer. Methods and materials Between 2006 and 2011, 282 consecutive patients with localized prostate cancer were treated with in-room CT-guided 3D-CART. Biochemical failure was defined as a rise of at least 2.0 ng/ml beyond the nadir prostate-specific antigen level. Toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results A total of 261 patients were analyzed retrospectively (median follow-up: 61.6 months). The median prescribed 3D-CART dose was 82 Gy (2 Gy/fraction, dose range: 78–86 Gy), and 193 of the patients additionally received hormonal therapy. The 5-year overall survival rate was 93.9 %. Among low-, intermediate-, and high-risk patients, 5-year rates of freedom from biochemical failure were 100, 91.5 and 90.3 %, respectively. Rates of grade 2–3 late gastrointestinal and genitourinary toxicities were 2.3 and 11.4 %, respectively. No patient experienced late grade 4 or higher toxicity. Conclusions In-room CT-guided 3D-CART was feasible and effective for localized prostate cancer. Treatment outcomes were comparable to those previously reported for intensity-modulated radiotherapy.
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Habl G, Katayama S, Uhl M, Kessel KA, Edler L, Debus J, Herfarth K, Sterzing F. Helical intensity-modulated radiotherapy of the pelvic lymph nodes with a simultaneous integrated boost to the prostate--first results of the PLATIN 1 trial. BMC Cancer 2015; 15:868. [PMID: 26547188 PMCID: PMC4637144 DOI: 10.1186/s12885-015-1886-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Definitive, percutaneous irradiation of the prostate and the pelvic lymph nodes in high-risk prostate cancer is the alternative to prostatectomy plus lymphadenectomy. To date, the role of whole pelvis radiotherapy (WPRT) has not been clarified especially taking into consideration the benefits of high conformal IMRT (intensity modulated radiotherapy) of complex-shaped target volumes. Methods From 2009 to 2012, 40 patients of high-risk prostate cancer with an increased risk of microscopic lymph node involvement were enrolled into this prospective phase II trial. Patients received at least two months of antihormonal treatment (AT) before radiotherapy continuing for at least 2 years. Helical IMRT (tomotherapy) of the pelvic lymph nodes (51.0 Gy) with a simultaneous integrated, moderate hypofractionated boost (single dose of 2.25 Gy) to the prostate (76.5 Gy) was performed in 34 fractions. PSA levels, prostate-related symptoms and quality of life were assessed at regular intervals for 24 months. Results Of the 40 patients enrolled, 38 finished the treatment as planned. Overall acute toxicity rates were low and no acute grade 3 or 4 gastrointestinal (GI) and genitourinary (GU) toxicity occurred. 21.6 % of patients experienced acute grade 2 but no late grade ≥2 GI toxicity. Regarding GU side effects, results showed 48.6 % acute grade 2 and 6.4 % late grade 2 toxicity. After a median observation time of 23.4 months the PLATIN 1 trial can be considered as sufficiently safe meeting the prospectively defined aims of the trial. With 34/37 patients free of a PSA recurrence it shows promising efficacy. Conclusion Tomotherapy of the pelvic lymph nodes with a simultaneous integrated boost to the prostate can be performed safely and without excessive toxicity. The combined irradiation of both prostate and pelvic lymph nodes seems to be as well tolerated as the irradiation of the prostate alone. Trial registration Trial Numbers: ARO 2009–05, ClinicalTrials.gov: NCT01903408.
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Affiliation(s)
- Gregor Habl
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany. .,Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany.
| | - Sonja Katayama
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Matthias Uhl
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Kerstin A Kessel
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
| | - Lutz Edler
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Juergen Debus
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Klaus Herfarth
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Florian Sterzing
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
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Hamlett LJ, McPartlin AJ, Maile EJ, Webster G, Swindell R, Rowbottom CG, Choudhury A, Aitkenhead AH. Parametrized rectal dose and associations with late toxicity in prostate cancer radiotherapy. Br J Radiol 2015; 88:20150110. [PMID: 26246172 DOI: 10.1259/bjr.20150110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated possible associations between planned dose-volume parameters and rectal late toxicity in 170 patients having radical prostate cancer radiotherapy. METHODS For each patient, the rectum was outlined from anorectal junction to sigmoid colon, and rectal dose was parametrized using dose-volume (DVH), dose-surface (DSH) and dose-line (DLH) histograms. Generation of DLHs differed from previous studies in that the rectal dose was parametrized without first unwrapping onto 2-dimensional dose-surface maps. Patient-reported outcomes were collected using a validated Later Effects in Normal Tissues Subjective, Objective, Management and Analytic questionnaire. Associations between dose and toxicity were assessed using a one-sided Mann-Whitney U test. RESULTS Associations (p < 0.05) were found between equieffective dose (EQD23) and late toxicity as follows: overall toxicity with DVH and DSH at 13-24 Gy; proctitis with DVH and DSH at 25-36 Gy and with DVH, DSH and DLH at 61-67 Gy; bowel urgency with DVH and DSH at 10-20 Gy. None of these associations met statistical significance following the application of a Bonferroni correction. CONCLUSION Independently confirmed associations between rectal dose and late toxicity remain elusive. Future work to increase the accuracy of the knowledge of the rectal dose, either by accounting for interfraction and intrafraction rectal motion or via stabilization of the rectum during treatment, may be necessary to allow for improved dose-toxicity comparisons. ADVANCES IN KNOWLEDGE This study is the first to use parametrized DLHs to study associations with patient-reported toxicity for prostate radiotherapy showing that it is feasible to model rectal dose mapping in three dimensions.
