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Cattell RF, Hsia AT, Kim J, Qian X, Lu S, Slade A, Mani K, Ryu S, Xu Z. Intrafractional motion and dosimetric analysis in prostate stereotactic body radiation therapy with auto beam hold technique. Biomed Phys Eng Express 2024; 10:045052. [PMID: 38923907 DOI: 10.1088/2057-1976/ad4b1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
Objective: To summarize our institutional prostate stereotactic body radiation therapy (SBRT) experience using auto beam hold (ABH) technique for intrafractional prostate motion and assess ABH tolerance of 10-millimeter (mm) diameter.Approach: Thirty-two patients (160 fractions) treated using ABH technique between 01/2018 and 03/2021 were analyzed. During treatment, kV images were acquired every 20-degree gantry rotation to visualize 3-4 gold fiducials within prostate to track target motion. If the fiducial center fell outside the tolerance circle (diameter = 10 mm), beam was automatically turned off for reimaging and repositioning. Number of beam holds and couch translational movement magnitudes were recorded. Dosimetric differences from intrafractional motion were calculated by shifting planned isocenter.Main Results: Couch movement magnitude (mean ± SD) in vertical, longitudinal and lateral directions were -0.7 ± 2.5, 1.4 ± 2.9 and -0.1 ± 0.9 mm, respectively. For most fractions (77.5%), no correction was necessary. Number of fractions requiring one, two, or three corrections were 15.6%, 5.6% and 1.3%, respectively. Of the 49 corrections, couch shifts greater than 3 mm were seen primarily in the vertical (31%) and longitudinal (39%) directions; corresponding couch shifts greater than 5 mm occurred in 2% and 6% of cases. Dosimetrically, 100% coverage decreased less than 2% for clinical target volume (CTV) (-1 ± 2%) and less than 10% for PTV (-10 ± 6%). Dose to bladder, bowel and urethra tended to increase (Bladder: ΔD10%:184 ± 466 cGy, ΔD40%:139 ± 241 cGy, Bowel: ΔD1 cm3:54 ± 129 cGy; ΔD5 cm3:44 ± 116 cGy, Urethra: ΔD0.03 cm3:1 ± 1%). Doses to the rectum tended to decrease (Rectum: ΔD1 cm3:-206 ± 564 cGy, ΔD10%:-97 ± 426 cGy; ΔD20%:-50 ± 251 cGy).Significance: With the transition from conventionally fractionated intensity modulated radiation therapy to SBRT for localized prostate cancer treatment, it is imperative to ensure that dose delivery is spatially accurate for appropriate coverage to target volumes and limiting dose to surrounding organs. Intrafractional motion monitoring can be achieved using triggered imaging to image fiducial markers and ABH to allow for reimaging and repositioning for excessive motion.
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Affiliation(s)
- Renee F Cattell
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - An Ting Hsia
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Jinkoo Kim
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Xin Qian
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Siming Lu
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Alexander Slade
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Kartik Mani
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Samuel Ryu
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
| | - Zhigang Xu
- Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, United States of America
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Zhou R, Lu D, Mi J, Wang C, Lu W, Wang Z, Li X, Wei C, Zhang H, Ji J, Zhang Y, Zhang D, Wang F. Disulfidptosis-related genes serve as potential prognostic biomarkers and indicate tumor microenvironment characteristics and immunotherapy response in prostate cancer. Sci Rep 2024; 14:14107. [PMID: 38898043 PMCID: PMC11187134 DOI: 10.1038/s41598-024-61679-y] [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: 03/07/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
Disulfidptosis, a newly identified programmed cell death pathway in prostate cancer (PCa), is closely associated with intracellular disulfide stress and glycolysis. This study aims to elucidate the roles of disulfidptosis-related genes (DRGs) in the pathogenesis and progression of PCa, with the goal of improving diagnostic and therapeutic approaches. We analyzed PCa datasets and normal tissue transcriptome data from TCGA, GEO, and MSKCC. Using consensus clustering analysis and LASSO regression, we developed a risk scoring model, which was validated in an independent cohort. The model's predictive accuracy was confirmed through Kaplan-Meier curves, receiver operating characteristic (ROC) curves, and nomograms. Additionally, we explored the relationship between the risk score and immune cell infiltration, and examined the tumor microenvironment and somatic mutations across different risk groups. We also investigated responses to immunotherapy and drug sensitivity. Our analysis identified two disulfidosis subtypes with significant differences in survival, immune environments, and treatment responses. According to our risk score, the high-risk group exhibited poorer progression-free survival (PFS) and higher tumor mutational burden (TMB), associated with increased immune suppression. Functional enrichment analysis linked high-risk features to key cancer pathways, including the IL-17 signaling pathway. Moreover, drug sensitivity analysis revealed varied responses to chemotherapy, suggesting the potential for disulfidosis-based personalized treatment strategies. Notably, we identified PROK1 as a crucial prognostic marker in PCa, with its reduced expression correlating with disease progression. In summary, our study comprehensively assessed the clinical implications of DRGs in PCa progression and prognosis, offering vital insights for tailored precision medicine approaches.
