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Aizawa R, Otani T, Ogata T, Moribata Y, Kido A, Akamatsu S, Goto T, Masui K, Sumiyoshi T, Kita Y, Kobayashi T, Nakamoto Y, Mizowaki T. Spatial Pattern of Intraprostatic Recurrence after Definitive External-Beam Radiation Therapy for Prostate Cancer: Implications for Focal Boost to Intraprostatic Dominant Lesion. Adv Radiat Oncol 2024; 9:101489. [PMID: 38681892 PMCID: PMC11043806 DOI: 10.1016/j.adro.2024.101489] [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: 08/23/2023] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose We retrospectively investigated spatial pattern associations between primary and recurrent tumor sites after definitive external-beam radiation therapy (EBRT) for prostate cancer, using positron emission tomography/computed tomography (PET/CT) with a prostate-specific membrane antigen (PSMA)-targeted probe, 18F-FSU-880. Methods and Materials We used data from our prior phase 2 trial involving patients who received PET/CT with 18F-FSU-880, which was designed to evaluate the tumor detection efficacy of PSMA-PET/CT for recurrent prostate cancer. Data from patients with local intraprostatic recurrence detected by PSMA-PET/CT after definitive EBRT were retrospectively analyzed. The prostate and seminal vesicles were divided into 14 sections. Two diagnostic radiologists separately re-evaluated the intraprostatic location of the primary tumor on magnetic-resonance imaging and that of the recurrent tumor on PSMA-PET/CT, respectively, and the rate of overlap between primary and recurrent tumors was calculated. The overlap rate was defined as "the number of sections that overlapped between the primary tumor and recurrent tumor" divided by "the total number of sections of recurrent tumor". A recurrent tumor was considered to be at the same location as the primary tumor when the overlap rate was equal to or greater than 75%, and a partial overlap was defined as an overlap rate between 25 and 74%. Results Twelve patients had local recurrence detected by PSMA-PET/CT. The median time to diagnosis of local recurrence was 9.1 (range, 2.2-12.3) years after definitive EBRT. The recurrent tumor was detected at the same location in 25.0%, and a partial overlap was noted in 41.7%. Conclusions Local intraprostatic recurrence after definitive EBRT often occurs at the same site or at a partially overlapping site adjacent to the primary intraprostatic dominant lesion. Our results support the merit of focal dose-escalation for intraprostatic dominant lesions in definitive EBRT.
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Affiliation(s)
- Rihito Aizawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoaki Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ogata
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Masui
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Sumiyoshi
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kita
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hsieh MT, Shakespeare TP, Winkley L, Goonetilleke D, Yap SZL, Tahir ARM. Long-term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre. J Med Imaging Radiat Oncol 2024; 68:325-332. [PMID: 38450897 DOI: 10.1111/1754-9485.13630] [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: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Concurrent chemoradiotherapy is the standard of care in the curative intent treatment of squamous cell carcinoma (SCC) of the anus. Volumetric arc therapy (VMAT) is a highly conformal radiation therapy technique that has been implemented to reduce toxicity for these patients. However, there are few reports evaluating the long-term outcomes of VMAT. Thus, we evaluated the survival and toxicity outcomes of anal cancer patients treated in our regional cancer centre undergoing curative intent chemoradiotherapy using VMAT and following the Australian EviQ guidelines. METHODS All consecutive patients treated with the VMAT technique for curative-intent definitive chemoradiotherapy for anal SCC at our institution from 2013 until 2022 were retrospectively reviewed for survival and toxicity outcomes. Kaplan-Meier estimates of locoregional control, distant metastasis-free survival, disease-free survival, anal cancer-specific survival and overall survival were obtained. RESULTS In total, 44 patients were analysed. The median follow-up was 48.9 months (Range 7.8-107). 97.7% of patients completed the prescribed radiation therapy and 88.6% chemotherapy. Five patients (11.4%) recurred. Four (9.1%) had isolated local failures, and one (2.3%) had an isolated distant failure. There were no regional nodal failures. The Kaplan-Meier estimates for locoregional control, distant metastasis-free survival, disease-free survival, anal cancer-specific survival and overall survival were 90.3%, 97.7%, 88.1%, 97.1% and 87% at 3 years, and 90.3%, 97.7%, 88.1%, 93.0% and 72.3% at 5 years, respectively. Acute grade 3 genitourinary (GU), gastrointestinal (GI) and skin toxicities occurred in 2.2%, 6.8% and 13.6% of patients, respectively. There were no acute grade 4 toxicities. Late grade 2 GU and GI toxicities occurred in 6.8% and 11.3% of patients, respectively. There were no late grade 3 or 4 toxicities or treatment-related deaths. The 5 -year colostomy-free survival rate was 86.4%. CONCLUSION Outcomes for anal SCC after definitive chemoradiotherapy using VMAT in our regional cancer centre results in low rates of grade 3/4 toxicity, high rates of organ preservation and excellent survival outcomes.