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Affiliation(s)
- Lynsey J Hamlett
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,2 Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew J McPartlin
- 3 Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Edward J Maile
- 4 Oxford University Clinical Academic Graduate School, Medical Sciences Division, John Radcliffe Hospital, Oxford, UK
| | - Gareth Webster
- 5 Hall-Edwards Radiotherapy Research Group, Medical Physics, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ric Swindell
- 6 The Christie NHS Foundation Trust, Manchester, UK
| | - Carl G Rowbottom
- 7 Department of Medical Physics, Clatterbridge Cancer Centre, Liverpool, UK
| | - Ananya Choudhury
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,3 Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Adam H Aitkenhead
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,2 Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
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Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol 2015; 34:377-82. [PMID: 26047655 DOI: 10.1007/s00345-015-1608-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Bulbomembranous stenosis is a significant complication of radiotherapy for prostate cancer. Our purpose is to report outcomes of urethroplasty for radiation-induced bulbomembranous urethral stenoses. METHODS Thirty-five patients underwent urethroplasty for refractory radiation-induced bulbomembranous stenoses from January 2004 to November 2013. Patients had a minimum follow-up of 12 months with routine cystoscopy at 6 and 12 months. Primary outcome was urethral patency, and secondary outcomes were 90-day complications, de novo incontinence, de novo erectile dysfunction and bothersome LUTS. Outcomes were compared using Fisher's exact test. RESULTS Of the 35 patients, 20 and 15 had stenosis related to external beam radiation therapy and brachytherapy, respectively. Mean stricture length was 3.5 cm. Reconstruction was performed using anastomotic urethroplasty in 23 patients (65.7 %), while 12 required tissue transfer as a buccal mucosa graft (20.0 %) or penile island flap (14.3 %). With 50.5 months of follow-up, thirty patients (85.7 %) achieved cystoscopic patency with no significant difference between techniques (p = 0.32). A 90-day complication rate of 31.4 % was observed (all Clavien 1-2) with no difference between techniques (p = 1.00). Adverse change in continence occurred in 25.7 % of patients (13.3 % in those without previous TURP). Postoperatively, persisting storage LUTS occurred in 40.0 and 30.4 % described adverse change in erectile function (exclusively in the anastomotic urethroplasty group). CONCLUSIONS Reconstruction of radiation-induced bulbomembranous stenosis yields satisfying patency rates. However, radiation-induced urethral stenosis is not an isolated problem as many patients suffer from storage symptoms, erectile dysfunction or incontinence as a consequence of treatment either before or after urethroplasty.
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22
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Comparing morbidity and cancer control after 3D-conformal (70/74 Gy) and intensity modulated radiotherapy (78/82 Gy) for prostate cancer. Strahlenther Onkol 2015; 191:338-46. [DOI: 10.1007/s00066-014-0806-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
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Freytag SO, Stricker H, Lu M, Elshaikh M, Aref I, Pradhan D, Levin K, Kim JH, Peabody J, Siddiqui F, Barton K, Pegg J, Zhang Y, Cheng J, Oja-Tebbe N, Bourgeois R, Gupta N, Lane Z, Rodriguez R, DeWeese T, Movsas B. Prospective randomized phase 2 trial of intensity modulated radiation therapy with or without oncolytic adenovirus-mediated cytotoxic gene therapy in intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2014; 89:268-76. [PMID: 24837889 DOI: 10.1016/j.ijrobp.2014.02.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the safety and efficacy of combining oncolytic adenovirus-mediated cytotoxic gene therapy (OAMCGT) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer. METHODS AND MATERIALS Forty-four men with intermediate-risk prostate cancer were randomly assigned to receive either OAMCGT plus IMRT (arm 1; n=21) or IMRT only (arm 2; n=23). The primary phase 2 endpoint was acute (≤90 days) toxicity. Secondary endpoints included quality of life (QOL), prostate biopsy (12-core) positivity at 2 years, freedom from biochemical/clinical failure (FFF), freedom from metastases, and survival. RESULTS Men in arm 1 exhibited a greater incidence of low-grade influenza-like symptoms, transaminitis, neutropenia, and thrombocytopenia than men in arm 2. There were no significant differences in gastrointestinal or genitourinary events or QOL between the 2 arms. Two-year prostate biopsies were obtained from 37 men (84%). Thirty-three percent of men in arm 1 were biopsy-positive versus 58% in arm 2, representing a 42% relative reduction in biopsy positivity in the investigational arm (P=.13). There was a 60% relative reduction in biopsy positivity in the investigational arm in men with <50% positive biopsy cores at baseline (P=.07). To date, 1 patient in each arm exhibited biochemical failure (arm 1, 4.8%; arm 2, 4.3%). No patient developed hormone-refractory or metastatic disease, and none has died from prostate cancer. CONCLUSIONS Combining OAMCGT with IMRT does not exacerbate the most common side effects of prostate radiation therapy and suggests a clinically meaningful reduction in positive biopsy results at 2 years in men with intermediate-risk prostate cancer.