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Affiliation(s)
- Rongbin Zhou
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed By the Province and Ministry, Guangxi Medical University, No. 22, Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dingjin Lu
- Department of Urology, People's Hospital of Beihai, Beihai, 536000, Guangxi, China
| | - Junhao Mi
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed By the Province and Ministry, Guangxi Medical University, No. 22, Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Chengbang Wang
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Wenhao Lu
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed By the Province and Ministry, Guangxi Medical University, No. 22, Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zuheng Wang
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiao Li
- School of Life Sciences, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chunmeng Wei
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huiyong Zhang
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jin Ji
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
- Department of Urology, Naval Medical Center, Naval Medical Univiersiy, 338 Huaihai West Road, Shanghai, 200433, China
| | - Yifeng Zhang
- Department of Urology, Naval Medical Center, Naval Medical Univiersiy, 338 Huaihai West Road, Shanghai, 200433, China.
| | - Duobing Zhang
- Department of Urology, Suzhou Hospital of Anhui Medical University, 616 The Third Bianyang Road, Yongqiao District, Suzhou, 234000, Anhui, China.
| | - Fubo Wang
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed By the Province and Ministry, Guangxi Medical University, No. 22, Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- School of Life Sciences, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Gao RW, Ma J, Pisansky TM, Kruse JJ, Stish BJ, Kowalchuk RO, McMenomy BP, Waddle MR, Phillips RM, Choo R, Davis BJ. Dosimetric Features of Ultra-Hypofractionated Intensity Modulated Proton Therapy for Prostate Cancer. Int J Part Ther 2024; 12:100015. [PMID: 38827121 PMCID: PMC11137510 DOI: 10.1016/j.ijpt.2024.100015] [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: 12/05/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose To report clinical and dosimetric characteristics of 5-fraction stereotactic ablative radiotherapy (SABR) using intensity modulated proton therapy (IMPT) for localized prostate cancer. Materials and Methods All patients receiving IMPT SABR from 2017 to 2021 for localized prostate cancer at our institution were included. Five fractions were delivered every other day to the prostate +/- seminal vesicles [clinical target volume (CTV)] with 3 mm/3% robustness. A 4-field arrangement with 2 anterior oblique and 2 opposed lateral beams was used in most patients (97%), and most (99%) had a retroprostatic hydrogel spacer. Results A total of 534 patients with low (14%), favorable intermediate (45%), unfavorable intermediate (36%), high (4.0%), or very high-risk (0.6%) disease are evaluated. Prescription dose was 36.25 Gy (31%), 38 Gy (38%), or 40 Gy (31%) was prescribed. Median volume percentage of CTV receiving at least 100% of prescription dose [V100% (%)] was 100% [interquartile range: 99.99-100]. Rectum V50% (%), V80% (%), and V90% (%) were significantly lower in patients who had spacer, with a mean difference of -9.70%, -6.59%, and -4.42%, respectively, compared to those who did not have spacer. Femoral head dose was lower with a 4-field arrangement. Mean differences in left and right femoral head V40% (%) were -6.99% and -10.74%, respectively. Conclusion We provide a large, novel report of patients treated with IMPT SABR for localized prostate cancer. Four-field IMPT with hydrogel spacer provides significant sparing of rectum and femoral heads without compromising target coverage.
