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Deodato F, Ferro M, Bonome P, Pezzulla D, Romano C, Buwenge M, Cilla S, Morganti AG, Macchia G. Stereotactic body radiotherapy (SIB-VMAT technique) to dominant intraprostatic lesion (DIL) for localized prostate cancer: a dose-escalation trial (DESTROY-4). Strahlenther Onkol 2024; 200:239-249. [PMID: 38180492 DOI: 10.1007/s00066-023-02189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE DESTROY-4 (DOSE-ESCALATION STUDY OF STEREOTACTIC BODY RADIATION THERAPY) was a Phase I trial aimed to evaluate the safety and the feasibility of escalating doses of stereotactic body radiation therapy (SBRT) on MRI-defined Dominant Intraprostatic Lesion (DIL) in low- and intermediate-risk pCa patients using a simultaneous integrated boost-volumetric arc therapy (SIB-VMAT) technique. METHODS Eligible patients included those with low- and intermediate-risk prostate carcinoma (NCCN risk classes) and an International Prostatic Symptoms Score (IPSS) ≤ 15. No restriction about DIL and prostate volumes was set. Pretreatment preparation required an enema and the placement of intraprostatic gold fiducials. SBRT was delivered in five consecutive daily fractions. For the first three patients, the DIL radiation dose was set at 8 Gy per fraction up to a total dose of 40 Gy (PTV1) and was gradually increased in succeeding cohorts to total doses of 42.5 Gy, 45.0 Gy, 47.5 Gy, and finally, 50.0 Gy, while keeping the prescription of 35 Gy/7 Gy per fraction for the entire prostate gland. Dose-limiting toxicity (DLT) was defined as grade 3 or worse gastrointestinal (GI) or genitourinary (GU) toxicity occurring within 90 days of follow-up (Common Terminology Criteria of Adverse Events scale 4.0). Patients completed quality-of-life questionnaires at defined intervals. RESULTS Twenty-four patients with a median age of 75 (range, 58-89) years were enrolled. The median follow-up was 26.3 months (8.9-84 months). 66.7% of patients were classified as intermediate-risk groups, while the others were low-risk groups, according to the NCCN guidelines. Enrolled patients were treated as follows: 8 patients (40 Gy), 5 patients (42.5 Gy), 4 patients (45 Gy), 4 patients (47.5 Gy), and 3 patients (50 Gy). No severe acute toxicities were observed. G1 and G2 acute GU toxicities occurred in 4 (16%) and 3 patients (12.5%), respectively. Two patients (8.3%) and 3 patients (12.5%) experienced G1 and G2 GI toxicities, respectively. Since no DLTs were observed, 50 Gy in five fractions was considered the MTD. The median nadir PSA was 0.20 ng/mL. A slight improvement in QoL values was registered after the treatment. CONCLUSION This trial confirms the feasibility and safety of a total SIB-VMAT dose of 35 Gy on the whole gland and 50 Gy on DIL in 5 fractions daily administered in a well-selected low- and intermediate-risk prostate carcinoma population. A phase II study is ongoing to confirm the tolerability of the schedule and assess the efficacy.
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Affiliation(s)
- Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Milena Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
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De Cock L, Draulans C, Pos FJ, Isebaert S, De Roover R, van der Heide UA, Smeenk RJ, Kunze-Busch M, van der Voort van Zyp J, de Boer H, Kerkmeijer LGW, Haustermans K. From once-weekly to semi-weekly whole prostate gland stereotactic radiotherapy with focal boosting: Primary endpoint analysis of the multicenter phase II hypo-FLAME 2.0 trial. Radiother Oncol 2023; 185:109713. [PMID: 37178932 DOI: 10.1016/j.radonc.2023.109713] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND PURPOSE The hypo-FLAME trial showed that once-weekly (QW) focal boosted prostate stereotactic body radiotherapy (SBRT) is associated with acceptable acute genitourinary (GU) and gastrointestinal (GI) toxicity. Currently, we investigated the safety of reducing the overall treatment time (OTT) of focal boosted prostate SBRT from 29 to 15 days. MATERIAL AND METHODS Patients with intermediate- and high-risk prostate cancer were treated with SBRT delivering 35 Gy in 5 fractions to the whole prostate gland with an iso-toxic boost up to 50 Gy to the intraprostatic lesion(s) in a semi-weekly (BIW) schedule. The primary endpoint was radiation-induced acute toxicity (CTCAE v5.0). Changes in quality of life (QoL) were examined in terms of proportions achieving a minimal clinically important change (MCIC). Finally, acute toxicity and QoL scores of the BIW schedule were compared with the results of the prior QW hypo-FLAME schedule (n = 100). RESULTS Between August 2020 and February 2022, 124 patients were enrolled and treated BIW. No grade ≥3 GU or GI toxicity was observed. The 90-days cumulative incidence of grade 2 GU and GI toxicity rates were 47.5% and 7.4%, respectively. Patients treated QW scored significant less grade 2 GU toxicity (34.0%, p = 0.01). No significant differences in acute GI toxicity were observed. Furthermore, patients treated QW had a superior acute bowel and urinary QoL. CONCLUSION Semi-weekly prostate SBRT with iso-toxic focal boosting is associated with acceptable acute GU and GI toxicity. Based on the comparison between the QW and BIW schedule, patients should be counselled regarding the short-term advantages of a more protracted schedule. Registration number ClinicalTrials.gov: NCT04045717.
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Affiliation(s)
- Lisa De Cock
- Department of Oncology, KU Leuven, Leuven, Belgium.
| | | | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Sofie Isebaert
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Hans de Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Karin Haustermans
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
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Lukka HR, Deshmukh S, Bruner DW, Bahary JP, Lawton CAF, Efstathiou JA, Kudchadker RJ, Ponsky LE, Seaward SA, Dayes IS, Gopaul DD, Michalski JM, Delouya G, Kaplan ID, Horwitz EM, Roach M, Feng FY, Pugh SL, Sandler HM, Kachnic LA. Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 116:770-778. [PMID: 36592721 PMCID: PMC10619484 DOI: 10.1016/j.ijrobp.2022.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE There is considerable interest in very short (ultrahypofractionated) radiation therapy regimens to treat prostate cancer based on potential radiobiological advantages, patient convenience, and resource allocation benefits. Our objective is to demonstrate that detectable changes in health-related quality of life measured by the bowel and urinary domains of the Expanded Prostate Cancer Index Composite (EPIC-50) were not substantially worse than baseline scores. METHODS AND MATERIALS NRG Oncology's RTOG 0938 is a nonblinded randomized phase 2 study of National Comprehensive Cancer Network low-risk prostate cancer in which each arm is compared with a historical control. Patients were randomized to 5 fractions (7.25 Gy in 2 week and a day [twice a week]) or 12 fractions (4.3Gy in 2.5 weeks [5 times a week]). Secondary objectives assessed patient-reported toxicity at 5 years using the EPIC. Chi-square tests were used to assess the proportion of patients with a deterioration from baseline of >5 points for bowel, >2 points for urinary, and >11 points for sexual score. RESULTS The study enrolled 127 patients to 5 fractions (121 eligible) and 128 patients to 12 fractions (125 eligible). The median follow-up for all patients at the time of analysis was 5.38 years. The 5-year frequency for >5 point change in bowel score were 38.4% (P = .27) and 23.4% (P = 0.98) for 5 and 12 fractions, respectively. The 5-year frequencies for >2 point change in urinary score were 46.6% (P = .15) and 36.4% (P = .70) for 5 and 12 fractions, respectively. For 5 fractions, 49.3% (P = .007) of patients had a drop in 5-year EPIC-50 sexual score of ≥11 points; for 12 fractions, 54% (P < .001) of patients had a drop in 5-year EPIC-50 sexual score of ≥11 points. Disease-free survival at 5 years is 89.6% (95% CI: 84.0-95.2) in the 5-fraction arm and 92.3% (95% CI: 87.4-97.1) in the 12-fraction arm. There was no late grade 4 or 5 treatment-related urinary or bowel toxicity. CONCLUSIONS This study confirms that, based on long-term changes in bowel and urinary domains and toxicity, the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.
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Affiliation(s)
- Himanshu R Lukka
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada.
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Universite´ de Montreal (CHUM), Montreal, Canada
| | | | | | | | - Lee E Ponsky
- Case Western Reserve University, Cleveland, Ohio
| | | | - Ian S Dayes
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada
| | | | | | - Guila Delouya
- Centre Hospitalier de l'Universite´ de Montreal (CHUM), Montreal, Canada
| | | | | | - Mack Roach
- University of California-San Francisco Medical Center, San Francisco, California
| | - Felix Y Feng
- University of California-San Francisco Medical Center, San Francisco, California
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Lisa A Kachnic
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada
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Bouleftour W, Guy JB, Moreno-Acosta P, Rodriguez Lafrasse C, Sargos P, Magné N. Challenges in radiobiology - technology duality as a key for a risk-free α/β ratio. Bull Cancer 2023:S0007-4551(23)00091-7. [PMID: 36872128 DOI: 10.1016/j.bulcan.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023]
Abstract
Since radiotherapy discovery, prediction of biological response to ionizing radiation remains a major challenge. Indeed, several radiobiological models appeared through radiotherapy history. Nominal single dose so popular in the 1970s, was tragically linked to the dark years in radiobiology by underestimating the late toxicity of the high-dose fractions. The actual prominent linear-quadratic model continues to prove to be an effective tool in radiobiology. Mainly with its pivotal α/β ratio, which gives a reliable estimate of tissues sensitivity to fractions. Despite these arguments, this model experiences limitations with substantial doubts of α/β ratio values. Interestingly, the story of radiobiology since X-ray discovery is truly instructive and teaches modern clinicians to refine fractionation schemes. Many fractionation schemes have been tested with successes or dramas. This review retraces radiobiological models' history, and confronts these models to new fractionation schemes, drawing a preventive message.