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Affiliation(s)
- Svend O Freytag
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
| | - Hans Stricker
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mei Lu
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Ibrahim Aref
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Deepak Pradhan
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Kenneth Levin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Jae Ho Kim
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - James Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Kenneth Barton
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Jan Pegg
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Yingshu Zhang
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Jingfang Cheng
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Nancy Oja-Tebbe
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Renee Bourgeois
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Nilesh Gupta
- Pathology, Henry Ford Health System, Detroit, Michigan
| | - Zhaoli Lane
- Pathology, Henry Ford Health System, Detroit, Michigan
| | - Ron Rodriguez
- Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Theodore DeWeese
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
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Aoki M, Mizowaki T, Akimoto T, Nakamura K, Ejima Y, Jingu K, Tamai Y, Nakajima N, Takemoto S, Kokubo M, Katoh H. Adjuvant radiotherapy after prostatectomy for prostate cancer in Japan: a multi-institutional survey study of the JROSG. JOURNAL OF RADIATION RESEARCH 2014; 55:533-40. [PMID: 24385470 PMCID: PMC4014160 DOI: 10.1093/jrr/rrt137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/27/2013] [Accepted: 10/28/2013] [Indexed: 06/03/2023]
Abstract
In Japan, the use of adjuvant radiotherapy after prostatectomy for prostate cancer has not increased compared with the use of salvage radiotherapy. We retrospectively evaluated the outcome of adjuvant radiotherapy together with prognostic factors of outcome in Japan. Between 2005 and 2007, a total of 87 patients were referred for adjuvant radiotherapy in 23 institutions [median age: 64 years (54-77 years), median initial prostate-specific antigen: 11.0 ng/ml (2.9-284 ng/ml), Gleason score (GS): 6, 7, 8, 9, 10 = 13.8, 35.6, 23.0, 27.6, 0%, respectively]. Rates of positive marginal status, seminal vesicle invasion (SVI) and extra-prostatic extension (EPE) were 74%, 26% and 64%, respectively. Median post-operative PSA nadir: 0.167 ng/ml (0-2.51 ng/ml). Median time from surgery to radiotherapy was 3 months (1-6 months). A total dose of ≥ 60 Gy and <65 Gy was administered to 69% of patients. The median follow-up time was 62 months. The 3- and 5-year biochemical relapse-free survival (bRFS) rates for all patients were 66.5% and 57.1%, respectively. The GS and marginal status (P = 0.019), GS and SVI (P = 0.001), marginal status and EPE (P = 0.017), type of hormonal therapy and total dose (P = 0.026) were significantly related. The 5-year bRFS rate was significantly higher in SVI-negative patients than SVI-positive patients (P = 0.001), and significantly higher in patients with post-operative PSA nadir ≤ 0.2 than in patients with post-operative PSA nadir >0.2 (P = 0.02), and tended to be more favorable after radiotherapy ≤ 3 months from surgery than >3 months from surgery (P = 0.069). Multivariate analysis identified SVI and post-operative PSA nadir as independent prognostic factors for bRFS (P = 0.001 and 0.018, respectively).
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Affiliation(s)
- Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, 54 Shogoin-kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuo Ejima
- Department of Radiology, Dokkyo Medical University, 880 Kita-kobayashi, Mibu-cho, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai Miyagi 980-8575, Japan
| | - Yoshifumi Tamai
- Department of Radiation Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Nobuaki Nakajima
- Department of Radiology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku Shizuoka 420-8527, Japan
| | - Shinya Takemoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Aichi 467-8601, Japan
| | - Masaki Kokubo
- Division of Radiation Oncology, Institute of Biomedical Research and Innovation Hospital, 2-2 Minatojima Minami-machi, Chuo-ku Kobe, Hyogo 650-0047, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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Heemsbergen WD, Al-Mamgani A, Slot A, Dielwart MF, Lebesque JV. Long-term results of the Dutch randomized prostate cancer trial: Impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol 2014; 110:104-9. [DOI: 10.1016/j.radonc.2013.09.026] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
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Dose escalation using ultra-high dose IMRT in intermediate risk prostate cancer without androgen deprivation therapy: preliminary results of toxicity and biochemical control. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:103. [PMID: 24330467 PMCID: PMC3878738 DOI: 10.1186/1756-9966-32-103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
Background To investigate the feasibility of dose escalation (86 Gy at 2 Gy/fraction) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer without androgen deprivation therapy. Methods Patients with histologically proven adenocarcinoma of the prostate, intermediate prognostic category, were enrolled in this study. Early and late toxicity were scored according to the Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. Treatment outcome was stated in terms of biochemical failure, biopsy result and clinical failure. Results 39 patients with a median follow-up of 71 months were analyzed. No patient experienced G3 or G4 acute gastrointestinal (GI) or genitourinary (GU) toxicity. G2 acute GI and GU toxicity were observed in 17 (44%) and 20 (51%) patients, respectively. Fourteen patients (36%) did not experience acute GI toxicity and 4 patients (10%) did not experience acute GU toxicity. G2 late GI bleeding occurred in 7 of 39 patients (18%). Both G3 and G4 late GI toxicity were seen only in one patient (2.5%). Two patients (5%) experienced G2 late GU toxicity, while G3 late GU toxicity occurred in 3 patients (8%). The 5-year actuarial freedom from biochemical failure (FFBF) was 87%. Thirty-four patients (87%) did not show biochemical relapse. Seventeen patients (44%) underwent biopsy two year after radiotherapy; of these only two were non-negative and both did not show evidence of biochemical disease. Conclusions IMRT treatment of patients with localized intermediate-risk prostate cancer at high dose levels without using androgen deprivation therapy (ADT) seems to give good disease control. Nevertheless, future trials should aim at further decreasing toxicity by exploiting image guidance techniques and by reducing the dose delivered at the interface between organs at risk and prostate.