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Affiliation(s)
- Robert W. Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jiasen Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M. Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon J. Kruse
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Roman O. Kowalchuk
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R. Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan M. Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J. Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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4
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Snyder J, Smith B, Aubin JS, Shepard A, Hyer D. Simulating an intra-fraction adaptive workflow to enable PTV margin reduction in MRIgART volumetric modulated arc therapy for prostate SBRT. Front Oncol 2024; 13:1325105. [PMID: 38260830 PMCID: PMC10800949 DOI: 10.3389/fonc.2023.1325105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose This study simulates a novel prostate SBRT intra-fraction re-optimization workflow in MRIgART to account for prostate intra-fraction motion and evaluates the dosimetric benefit of reducing PTV margins. Materials and methods VMAT prostate SBRT treatment plans were created for 10 patients using two different PTV margins, one with a 5 mm margin except 3 mm posteriorly (standard) and another using uniform 2 mm margins (reduced). All plans were prescribed to 36.25 Gy in 5 fractions and adapted onto each daily MRI dataset. An intra-fraction adaptive workflow was simulated for the reduced margin group by synchronizing the radiation delivery with target position from cine MRI imaging. Intra-fraction delivered dose was reconstructed and prostate DVH metrics were evaluated under three conditions for the reduced margin plans: Without motion compensation (no-adapt), with a single adapt prior to treatment (ATP), and lastly for intra-fraction re-optimization during delivery (intra). Bladder and rectum DVH metrics were compared between the standard and reduced margin plans. Results As expected, rectum V18 Gy was reduced by 4.4 ± 3.9%, D1cc was reduced by 12.2 ± 6.8% (3.4 ± 2.3 Gy), while bladder reductions were 7.8 ± 5.6% for V18 Gy, and 9.6 ± 7.3% (3.4 ± 2.5 Gy) for D1cc for the reduced margin reference plans compared to the standard PTV margin. For the intrafraction replanning approach, average intra-fraction optimization times were 40.0 ± 2.9 seconds, less than the time to deliver one of the four VMAT arcs (104.4 ± 9.3 seconds) used for treatment delivery. When accounting for intra-fraction motion, prostate V36.25 Gy was on average 96.5 ± 4.0%, 99.1 ± 1.3%, and 99.6 ± 0.4 for the non-adapt, ATP, and intra-adapt groups, respectively. The minimum dose received by the prostate was less than 95% of the prescription dose in 84%, 36%, and 10% of fractions, for the non-adapt, ATP, and intra-adapt groups, respectively. Conclusions Intra-fraction re-optimization improves prostate coverage, specifically the minimum dose to the prostate, and enables PTV margin reduction and subsequent OAR sparing. Fast re-optimizations enable uninterrupted treatment delivery.
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Affiliation(s)
- Jeffrey Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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5
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When Patience is a Failing: The Case for Patient Reported Outcomes Adoption. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00091-3. [PMID: 36724856 DOI: 10.1016/j.ijrobp.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/30/2023]
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6
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Chang P, Chen S, Chang X, Zhu J, Tang Q, Ma L. EXTL3 could serve as a potential biomarker of prognosis and immunotherapy for prostate cancer and its potential mechanisms. Eur J Med Res 2022; 27:115. [PMID: 35818069 PMCID: PMC9275153 DOI: 10.1186/s40001-022-00740-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background Exostosin like glycosyltransferase 3 (EXTL3) had been reported to be associated with immune deficiency and play prognostic roles in various cancers. However, little is known about the associations between EXTL3 and prostate cancer (PCa). Hence, this article was designed to clarify their associations. Methods All original data were downloaded from The Cancer Genome Atlas (TCGA) database. Gene set enrichment analysis (GSEA) and CellMiner database was utilized, respectively, to identify EXTL3-related signaling pathways and drugs. We explored the relationships between EXTL3 expression and immunity to further evaluate the involvement of EXTL3 in response to immunotherapies. LncRNA/RBP/EXTL3 mRNA networks were also identified for its potential mechanism. Results Compared with normal prostate samples, EXTL3 was poorly expressed in PCa samples not only in mRNA expression levels, but also in protein expression levels, with worse overall survival (P < 0.05) and this gene could be an independent prognostic biomarker for PCa (both P < 0.05). EXTL3 was revealed to be markedly linked with seven signaling pathways in PCa by GSEA, including calcium, chemokine, ERBB, JAK STAT, MAPK, WNT, oxidative phosphorylation pathways. EXTL3 expression was also revealed to be significantly associated with MSI, immune cells, immune checkpoint molecules, tumor microenvironment and immune cells infiltration. We further predicted immune responses of EXTL3 gene to immunotherapies by TIDE database and the IMvigor210 cohort. A total of six LncRNA/RBP/EXTL3 mRNA networks were eventually identified for its potential mechanisms. Conclusions EXTL3 could serve as a potential biomarker of prognosis and immunotherapy for PCa and six LncRNA/RBP/EXTL3 mRNA networks were also identified for its potential mechanisms.