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Affiliation(s)
- Wafa Bouleftour
- University Hospital of Saint-Etienne, North Hospital, Medical oncology department, 42270 Saint-Priest-en-Jarez, France.
| | - Jean-Baptiste Guy
- Centre Marie-Curie, Radiotherapy department, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - Pablo Moreno-Acosta
- Clinical, Molecular and Cellular Radiobiology Research Group, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia
| | - Claire Rodriguez Lafrasse
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, UMR CNRS5822/IP2I, Université de Lyon, Lyon 1 University, 69921 Oullins, France; Université de Lyon, Lyon 1 University, UMR CNRS5822/IP2I, 69100 Villeurbanne, France
| | - Paul Sargos
- Institut Bergonié, Department of Radiation Oncology, 33076 Bordeaux, France
| | - Nicolas Magné
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, UMR CNRS5822/IP2I, Université de Lyon, Lyon 1 University, 69921 Oullins, France; Université de Lyon, Lyon 1 University, UMR CNRS5822/IP2I, 69100 Villeurbanne, France; Institut Bergonié, Department of Radiation Oncology, 33076 Bordeaux, France
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Hu W, Li P, Hong Z, Guo X, Pei Y, Zhang Z, Zhang Q. Functional imaging-guided carbon ion irradiation with simultaneous integrated boost for localized prostate cancer: study protocol for a phase II randomized controlled clinical trial. Trials 2022; 23:934. [PMID: 36348363 PMCID: PMC9644615 DOI: 10.1186/s13063-022-06798-5] [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: 12/21/2021] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Background Due to the physical dose distribution characteristic of “Bragg peak” and the biological effect as a kind of high linear energy transfer ray, heavy ion therapy has advantages over conventional photon therapy in both efficacy and safety. Based on the evidence that prostate cancer lesions before treatment are the most common sites of tumor residual or recurrence after treatment, simultaneous integrated boost radiation therapy for prostate cancer has been proven to have the advantage of improving efficacy without increasing toxicities. Methods This study is a prospective phase II randomized controlled clinical trial evaluating the efficacy and safety of functional imaging-guided carbon ion irradiation with simultaneous integrated boost for localized prostate cancer. One hundred and forty patients with localized prostate cancer will be randomized into carbon ion radiotherapy group and simultaneous integrated boost carbon ion radiotherapy group at a 1:1 ratio. The primary endpoint is to compare the incidence of treatment-related grade 2 and higher acute toxicities between the two groups according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03. Secondary endpoints are late toxicities, biochemical relapse-free survival, overall survival, progression-free survival, and quality of life. Discussion This study adopts functional imaging-guided simultaneous integrated boost of carbon ion radiotherapy for localized prostate cancer, aiming to evaluate the differences in the severity and incidence of acute toxicities in patients with localized prostate cancer treated with carbon ion radiotherapy and simultaneous integrated boost carbon ion radiotherapy, in order to optimize the carbon ion treatment strategy for localized prostate cancer. Trial registration ClinicalTrials.gov NCT05010343. Retrospectively registered on 18 August 2021
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Guerini AE, Noale M, Mortellaro G, Lisi R, Bruni A, Santini R, Muto P, Ferrera G, Cossali G, Morelli V, Magrini SM, Spiazzi L, Buglione M. Early results of PRO-EPI: PROspective multicenter observational study on elective pelvic nodes irradiation in patients with intermediate/high/very high-risk non-metastatic prostate cancer submitted to radical, adjuvant, or salvage radiotherapy with or without concomitant androgen deprivation therapy. Front Oncol 2022; 12:951220. [PMID: 36408148 PMCID: PMC9666761 DOI: 10.3389/fonc.2022.951220] [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: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary: Although radiotherapy plays a fundamental role in the management of intermediate/high/very high-risk non-metastatic prostatic cancer (IHR-nmPca), there is still no consensus on the optimal treatment strategy in this setting. Remarkably, the role of elective nodal irradiation (ENI) is still highly controversial. The PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) was designed to provide "real life" data regarding the patterns of care for IHR-nmPca. Forty-three Italian Radiation Oncology centers participated in the PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) project, with 1029 patients enrolled. In this preliminary analysis, we longitudinally evaluated the impact of Elective Nodal Irradiation (ENI) and radiotherapy features on toxicity and quality of life (QoL). Six months follow-up data were available for 913 patients and 12 months data for 762 patients. Elective Nodal Irradiation was given to 506 patients (48.9%). Volumetric Intensity-Modulated Radiation Therapy (IMRT) was adopted in more than 77% of patients and Image-Guided Radiation Therapy (IGRT) in 84.4%. Androgen deprivation therapy (ADT) was administered to the majority of patients (68.3%), and it was associated to ENI in 408 cases (81.1%). Toxicity was mostly mild and reversible and IGRT resulted in a significant reduction of rectal toxicity, although a non-significant trend toward increased urinary toxicity was observed. No statistically significant differences in QoL and toxicity were seen in patients treated with or without ENI. The adoption of IGRT is widespread and increasing and could reduce treatment toxicity. ENI is not yet the standard treatment, but it is performed in a growing fraction of cases and not resulting into an increase in toxicity or in a deterioration of QoL. Further analyses are needed to clarify the long-term toxicity profile and the impact of ENI on survival.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy,*Correspondence: Andrea Emanuele Guerini,
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Gianluca Mortellaro
- Department of Radiation Oncology, Azienda ospedaliera di rilievo nazionale e di alta specializzazione (ARNAS) Ospedale Civico, Palermo, Italy
| | - Roberto Lisi
- Department of Radiotherapy, Policlinico Umberto I “Sapienza” University of Rome, Rome, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, Modena, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori, “Fondazione G. Pascale”-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| | - Giuseppe Ferrera
- Department of Radiation Oncology, Azienda ospedaliera di rilievo nazionale e di alta specializzazione (ARNAS) Ospedale Civico, Palermo, Italy
| | - Gianluca Cossali
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | | | - Stefano Maria Magrini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
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Valeriani M, Di Staso M, Facondo G, Vullo G, De Sanctis V, Gravina GL, di Genesio Pagliuca M, Osti MF, Bonfili P. Hypofractionated Radiotherapy in Intermediate-Risk Prostate Cancer Patients: Long-Term Results. J Clin Med 2022; 11:jcm11164783. [PMID: 36013023 PMCID: PMC9410091 DOI: 10.3390/jcm11164783] [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: 07/27/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To evaluate outcomes in terms of survival and toxicity in a series of intermediate-risk prostate cancer (PCa) patients treated with hypofractionated radiotherapy (HyRT) + hormonal therapy (HT) with or without image guidance (IGRT) and to investigate the impact of different variables. Methods: This is a multi-centric study. From January 2005 to December 2019, we treated 313 intermediate-risk PCa patients (T2b−T2c, Gleason score 7, or pre-treatment PSA 10 to 20 ng/mL) with HyRT. Patients received 54.75 Gy in 15 fractions in 5 weeks plus 9 months of neo-adjuvant, concomitant, and adjuvant HT with or without IGRT. Results: Median follow-up was 91.6 months (range 5.1−167.8 months). Median OS was not reached, and the 8- and 10-year OS was 81.9% and 72.4%, respectively. Median CSS was not reached, and the 8- and 10-year CSS was 97.9% and 94.5%, respectively. PSA at first follow-up <0.8 ng/mL was significantly related to better oncological outcomes (CSS, bRFS, LRFS, cPFS, and MFS) in both univariate and multivariate analysis. After Propensity Score matching, grade 2−3 acute and cumulative late GU (p = 0.153 and p = 0.581, respectively) and GI (p = 0.196 and p = 0.925, respectively) toxicity were not statistically different in patients treated with or without IGRT. Conclusions: HyRT is effective and safe regardless of the use of IGRT. PSA at first follow-up is an easily accessible prognostic factor that may help the clinicians to identify patients who require a treatment intensification.
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Affiliation(s)
- Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, 00189 Rome, Italy
- Correspondence:
| | - Mario Di Staso
- Radiotherapy Oncology Unit, University of L’Aquila, St Salvatore Hospital, 67100 L’Aquila, Italy
| | - Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, 00189 Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, 00189 Rome, Italy
| | - Vitaliana De Sanctis
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, 00189 Rome, Italy
| | - Giovanni Luca Gravina
- Radiotherapy Oncology Unit, University of L’Aquila, St Salvatore Hospital, 67100 L’Aquila, Italy
| | | | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, 00189 Rome, Italy
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Brand DH, Kirby AM, Yarnold JR, Somaiah N. How Low Can You Go? The Radiobiology of Hypofractionation. Clin Oncol (R Coll Radiol) 2022; 34:280-287. [PMID: 35260319 DOI: 10.1016/j.clon.2022.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 12/25/2022]
Abstract
Hypofractionated radical radiotherapy is now an accepted standard of care for tumour sites such as prostate and breast cancer. Much research effort is being directed towards more profoundly hypofractionated (ultrahypofractionated) schedules, with some reaching UK standard of care (e.g. adjuvant breast). Hypofractionation exerts varying influences on each of the major clinical end points of radiotherapy studies: acute toxicity, late toxicity and local control. This review will discuss these effects from the viewpoint of the traditional 5 Rs of radiobiology, before considering non-canonical radiobiological effects that may be relevant to ultrahypofractionated radiotherapy. The principles outlined here may assist the reader in their interpretation of the wealth of clinical data presented in the tumour site-specific articles in this special issue.
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Affiliation(s)
- D H Brand
- The Institute of Cancer Research, London, UK
| | - A M Kirby
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - J R Yarnold
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - N Somaiah
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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9
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Lazo A, de la Torre-Luque A, Arregui G, Rivas D, Serradilla A, Gómez J, Jurado F, Núñez MI, López E. Long-Term Outcomes of Dose-Escalated Hypofractionated Radiotherapy in Localized Prostate Cancer. BIOLOGY 2022; 11:435. [PMID: 35336808 PMCID: PMC8945092 DOI: 10.3390/biology11030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
This retrospective study aimed to provide some clinical outcomes regarding effectiveness, toxicity, and quality of life in PCa patients treated with dose-escalated moderately hypofractionated radiation therapy (HFRT). Patients received HFRT to a total dose of 66 Gy in 22 fractions (3 Gy/fraction) delivered via volume modulated arc therapy (VMAT) in 2011-2016. Treatment effectiveness was measured by the biochemical failure-free survival rate. Toxicity was assessed according to the criteria of the Radiation Therapy Oncology Group (RTOG) and quality of life according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC). In this regard, quality of life (QoL) was measured longitudinally, at a median of 2 and 5 years after RT. Enrolled patients had low-risk (40.2%), intermediate-risk (47.5%), and high-risk (12.3%) PCa. Median follow-up was 75 months. The biochemical failure-free survival rate was 94.2%. The incidence of acute grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicity was 9.84% and 28.69%, respectively. The incidence rate of late grade 2 or higher GI and GU toxicity was 1.64% and 4.10%, respectively. Expanded Prostate Cancer Index Composite (EPIC) scores showed that the majority of patients maintained their QoL. HFRT to 66 Gy with VMAT was associated with adequate biochemical control, low toxicity and good reported GU and GI quality of life.
