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Gul OV, Basaran H, Inan G. Evaluation of incidental testicular dose with thermoluminescence dosimetry during prostate radiotherapy. Med Dosim 2022; 47:203-206. [DOI: 10.1016/j.meddos.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/12/2022] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
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125I Interstitial brachytherapy with or without androgen deprivation therapy among unfavorable-intermediate and high-risk prostate cancer. Brachytherapy 2021; 21:85-93. [PMID: 34656435 DOI: 10.1016/j.brachy.2021.09.001] [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: 02/10/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE/OBJECTIVE(S) To determine if patients with unfavorable intermediate-risk (UIR), high-risk (HR), or very high-risk (VHR) prostate cancer (PCa) treated with 125I interstitial brachytherapy benefit from androgen deprivation therapy (ADT). MATERIALS/METHODS We reviewed our institutional database of patients with UIR, HR, or VHR PCa, per 2018 NCCN risk classification, treated with definitive 125I interstitial brachytherapy with or without ADT from 1998-2017. Outcomes including biochemical failure (bF), distant metastases (DM), and overall survival (OS) were analyzed with the Kaplan-Meier method and Cox proportional hazards regression. PCa-specific mortality (PCSM) was analyzed with Fine-Gray competing-risk regression. RESULTS Of 1033 patients, 262 (25%) received ADT and 771 (75%) did not. Median ADT duration was 6 months. By risk group, 764 (74%) patients were UIR, 219 (21%) HR, and 50 (5%) VHR. ADT was more frequently given to HR (50%) and VHR (56%) patients compared to UIR (16%; p<0.001), to older patients (p<0.001), corresponding with increasing PSA (p<0.001) and Grade Group (p<0.001). Median follow-up was 4.9 years (0.3-17.6 years). On multivariable analysis accounting for risk group, age, and year of treatment, ADT was not associated with bF, DM, PCSM, or OS (p≥0.05 each). CONCLUSION Among patients with UIR, HR, and VHR PCa, the addition of ADT to 125I interstitial brachytherapy was not associated with improved outcomes, and no subgroup demonstrated benefit. Our findings do not support the use of ADT in combination with 125I interstitial brachytherapy. Prospective studies are required to elucidate the role of ADT for patients with UIR, HR, and VHR PCa treated with prostate brachytherapy.
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Wilke D, Wood L, Cwajna S, Rutledge R, Hollenhorst H, Bowes D, Patil N, Ago CT, Pignol JP. Sequence Inversion to Facilitate Concurrent Radiotherapy and Systemic Therapy. A Proof of Principle Study in the Setting of a Phase II Randomized Trial in Prostate Cancer. Front Oncol 2020; 10:570660. [PMID: 33102224 PMCID: PMC7556110 DOI: 10.3389/fonc.2020.570660] [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: 06/08/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Concomitant chemo-radiation for pelvic cancers remains challenging to be delivered at full doses. We hypothesized that fewer delays in chemotherapy would occur if the sequence of radiotherapy would be reversed, starting with the boost volume followed by the elective nodal volume. We report the result of a Phase II randomized study for high risk prostate cancer. Patients and Method: The study was a double-blinded phase II randomized trial. Patients were eligible if they had non-metastatic high-risk prostate cancer. All patients received 2.5 years of hormonal therapy and 46.5 Gy in 25 fractions to the pelvic lymph nodes. Patients received a radiation boost to the prostate, either before or after whole pelvic irradiation. Concurrent (20 mg/m2) Docetaxel was given on the first day of radiotherapy and weekly thereafter for a total of eight treatments until predefined toxicity stopping rules. Results: Ninety patients were included and randomized. Four were ineligible for the analysis. In total, 42 patients were randomized to the standard sequence, 44 patients to the experimental sequence. There were statistically fewer GI or GU toxicities leading to a docetaxel dose reduction or omission in the experimental sequence compared to the standard sequence, 5 vs. 15 events (p = 0.027). There was no difference in overall survival, cause-specific survival, or biochemical-relapse free survival between the two sequences. Conclusions: This is the first study to test sequence inversion for pelvic radio-chemotherapy in a randomized double-blind trial. Less chemotherapy interruptions or dose reductions occurred by inverting the radiation sequence of the large field and the boost. The trial was registered with Clinicaltrials.gov: NCT00452556.