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Dong P, Nguyen D, Ruan D, King C, Long T, Romeijn E, Low DA, Kupelian P, Steinberg M, Yang Y, Sheng K. Feasibility of prostate robotic radiation therapy on conventional C-arm linacs. Pract Radiat Oncol 2013; 4:254-60. [PMID: 25012834 DOI: 10.1016/j.prro.2013.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Significant dosimetric improvement for radiation therapy using optimized noncoplanar fields has been previously demonstrated. The purpose here is to study the feasibility of optimized robotic noncoplanar radiation therapy, termed 4π therapy, for prostate cancer treatments on a conventional C-arm linac. METHODS AND MATERIALS Twelve low-risk prostate cancer patients previously treated by 2-arc volumetric modulated arc therapy (VMAT) were selected. Forty gray in 5 fractions were prescribed to cover 95% of the prostate planning target volume (PTV). To replan by 4π therapy, a column generation method was used to optimize beam orientations and fluence. A total of 30 beams were selected for each patient. RESULTS Both planning methods provided adequate PTV coverage. Compared against VMAT plans, the 4π plan reduced the rectum V50%, V80%, V90%, D1cc, and the penile bulb maximum doses by 50%, 28%, 19% 11%, and 9% (P < .005), respectively, and the mean body dose was reduced from 2.07 Gy to 1.75 Gy (P = .0001). The bladder dose was only slightly reduced. CONCLUSIONS By optimizing beam angles and fluences in the noncoplanar solution space, superior prostate treatment plan quality was achieved compared against state of the art VMAT plans. The dosimetric potential for 4π therapy is established on an existing C-arm linac platform.
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Affiliation(s)
- Peng Dong
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Dan Nguyen
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Christopher King
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Troy Long
- Department of Industrial and Operations, University of Michigan, Ann Arbor, Michigan
| | - Edwin Romeijn
- Department of Industrial and Operations, University of Michigan, Ann Arbor, Michigan
| | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Michael Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Yingli Yang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
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Stereotactic body radiation therapy for the primary treatment of localized prostate cancer. ACTA ACUST UNITED AC 2012; 2:63-70. [PMID: 23504305 PMCID: PMC3594824 DOI: 10.1007/s13566-012-0067-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/30/2012] [Indexed: 01/26/2023]
Abstract
Objective The low alpha/beta ratio of prostate cancer suggests that hypofractionated schemes of dose-escalated radiotherapy should be advantageous. We report our experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer to assess efficacy and toxicity. Methods From 2007 to 2010, 70 patients (51 % low risk, 31 % intermediate risk, and 17 % high risk) with localized prostate cancer were treated with SBRT using the CyberKnife system. One-third of patients received androgen deprivation therapy. Doses of 37.5 Gy (n = 29), 36.25 Gy (n = 36), and 35 Gy (n = 5) were administered in five fractions and analyzed as high dose (37.5 Gy) vs. low dose (36.25 and 35 Gy). Results At a median 27 and 37 months follow-up, the low and high dose groups' median PSA nadir to date was 0.3 and 0.2 ng/ml, respectively. The 3-year freedom from biochemical failure (FFBF) was 100 %, 95.0 % and 77.1 % for the low-, intermediate- and high-risk patients. A dose response was observed in intermediate- and high-risk patients with 72 % vs. 100 % 3-year FFBF for the low and high dose groups, respectively (p = 0.0363). Grade III genitourinary toxicities included 4 % acute and 3 % late (all high dose). Potency was preserved in 83 % of hormone naïve patients. Conclusion CyberKnife dose escalated SBRT for low-, intermediate- and high-risk prostate cancer exhibits favorable efficacy with acceptable toxicity.
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Wootton LS, Kudchadker RJ, Beddar AS, Lee AK. Effectiveness of a novel gas-release endorectal balloon in the removal of rectal gas for prostate proton radiation therapy. J Appl Clin Med Phys 2012; 13:3945. [PMID: 22955660 PMCID: PMC5718230 DOI: 10.1120/jacmp.v13i5.3945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/01/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022] Open
Abstract
Endorectal balloons (ERBs) are routinely used in prostate proton radiation therapy to immobilize the prostate and spare the rectal wall. Rectal gas can distend the rectum and displace the prostate even in the presence of ERBs. The purpose of this work was to quantify the effects an ERB with a passive gas release conduit had on the incidence of rectal gas. Fifteen patients who were treated with a standard ERB and 15 with a gas-release ERB were selected for this retrospective study. Location and cross-sectional area of gas pockets and the fraction of time they occurred on 1133 lateral kilovoltage (kV) images were analyzed. Gas locations were classified as trapped between the ERB and anterior rectal wall, between the ERB and posterior rectal wall, or superior to the ERB. For patients using the standard ERB, gas was found in at least one region in 45.8% of fractions. Gas was trapped in the anterior region in 37.1% of fractions, in the posterior region in 5.0% of fractions, and in the sigmoid region in 9.6% of fractions. For patients using the ERB with the gas-release conduit, gas was found in at least one region in 19.7% of fractions. Gas was trapped in the anterior region in 5.6% of fractions, in the posterior region in 8.3% of fractions, and in the sigmoid region in 7.4% of fractions. Both the number of fractions with gas in the anterior region and the number of fractions with gas in at least one region were significantly higher in the former group than in the latter. The cross-sectional area of trapped gas did not differ between the two groups. Thus gas-release balloon can effectively release gas, and may be able to improve clinical workflow by reducing the need for catheterization.