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Affiliation(s)
- Antonio Lazo
- Department of Radiation Oncology, San Cecilio Clinical University Hospital, 18016 Granada, Spain;
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, CIBERSAM, Complutense University of Madrid, 28040 Madrid, Spain
| | | | - Daniel Rivas
- Department of Radiation Oncology, GenesisCare, 29018 Malaga, Spain;
| | - Ana Serradilla
- Department of Radiation Oncology, GenesisCare, 18004 Granada, Spain;
| | - Joaquin Gómez
- Department of Radiation Oncology, Torrecardenas Hospitalary Complex, 04009 Almeria, Spain;
| | - Francisca Jurado
- Department of Radiation Oncology, GenesisCare, 14012 Cordoba, Spain;
| | - María Isabel Núñez
- Department of Radiology and Physical Medicine, Granada University, 18012 Granada, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, Granada University, 18016 Granada, Spain
- Biosanitary Research Institute, ibs. Granada, 18012 Granada, Spain
| | - Escarlata López
- Department of Radiation Oncology, GenesisCare, 28043 Madrid, Spain;
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10
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Takakusagi Y, Usui K, Mizoguchi N, Nagatsuka J, Hikage T, Kodama Y, Ezura T, Kusunoki T, Oizumi Y. Comparison of Moderate Hypofractionated Volumetric-Modulated Arc Therapy Plans With and Without Flattening Filter for Localized Prostate Cancer. Cureus 2021; 13:e18034. [PMID: 34671522 PMCID: PMC8520568 DOI: 10.7759/cureus.18034] [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] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aim The aim of this study was to compare volumetric-modulated arc therapy (VMAT) radiation plans between conventional VMAT with flattening filter (cFF-VMAT) and flattening filter-free VMAT (FFF-VMAT) for localized prostate cancer. Materials and methods Ten patients with localized prostate cancer who underwent cFF-VMAT at Yokosuka General Hospital Uwamachi, Yokosuka, Japan, from July 2020 to October 2020 were enrolled. Dose-volume histogram (DVH) parameters of the target volume, normal organs, monitor units (MU), and beam-on time (BOT) were compared between cFF-VMAT and FFF-VMAT plans. Results No significant difference was observed for DVH parameters for the target volume. No significant difference was observed in all parameters for the bladder and rectum between the cFF-VMAT and FFF-VMAT groups. The mean values of MU were 686 ± 52 and 784 ± 80 in cFF-VMAT and FFF-VMAT, respectively (p < 0.001). The mean BOT was 97.0 ± 6.6 s and 72.9 ± 1.4 s for cFF-VMAT and FFF-VMAT, respectively (p < 0.001). Conclusion DVH parameters of the target volume and normal organs were not significantly different between the cFF-VMAT and FFF-VMAT plans. In FFF-VMAT, MU was significantly higher, and the BOT was significantly shorter than those in cFF-VMAT.
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Affiliation(s)
- Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, JPN
| | - Keisuke Usui
- Department of Radiation Oncology, Juntendo University, Tokyo, JPN
| | | | - Jun Nagatsuka
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Takeshi Hikage
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Yasuhiko Kodama
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Takatomo Ezura
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, JPN
| | - Terufumi Kusunoki
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, JPN
| | - Yukio Oizumi
- Department of Radiation Oncology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
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11
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Zhao X, Ye Y, Yu H, Jiang L, Cheng C, Guo X, Ju X, Zhu X, Zhang H. Five-year outcomes of stereotactic body radiation therapy (SBRT) for prostate cancer: the largest experience in China. J Cancer Res Clin Oncol 2021; 147:3557-3564. [PMID: 34528135 PMCID: PMC8557180 DOI: 10.1007/s00432-021-03785-2] [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: 01/30/2021] [Accepted: 08/28/2021] [Indexed: 01/02/2023]
Abstract
Objective To evaluate the efficacy and safety of SBRT for localized prostate cancer (PCa) with CyberKnife in China. Moreover, it is the largest-to-date pilot study to report 5-year outcomes of SBRT for localized PCa from China. Methods In this retrospective study, 133 PCa patients in our center were treated by SBRT with CyberKnife (Accuray Inc., Sunnyvale, USA) from October 2012 to July 2019. Follow-up was performed every 3 months for efficacy and toxicity evaluation. Biochemical progression-free survival (bPFS) and toxicities were assessed using the Phoenix definition and the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0, respectively. Factors predictive of bPFS were identified with COX regression analysis. Results 133 patients (10 low-, 21 favorable intermediate-, 31 unfavorable intermediate-, 45 high-, and 26 very high risk cases on the basis of NCCN risk classification) with a median age of 76 years (range 54–87 years) received SBRT. The median dose was 36.25 Gy (range 34–37.5 Gy) in 5 fractions. Median follow-up time was 57.7 months (3.5–97.2 months). The overall 5-year bPFS rate was 83.6% for all patients. The 5-year bPFS rate of patients with low-, favorable intermediate-, unfavorable intermediate-, high-, and very high risk PCa was 87.5%, 95.2%, 90.5%, 86.3%, and 61.6%, respectively. Urinary symptoms were all alleviated after SBRT. All patients tolerated SBRT with 1 (0.8%) patient reporting grade-3 acute and 1 (0.8%) patient reporting grade-3 late genitourinary (GU) toxicity, respectively. There were no grade 4 toxicities. Gleason score (P < 0.001, HR = 7.483, 95%CI: 2.686–20.846) was the independent predictor of bPFS rate after multivariate analysis. Conclusion SBRT is an efficient and safe treatment modality for localized PCa with high 5-year bPFS rates and acceptable toxicities.
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Affiliation(s)
- Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Yusheng Ye
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Haiyan Yu
- Department of Oncology, Xuanhan County People's Hospital, Dazhou, 636150, China
| | - Lingong Jiang
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Chao Cheng
- Department of Nuclear Medicine, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Xueling Guo
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Xiaoping Ju
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Xiaofei Zhu
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, The Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
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12
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Matsumoto Y, Fukumitsu N, Ishikawa H, Nakai K, Sakurai H. A Critical Review of Radiation Therapy: From Particle Beam Therapy (Proton, Carbon, and BNCT) to Beyond. J Pers Med 2021; 11:jpm11080825. [PMID: 34442469 PMCID: PMC8399040 DOI: 10.3390/jpm11080825] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
In this paper, we discuss the role of particle therapy—a novel radiation therapy (RT) that has shown rapid progress and widespread use in recent years—in multidisciplinary treatment. Three types of particle therapies are currently used for cancer treatment: proton beam therapy (PBT), carbon-ion beam therapy (CIBT), and boron neutron capture therapy (BNCT). PBT and CIBT have been reported to have excellent therapeutic results owing to the physical characteristics of their Bragg peaks. Variable drug therapies, such as chemotherapy, hormone therapy, and immunotherapy, are combined in various treatment strategies, and treatment effects have been improved. BNCT has a high dose concentration for cancer in terms of nuclear reactions with boron. BNCT is a next-generation RT that can achieve cancer cell-selective therapeutic effects, and its effectiveness strongly depends on the selective 10B accumulation in cancer cells by concomitant boron preparation. Therefore, drug delivery research, including nanoparticles, is highly desirable. In this review, we introduce both clinical and basic aspects of particle beam therapy from the perspective of multidisciplinary treatment, which is expected to expand further in the future.
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Affiliation(s)
- Yoshitaka Matsumoto
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
- Correspondence: ; Tel.: +81-29-853-7100
| | | | - Hitoshi Ishikawa
- National Institute of Quantum and Radiological Science and Technology Hospital, Chiba 263-8555, Japan;
| | - Kei Nakai
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
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13
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Muggeo-Bertin E, Moeckli R, Vallet V, Berthold D, Godin S, Bourhis J, Herrera FG. A new method to visualize and to spare the ureters during SBRT for oligo metastatic patients. Tech Innov Patient Support Radiat Oncol 2021; 19:7-10. [PMID: 34189285 PMCID: PMC8215296 DOI: 10.1016/j.tipsro.2021.05.003] [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: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/30/2021] [Indexed: 11/24/2022] Open
Abstract
Ureteral injury following abdominal irradiation may have serious consequences. Urography CT scan is a simple procedure to spare ureters during SBRT. Using a urography CT scan can significantly reduce the dose to the ureters.
This article describes a ureter-sparing procedure used to treat lymph node metastases with SBRT. We delivered 35 Gy in 5 fractions of 7 Gy to patients with lesions located less than 7 mm from the ureters using a urography CT scan for planification. Two dosimetry plans were created, one using a CT scan urography-based contour and the other using the native phase. PTV coverage were not statistically different but this technique was able to significantly reduce median delivered Dmax to the ureters. These preliminary results demonstrate the feasibility of locating the ureters in a planning CT scan to protect them.
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Affiliation(s)
- Emilien Muggeo-Bertin
- Radiation Oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Veronique Vallet
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Dominik Berthold
- Medical Oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Sarah Godin
- Radiation Oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Jean Bourhis
- Radiation Oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Fernanda G. Herrera
- Radiation Oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Immuno-oncology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Ludwig Institute for Cancer Research, Lausanne Branch at University of Lausanne, Lausanne, Vaud, Switzerland
- Corresponding author at: Rue du Bugnon 46, Lausanne 1011, Switzerland.
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14
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Mazzeo E, Triggiani L, Frassinelli L, Guarneri A, Bartoncini S, Antognoni P, Gottardo S, Greco D, Borghesi S, Nanni S, Bruni A, Ingrosso G, D’Angelillo RM, Detti B, Francolini G, Magli A, Guerini AE, Arcangeli S, Spiazzi L, Ricardi U, Lohr F, Magrini SM. How Has Prostate Cancer Radiotherapy Changed in Italy between 2004 and 2011? An Analysis of the National Patterns-Of-Practice (POP) Database by the Uro-Oncology Study Group of the Italian Society of Radiotherapy and Clinical Oncology (AIRO). Cancers (Basel) 2021; 13:cancers13112702. [PMID: 34070797 PMCID: PMC8199007 DOI: 10.3390/cancers13112702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary This is a safety and efficacy analysis from a very large dataset of patients affected by localized prostate cancer having received radiotherapy with or without concomitant androgen deprivation therapy in twelve academic and non-academic Italian Institutions. The aim of this retrospective "real life" study was to provide additional data on clinical presentation, diagnostic workup, radiation therapy management and toxicity as collected within the framework of POP III. Though the usual limitations for a retrospective analysis apply, it nevertheless may expand the current knowledge in this area showing the progress of radiation therapy techniques and clinical outcomes in the period between 2004 and 2011 after a significant period of follow up. Abstract Background and purpose: Two previous “Patterns Of Practice” surveys (POP I and POP II), including more than 4000 patients affected by prostate cancer treated with radical external beam radiotherapy (EBRT) between 1980 and 2003, established a “benchmark” Italian data source for prostate cancer radiotherapy. This report (POP III) updates the previous studies. Methods: Data on clinical management and outcome of 2525 prostate cancer patients treated by EBRT from 2004 to 2011 were collected and compared with POP II and, when feasible, also with POP I. This report provides data on clinical presentation, diagnostic workup, radiation therapy management, and toxicity as collected within the framework of POP III. Results: More than 50% of POP III patients were classified as low or intermediate risk using D’Amico risk categories as in POP II; 46% were classified as ISUP grade group 1. CT scan, bone scan, and endorectal ultrasound were less frequently prescribed. Dose-escalated radiotherapy (RT), intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), and hypofractionated RT were more frequently offered during the study period. Treatment was commonly well tolerated. Acute toxicity improved compared to the previous series; late toxicity was influenced by prescribed dose and treatment technique. Five-year overall survival, biochemical relapse free survival (BRFS), and disease specific survival were similar to those of the previous series (POP II). BRFS was better in intermediate- and high-risk patients treated with ≥ 76 Gy. Conclusions: This report highlights the improvements in radiotherapy planning and dose delivery among Italian Centers in the 2004–2011 period. Dose-escalated treatments resulted in better biochemical control with a reduction in acute toxicity and higher but acceptable late toxicity, as not yet comprehensively associated with IMRT/IGRT. CTV-PTV margins >8 mm were associated with increased toxicity, again suggesting that IGRT—allowing for tighter margins—would reduce toxicity for dose escalated RT. These conclusions confirm the data obtained from randomized controlled studies.