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Affiliation(s)
- Pingan Chang
- Nantong University, Nantong, 226001, Jiangsu, China.,Department of Urology, The Affiliated Dongtai Hospital of Nantong University, No.2 Fukang West Road, Yancheng, 224200, Jiangsu, China
| | - Shenglan Chen
- Department of Anesthesiology, The Affiliated Dongtai Hospital of Nantong University, Yancheng, 224200, Jiangsu, China
| | - Xiumei Chang
- Department of Urology, The Affiliated Dongtai Hospital of Nantong University, No.2 Fukang West Road, Yancheng, 224200, Jiangsu, China
| | - Jiaxi Zhu
- Nantong University, Nantong, 226001, Jiangsu, China
| | - Qingsheng Tang
- Department of Urology, The Affiliated Dongtai Hospital of Nantong University, No.2 Fukang West Road, Yancheng, 224200, Jiangsu, China.
| | - Limin Ma
- Department of Urology, Affiliated Hospital of Nantong University, No. 20 West Temple Road, Nantong, 226001, Jiangsu, China.
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Kundu P, Lin EY, Yoon SM, Parikh NR, Ruan D, Kishan AU, Lee A, Steinberg ML, Chang AJ. Rectal Radiation Dose and Clinical Outcomes in Prostate Cancer Patients Treated With Stereotactic Body Radiation Therapy With and Without Hydrogel. Front Oncol 2022; 12:853246. [PMID: 35350564 PMCID: PMC8957858 DOI: 10.3389/fonc.2022.853246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients with prostate cancer treated with stereotactic body radiation therapy (SBRT) may experience gastrointestinal (GI) toxicity. The hydrogel may mitigate this toxicity by reducing the rectal radiation dose. The purpose of this study is to compare rectal radiation dose and GI toxicity in patients receiving prostate SBRT with and without hydrogel. Methods Consecutive patients treated with SBRT between February 2017 and January 2020 with and without hydrogel were retrospectively identified. Baseline characteristics including prostate volume, rectal diameter, body mass index (BMI), age, pretreatment prostate-specific antigen (PSA), Gleason score, T-stage, and androgen deprivation therapy (ADT) usage were compared. Dosimetric outcomes (V40Gy, V36Gy, V32Gy, V38Gy, and V20Gy), rates of acute (≤90 days) and late (>90 days) GI toxicity, and PSA outcomes were evaluated for patients with and without hydrogel. Results A total of 92 patients were identified (51 hydrogel and 41 non-hydrogel). There were no significant differences in baseline characteristics. Rectal V38(cc) was significantly less in the hydrogel group (mean 0.44 vs. mean 1.41 cc, p = 0.0002), and the proportion of patients with V38(cc) < 2 cc was greater in the hydrogel group (92% vs. 72%, p = 0.01). Rectal dose was significantly lower for all institutional dose constraints in the hydrogel group (p < 0.001). The hydrogel group experienced significantly less acute overall GI toxicity (16% hydrogel vs. 28% non-hydrogel, p = 0.006), while the difference in late GI toxicity trended lower with hydrogel but was not statistically significant (4% hydrogel vs. 10% non-hydrogel, p = 0.219). At a median follow-up of 14.8 months, there were no biochemical recurrences in either group. Conclusion Hydrogel reduces rectal radiation dose in patients receiving prostate SBRT and is associated with a decreased rate of acute GI toxicity.