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Affiliation(s)
- Landon S Wootton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity. JOURNAL OF RADIOTHERAPY IN PRACTICE 2012. [DOI: 10.1017/s1460396911000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurpose: To evaluate the toxicity of hypofractionated helical intensity-modulated radiotherapy (IMRT) for men with intermediate- and high-risk prostate cancer.Methods and Materials: A retrospective toxicity analysis was performed in 22 patients treated definitively with hypofractionated helical IMRT. The helical IMRT were designed to deliver 75 Gy in 2.5 Gy/fraction to the prostate gland, 63 Gy in 2.1 Gy/fraction to seminal vesicle, and 54 Gy in 1.8 Gy/fraction to pelvic lymph nodes. No patient received hormonal therapy. Toxicity was graded by the Radiation Therapy Oncology Group (RTOG) scales.Results: All patients tolerated the treatment well without treatment interruption, and there was no Grade 3 or more acute toxicity. With a median follow-up of 24.5 months, there was no Grade 3 or more late toxicity. The late Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity for total 22 patients were 9.1% and 18.2%, respectively, and the late Grade 1 GI and GU toxicity were 18.2% and 50%, respectively. Late GU toxicity was associated with greater bladder volume irradiated ≥70 Gy. Late GI toxicity did not correlate with any of the dosimetric parameters.Conclusions: This study demonstrate that hypofractionated helical IMRT with high biologic effective dose (BED) is well tolerated with favourable toxicity rate. If longer follow-up periods and larger cohorts confirm the favourable biochemical control rate and our favourable toxicity assessment results, the hypofractionated IMRT (total 75 Gy, 2.5 Gy/fraction) might be implemented in clinical field for treatment of prostate cancer.
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Kozakai N, Kikuchi E, Hasegawa M, Suzuki E, Ide H, Miyajima A, Horiguchi Y, Nakashima J, Umezawa K, Shigematsu N, Oya M. Enhancement of radiosensitivity by a unique novel NF-κB inhibitor, DHMEQ, in prostate cancer. Br J Cancer 2012; 107:652-7. [PMID: 22805327 PMCID: PMC3419964 DOI: 10.1038/bjc.2012.321] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Inducible activation of nuclear factor (NF)-κB is one of the principal mechanisms through which resistant prostate cancer cells are protected from radiotherapy. We hypothesised that inactivation of inducible NF-κB with a novel NF-κB inhibitor, DHMEQ, would increase the therapeutic effects of radiotherapy. Methods: PC-3 and LNCaP cells were exposed to irradiation and/or DHMEQ. Cell viability, cell cycle analysis, western blotting assay, and NF-κB activity were measured. The antitumour effect of irradiation combined with DHMEQ in vivo was also assessed. Results: The combination of DHMEQ with irradiation resulted in cell growth inhibition and G2/M arrest relative to treatment with irradiation alone. Inducible NF-κB activity by irradiation was inhibited by DHMEQ treatment. The expression of p53 and p21 in LNCaP, and of 14-3-3σ in PC-3 cells, was increased in the combination treatment. In the in vivo study, 64 days after the start of treatment, tumour size was 85.1%, 77.1%, and 64.7% smaller in the combination treatment group than that of the untreated control, DHMEQ-treated alone, and irradiation alone groups, respectively. Conclusion: Blockade of NF-κB activity induced by radiation with DHMEQ could overcome radio-resistant responses and may become a new therapeutic modality for treating prostate cancer.
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Affiliation(s)
- N Kozakai
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Spratt DE, Pei X, Yamada J, Kollmeier MA, Cox B, Zelefsky MJ. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 85:686-92. [PMID: 22795805 DOI: 10.1016/j.ijrobp.2012.05.023] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/11/2012] [Accepted: 05/15/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To report long-term survival and toxicity outcomes with the use of high-dose intensity modulated radiation therapy (IMRT) to 86.4 Gy for patients with localized prostate cancer. METHODS AND MATERIALS Between August 1997 and December 2008, 1002 patients were treated to a dose of 86.4 Gy using a 5-7 field IMRT technique. Patients were stratified by prognostic risk group based on National Comprehensive Cancer Network risk classification criteria. A total of 587 patients (59%) were treated with neoadjuvant and concurrent androgen deprivation therapy. The median follow-up for the entire cohort was 5.5 years (range, 1-14 years). RESULTS For low-, intermediate-, and high-risk groups, 7-year biochemical relapse-free survival outcomes were 98.8%, 85.6%, and 67.9%, respectively (P<.001), and distant metastasis-free survival rates were 99.4%, 94.1%, and 82.0% (P<.001), respectively. On multivariate analysis, T stage (P<.001), Gleason score (P<.001), and >50% of initial biopsy positive core (P=.001) were predictive for distant mestastases. No prostate cancer-related deaths were observed in the low-risk group. The 7-year prostate cancer-specific mortality (PCSM) rates, using competing risk analysis for intermediate- and high-risk groups, were 3.3% and 8.1%, respectively (P=.008). On multivariate analysis, Gleason score (P=.004), percentage of biopsy core positivity (P=.003), and T-stage (P=.033) were predictive for PCSM. Actuarial 7-year grade 2 or higher late gastrointestinal and genitourinary toxicities were 4.4% and 21.1%, respectively. Late grade 3 gastrointestinal and genitourinary toxicity was experienced by 7 patients (0.7%) and 22 patients (2.2%), respectively. Of the 427 men with full potency at baseline, 317 men (74%) retained sexual function at time of last follow-up. CONCLUSIONS This study represents the largest cohort of patients treated with high-dose radiation to 86.4 Gy, using IMRT for localized prostate cancer, with the longest follow-up to date. Our findings indicate that this treatment results in excellent clinical outcomes with acceptable toxicity.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Patient positioning variations to reduce dose to normal tissues during 3D conformal radiotherapy for high-risk prostate cancer. Strahlenther Onkol 2012; 188:816-22. [PMID: 22614029 DOI: 10.1007/s00066-012-0126-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this work was to assess optimal treatment positioning of 3D conformal radiotherapy (3DCRT) for high-risk prostate cancer patients. PATIENTS AND METHODS Treatment plans of 25 patients in different patient positions were evaluated: with knee and ankle support (KAS) in the supine position and with a belly board (BB) in the prone position both with full (FB) and empty bladder (EB). Planning target volumes (PTVs) for pelvis, prostate and vesicles, prostate, and organs at risk (OARs) were delineated. Dose and overlapping volumes were evaluated. RESULTS Overlapping volumes were significantly smaller with a FB than with an EB. No significant differences were found in overlapping volumes with respect to patient fixation systems, but the percentage values of dose to the OARs showed significantly better results employing KAS than a BB. A FB reduced the dose volumes to the OARs. Comparison with respect to circumference of abdomen (CA) showed significantly smaller overlapping at large CA in most of the cases. CONCLUSION Supine position is suggested with KAS combined with a FB (especially in cases of larger CA) when using 3DCRT with planning technique modification for high-risk prostate cancer patients to reduce the dose of OARs, based on our results.