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Affiliation(s)
- Ercole Mazzeo
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Luca Frassinelli
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Alessia Guarneri
- Department of Oncology, Radiation Oncology, Azienda Ospedaliero-Universitaria Città della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (S.B.)
| | - Sara Bartoncini
- Department of Oncology, Radiation Oncology, Azienda Ospedaliero-Universitaria Città della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (S.B.)
| | - Paolo Antognoni
- Radiotherapy Deparment, ASST dei Sette Laghi-Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Stefania Gottardo
- Service of Radiotherapy, Istituito Clinico Sant’Ambrogio, 25123 Milan, Italy;
| | - Diana Greco
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, 52100 Arezzo, Italy; (S.B.); (S.N.)
| | - Sara Nanni
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, 52100 Arezzo, Italy; (S.B.); (S.N.)
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
- Correspondence:
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | | | - Beatrice Detti
- Unit of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (B.D.); (G.F.)
| | - Giulio Francolini
- Unit of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (B.D.); (G.F.)
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, 33100 Udine, Italy;
| | - Andrea Emanuele Guerini
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Stefano Arcangeli
- Department of Radiation Oncology, S. Gerardo Hospital—University of Milan Bicocca, 20900 Monza, Italy;
| | - Luigi Spiazzi
- Department of Medical Physics, Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy;
| | - Frank Lohr
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
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15
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Mahadevan A, Emami B, Grimm J, Kleinberg LR, Redmond KJ, Welsh JS, Rostock R, Kemmerer E, Forster KM, Stanford J, Shah S, Asbell SO, LaCouture TA, Scofield C, Butterwick I, Xue J, Muacevic A, Adler JR. Potential Clinical Significance of Overall Targeting Accuracy and Motion Management in the Treatment of Tumors That Move With Respiration: Lessons Learnt From a Quarter Century of Stereotactic Body Radiotherapy From Dose Response Models. Front Oncol 2021; 10:591430. [PMID: 33634020 PMCID: PMC7900559 DOI: 10.3389/fonc.2020.591430] [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: 08/04/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine the long-term normal tissue complication probability with stereotactic body radiation therapy (SBRT) treatments for targets that move with respiration and its relation with the type of respiratory motion management (tracking vs. compression or gating). METHODS A PubMed search was performed for identifying literature regarding dose, volume, fractionation, and toxicity (grade 3 or higher) for SBRT treatments for tumors which move with respiration. From the identified papers logistic or probit dose-response models were fitted to the data using the maximum-likelihood technique and confidence intervals were based on the profile-likelihood method in the dose-volume histogram (DVH) Evaluator. RESULTS Pooled logistic and probit models for grade 3 or higher toxicity for aorta, chest wall, duodenum, and small bowel suggest a significant difference when live motion tracking was used for targeting tumors with move with respiration which was on the average 10 times lower, in the high dose range. CONCLUSION Live respiratory motion management appears to have a better toxicity outcome when treating targets which move with respiration with very steep peripheral dose gradients. This analysis is however limited by sparsity of rigorous data due to poor reporting in the literature.
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Affiliation(s)
- Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, United States
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James S. Welsh
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, United States
| | - Robert Rostock
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Eric Kemmerer
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Kenneth M. Forster
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Jason Stanford
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Sunjay Shah
- Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE, United States
| | - Sucha O. Asbell
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tamara A. LaCouture
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Carla Scofield
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Ian Butterwick
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Jinyu Xue
- Department of Radiation Oncology, New York University, New York City, NY, United States
| | | | - John R. Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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Peyraga G, Lizee T, Khalifa J, Blais E, Mauriange-Turpin G, Supiot S, Krhili S, Tremolieres P, Graff-Cailleaud P. Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa). Cancer Radiother 2021; 25:400-409. [PMID: 33478838 DOI: 10.1016/j.canrad.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.
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Affiliation(s)
- G Peyraga
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France; Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France.
| | - T Lizee
- Radiation therapy department, Integrated centre of oncology (Paul Papin), Angers, France
| | - J Khalifa
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France
| | - E Blais
- Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France
| | - G Mauriange-Turpin
- Radiation therapy department, University hospital centre, Limoges, France
| | - S Supiot
- Radiation therapy department, Integrated centre of oncology (Rene Gauducheau), Saint-Herblain, France
| | - S Krhili
- Radiation therapy department, Curie Institute, Paris, France
| | - P Tremolieres
- Radiation therapy department, Integrated centre of oncology (Paul Papin), Angers, France
| | - P Graff-Cailleaud
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France
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17
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Bosch R, McCloskey K, Bahl A, Arlandis S, Ockrim J, Weiss J, Greenwell T. Can radiation-induced lower urinary tract disease be ameliorated in patients treated for pelvic organ cancer: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S148-S155. [PMID: 32662556 PMCID: PMC7496485 DOI: 10.1002/nau.24380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022]
Abstract
Aims This article reviews the clinical outcomes and basic science related to negative effects of radiotherapy (RT) on the lower urinary tract (LUT) when used to treat pelvic malignancies. Methods The topic was discussed at the 2019 meeting of the International Consultation on Incontinence―Research Society during a “think tank” session and is summarized in the present article. Results RT is associated with adverse effects on the LUT, which may occur during treatment or which can develop over decades posttreatment. Here, we summarize the incidence and extent of clinical symptoms associated with several modes of delivery of RT. RT impact on normal tissues including urethra, bladder, and ureters is discussed, and the underlying biology is examined. We discuss innovative in vivo methodologies to mimic RT in the laboratory and their potential use in the elucidation of mechanisms underlying radiation‐associated pathophysiology. Finally, emerging questions that need to be addressed through further research are proposed. Conclusions We conclude that RT‐induced negative effects on the LUT represent a significant clinical problem. Although this has been reduced with improved methods of delivery to spare normal tissue, we need to (a) discover better approaches to protect normal tissue and (b) develop effective treatments to reverse radiation damage.
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Affiliation(s)
- Ruud Bosch
- Department of Urologic Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen McCloskey
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Amit Bahl
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Salvador Arlandis
- Functional and Reconstructive Urology Section, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Jeremy Ockrim
- Female, Functional and Restorative Urology Unit, University College London Hospitals, London, UK
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Tamsin Greenwell
- Female, Functional and Restorative Urology Unit, University College London Hospitals, London, UK
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Ishikawa H, Higuchi K, Kaminuma T, Takezawa Y, Saito Y, Etsunaga T, Maruo K, Kawamura H, Kubo N, Nakano T, Kobayashi M. The effects of PSA kinetics on the outcome of hypofractionated salvage radiotherapy for biochemical recurrence of prostate cancer after prostatectomy. JOURNAL OF RADIATION RESEARCH 2020; 61:908-919. [PMID: 32888035 PMCID: PMC7674678 DOI: 10.1093/jrr/rraa074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
The feasibility and efficacy of hypofractionated salvage radiotherapy (HS-RT) for prostate cancer (PC) with biochemical recurrence (BR) after prostatectomy, and the usefulness of prostate-specific antigen (PSA) kinetics as a predictor of BR, were evaluated in 38 patients who received HS-RT without androgen deprivation therapy between May 2009 and January 2017. Their median age, PSA level and PSA doubling time (PSA-DT) at the start of HS-RT were 68 (53-74) years, 0.28 (0.20-0.79) ng/ml and 7.7 (2.3-38.5) months, respectively. A total dose of 60 Gy in 20 fractions (three times a week) was three-dimensionally delivered to the prostate bed. After a median follow-up of 62 (30-100) months, 19 (50%) patients developed a second BR after HS-RT, but only 1 patient died before the last follow-up. The 5-year overall survival and BR-free survival rates were 97.1 and 47.4%, respectively. Late grade 2 gastrointestinal and genitourinary morbidities were observed in 0 and 5 (13%) patients, respectively. The PSA level as well as pathological T-stage and surgical margin status were regarded as significant predictive factors for a second BR by multivariate analysis. BR developed within 6 months after HS-RT in 11 (85%) of 13 patients with a PSA-DT < 10 months compared with 1 (17%) of 6 with a PSA-DT ≥ 10 months (median time to BR: 3 vs 14 months, P < 0.05). Despite the small number of patients, our HS-RT protocol seems feasible, and PSA kinetics may be useful for predicting the risk of BR and determining the appropriate follow-up schedule.
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Affiliation(s)
- Hitoshi Ishikawa
- Department of Radiation Oncology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Anagawa 4-9-7, Inage, 263-8555 Chiba, Japan
| | - Keiko Higuchi
- Corresponding author. Department of Radiation Oncology, Isesaki Municipal Hospital, 12-1 Tsunatorimoto, Isesaki, Gunma, 372-0802, Japan. Tel: +81-270-25-5022, Fax: +81-270-25-5202;
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa 3-39-22, Maebashi, 371-8511 Gunma, Japan
| | - Yutaka Takezawa
- Department of Urology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan
| | - Yoshitaka Saito
- Department of Urology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan
| | - Toru Etsunaga
- Department of Urology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8575 Ibaraki, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa 3-39-22, Maebashi, 371-8511 Gunma, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa 3-39-22, Maebashi, 371-8511 Gunma, Japan
| | - Takashi Nakano
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Anagawa 4-9-7, Inage, 263-8555 Chiba, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa 3-39-22, Maebashi, 371-8511 Gunma, Japan
| | - Mikio Kobayashi
- Department of Urology, Isesaki Municipal Hospital, Tsunatorimoto 12-1, Isesaki, 372-0802 Gunma, Japan
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Cuccia F, Mazzola R, Nicosia L, Giaj-Levra N, Figlia V, Ricchetti F, Rigo M, Vitale C, Corradini S, Alongi F. Prostate re-irradiation: current concerns and future perspectives. Expert Rev Anticancer Ther 2020; 20:947-956. [PMID: 32909471 DOI: 10.1080/14737140.2020.1822742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION To date, the optimal management of locally relapsed prostate cancer patients after an initial course of radiotherapy remains a matter of debate. In recent years, local approaches have been proposed as a therapeutic option, which may potentially delay the initiation of hormone therapy. In the case of external beam radiotherapy (EBRT), re-irradiation has been supported by growing evidence in the literature, mostly represented by extreme hypofractionated schedules delivered with stereotactic body radiotherapy (SBRT). AREAS COVERED We performed a systematic review of the literature using the PICO methodology to explore the available evidence regarding the use of EBRT in the setting of locally relapsed prostate cancer, both in terms of safety, tolerability and preliminary clinical outcomes. EXPERT OPINION Current literature data report the use of EBRT and particularly of SBRT for the safe and feasible re-treatment of locally recurrent prostate cancer after an initial treatment course of radiotherapy. When extreme hypofractionation is adopted, only occasional grade ≥3 late adverse events are reported. Despite the current lack of high-level evidence and the short follow-up, preliminary clinical outcomes are promising and allow clinicians to hypothesize further prospective studies to evaluate SBRT as an alternative to the early initiation of androgen-deprivation therapy.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, University of Munich , Munich, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy.,University of Brescia , Brescia, Italy
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Nutzen der hypofraktionierten Strahlentherapie bei Männern mit lokalisiertem Prostatakarzinom. Urologe A 2020; 59:953-956. [DOI: 10.1007/s00120-020-01262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Applications of Nonlinear Programming to the Optimization of Fractionated Protocols in Cancer Radiotherapy. INFORMATION 2020. [DOI: 10.3390/info11060313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present work of review collects and evidences the main results of our previous papers on the optimization of fractionated radiotherapy protocols. The problem under investigation is presented here in a unitary framework as a nonlinear programming application that aims to determine the optimal schemes of dose fractionation commonly used in external beam radiotherapy. The radiation responses of tumor and normal tissues are described by means of the linear quadratic model. We formulate a nonlinear, non-convex optimization problem including two quadratic constraints to limit the collateral normal tissue damages and linear box constraints on the fractional dose sizes. The general problem is decomposed into two subproblems: (1) analytical determination of the optimal fraction dose sizes as a function of the model parameters for arbitrarily fixed treatment lengths; and (2) numerical determination of the optimal fraction number, and of the optimal treatment time, in different parameter settings. After establishing the boundedness of the optimal number of fractions, we investigate by numerical simulation the optimal solution behavior for experimentally meaningful parameter ranges, recognizing the crucial role of some parameters, such as the radiosensitivity ratio, in determining the optimality of hypo- or equi-fractionated treatments. Our results agree with findings of the theoretical and clinical literature.