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Affiliation(s)
- Palak Kundu
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Eric Y Lin
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Stephanie M Yoon
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Neil R Parikh
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dan Ruan
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Alan Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Michael L Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Albert J Chang
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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8
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Rowe LS, Mandia JJ, Salerno KE, Shankavaram UT, Das S, Escorcia FE, Ning H, Citrin DE. Bowel and bladder reproducibility in image guided radiation therapy for prostate cancer: Results of a patterns of practice survey. Adv Radiat Oncol 2022; 7:100902. [PMID: 35847548 PMCID: PMC9280021 DOI: 10.1016/j.adro.2022.100902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Optimal management of patients with prostate cancer (PCa) to achieve bowel and bladder reproducibility for radiation therapy (RT) and the appropriate planning target volume (PTV) expansions for use with modern image guidance is uncertain. We surveyed American Society of Radiation Oncology radiation oncologists to ascertain practice patterns for definitive PCa RT with respect to patient instructions and set up, daily image guidance, and subsequent PTV expansions. Methods and Materials A pattern of practice survey was sent to American Society of Radiation Oncology radiation oncologists who self-identified as specializing in PCa. Respondents identified the fractionation regimens routinely used, and their practices regarding diet, bowel, and bladder instructions for patients with PCa before RT simulation and throughout treatment. Questions regarding PTV margins, daily set up practices, and use of image guidance were included. Results Of 190 respondents, 158 reported using conventional fractionation (CFx), 49 moderate hypofractionation (MHFx), and 61 stereotactic body radiation therapy (SBRT). Diet modifications during RT were advised by 84% of respondents, treatment with full bladder by 96%, and bowel instructions by 78%. Prescription of bowel medication was higher for respondents using SBRT (95.1%) versus those using CFx/MHFx (55.1%; 34.7%). The most common implantable device reported was fiducial markers, with increased use in SBRT (86.0%; 68.9%) versus CFx/MHFx. Cone beam computed tomography was the most common daily imaging technique across fractionation regimens. SBRT showed correlation between PTV margin expansions, fiducial marker use, and image guidance. Conclusions Survey results indicate heterogeneity in treatment modality, dose, patient instructions, and PTV expansions used by radiation oncologists in the treatment of patients with PCa. Further investigation to define appropriate patient instructions on bowel preparation to maximize target reproducibility in PCa is needed, as is continued guidance on evidence-based approaches for image guidance and PTV margin selection.
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Liu J, Li Y, Zhang Q, Lv C, Wang M, Jiao Y, Wang C. PVT1 Expression Is a Predictor for Poor Survival of Prostate Cancer Patients. Technol Cancer Res Treat 2021; 20:1533033820971610. [PMID: 33752525 PMCID: PMC8093616 DOI: 10.1177/1533033820971610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Dysregulation of long noncoding RNA is associated with a variety of cancers
and LncRNA has anticancer or carcinogenic activities. PVT1, as a long
noncoding RNA, plays an important role in the development of cancer. Methods: We use R to download and analyze the data in TCGA database. ROC curve is
generated to evaluate the significance of PVT1 expression for the diagnosis
of prostate cancer. Chi-square test is used to test correlation between PVT1
expression and clinical pathological features. Survival curve and univariate
and multivariate cox regression analysis is performed to compare differences
in the effect on the survival rate between PVT1 high expression and low
expression. Results: The expression of PTV1 in tumor tissues was significantly higher than that in
normal tissues(P<2.2e-16). The difference of PTV1 expression was observed
according to vital status (P = 0.0051) and Gleason score (P = 0.0012). The
expression of PTV1 is significantly associated with T classification (P <
0.0001), N classification (P = 0.0499), PSA (P = 0.0001), Gleason Score (P
< 0.0001), targeted molecular therapy (P = 0.0264) and vital status(P =
0.0036). The area under the ROC curve (AUC) was 0.860, which revealed PTV1
expression has excellent diagnostic value in prostate cancer. Patients with
high PVT1 expression had a worse prognosis. Conclusions: PVT1 expression may be a biomarker for the diagnosis and prognosis of
prostate cancer.