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Affiliation(s)
- Michael Ti Hsieh
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
- RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Thomas Philip Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
- RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Lauren Winkley
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Daniel Goonetilleke
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Shaun Zheng Liang Yap
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Aizawa R, Inokuchi H, Ikeda I, Nakamura K, Ogata T, Akamatsu S, Goto T, Masui K, Sumiyoshi T, Kita Y, Kobayashi T, Mizowaki T. Impact of prostate position-based image-guidance in intensity-modulated radiation therapy for localized prostate cancer. Int J Clin Oncol 2024; 29:325-332. [PMID: 38191958 DOI: 10.1007/s10147-023-02456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND/PURPOSE The long-term clinical impact of prostate position-based image-guided radiotherapy (IGRT) for localized prostate cancer remains unclear. MATERIALS AND METHODS We retrospectively compared clinical outcomes following intensity-modulated radiation therapy (IMRT) with cone-beam computed tomography-based prostate position-based IGRT (P-IGRT) or without P-IGRT (non-P-IGRT). From June 2011, we applied P-IGRT in IMRT for intermediate-risk (IR) prostate cancer (PCa) (D'Amico risk classification) (76 Gy in 38 fractions, with smaller margins). Clinical outcomes of patients who received P-IGRT between June 2011 and June 2019 were retrospectively compared with those of patients with IR PCa who received IMRT without P-IGRT between October 2002 and May 2011 in our institution (74 Gy in 37 fractions). RESULTS A total of 222 consecutive patients were analyzed: 114 in the P-IGRT cohort and 108 in the non-P-IGRT cohort. The median follow-up period after IMRT was 7.1 years for the P-IGRT cohort and 10.8 years for the non-P-IGRT cohort. The biochemical failure-free rate was significantly better in the P-IGRT cohort (94.9% for the P-IGRT cohort vs 82.7% for the non-P-IGRT cohort at 10 years, p = 0.041). The rate of rectal bleeding which needs intervention including the use of suppositories was significantly lower in the P-IGRT cohort (p < 0.001). CONCLUSIONS The use of P-IGRT with higher doses and smaller margins was correlated with significantly better biochemical control, and a lower incidence of rectal bleeding in IMRT for intermediate-risk prostate cancer. The enhanced accuracy using P-IGRT has the potential to independently improve disease control and reduce late rectal bleeding.
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Affiliation(s)
- Rihito Aizawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Itaru Ikeda
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Ogata
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kimihiko Masui
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayuki Sumiyoshi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuki Kita
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Makino T, Izumi K, Iwamoto H, Mizokami A. Treatment Strategies for High-Risk Localized and Locally Advanced and Oligometastatic Prostate Cancer. Cancers (Basel) 2021; 13:cancers13174470. [PMID: 34503280 PMCID: PMC8430548 DOI: 10.3390/cancers13174470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The definitions of locally advanced and oligometastatic prostate cancer are ambiguous, and there are no standard treatments for these. Although multidisciplinary treatment combining systemic and local treatment may be effective, there are many unresolved issues such as the choice of local treatment, use of new endocrine agents and chemotherapy, and selection of optimal patients. The present article discusses the definitions, diagnoses, and treatment of very high-risk prostate cancer and oligometastatic prostate cancer. Abstract Despite the significant advances in the treatment of high-risk prostate cancer, patients with very high-risk features such as being locally advanced (clinical stage T3–4 or minimal nodal involvement), having a high Gleason pattern, or with oligometastasis may still have a poor prognosis despite aggressive treatment. Multidisciplinary treatment with both local and systemic therapies is thought to be effective, however, unfortunately, there is still no standard treatment. However, in recent years, local definitive therapy using a combination of radiotherapy and androgen deprivation is being supported by several randomized clinical trials. This study reviews the current literature with a focus on the definition of very high-risk prostate cancer, the role of modern imaging, and its treatment options.