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Delouya G, Kaufman G, Sylvestre MP, Nguyen TV, Bahary JP, Taussky D, Després P. The importance of an exponential prostate-specific antigen decline after external beam radiotherapy for intermediate risk prostate cancer. Cancer Epidemiol 2012; 36:e137-41. [DOI: 10.1016/j.canep.2011.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 09/16/2011] [Accepted: 10/20/2011] [Indexed: 11/28/2022]
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35
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Senthi S, Gill SS, Haworth A, Kron T, Cramb J, Rolfo A, Thomas J, Duchesne GM, Hamilton CH, Joon DL, Bowden P, Foroudi F. Benchmarking Dosimetric Quality Assessment of Prostate Intensity-Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 2012; 82:998-1005. [DOI: 10.1016/j.ijrobp.2010.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 12/05/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
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36
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Lock M, Best L, Wong E, Bauman G, D'Souza D, Venkatesan V, Sexton T, Ahmad B, Izawa J, Rodrigues G. A Phase II Trial of Arc-Based Hypofractionated Intensity-Modulated Radiotherapy in Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2011; 80:1306-15. [DOI: 10.1016/j.ijrobp.2010.04.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/08/2010] [Accepted: 04/07/2010] [Indexed: 11/17/2022]
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Gouazé-Andersson V, Flowers M, Karimi R, Fabriás G, Delgado A, Casas J, Cabot MC. Inhibition of acid ceramidase by a 2-substituted aminoethanol amide synergistically sensitizes prostate cancer cells to N-(4-hydroxyphenyl) retinamide. Prostate 2011; 71:1064-73. [PMID: 21557271 DOI: 10.1002/pros.21321] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 11/18/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the therapeutic efficacy of fenretinide (4-HPR), a ceramide-generating anticancer agent, could be enhanced in prostate cancer cells by inclusion of a novel synthetic acid ceramidase (AC) inhibitor, DM102, a pivaloylamide of a 2-substituted aminoethanol. In prostate cancer, AC plays a role in progression and resistance to chemotherapy. METHODS PC-3 and DU 145 hormone-refractory human prostate cancer cell lines were used. Cells were exposed to 4-HPR, DM102, and combinations; viability, apoptosis, cell migration, ceramide metabolism, and levels of reactive oxygen species (ROS) were assessed. RESULTS Single agent 4-HPR and DM102 (2.5-10 µM) were weakly cytotoxic; however, combinations synergistically decreased cell viably to as low as 1.5% of control. N-oleoylethanolamine (NOE), a frequently employed AC inhibitor, was not effective in producing synergy. The 4-HPR/DM102 regimen enhanced caspase activity and increased [(3) H](dihydro)ceramide and ROS levels 6- and 30-fold over control, respectively. The antioxidant vitamin E, but not the de novo ceramide synthesis inhibitor myriocin, partially rescued cells from 4-HPR/DM102 cytotoxicity. The 4-HPR/DM102 combination also elicited synergistic cytotoxicity in DU 145 cells, another human hormone-refractory prostate cancer cell line. CONCLUSION This study shows that 4-HPR cytotoxicity is enhanced in a synergistic fashion by inclusion of the AC inhibitor DM102, by a mechanism that enlists generation of ROS, and thus provides a system to raise 4-HPR therapeutic potential. The role of ceramide however in the cytotoxic response is not clear, as blocking ceramide generation failed to rescue PC-3 cells from 4-HPR/DM102 cytotoxicity.
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Residual prostate cancer in patients treated with endocrine therapy with or without radical radiotherapy: a side study of the SPCG-7 randomized trial. Int J Radiat Oncol Biol Phys 2011; 80:55-61. [PMID: 20598453 DOI: 10.1016/j.ijrobp.2010.01.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE The Scandinavian Prostate Cancer Group-7 randomized trial demonstrated a survival benefit of combined endocrine therapy and external-beam radiotherapy over endocrine therapy alone in patients with high-risk prostate cancer. In a subset of the study population, the incidence and clinical implications of residual prostate cancer in posttreatment prostate biopsy specimens was evaluated. METHODS AND MATERIALS Biopsy specimens were obtained from 120 of 875 men in the Scandinavian Prostate Cancer Group-7 study. RESULTS Biopsies were performed at median of 45 months follow-up. In 63 patients receiving endocrine treatment only and 57 patients receiving combined treatment, residual cancer was found in 66% (n = 41) and 22% (n = 12), respectively (p < 0.0001). The vast majority of residual tumors were poorly differentiated (Gleason score ≥ 8). Endocrine therapy alone was predictive of residual prostate cancer: odds ratio 7.49 (3.18-17.7), p < 0.0001. In patients with positive vs. negative biopsy the incidences of clinical events were as follows: biochemical recurrence 74% vs. 27% (p < 0.0001), local progression 26% vs. 4.7% (p = 0.002), distant recurrence 17% vs. 9.4% (p = 0.27), clinical recurrence 36% vs. 13% (p = 0.006), cancer-specific death 19% vs. 9.7% (p = 0.025). In multivariable analysis, biochemical recurrence was significantly associated with residual cancer: hazard ratio 2.69 (1.45-4.99), p = 0.002, and endocrine therapy alone hazard ratio 3.45 (1.80-6.62), p < 0.0001. CONCLUSIONS Radiotherapy combined with hormones improved local tumor control in comparison with endocrine therapy alone. Residual prostate cancer was significantly associated with serum prostate-specific antigen recurrence, local tumor progression, clinical recurrence, and cancer-specific death in univariable analysis. Residual cancer was predictive of prostate-specific antigen recurrence in multivariable analysis.