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Affiliation(s)
- Derek Wilke
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Lori Wood
- Division of Medical Oncology, Department of Internal Medicine, Dalhousie University, Halifax, NS, Canada
| | - Slawa Cwajna
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Helmut Hollenhorst
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Casely T Ago
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
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Onal C, Bozca R, Dolek Y, Guler OC, Arslan G. Incidental testicular doses during volumetric-modulated arc radiotherapy in prostate cancer patients. Radiol Med 2020; 125:777-783. [PMID: 32125635 DOI: 10.1007/s11547-020-01158-2] [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: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the incidental testicular doses during volumetric-modulated arc therapy (VMAT) in patients receiving prostate-only and pelvic lymphatic irradiation. MATERIALS AND METHODS Testicular doses in 40 intermediate- and high-risk prostate cancer patients were determined on treatment planning system (TPS) using the VMAT technique at 6 MV. Scattered testicular doses were also measured by MOSFET detectors placed on testis surface. The testicular doses of patients treated with prostate-only and pelvic field irradiation were compared. RESULTS The median testicular doses measured per 200 cGy fraction by TPS and MOSFET detectors were 1.7 cGy (0.7-4.1 cGy) and 4.8 cGy (3.6-8.8 cGy), respectively. The TPS doses and MOSFET readings showed a significant strong correlation (Pearson r = 0.848, p < 0.001). The testicular doses measured by TPS (1.34 ± 0.36 cGy vs. 2.60 ± 0.95 cGy; p < 0.001) and MOSFET (4.52 ± 0.64 cGy vs. 6.56 ± 1.23 cGy; p < 0.001) were significantly lower in patients with prostate-only irradiation than in those with pelvic field irradiation. The mean cumulative scattered dose for prostate-only field delivering 78 Gy was 1.8 Gy and that for pelvic field irradiation was 2.6 Gy, consistent with the reported findings. CONCLUSIONS The patients with prostate-only irradiation received lower testicular doses than those with additional pelvic field irradiation possibly due to the increased scattered doses in large field irradiation using the VMAT technique. The clinical response to increased incidental testicular doses due to pelvic field irradiation remains unknown, and it warrants further investigation.
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Affiliation(s)
- Cem Onal
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
| | - Recep Bozca
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Yemliha Dolek
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Ozan Cem Guler
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Gungor Arslan
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
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Lee SU, Cho KH, Park W, Cho WK, Kim JS, Wee CW, Kim YS, Kim JH, Nam TK, Cho J, Jeong SM, Kim Y, Shim SJ, Choi Y, Kim JS. Clinical Outcomes of Postoperative Radiotherapy Following Radical Prostatectomy in Patients with Localized Prostate Cancer: A Multicenter Retrospective Study (KROG 18-01) of a Korean Population. Cancer Res Treat 2019; 52:167-180. [PMID: 31291715 PMCID: PMC6962467 DOI: 10.4143/crt.2019.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the clinical outcomes of postoperative radiotherapy (PORT) patients who underwent radical prostatectomy for localized prostate cancer. Materials and Methods Localized prostate cancer patients who received PORT after radical prostatectomy between 2001 and 2012 were identified retrospectively in a multi-institutional database. In total, 1,117 patients in 19 institutions were included. Biochemical failure after PORT was defined as prostate-specific antigen (PSA) ≥ nadir+2 after PORT or initiation of androgen deprivation therapy (ADT) for increasing PSA regardless of its value. RESULTS Ten-year biochemical failure-free survival, clinical failure-free survival, distant metastasisfree survival, overall survival (OS), and cause-specific survival were 60.5%, 76.2%, 84.4%, 91.1%, and 96.6%, respectively, at a median of 84 months after PORT. Pre-PORT PSA ≤ 0.5 ng/ml and Gleason's score ≤ 7 predicted favorable clinical outcomes, with 10-year OS rates of 92.5% and 94.1%, respectively. The 10-year OS rate was 82.7% for patients with a PSA > 1.0 ng/mL and 86.0% for patients with a Gleason score of 8-10. The addition of longterm ADT (≥ 12 months) to PORT improved OS, particularly in those with a Gleason score of 8-10 or ≥ T3b. CONCLUSION Clinical outcomes of PORT in a Korean prostate cancer population were very similar to those in Western countries. Lower Gleason score and serum PSA level at the time of PORT were significantly associated with favorable outcomes. Addition of long-term ADT (≥ 12 months) to PORT should be considered, particularly in unfavorable risk patients with Gleason scores of 8-10 or ≥ T3b.