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Affiliation(s)
- Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Ishikawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Correspondence: ; Tel.: +81-76-265-2393; Fax: +81-76-234-4263
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
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Hart J, Spencer B, McDermott CM, Chess-Williams R, Sellers D, Christie D, Anoopkumar-Dukie S. A Pilot retrospective analysis of alpha-blockers on recurrence in men with localised prostate cancer treated with radiotherapy. Sci Rep 2020; 10:8191. [PMID: 32424131 PMCID: PMC7235269 DOI: 10.1038/s41598-020-65238-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
While alpha-blockers are commonly used to reduce lower urinary tract symptoms in prostate cancer patients receiving radiotherapy, their impact on response to radiotherapy remains unknown. Therefore, this pilot study aimed to retrospectively determine if alpha-blockers use, influenced response to radiotherapy for localised prostate cancer. In total, 303 prostate cancer patients were included, consisting of 84 control (alpha-blocker naïve), 72 tamsulosin and 147 prazosin patients. The main outcomes measured were relapse rates (%), time to biochemical relapse (months) and PSA velocity (ng/mL/year). Recurrence free survival was calculated using Kaplan-Meier analysis. Prazosin significantly reduced biochemical relapse at both two and five-years (2.72%, 8.84%) compared to control (22.61%, 34.52%). Recurrence free survival was also significantly higher in the prazosin group. This remained after multivariable analysis (HR: 0.09, 95% CI: 0.04-0.26, p < 0.001). Patients receiving prazosin had a 3.9 times lower relative risk of biochemical relapse compared to control. Although not statistically significant, tamsulosin and prazosin extended recurrence free survival by 13.15 and 9.21 months respectively. We show for the first time that prazosin may reduce risk of prostate cancer recurrence and delay time to biochemical relapse and provides justification for prospective studies to examine its potential as an adjunct treatment option for localised prostate cancer.
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Affiliation(s)
- Jordan Hart
- Menzies Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Briohny Spencer
- Menzies Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Catherine M McDermott
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Donna Sellers
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - David Christie
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Genesis Cancer Care, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Shailendra Anoopkumar-Dukie
- Menzies Health Institute, Griffith University, Queensland, Australia.
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia.
- Quality Use of Medicines Network, Griffith University, Queensland, Australia.
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Shakespeare TP, Westhuyzen J, Lim Yew Fai T, Aherne NJ. Choosing between conventional and hypofractionated prostate cancer radiation therapy: Results from a study of shared decision-making. Rep Pract Oncol Radiother 2020; 25:193-199. [PMID: 32021576 PMCID: PMC6994273 DOI: 10.1016/j.rpor.2019.12.028] [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: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022] Open
Abstract
AIM To evaluate patient choice of prostate cancer radiotherapy fractionation, using a decision aid. BACKGROUND Recent ASTRO guidelines recommend patients with localised prostate cancer be offered moderately hypofractionated radiation therapy after discussing increased acute toxicity and uncertainty of long-term results compared to conventional fractionation. MATERIALS AND METHODS A decision aid was designed to outline the benefits and potential downsides of conventionally and moderately hypofractionated radiation therapy. The aid incorporated the ASTRO guideline to outline risks and benefits. RESULTS In all, 124 patients with localised prostate cancer were seen from June-December 2018. Median age was 72 (range 50-90), 49.6 % were intermediate risk (50.4 % high risk). All except three patients made a choice using the aid; the three undecided patients were hypofractionated. In all, 33.9 % of patients chose hypofractionation: falling to 25.3 % for patients under 75 years, 24.3 % for patients living within 30 miles of the cancer centre, and 14.3 % for patients with baseline gastrointestinal symptoms. On multivariate analysis, younger age, proximity to the centre, and having baseline gastrointestinal symptoms significantly predicted for choosing conventional fractionation. Insurance status, attending clinician, baseline genitourinary symptoms, work/carer status, ECOG, cancer risk group and driving status did not impact choice. Reasons for choosing conventional fractionation were certainty of long-term results (84 %) and lower acute bowel toxicity (51 %). CONCLUSIONS Most patients declined the convenience of moderate hypofractionation due to potentially increased acute toxicity, and the uncertainty of long-term outcomes. We advocate that no patient should be offered hypofractionation without a thorough discussion of uncertainty and acute toxicity.