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Pan X, Levin-Epstein R, Huang J, Ruan D, King CR, Kishan AU, Steinberg ML, Qi XS. Dosimetric predictors of patient-reported toxicity after prostate stereotactic body radiotherapy: Analysis of full range of the dose-volume histogram using ensemble machine learning. Radiother Oncol 2020; 148:181-188. [PMID: 32388444 DOI: 10.1016/j.radonc.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to evaluate the associations between dosimetric parameters and patient-reported outcomes, and to identify latent dosimetric parameters that most correlate with acute and subacute patient-reported urinary and rectal toxicity after prostate stereotactic body radiotherapy (SBRT) using machine learning methods. MATERIALS AND METHODS Eighty-six patients who underwent prostate SBRT (40 Gy in 5 fractions) were included. Patient-reported health-related quality of life (HRQOL) outcomes were derived from bowel and bladder symptom scores on the Expanded Prostate Cancer Index Composite (EPIC-26) at 3 and 12 months post-SBRT. We utilized ensemble machine learning (ML) to interrogate the entire dose-volume histogram (DVH) to evaluate relationships between dose-volume parameters and HRQOL changes. The latent predictive dosimetric parameters that were most associated with HRQOL changes in urinary and rectal function were thus identified. An external cohort of 26 prostate SBRT patients was acquired to further test the predictive models. RESULTS Bladder dose-volume metrics strongly predicted patient-reported urinary irritative and incontinence symptoms (area under the curves [AUCs] of 0.79 and 0.87, respectively) at 12 months. Maximum bladder dose, bladder V102.5%, bladder volume, and conformity indices (V50/VPTV and V100/VPTV) were most predictive of HRQOL changes in both urinary domains. No strong rectal toxicity dosimetric association was identified (AUC = 0.64). CONCLUSION We demonstrated the application of advanced ML methods to identify a set of dosimetric variables that most highly correlated with patient-reported urinary HRQOL. DVH quantities identified with these methods may be used to achieve outcome-driven planning objectives to further reduce patient-reported toxicity with prostate SBRT.
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Affiliation(s)
- Xiaoying Pan
- School of Computer Science and Technology, Xi'an University of Posts & Telecommunications, China; Shaanxi Key Laboratory of Network Data Analysis and Intelligent Processing, Xi'an University of Posts and Telecommunications, China; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Rebecca Levin-Epstein
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Jiahao Huang
- School of Computer Science and Technology, Xi'an University of Posts & Telecommunications, China
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - X Sharon Qi
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States.
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Macias VA, Barrera‐Mellado I. Ultra-hypofractionated radiation therapy for unfavourable intermediate-risk and high-risk prostate cancer is safe and effective: 5-year outcomes of a phase II trial. BJU Int 2020; 125:215-225. [PMID: 31614071 PMCID: PMC7003804 DOI: 10.1111/bju.14925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To report toxicity (primary endpoint) and biochemical disease-free survival (BDFS) outcomes of a phase II trial evaluating ultra-hypofractionated radiation therapy (UHRT), focusing on patients with unfavourable intermediate-risk and high-risk prostate cancer (PCa). PATIENTS AND METHODS From 2012 to 2017, 154 patients (92 with unfavourable intermediate-risk or high-risk PCa) were treated with helical TomoTherapy delivering 43.8-45.2 Gy in eight fractions over 3 weeks. Of these, 73% received hormonotherapy (51% neoadjuvant). RESULTS The median (range) follow-up was 48 (19-84) months. For the whole series, crude BDFS and 5-year BDFS rates were 97.4% and 94.3%, respectively. The corresponding figures for unfavourable intermediate-risk and high-risk PCa were 96.7% and 90%, respectively. The crude metastasis-free survival rate was 98% for the unfavourable intermediate-risk and high-risk group. For the whole series, the 5-year cumulative urinary/intestinal grade 2+ late toxicity was 17.8/7.4%. No grade 4-5 toxicity was observed. One patient experienced late grade 3 toxicity (urinary). CONCLUSION This eight-fraction UHRT regimen can be safely delivered to patients with unfavourable intermediate-risk/high-risk PCa. Its relapse rates are similar to those reported for the combination of external beam radiotherapy plus brachytherapy, however, the observed toxicity profile is milder. The disease survival rates compare favourably with historical controls in some other forms of radiotherapy, with similar side effects. Since the low rate of biochemical/metastasis relapse is encouraging, further research to confirm these results is justified.
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Affiliation(s)
- Victor A. Macias
- Radiation Oncology DepartmentHospital Universitario y Politécnico La FeValenciaSpain
- Hospital Universitario de SalamancaSalamancaSpain
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24
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[Ultra-hypofractionation in localized prostate cancer. 5-year results of the HYPO-RT-PC trial: Commentary I]. Strahlenther Onkol 2019; 195:1116-1118. [PMID: 31667552 DOI: 10.1007/s00066-019-01535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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[Moderate or extreme hypofractionation and localized prostate cancer: The times are changing]. Cancer Radiother 2019; 23:503-509. [PMID: 31471253 DOI: 10.1016/j.canrad.2019.07.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
There are many treatment options for localized prostate cancers, including active surveillance, brachytherapy, external beam radiotherapy, and radical prostatectomy. Quality of life remains a primary objective in the absence of superiority of one strategy over another in terms of specific survival with similar long-term biochemical control rates. Despite a significant decrease in digestive and urinary toxicities thanks to IMRT and IGRT, external radiotherapy remains a treatment that lasts approximately 2 months or 1.5 months, when combined with a brachytherapy boost. Given the specific radiosensitivity of this tumor, several randomized studies have shown that a hypofractionated scheme is not inferior in terms of biochemical control and toxicities, allowing to divide the number of fractions by a factor 2 to 8. Given that SBRT becomes a validated therapeutic option for a selected population of patients with localized prostate cancer, extreme hypofractionation is becoming a strong challenger of conventional external radiotherapy or brachytherapy.
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Ishikawa H, Tsuji H, Murayama S, Sugimoto M, Shinohara N, Maruyama S, Murakami M, Shirato H, Sakurai H. Particle therapy for prostate cancer: The past, present and future. Int J Urol 2019; 26:971-979. [PMID: 31284326 PMCID: PMC6852578 DOI: 10.1111/iju.14041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/21/2019] [Indexed: 01/08/2023]
Abstract
Although prostate cancer control using radiotherapy is dose‐dependent, dose–volume effects on late toxicities in organs at risk, such as the rectum and bladder, have been observed. Both protons and carbon ions offer advantageous physical properties for radiotherapy, and create favorable dose distributions using fewer portals compared with photon‐based radiotherapy. Thus, particle beam therapy using protons and carbon ions theoretically seems suitable for dose escalation and reduced risk of toxicity. However, it is difficult to evaluate the superiority of particle beam radiotherapy over photon beam radiotherapy for prostate cancer, as no clinical trials have directly compared the outcomes between the two types of therapy due to the limited number of facilities using particle beam therapy. The Japanese Society for Radiation Oncology organized a joint effort among research groups to establish standardized treatment policies and indications for particle beam therapy according to disease, and multicenter prospective studies have been planned for several common cancers. Clinical trials of proton beam therapy for intermediate‐risk prostate cancer and carbon‐ion therapy for high‐risk prostate cancer have already begun. As particle beam therapy for prostate cancer is covered by the Japanese national health insurance system as of April 2018, and the number of facilities practicing particle beam therapy has increased recently, the number of prostate cancer patients treated with particle beam therapy in Japan is expected to increase drastically. Here, we review the results from studies of particle beam therapy for prostate cancer and discuss future developments in this field.
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Affiliation(s)
- Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeyuki Murayama
- Division of Proton Therapy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Quel rapport alpha/bêta pour le cancer prostatique en 2019 ? Cancer Radiother 2019; 23:342-345. [DOI: 10.1016/j.canrad.2019.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/06/2019] [Indexed: 12/13/2022]
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Greco C, Vazirani AA, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Vasconcelos AL, Antunes I, Kociolek J, Fuks Z. The evolving role of external beam radiotherapy in localized prostate cancer. Semin Oncol 2019; 46:246-253. [DOI: 10.1053/j.seminoncol.2019.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/07/2019] [Indexed: 12/30/2022]
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Martell K, Cheung P, Morton G, Chung H, Deabreu A, Zhang L, Pang G, Alayed Y, Mamedov A, Gladwish A, Loblaw A. 5-Year Outcomes of a Prospective Phase 1/2 Study of Accelerated Hypofractionated Radiation Therapy to the Prostate Bed. Pract Radiat Oncol 2019; 9:354-361. [PMID: 31103715 DOI: 10.1016/j.prro.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the 5-year outcomes from a single institution, prospective, phase 1/2 study on hypofractionated, accelerated radiation therapy to the prostate bed after radical prostatectomy. METHODS AND MATERIALS Patients enrolled in this study were all eligible for postoperative radiation therapy and received a prescribed dose of 51 Gy in 17 fractions to the prostate bed. On follow-up, gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0; prostate-specific antigen (PSA) was evaluated and quality of life was assessed using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. RESULTS A total of 30 patients were enrolled between 2008 and 2011. Median age was 65 (52-75) years. Median pretreatment PSA was 0.12 ng/mL (0.01-1.42). Twenty-six (93%) patients had Gleason ≤7 disease, 13 (43%) had pT3 disease, and 20 (67%) had positive margins. Twenty-six patients (87%) underwent radiation therapy as salvage treatment. After a median follow-up of 6.4 (2.1-8.1) years, no patient experienced Common Terminology Criteria for Adverse Events grade 3/4 toxicity. Eleven patients (37%) had grade 2 genitourinary and 2 (7%) had grade 2 gastrointestinal toxicity. At baseline and 5 years after radiation therapy, mean EPIC urinary domain score was 80% (standard deviation, 18%) and 82% (17%). Mean EPIC bowel domain score was 93% (13%) and 93% (15%). One patient (4%) had a minimally clinically important change in urinary domain score and 1 patient (4%) had a minimally clinically important change in bowel domain score. Nelson-Aalen estimated cumulative incidence of biochemical failure was 31% (nadir +0.2) and 18% (nadir +2.0) at 5 years. Four-year PSA ≥0.4 was predictive of subsequent androgen deprivation therapy use (Nelson-Aalen cumulative incidence: 1.45; P < .0001). Five patients (17%) received hormonal therapy for biochemical failure. Nelson-Aalen estimated cumulative incidence of hormone therapy use was 14% at 5 years. All patients who received hormone therapy had PSA >0.4 at 4 years. CONCLUSIONS In this phase 1/2 study, hypofractionated postoperative radiation therapy seems to have good clinical efficacy without significant late toxicity. Phase 3 studies are warranted.