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Affiliation(s)
- Sung Uk Lee
- The Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kwan Ho Cho
- The Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Song Mi Jeong
- Department of Radiation Oncology, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Youngkyong Kim
- Department of Radiation Oncology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Su Jung Shim
- Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea
| | - Jun-Sang Kim
- Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea
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Laing R, Uribe J, Uribe-Lewis S, Money-Kyrle J, Perna C, Chintzoglou S, Khaksar S, Langley SE. Low-dose-rate brachytherapy for the treatment of localised prostate cancer in men with a high risk of disease relapse. BJU Int 2018; 122:610-617. [DOI: 10.1111/bju.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lee SU, Cho KH. Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy, and their combination. Radiat Oncol J 2017; 35:189-197. [PMID: 29037021 PMCID: PMC5647755 DOI: 10.3857/roj.2017.00318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/25/2017] [Accepted: 08/11/2017] [Indexed: 12/29/2022] Open
Abstract
Locally advanced prostate cancer (LAPC) is defined as histologically proven T3–4 prostatic adenocarcinoma. In this review, we define the individual roles of radiotherapy (RT), short-term (ST-) and long-term (LT-) androgen deprivation therapy (ADT), and their combination in multimodal therapy for LAPC. Despite limitations in comparing the clinical outcomes among published papers, in the present study, a trend of 10-year clinical outcomes was roughly estimated by calculating the average rates weighted by the cohort number. With RT alone, the following rates were estimated: 87% biochemical failure, 34% local failure (LF), 48% distant metastasis (DM), 38% overall survival (OS), and 27% disease-specific mortality (DSM). Those associated with ADT alone were 74% BCF, 54% OS, and 25% DSM, which appeared to be better than those of RT alone. The addition of ADT to RT produced a notable local and systemic effect, regardless of ST- or LT-ADT. The LF rate decreased from 34% with RT alone to 21% with ST-ADT and further to 15% with LT-ADT. The DM and DSM rates also showed a similar trend among RT alone, RT+ST-ADT, and RT+LT-ADT. The combination of RT+LT-ADT resulted in the best long-term clinical outcomes, indicating that both RT and ADT are important parts of multimodal therapy.
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Affiliation(s)
- Sung Uk Lee
- The Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kwan Ho Cho
- The Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Hegde JV, Demanes DJ, Veruttipong D, Raince J, Park SJ, Raman SS, Nickols NG, King CR, Kishan AU, Steinberg ML, Kamrava M. Pretreatment 3T multiparametric MRI staging predicts for biochemical failure in high-risk prostate cancer treated with combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy 2017; 16:1106-1112. [PMID: 28807747 DOI: 10.1016/j.brachy.2017.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). MATERIALS AND METHODS This institutional review board-approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan-Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis. RESULTS The median prostate-specific antigen at diagnosis was 9 ng/mL (range 2-100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055). CONCLUSIONS For high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jagdeep Raince
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- Departments of Radiology, Urology, and Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA
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