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A Method for the Prediction of Late Organ-at-Risk Toxicity After Radiotherapy of the Prostate Using Equivalent Uniform Dose. Int J Radiat Oncol Biol Phys 2011; 80:608-13. [DOI: 10.1016/j.ijrobp.2010.07.1994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/26/2010] [Accepted: 07/16/2010] [Indexed: 11/17/2022]
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Block AM, Lin J, Hoggarth MA, Quinn M, Garza R, Mantz CA, Roeske JC. Dose-volume factors to select patient-specific image-guidance action thresholds in prostate cancer. Technol Cancer Res Treat 2011; 10:211-7. [PMID: 21517127 DOI: 10.7785/tcrt.2012.500196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
For radiation delivery tracking systems that monitor intrafraction prostate motion, generalized departmental threshold protocols may be used. The purpose of this study is to determine whether predefined action thresholds can be generally applied or if patient-specific action thresholds may be required. Software algorithms were developed in the MatLab (The Mathworks Inc., Natick, MA) software environment to simulate shifts of the patient structure set consisting of prostate, bladder, and rectum. These structures were shifted by 1/2 10 mm in each direction in 1 mm increments to simulate displacements during treatment, without taking into consideration organ deformity. Dose-volume data at each shift were plotted and analyzed. A linear relationship was observed between planning dose-volume parameters and shifted dose-volume parameters. For a 5 mm anterior shift, it was observed that individual rectal V70 values increased by absolute magnitudes of 6-15%, dependent on the planning rectal V70 of each patient. Likewise, for a 5 mm inferior shift, individual bladder V70 values increased by 1-14%, dependent on planning bladder V70. This linear relationship was observed for all levels of shifts up to 10 mm. Since rectum and bladder dose-volume changes due to patient shifts are dependent on dose-volume parameters, this study suggests that patient-specific action thresholds may be necessary.
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Affiliation(s)
- A M Block
- Stritch School of Medicine and Department of Radiation Oncology, Loyola University Medical Center, 2160 S. First Ave. Maguire Center - Rm. 2946, Maywood, IL 60153, USA
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A significant decrease in rectal volume and diameter during prostate IMRT. Radiother Oncol 2011; 98:187-91. [DOI: 10.1016/j.radonc.2010.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 10/06/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
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Hayden AJ, Martin JM, Kneebone AB, Lehman M, Wiltshire KL, Skala M, Christie D, Vial P, McDowall R, Tai KH. Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma. J Med Imaging Radiat Oncol 2010; 54:513-25. [DOI: 10.1111/j.1754-9485.2010.02214.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hennequin C, Rivera S, Quero L, Latorzeff I. Cancer de prostate : doses et volumes cibles. Cancer Radiother 2010; 14:474-8. [DOI: 10.1016/j.canrad.2010.07.229] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 07/05/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
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Miralbell R, Mollà M, Rouzaud M, Hidalgo A, Toscas JI, Lozano J, Sanz S, Ares C, Jorcano S, Linero D, Escudé L. Hypofractionated Boost to the Dominant Tumor Region With Intensity Modulated Stereotactic Radiotherapy for Prostate Cancer: A Sequential Dose Escalation Pilot Study. Int J Radiat Oncol Biol Phys 2010; 78:50-7. [PMID: 19910135 DOI: 10.1016/j.ijrobp.2009.07.1689] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 06/18/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Konski A. Cost-effectiveness of intensity-modulated radiation therapy. Expert Rev Pharmacoecon Outcomes Res 2010; 5:137-40. [PMID: 19807569 DOI: 10.1586/14737167.5.2.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Technical advances have given medicine the opportunity to refine current treatment techniques to improve outcomes. Computed tomography, magnetic resonance imaging and high energy linear accelerators are but a few examples of technology translating into clinical practice. Intensity-modulated radiation therapy is a form of 3D conformal radiation that is being increasingly incorporated into the management of patients with prostate cancer. As with any new technology, the cost of intensity-modulated radiation therapy is considerably greater than standard therapy. Economic models can be useful to compare treatments when this comparison cannot be performed in a clinical trial. A Markov Model was used to compare the use of intensity-modulated radiation with 3D conformal radiation therapy in the treatment of a 70 year old man with a good- and intermediate-risk prostate cancer. Cost data for men with Medicare insurance and prostate cancer treated with intensity-modulated radiation therapy and 3D conformal radiation therapy was obtained from the billing department at the Fox Chase Cancer Center (PA, USA). Utilities were collected from men undergoing intensity-modulated radiation therapy and 3D conformal radiation therapy for prostate cancer. Intensity-modulated radiation therapy was found to be cost effective in the treatment of a 70 year old man with prostate cancer with a incremental cost-effectiveness ratio of USD 16,182/quality-adjusted life year for men with intermediate-risk prostate cancer and USD 17,448/ quality-adjusted life year for men with good-risk prostate cancer. Sensitivity analysis found that a longer time horizon of the analysis and younger age at treatment favorably impact the cost-effectiveness ratio.