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Affiliation(s)
- Kevin Martell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Hans Chung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Andrea Deabreu
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - Liying Zhang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Geordi Pang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Yasir Alayed
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Alexandre Mamedov
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - Adam Gladwish
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto; Institute for Health Policy, Measurement and Evaluation, University of Toronto.
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Impact of Radiation Therapy Dose Escalation on Prostate Cancer Outcomes and Toxicities. Am J Clin Oncol 2019; 41:409-415. [PMID: 27014930 DOI: 10.1097/coc.0000000000000285] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Freedom from biochemical failure (FFBF) is a common primary outcome of randomized-controlled trials of prostate cancer (PCa). We aimed to determine how increasing the PCa biologically equivalent dose (BED) of external radiation therapy (RT) is correlated with FFBF and overall patient outcomes: overall survival (OS), distant metastasis (DM), and cancer-specific mortality (CSM); as well as genitourinary (GU), and gastrointestinal toxicities. MATERIALS AND METHODS We performed a meta-analysis of 6884 PCa patients from 12 randomized-controlled trials of external beam RT. Mixed effects regression models were used to estimate weighted linear relationships between BED and observed percentages of 5- and 10-year outcomes. For toxicities, a subset analysis of using 3-dimensional conformal RT (3D-CRT) versus intensity-modulated RT (IMRT) was performed. RESULTS Increasing BED correlated with improved FFBF: 10-year absolute improvement of 9.6% and 7.2% for low-risk and intermediate-risk patients, respectively (P<0.05); but not with improvement of OS, DM, or CSM at either time point. BED escalation was not correlated with increased acute toxicities; it was correlated with increased late gastrointestinal toxicities in patients treated with 3D-CRT (1.5% increase over BED range, P<0.01). IMRT patients had significantly fewer late toxicities, despite being treated at higher BED. CONCLUSIONS RT BED escalation has resulted in significantly improved PCa FFBF at up to 10 years; but not with improvement in OS, DM, or CSM. Thus, FFBF is a poor surrogate of overall patient outcomes for trials of RT. Late toxicities were less frequent with IMRT than with 3D-CRT, even at higher BED.
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Tamponi M, Gabriele D, Maggio A, Stasi M, Meloni GB, Conti M, Gabriele P. Prostate cancer dose-response, fractionation sensitivity and repopulation parameters evaluation from 25 international radiotherapy outcome data sets. Br J Radiol 2019; 92:20180823. [PMID: 31017457 DOI: 10.1259/bjr.20180823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study was undertaken to model the biochemical free survival at 5 years and to evaluate the parameters defining dose-response curve, dose-fractionation radiosensitivity and repopulation. METHODS It was carried out a literature search on Pubmed to retrieve data sets of patients treated with external beam radiation therapy of 1.8-4.0 Gy per fraction and overall treatment time of 3 to 10 weeks. 10 groups were identified, based on risk class and androgen deprivation therapy (ADT). Dose-response curve D50 (dose at 50% probability of control) and g50 (steepness), α/β (dose-fractionation radiosensitivity), and repopulation parameters, dprolif and Tprolif , were calculated. Bootstrap-based cross-validation was performed and median and 95% CI (confidence interval) were evaluated. RESULTS 25 data sets, including 20,310 patients, were considered. The median (95% CI) D50 and g50 values were 62 (CI 53 - 66) Gy and 1.6 (0.8 - 2.4). ADT patients showed lower values of D50 and g50 (57 ± 5 Gy and 1.1 ± 0.4) compared to no-ADT patients (65 ± 2 Gy and 2.3 ± 0.6), with p < 0.0001 and p = 0.002. If we did not consider any dependence on overall treatment time, the median (95% CI) value of α/β was 1.4 (1.0 - 1.9) Gy with p < 0.0001 for all patients. The median values of dproli f and Tprolif were 0.0 to 0.3 Gy/d and 18-40 days. CONCLUSION Dose-response curve resulted dependent on risk class and ADT, with higher steepness for no-ADT patients. Low values of dose-fractionation radiosensitivity were found, supporting the use of moderate hypofractionated radiotherapy in each risk class. A limited dependence on repopulation was observed. ADVANCES IN KNOWLEDGE Prostate cancer response to moderate hypofractionated radiotherapy was reliably quantified considering risk class and androgen deprivation therapy.
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Affiliation(s)
- Matteo Tamponi
- 1 ATS, Sardinia Regional Health Service , Sassari , Italy
| | | | - Angelo Maggio
- 3 Medical Physics, Candiolo Cancer Institute - FPO , IRCCS, Candiolo (To) , Italy
| | - Michele Stasi
- 3 Medical Physics, Candiolo Cancer Institute - FPO , IRCCS, Candiolo (To) , Italy
| | | | - Maurizio Conti
- 2 Institute of Radiological Sciences University of Sassari , Italy.,4 Department of Diagnostic Imaging, AOU, University Hospital Trust of Sassari , Italy
| | - Pietro Gabriele
- 5 Radiation Therapy, Candiolo Cancer Institute - FPO , IRCCS, Candiolo (To) , Italy
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Takakusagi Y, Kawamura H, Okamoto M, Kaminuma T, Kubo N, Mizukami T, Sato H, Onishi M, Ohtake N, Sekihara T, Nakano T. Long-term outcome of hypofractionated intensity-modulated radiotherapy using TomoTherapy for localized prostate cancer: A retrospective study. PLoS One 2019; 14:e0211370. [PMID: 30807581 PMCID: PMC6391012 DOI: 10.1371/journal.pone.0211370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, the clinical outcome of prostate cancer treated by hypofractionated radiation therapy has been reported. However, there are few reports from Japan. In Hidaka Hospital, hypofractionated intensity-modulated radiotherapy (HIMRT) for prostate cancer was initiated in 2007. The purpose of this study is to analyze the long-term outcome. METHODS Ninety-two patients with localized prostate cancer treated with HIMRT at Hidaka Hospital between 2007 and 2009 were retrospectively analyzed. HIMRT was delivered using TomoTherapy. The prescription dose was 66 Gy at 95% of the PTV in 22 fractions performed 3 days a week over 7 weeks in all patients. The overall survival rate, biochemical relapse-free rate, and acute and late toxicities were evaluated. RESULTS The median follow-up duration was 78 (range 14-100) months. The median age at the start of the HIMRT was 72 (range 46-84) years. The disease characteristics were as follows: stage T1c, 45; T2a, 20; T2b, 5; T2c, 1; T3a, 13; T3b, 6; T4, 2; Gleason score 6, 13; 7, 44; 8, 20; 9, 15; 10, 0; pretreatment PSA ≤10 ng/mL, 42; 10 to ≤20, 27; and >20, 23. According to the D'Amico classification system, 10, 37, and 45 patients were classified as low-risk, intermediate-risk, and high-risk. The overall survival rate, the cause-specific survival rate, and the biochemical relapse-free rate at 5 years was 94.7%, 100% and 98.9%, respectively. Severe acute toxicity (grade 3 or more) was not observed. The late urinary toxicity was 52.2% in grade 0, 28.3% in grade 1, 19.6% in grade 2, and 2.2% in grade 3. The late rectal toxicity was 78.3% in grade 0, 7.6% in grade 1, 9.8% in grade 2, and 4.3% in grade 3. CONCLUSIONS The present study demonstrated that HIMRT using TomoTherapy for prostate cancer has a favorable outcome with tolerable toxicity.
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Affiliation(s)
- Yosuke Takakusagi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
- Oncology Center, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
- Oncology Center, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
- * E-mail:
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Tatsuji Mizukami
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Hiro Sato
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Masahiro Onishi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Nobuaki Ohtake
- Department of Urology, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Tetsuo Sekihara
- Department of Urology, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
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Genitourinary System Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Arcangeli G, Arcangeli S, Pinzi V, Benassi M, Benassi M, Strigari L. Optimal scheduling of hypofractionated radiotherapy for localized prostate cancer: A systematic review and metanalysis of randomized clinical trials. Cancer Treat Rev 2018; 70:22-29. [DOI: 10.1016/j.ctrv.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022]
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Gopaul D, Panjwani D, Stephens RF, Lock M. Phase II Trial of Pure Hypofractionated Radiotherapy in the Treatment of Localized Carcinoma of the Prostate. Cureus 2018; 10:e3435. [PMID: 30546982 PMCID: PMC6289559 DOI: 10.7759/cureus.3435] [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: 07/18/2018] [Accepted: 10/09/2018] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity and the biochemical control of pure hypofractionated radiotherapy (without acceleration) for the treatment of prostate cancer. Methods and materials This phase II prospective trial evaluated low-risk and intermediate-risk prostate cancer patients who received hypofractionated radiotherapy. Fifty-three patients with low-risk prostate cancer received 50 Gy in 15 fractions, 156 patients with intermediate-risk prostate cancer received 60 Gy in 20 fractions over eight weeks. Acute toxicity and late toxicity were graded per the Radiation Therapy Oncology Group (RTOG) toxicity scales and the Phoenix Definition (nadir plus two) defined biochemical failure. Results Median follow-up was 6.5 years. Acute phase grade 2/3 toxicity was 6%/0 and 8%/2% for GI and GU symptoms, respectively, and one grade 4 acute GU toxicity (0.5%). Late grade 2/3 GI and GU toxicity were 7%/0 and 8%/0.5%, respectively. There were no late grade 4 toxicities. The five-year freedom-from-biochemical-failure (FFBF) rates were 85% for low-risk patients and 80% for intermediate-risk patients. Conclusions Pure hypofractionation seems to be associated with low toxicity rates and biochemical control rates that are similar or better than those observed with accelerated hypofractionated or conventionally fractionated therapy.