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Affiliation(s)
- Jianhua Liu
- Department of Urology, 117971The First Hospital of Jilin University, Changchun, China
| | - Yanqing Li
- Department of Pathophysiology, College of Basic Medical Sciences, 12510Jilin University, Changchun, China
| | - Qiqi Zhang
- The Key Laboratory of Molecular Epigenetics of MOE, Institute of Genetics and Cytology, 47821Northeast Normal University, Changchun, Jilin, China
| | - Chaoxiang Lv
- The Key Laboratory of Molecular Epigenetics of MOE, Institute of Genetics and Cytology, 47821Northeast Normal University, Changchun, Jilin, China
| | - Mingwei Wang
- Ministry of Health Key Laboratory of Radiobiology, 220738School of Public Health of Jilin University, Changchun, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, 117971The First Hospital of Jilin University, Changchun, China
| | - Chunxi Wang
- Department of Urology, 117971The First Hospital of Jilin University, Changchun, China
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Nagar H, Spratt DE. Challenging the Norm: What Level of Evidence Is Necessary to Adopt Postprostatectomy Hypofractionated Radiation Therapy? Int J Radiat Oncol Biol Phys 2021; 107:297-298. [PMID: 32386737 DOI: 10.1016/j.ijrobp.2020.02.465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Bohoudi O, Bruynzeel AME, Tetar S, Slotman BJ, Palacios MA, Lagerwaard FJ. Dose accumulation for personalized stereotactic MR-guided adaptive radiation therapy in prostate cancer. Radiother Oncol 2021; 157:197-202. [PMID: 33545251 DOI: 10.1016/j.radonc.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Adaptive MR-guided radiotherapy (MRgRT) is an innovative approach for delivering stereotactic body radiotherapy (SBRT) in prostate cancer (PC). Despite the increased clinical use of SBRT for PC, there is limited data on the relation between the actual delivered dose and toxicity. We aimed to identify dose parameters based on the total accumulated delivered bladder dose (DOSEACCTX). Furthermore, for future personalization, we studied whether prospective accumulation of the first 3 of 5 fractions (DOSEACC3FR) could be used as a representative of DOSEACCTX. MATERIALS AND METHODS We deployed a recently validated deformable image registration-based dose accumulation strategy to reconstruct DOSEACCTX and DOSEACC3FR in 101 PC patients treated with stereotactic MRgRT. IPSS scores at baseline, end of MRgRT, at 6 and 12 weeks after treatment were analyzed to identify a clinically relevant increase of acute urinary symptoms. A receiver operator characteristic curve analysis was used to investigate the correlation of an increase in IPSS and bladder DOSEACCTX (range V5-V36.25 Gy, D1cc, D5cc) and DOSEACC3FR (range V6-V21.8 Gy, D1cc, D5cc) parameters. RESULTS A clinically relevant increase in IPSS in the three months following MRgRT was observed in 25 patients. The V20Gy-32Gy from DOSEACCTX and V15Gy-18Gy from DOSEACC3FR showed good correlation with IPSS increase with area under the curve (AUC) values ranging from 0.71 to 0.75. In contrast, baseline dosimetry showed a poor correlation with AUC values between 0.53 and 0.62. CONCLUSION DOSEACCTX was superior to baseline dosimetry in predicting acute urinary symptoms. Because DOSEACC3FR also showed good correlation, this can potentially be used to optimize MRgRT for the remaining fractions.
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Affiliation(s)
- Omar Bohoudi
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - Anna M E Bruynzeel
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Shyama Tetar
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ben J Slotman
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Miguel A Palacios
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Dept. Of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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12
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Stereotactic body radiation therapy use for high risk prostate cancer in the United States. Prostate Cancer Prostatic Dis 2020; 24:578-581. [PMID: 33188271 PMCID: PMC8116349 DOI: 10.1038/s41391-020-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
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13
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Levin-Epstein RG, Jiang NY, Wang X, Upadhyaya SK, Collins SP, Suy S, Aghdam N, Mantz C, Katz AJ, Miszczyk L, Napieralska A, Namysl-Kaletka A, Prionas N, Bagshaw H, Buyyounouski MK, Cao M, Agazaryan N, Dang A, Yuan Y, Kupelian PA, Zaorsky NG, Spratt DE, Mohamad O, Feng FY, Mahal BA, Boutros PC, Kishan AU, Juarez J, Shabsovich D, Jiang T, Kahlon S, Patel A, Patel J, Nickols NG, Steinberg ML, Fuller DB, Kishan AU. Dose-response with stereotactic body radiotherapy for prostate cancer: A multi-institutional analysis of prostate-specific antigen kinetics and biochemical control. Radiother Oncol 2020; 154:207-213. [PMID: 33035622 DOI: 10.1016/j.radonc.2020.09.