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Affiliation(s)
- Andre Konski
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA 19111, USA.
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Smeenk RJ, Teh BS, Butler EB, van Lin EN, Kaanders JH. Is there a role for endorectal balloons in prostate radiotherapy? A systematic review. Radiother Oncol 2010; 95:277-82. [DOI: 10.1016/j.radonc.2010.04.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 01/21/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Kuban DA, Levy LB, Cheung MR, Lee AK, Choi S, Frank S, Pollack A. Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? Int J Radiat Oncol Biol Phys 2010; 79:1310-7. [PMID: 20493642 DOI: 10.1016/j.ijrobp.2010.01.006] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 12/17/2009] [Accepted: 01/07/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE To report long-term failure patterns and survival in a randomized radiotherapy dose escalation trial for prostate cancer. MATERIALS AND METHODS A total of 301 patients with Stage T1b-T3 prostate cancer treated to 70 Gy versus 78 Gy now have a median follow-up of 9 years. Failure patterns and survival were compared between dose levels. The cumulative incidence of death from prostate cancer versus other causes was examined and regression analysis was used to establish predictive factors. RESULTS Patients with pretreatment prostate-specific antigen (PSA) >10 ng/mL or high-risk disease had higher biochemical and clinical failures rates when treated to 70 Gy. These patients also had a significantly higher risk of dying of prostate cancer. Patients <70 years old at treatment died of prostate cancer nearly three times more frequently than of other causes when they were radiated to 70 Gy, whereas those treated to 78 Gy died of other causes more frequently. Patients age 70 or older treated to 70 Gy died of prostate cancer as often as other causes, and those receiving 78 Gy never died of prostate cancer within 10 years of follow-up. In regression analysis, factors predicting for death from prostate cancer were pretreatment PSA >10.5 ng/mL, Gleason score 9 and 10, recurrence within 2.6 years of radiation, and doubling time of <3.6 months at the time of recurrence. CONCLUSIONS Moderate dose escalation (78 Gy) decreases biochemical and clinical failure as well as prostate cancer death in patients with pretreatment PSA >10 ng/mL or high-risk disease.
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Affiliation(s)
- Deborah A Kuban
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030., USA.
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Kron T, Thomas J, Fox C, Thompson A, Owen R, Herschtal A, Haworth A, Tai KH, Foroudi F. Intra-fraction prostate displacement in radiotherapy estimated from pre- and post-treatment imaging of patients with implanted fiducial markers. Radiother Oncol 2010; 95:191-7. [DOI: 10.1016/j.radonc.2010.01.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 01/21/2010] [Accepted: 01/23/2010] [Indexed: 11/28/2022]
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Doležel M, Odrazka K, Vaculikova M, Vanasek J, Sefrova J, Paluska P, Zouhar M, Jansa J, Macingova Z, Jarosova L, Brodak M, Moravek P, Hartmann I. Dose Escalation in Prostate Radiotherapy up to 82 Gy Using Simultaneous Integrated Boost. Strahlenther Onkol 2010; 186:197-202. [DOI: 10.1007/s00066-010-2065-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 12/22/2009] [Indexed: 11/29/2022]
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Niyazi M, Bartenstein P, Belka C, Ganswindt U. Choline PET based dose-painting in prostate cancer--modelling of dose effects. Radiat Oncol 2010; 5:23. [PMID: 20298546 PMCID: PMC2848061 DOI: 10.1186/1748-717x-5-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/18/2010] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Several randomized trials have documented the value of radiation dose escalation in patients with prostate cancer, especially in patients with intermediate risk profile. Up to now dose escalation is usually applied to the whole prostate. IMRT and related techniques currently allow for dose escalation in sub-volumes of the organ. However, the sensitivity of the imaging modality and the fact that small islands of cancer are often dispersed within the whole organ may limit these approaches with regard to a clear clinical benefit. In order to assess potential effects of a dose escalation in certain sub-volumes based on choline PET imaging a mathematical dose-response model was developed. METHODS Based on different assumptions for alpha/beta, gamma 50, sensitivity and specificity of choline PET, the influence of the whole prostate and simultaneous integrated boost (SIB) dose on tumor control probability (TCP) was calculated. Based on the given heterogeneity of all potential variables certain representative permutations of the parameters were chosen and, subsequently, the influence on TCP was assessed. RESULTS Using schedules with 74 Gy within the whole prostate and a SIB dose of 90 Gy the TCP increase ranged from 23.1% (high detection rate of choline PET, low whole prostate dose, high gamma 50/ASTRO definition for tumor control) to 1.4% TCP gain (low sensitivity of PET, high whole prostate dose, CN + 2 definition for tumor control) or even 0% in selected cases. The corresponding initial TCP values without integrated boost ranged from 67.3% to 100%. According to a large data set of intermediate-risk prostate cancer patients the resulting TCP gains ranged from 22.2% to 10.1% (ASTRO definition) or from 13.2% to 6.0% (CN + 2 definition). DISCUSSION Although a simplified mathematical model was employed, the presented model allows for an estimation in how far given schedules are relevant for clinical practice. However, the benefit of a SIB based on choline PET seems less than intuitively expected. Only under the assumption of high detection rates and low initial TCP values the TCP gain has been shown to be relevant. CONCLUSIONS Based on the employed assumptions, specific dose escalation to choline PET positive areas within the prostate may increase the local control rates. Due to the lack of exact PET sensitivity and prostate alpha/beta parameter, no firm conclusions can be made. Small variations may completely abrogate the clinical benefit of a SIB based on choline PET imaging.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Claus Belka
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
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