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Affiliation(s)
- Darin Gopaul
- Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, CAN
| | - Dilip Panjwani
- Radiation Oncology, Prince Edward Island Cancer Treatment Centre, Charlottetown, CAN
| | | | - Michael Lock
- Radiation Oncology, Schulich School of Medicine & Dentistry - Western University, London, CAN
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Herrera FG, Valerio M, Berthold D, Tawadros T, Meuwly JY, Vallet V, Baumgartner P, Thierry AC, De Bari B, Jichlinski P, Kandalaft L, Coukos G, Harari A, Bourhis J. 50-Gy Stereotactic Body Radiation Therapy to the Dominant Intraprostatic Nodule: Results From a Phase 1a/b Trial. Int J Radiat Oncol Biol Phys 2018; 103:320-334. [PMID: 30267761 DOI: 10.1016/j.ijrobp.2018.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/03/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Although localized prostate cancer (PCa) is multifocal, the dominant intraprostatic nodule (DIN) is responsible for disease progression after radiation therapy. PCa expresses antigens that could be recognized by the immune system. We therefore hypothesized that stereotactic dose escalation to the DIN is safe, may increase local control, and may initiate tumor-specific immune responses. PATIENTS AND METHODS Patients with localized PCa were treated with stereotactic extreme hypofractionated doses of 36.25 Gy in 5 fractions to the whole prostate while simultaneously escalating doses to the magnetic resonance image-visible DIN (45 Gy, 47.5 Gy, and 50 Gy in 5 fractions). The phase 1a part was designed to determine the recommended phase 1b dose in a "3 + 3" cohort-based, dose-escalation design. The primary endpoint was dose-limiting toxicities defined as ≥grade 3 gastrointestinal (GI) or genitourinary (GU) toxicity (or both) by National Cancer Institute Common Terminology Criteria for Adverse Events (version 4) up to 90 days after the first radiation fraction. The secondary endpoints were prostate-specific antigen kinetics, quality of life (QoL), and blood immunologic responses. RESULTS Nine patients were treated in phase 1a. No dose-limiting toxicities were observed at either level, and therefore the maximum tolerated dose was not reached. Further characterization of tolerability, efficacy, and immunologic outcomes was conducted in the subsequent 11 patients irradiated at the highest dose level (50 Gy) in the phase 1b expansion cohort. Toxicity was 45% and 25% for grades 1 and 2 GU, and 20% and 5% for grades 1 and 2 GI, respectively. No grade 3 or worse toxicity was reported. The average (±standard error of the mean) of the QoL assessments at baseline and at 3-month posttreatment were 0.8 (±0.8) and 3.5 (±1.5) for the bowel (mean difference, 2.7; 95% confidence interval, 0.1-5), and 6.4 (±0.8) and 7.27 (±0.9) for the International Prostate Symptom Score (mean difference, 0.87; 95% confidence interval, 0.3-1.9), respectively. A subset of patients developed antigen-specific immune responses against prostate-specific membrane antigen (n = 2), prostatic acid phosphatase (n = 1), prostate stem cell antigen (n = 4), and prostate-specific antigen (n = 2). CONCLUSIONS Irradiation of the whole prostate with 36.25 Gy in 5 fractions and dose escalation to 50 Gy to the DIN was tolerable and determined as the recommended phase 1b dose. This treatment has promising antitumor activity, which will be confirmed by the ongoing phase 2 part. Preliminary QoL analysis showed minimal impact in GU, GI, and sexual domains. Stereotactic irradiation induced antigen-specific immune responses in a subset of patients.
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Affiliation(s)
- Fernanda G Herrera
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland.
| | - Massimo Valerio
- Department of Oncology, Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dominik Berthold
- Department of Oncology, Medical Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thomas Tawadros
- Department of Oncology, Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Veronique Vallet
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Petra Baumgartner
- Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland
| | - Anne-Christine Thierry
- Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland
| | - Berardino De Bari
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Jichlinski
- Department of Oncology, Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lana Kandalaft
- Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland
| | - George Coukos
- Department of Oncology, Medical Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland
| | - Alexandre Harari
- Department of Oncology, Immune Monitoring Core Facility, Center of Experimental Therapeutics, Ludwig Cancer Research Center, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Datta NR, Stutz E, Rogers S, Bodis S. Clinical estimation of α/β values for prostate cancer from isoeffective phase III randomized trials with moderately hypofractionated radiotherapy. Acta Oncol 2018; 57:883-894. [PMID: 29405785 DOI: 10.1080/0284186x.2018.1433874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The α/β values for prostate cancer (PCa) are usually assumed to be low (1.0-1.8 Gy). This study estimated the α/β values of PCa from phase III randomized trials of conventional (CRT) versus hypofractionated (HRT) external beam radiotherapy (RT), reported as isoeffective in terms of their 5-year biochemical (BF) or biochemical and/or clinical failure (BCF) rates. MATERIAL AND METHODS The α/β for each trial was estimated from the equivalent biological effective doses using the linear-quadratic model for each of their HRT and CRT schedules. The cumulative outcomes of these trials were evaluated by meta-analysis for odds ratio (OR), risk ratio (RR) and risk difference (RD). RESULTS Eight trials from seven studies, randomized 6993 patients between CRT (n = 2941) and HRT (n = 4052). RT treatment varied between the two treatment groups in terms of dose/fraction, total dose, overall treatment time and %patients on androgen deprivation therapy (ADT). Differences in OR, RR, and RD for both BF and BCF were nonsignificant. The computed α/β ranged from 1.3 to 11.1 Gy (4.9 ± 3.9 Gy; 95% CI: 1.6-8.2). On multivariate regression, %ADT was the sole determinant of computed α/β (model R2: 0.98, p < .001). CONCLUSIONS Clinically estimated α/β for PCa from isoeffective randomized trials using known variables in the linear-quadratic expression ranged between 1.3 and 11.1 Gy. The estimated α/β values were inversely related to %ADT usage, which should be considered when planning future RT dose-fractionation schedules.
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Affiliation(s)
- Niloy R. Datta
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Stutz
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Susanne Rogers
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
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Lukka HR, Pugh SL, Bruner DW, Bahary JP, Lawton CAF, Efstathiou JA, Kudchadker RJ, Ponsky LE, Seaward SA, Dayes IS, Gopaul DD, Michalski JM, Delouya G, Kaplan ID, Horwitz EM, Roach M, Pinover WH, Beyer DC, Amanie JO, Sandler HM, Kachnic LA. Patient Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 102:287-295. [PMID: 29913254 DOI: 10.1016/j.ijrobp.2018.06.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE There is considerable interest in very short (ultrahypofractionated) radiation therapy regimens to treat prostate cancer based on potential radiobiological advantages, patient convenience, and resource allocation benefits. Our objective is to demonstrate that detectable changes in health-related quality of life measured by the bowel and urinary domains of the Expanded Prostate Cancer Index Composite (EPIC-50) were not substantially worse than baseline scores. METHODS AND MATERIALS NRG Oncology's RTOG 0938 is a nonblinded randomized phase 2 study of National Comprehensive Cancer Network low-risk prostate cancer in which each arm is compared with a historical control. Patients were randomized to 5 fractions (7.25 Gy in 2 weeks) or 12 fractions (4.3 Gy in 2.5 weeks). The co-primary endpoints were the proportion of patients with a change in EPIC-50 bowel score at 1 year (baseline to 1 year) >5 points and in EPIC-50 urinary score >2 points tested with a 1-sample binomial test. RESULTS The study enrolled 127 patients to 5 fractions (121 analyzed) and 128 patients to 12 fractions (125 analyzed). Median follow-up for all patients at the time of analysis was 3.8 years. The 1-year frequency for >5 point change in bowel score were 29.8% (P < .001) and 28.4% (P < .001) for 5 and 12 fractions, respectively. The 1-year frequencies for >2 point change in urinary score were 45.7% (P < .001) and 42.2% (P < .001) for 5 and 12 fractions, respectively. For 5 fractions, 32.9% of patients had a drop in 1-year EPIC-50 sexual score of ≥11 points (P = .34); for 12 fractions, 30.9% of patients had a drop in 1-year EPIC-50 sexual score of ≥ 11 points (P = .20). Disease-free survival at 2 years is 99.2% (95% confidence interval: 97.5-100) in the 5-fraction arm and 97.5% (95% confidence interval: 94.6-100) in the 12-fraction arm. There was no late grade 4 or 5 treatment-related urinary or bowel toxicity. CONCLUSIONS This study confirms that, based on changes in bowel and urinary domains and toxicity (acute and late), the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.
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Affiliation(s)
- Himanshu R Lukka
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Stephanie L Pugh
- NRGOncologyStatistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | - Lee E Ponsky
- Case Western Reserve University, Cleveland, Ohio
| | | | - Ian S Dayes
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Guila Delouya
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | | | - Mack Roach
- University of California-San Francisco Medical Center, San Francisco, California
| | | | - David C Beyer
- Arizona Oncology Services Foundation, Tucson, Arizona
| | | | | | - Lisa A Kachnic
- Vanderbilt University Medical Center, Nashville, Tennessee
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Dang A, Kupelian PA, Cao M, Agazaryan N, Kishan AU. Image-guided radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:308-320. [PMID: 30050792 PMCID: PMC6043755 DOI: 10.21037/tau.2017.12.37] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intensity-modulated radiotherapy (IMRT) has become the standard radiotherapy technology utilized for the treatment of prostate cancer, as it permits the delivery of highly conformal radiation dose distributions. Image-guided radiotherapy (IGRT) is an essential companion to IMRT that allows the treatment team to account for daily changes in target anatomy and positioning. In the present review, we will discuss the different sources of geometric uncertainty and review the rationale behind using IGRT in the treatment of prostate cancer. We will then describe commonly employed IGRT techniques and review their benefits and drawbacks. Additionally, we will review the evidence suggesting a potential clinical benefit to utilizing IGRT.
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Affiliation(s)
- Audrey Dang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Patrick A Kupelian
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Chang MG, Mukhopadhyay N, Holdford D, Skinner V, Saraiya S, Moghanaki D, Anscher MS. Phase 1/2 study of hypofractionated intensity-modulated radiation therapy for prostate cancer including simultaneously integrated boost. Pract Radiat Oncol 2018; 8:e149-e157. [DOI: 10.1016/j.prro.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/16/2022]
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Feutren T, Herrera FG. Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review. Prostate Int 2018; 6:75-87. [PMID: 30140656 PMCID: PMC6104294 DOI: 10.1016/j.prnil.2018.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/10/2018] [Accepted: 03/21/2018] [Indexed: 12/22/2022] Open
Abstract
Radiation therapy (RT) is a curative treatment option for localized prostate cancer. Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule (IDN) is an emerging treatment option that involves the prophylactic irradiation of the whole prostate while increasing RT doses to the visible prostatic tumor. Because of the lack of large multicentre trials, a systematic review was performed in an attempt to get an overview on the feasibility and efficacy of focal dose escalation to the IDN. A bibliographic search for articles in English, which were listed in MEDLINE from 2000 to 2016 to identify publications on RT with focal directed boost to the IDN, was performed. The review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Twenty-two articles describing 1,378 patients treated with RT using focal boost were identified and fulfilled the selection criteria. Intensity-modulated radiation therapy (IMRT) was used in 720 patients (52.3%), volumetric modulated arc therapy was used in 45 patients (3.3%), stereotactic body radiation therapy (SBRT) in 113 patients (8.2%), and low–dose rate and high–dose rate brachytherapy (BT) were used in 305 patients (22.1%) and 195 patients (14.1%), respectively. Use of androgen deprivation therapy varied substantially among series. Biochemical disease-free survival at 5 years was reported for a cohort of 812 (58.9%) patients. The combined median biochemical disease-free survival for this group of patients was 85% (range: 78.8–100%; 95% confidence interval: 77.1–82.7%). The average occurrence of grade III or worse gastrointestinal and genitourinary late toxicity was, respectively, 2.5% and 3.1% for intensity-modulated RT boost, 10% and 6% for stereotactic body RT, 6% and 2% for low–dose rate BT, and 4% and 4.3% for high–dose rate BT. This review shows encouraging results for focal dose escalation to the IDN with acceptable short- to medium-term side effects and biochemical disease control rates. However, owing to the heterogeneity of patient population and the short follow-up, the results should be interpreted with caution. Considering that the clinical endpoint in the studies was biochemical recurrence, the use and duration of androgen deprivation therapy administration should be carefully considered before driving definitive conclusions. Randomized trials with long-term follow-up are needed before this technique can be generally recommended.