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The optimal dose for prostate stereotactic body radiotherapy (SBRT) is still unknown. This study evaluated the dose-response relationships for prostate-specific antigen (PSA) decay and biochemical recurrence (BCR) among 4 SBRT dose regimens. MATERIALS AND METHODS In 1908 men with low-risk (50.0%), favorable intermediate-risk (30.9%), and unfavorable intermediate-risk (19.1%) prostate cancer treated with prostate SBRT across 8 institutions from 2003 to 2018, we examined 4 regimens (35 Gy/5 fractions [35/5, n = 265, 13.4%], 36.25 Gy/5 fractions [36.25/5, n = 711, 37.3%], 40 Gy/5 fractions [40/5, n = 684, 35.8%], and 38 Gy/4 fractions [38/4, n = 257, 13.5%]). Between dose groups, we compared PSA decay slope, nadir PSA (nPSA), achievement of nPSA ≤0.2 and ≤0.5 ng/mL, and BCR-free survival (BCRFS). RESULTS Median follow-up was 72.3 months. Median nPSA was 0.01 ng/mL for 38/4, and 0.17-0.20 ng/mL for 5-fraction regimens (p < 0.0001). The 38/4 cohort demonstrated the steepest PSA decay slope and greater odds of nPSA ≤0.2 ng/mL (both p < 0.0001 vs. all other regimens). BCR occurred in 6.25%, 6.75%, 3.95%, and 8.95% of men treated with 35/5, 36.25/5, 40/5, and 38/4, respectively (p = 0.12), with the highest BCRFS after 40/5 (vs. 35/5 hazard ratio [HR] 0.49, p = 0.026; vs. 36.25/5 HR 0.42, p = 0.0005; vs. 38/4 HR 0.55, p = 0.037) including the entirety of follow-up, but not for 5-year BCRFS (≥93% for all regimens, p ≥ 0.21). CONCLUSION Dose-escalation was associated with greater prostate ablation and PSA decay. Dose-escalation to 40/5, but not beyond, was associated with improved BCRFS. Biochemical control remains excellent, and prospective studies will provide clarity on the benefit of dose-escalation.
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Affiliation(s)
| | - Naomi Y Jiang
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Xiaoyan Wang
- UCLA Division of General Internal Medicine and Health Services Research, USA
| | - Shrinivasa K Upadhyaya
- Department of Biological and Agricultural Engineering, University of California, Davis, USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, USA
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, USA
| | | | - Alan J Katz
- FROS Radiation Oncology and CyberKnife Center, Flushing, USA
| | - Leszek Miszczyk
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland
| | - Aleksandra Napieralska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland
| | | | - Nicholas Prionas
- Department of Radiation Oncology, Stanford University Medical Center, USA
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University Medical Center, USA
| | | | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Audrey Dang
- Department of Radiation Oncology, Tulane Medical Center, New Orleans, USA
| | - Ye Yuan
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Patrick A Kupelian
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, USA
| | | | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, USA; Department of Urology, University of California, Los Angeles, USA
| | - Arun U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Jesus Juarez
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - David Shabsovich
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Tommy Jiang
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Sartajdeep Kahlon
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Ankur Patel
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Jay Patel
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California, Los Angeles, USA; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | | | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, USA; Department of Urology, University of California, Los Angeles, USA.
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Adorno Febles VR, Blacksburg S, Haas JA, Wise DR. Translating the Immunobiology of SBRT to Novel Therapeutic Combinations for Advanced Prostate Cancer. Front Oncol 2020; 10:830. [PMID: 32670868 PMCID: PMC7326115 DOI: 10.3389/fonc.2020.00830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/28/2020] [Indexed: 12/30/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an increasingly used radiation modality for the treatment of both localized and metastatic prostate cancer. Substantial data suggests that prostate cancer may be more sensitive to higher doses of radiation per fraction due to its low α/β ratio. This increased sensitivity raises important questions as to how SBRT should be combined with systemic therapy for clinically significant prostate cancer, including whether androgen deprivation therapy retains its beneficial effects when combined with SBRT. Furthermore, pre-clinical and clinical data suggest pronounced immunomodulatory effects of SBRT, including observed improvements in T cell priming and trafficking. These data support investigational strategies combining SBRT with immunotherapy. Here we aim to review the data for the use of SBRT in both the local and metastatic disease settings as well as ongoing translational and clinical research examining combinations with ADT, immunotherapy and other targeted agents.
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Affiliation(s)
- Victor R Adorno Febles
- Perlmutter Cancer Center, Langone Medical Center, New York University, New York, NY, United States
| | - Seth Blacksburg
- New York University Winthrop Hospital, Mineola, NY, United States
| | - Jonathan A Haas
- New York University Winthrop Hospital, Mineola, NY, United States
| | - David R Wise
- Perlmutter Cancer Center, Langone Medical Center, New York University, New York, NY, United States
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