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Affiliation(s)
- Thomas Feutren
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Current Position Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France
| | - Fernanda G. Herrera
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Corresponding author. Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Kang JK, Cho CK, Choi CW, Yoo S, Kim MS, Yang K, Yoo H, Kim JH, Seo YS, Lee DH, Jo M. Image-Guided Stereotactic Body Radiation Therapy for Localized Prostate Cancer. TUMORI JOURNAL 2018; 97:43-8. [DOI: 10.1177/030089161109700109] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose We report the results of a retrospective study of stereotactic body radiation therapy (SBRT) using CyberKnife for localized prostate cancer. The study focused on the safety and feasibility of this treatment modality. Materials and methods Between October 2002 and December 2007, 44 patients suffering from localized adenocarcinoma of the prostate were treated with SBRT using CyberKnife at the Korea Cancer Center Hospital. The patients were divided into 3 groups: a low-risk group (5 patients), an intermediate-risk group (10 patients), and a high-risk group (29 patients). Five patients received 32 Gy in 4 fractions, 28 patients received 34 Gy in 4 fractions, and 11 patients received 36 Gy in 4 fractions. Results The median age of the patients was 69 years (range, 53–79 years) and the median duration of follow-up 40 months (range, 12–78 months). There were 6 acute and 3 late grade 2 urinary toxicities, and 4 acute and 5 late grade 2 rectal toxicities, but there were no grade 3 or higher treatment-related toxicities. The 5-year cause-specific survival rate and progression-free survival rate were both 100%. At last follow-up, the biochemical failure-free rate of the low-risk, intermediate-risk and high-risk patients was 100%, 100% and 90.8%, respectively. Conclusion SBRT using CyberKnife for localized prostate cancer is safe and well tolerated. We obtained promising results with 34 Gy in a 4-fraction regimen especially for the high-risk patients. Free full text available at www.tumorionline.it
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Affiliation(s)
- Jin-Kyu Kang
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul Koo Cho
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul Won Choi
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - SeongYul Yoo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - KwangMo Yang
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - HyungJun Yoo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young Seok Seo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Dong Han Lee
- CyberKnife Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - MoonKi Jo
- Department of Urology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Valeriani M, Carnevale A, Osti MF, Minniti G, De Sanctis V, Agolli L, Bracci S, Enrici RM. Hypofractionated Intensity-Modulated Simultaneous Integrated Boost and Image-Guided Radiotherapy in the Treatment of High-Risk Prostate Cancer Patients: A Preliminary Report on Acute Toxicity. TUMORI JOURNAL 2018; 99:474-9. [DOI: 10.1177/030089161309900406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate acute toxicity of hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in the treatment of high-risk prostate cancer patients. Methods Between November 2009 and March 2012, 59 patients with high-risk prostate cancer were enrolled. The eclipse inverse planning system (Varian) was used to calculate an IMRT plan with simultaneous integrated boost, delivering 68.75 Gy (2.75 Gy per fraction) to the prostate, 55 Gy (2.2 Gy per fraction) to the seminal vesicles and positive nodes, and 45 Gy (1.8 Gy per fraction) to the pelvis, 4 fractions per week, 25 fractions. Prior to each treatment, patients underwent a kilo-voltage cone-beam CT performing an image-guided radiation therapy (IGRT). All patients were submitted to neoadjuvant, concomitant and adjuvant hormone therapy. Results The median follow-up for all patients was 13 months (range, 3–28). At the last follow-up, no grade 3 or 4 side effect was observed. Toxicity occurred as follows during the treatment: grade 1 and 2 gastrointestinal toxicity 5.2% and 6.9%, respectively; grade 1 and 2 genitourinary toxicity 24.1% and 1.7%, respectively. Only 1.7% of the patients developed grade 3 genitourinary toxicity. No grade 3 gastrointestinal toxicity was observed. Conclusions The present study demonstrated that 4/w hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in patients with high-risk prostate cancer is feasible and safe. Low acute toxicity rates were verified. Longer follow-up is needed to evaluate the outcomes in terms of late toxicity and survival.
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Affiliation(s)
- Maurizio Valeriani
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Alessia Carnevale
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Giuseppe Minniti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Linda Agolli
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Stefano Bracci
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Riccardo Maurizi Enrici
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
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Bruni C, Conte F, Papa F, Sinisgalli C. Optimal number and sizes of the doses in fractionated radiotherapy according to the LQ model. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2018; 36:1-53. [DOI: 10.1093/imammb/dqx020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 12/10/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C Bruni
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - F Conte
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - F Papa
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - C Sinisgalli
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
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Cosset JM. [Hypofractionated irradiation of prostate cancer: What is the radiobiological understanding in 2017?]. Cancer Radiother 2017; 21:447-453. [PMID: 28847464 DOI: 10.1016/j.canrad.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
For prostate cancer, hypofractionation has been based since 1999 on radiobiological data, which calculated a very low alpha/beta ratio (1.2 to 1.5Gy). This suggested that a better local control could be obtained, without any toxicity increase. Consequently, two types of hypofractionated schemes were proposed: "moderate" hypofractionation, with fractions of 2.5 to 4Gy, and "extreme" hypofractionation, utilizing stereotactic techniques, with fractions of 7 to 10Gy. For moderate hypofractionation, the linear-quadratic (LQ) model has been used to calculate the equivalent doses of the new protocols. The available trials have often shown a "non-inferiority", but no advantage, while the equivalent doses calculated for the hypofractionated arms were sometimes very superior to the doses of the conventional arms. This finding could suggest either an alpha/beta ratio lower than previously calculated, or a negative impact of other radiobiological parameters, which had not been taken into account. For "extreme" hypofractionation, the use of the LQ model is discussed for high dose fractions. Moreover, a number of radiobiological questions are still pending. The reduced overall irradiation time could be either a positive point (better local control) or a negative one (reduced reoxygenation). The prolonged duration of the fractions could lead to a decrease of efficacy (because allowing for reparation of sublethal lesions). Finally, the impact of the large fractions on the microenvironment and/or immunity remains discussed. The reported series appear to show encouraging short to mid-term results, but the results of randomized trials are still awaited. Today, it seems reasonable to only propose those extreme hypofractionated schemes to well-selected patients, treating small volumes with high-level stereotactic techniques.
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Affiliation(s)
- J-M Cosset
- GIE Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France.
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Hoskin P, Rojas A, Ostler P, Hughes R, Alonzi R, Lowe G. Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer. Radiother Oncol 2017; 124:56-60. [DOI: 10.1016/j.radonc.2017.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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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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Ödén J, Eriksson K, Toma-Dasu I. Incorporation of relative biological effectiveness uncertainties into proton plan robustness evaluation. Acta Oncol 2017; 56:769-778. [PMID: 28464736 DOI: 10.1080/0284186x.2017.1290825] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The constant relative biological effectiveness (RBE) of 1.1 is typically assumed in proton therapy. This study presents a method of incorporating the variable RBE and its uncertainties into the proton plan robustness evaluation. MATERIAL AND METHODS The robustness evaluation was split into two parts. In part one, the worst-case physical dose was estimated using setup and range errors, including the fractionation dependence. The results were fed into part two, in which the worst-case RBE-weighted doses were estimated using a Monte Carlo method for sampling the input parameters of the chosen RBE model. The method was applied to three prostate, breast and head and neck (H&N) plans for several fractionation schedules using two RBE models. The uncertainties in the model parameters, linear energy transfer and α/β were included. The resulting DVH error bands were compared with the use of a constant RBE without uncertainties. RESULTS All plans were evaluated as robust using the constant RBE. Applying the proposed methodology using the variable RBE models broadens the DVH error bands for all structures studied. The uncertainty in α/β was the dominant factor. The variable RBE also shifted the nominal DVHs towards higher doses for most OARs, whereas the direction of this shift for the clinical target volumes (CTVs) depended on the treatment site, RBE model and fractionation schedule. The average RBE within the CTV, using one of the RBE models and 2 Gy(RBE) per fraction, varied between 1.11-1.26, 1.06-1.16 and 1.14-1.25 for the breast, H&N and prostate patients, respectively. CONCLUSIONS A method of incorporating RBE uncertainties into the robustness evaluation has been proposed. By disregarding the variable RBE and its uncertainties, the variation in the RBE-weighted CTV and OAR doses may be underestimated. This could be an essential factor to take into account, especially in normal tissue complication probabilities based comparisons between proton and photon plans.
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Affiliation(s)
- Jakob Ödén
- Department of Physics, Medical Radiation Physics, Stockholm University, Stockholm, Sweden
- RaySearch Laboratories, Stockholm, Sweden
| | | | - Iuliana Toma-Dasu
- Department of Physics, Medical Radiation Physics, Stockholm University, Stockholm, Sweden
- Department of Oncology and Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
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Gómez L, Andrés C, Ruiz A. Dosimetric impact in the dose-volume histograms of rectal and vesical wall contouring in prostate cancer IMRT treatments. Rep Pract Oncol Radiother 2017; 22:223-230. [PMID: 28461787 DOI: 10.1016/j.rpor.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/29/2016] [Accepted: 02/26/2017] [Indexed: 12/25/2022] Open
Abstract
AIM The main purpose of this study was to evaluate the differences in dose-volume histograms of IMRT treatments for prostate cancer based on the delineation of the main organs at risk (rectum and bladder) as solid organs or by contouring their wall. BACKGROUND Rectum and bladder have typically been delineated as solid organs, including the waste material, which, in practice, can lead to an erroneous assessment of the risk of adverse effects. MATERIALS AND METHODS A retrospective study was made on 25 patients treated with IMRT radiotherapy for prostate adenocarcinoma. 76.32 Gy in 36 fractions was prescribed to the prostate and seminal vesicles. In addition to the delineation of the rectum and bladder as solid organs (including their content), the rectal and bladder wall were also delineated and the resulting dose-volume histograms were analyzed for the two groups of structures. RESULTS Data analysis shows statistically significant differences in the main parameters used to assess the risk of toxicity of a prostate radiotherapy treatment. Higher doses were received on the rectal and bladder walls compared to doses received on the corresponding solid organs. CONCLUSIONS The observed differences in terms of received doses to the rectum and bladder based on the method of contouring could gain greater importance in inverse planning treatments, where the treatment planning system optimizes the dose in these volumes. So, one should take into account the method of delineating of these structures to make a clinical decision regarding dose limitation and risk assessment of chronic toxicity.
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Affiliation(s)
- Laura Gómez
- Instituto Oncológico, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Carlos Andrés
- Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Antonio Ruiz
- Instituto Oncológico, Hospital Recoletas Campo Grande, Valladolid, Spain
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