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Affiliation(s)
- Thomas P. Shakespeare
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Tracy Lim Yew Fai
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Noel J. Aherne
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, New South Wales, Australia
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Singh S, McDonald JT, Ilie G, Adisesh A. An examination of the association between lifetime history of prostate and pancreatic cancer diagnosis and occupation in a population sample of Canadians. PLoS One 2020; 15:e0227622. [PMID: 32023280 PMCID: PMC7001921 DOI: 10.1371/journal.pone.0227622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Occupation was assessed as possible risk factors for prostate (PCa) and pancreatic cancer in a large Canadian worker cohort. METHODS The Canadian Census Health and Environment Cohort (CanCHEC) was derived from linking the 1991 Canadian Census Cohort to the Canadian Cancer Database (1969-2010), Canadian Mortality Database (1991-2011), and Tax Summary Files (1981-2011). From the total sample of 1,931,110 persons, we identified and derived two samples of 28,610 men and 3,220 men and women with a past history of PCa and pancreatic cancer diagnoses, respectively. Cox proportional hazards models were used to estimate hazards ratios and 95% confidence intervals for occupation. RESULTS In Canadian men aged 24-64 years, the highest elevated risks of PCa were observed for library clerks (HR = 2.36, 95% CI:1.12-4.97), medical radiation technologists (HR = 1.66, 95% CI:1.04-2.65), telecommunications and line cable workers (HR = 1.62, 95% CI: 1.22-3.16) and commissioned police officers (HR = 1.54, 95% CI: 1.10-2.16. The highest elevated risk for pancreatic cancer were observed for commissioned police officers (HR = 4.34, 95% CI: 1.85-10.21), photographic and film processors (HR = 3.97, 95% CI:1.69-9.34), railway and motor transport labourers (HR = 3.94, 95% CI: 1.67-9.29), and computer engineers (HR = 3.82, 95%CI: 1.52-9.61). CONCLUSION These findings emphasize the need for further study of job-related exposures and the potential influence of non-occupational factors such as screening practices.
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Affiliation(s)
- Smriti Singh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Gabriela Ilie
- Department of Community Health and Epidemiology, Urology, and Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anil Adisesh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Low incidence of late recurrence in patients with intermediate-risk prostate cancer treated by intensity-modulated radiation therapy plus short-term androgen deprivation therapy. Int J Clin Oncol 2019; 25:713-719. [PMID: 31820209 DOI: 10.1007/s10147-019-01596-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study evaluated the long-term outcomes of intensity-modulated radiation therapy (IMRT) combined with short-term neoadjuvant androgen deprivation therapy (ADT) in patients with intermediate-risk (IR) prostate cancer (PCa). MATERIALS AND METHODS Patients with IR PCa treated with IMRT at our institution between September 2000 and November 2010 were analyzed retrospectively. The treatment consisted of IMRT (70-78 Gy in 35-39 fractions) combined with 6 months of neoadjuvant ADT. Salvage ADT was initiated when the prostate-specific antigen level was > 4.0 ng/mL RESULTS: In total, 106 consecutive patients with IR PCa (median age: 70 years old) were analyzed. The median follow-up period was 8.0 years. The overall survival, PCa-specific survival, biochemical failure, and clinical failure rates were 99.0%, 100.0%, 6.8%, and 1.9% at 5 years and 89.1%, 100.0%, 11.3%, and 2.9% at 10 years, respectively. Late recurrence (> 5 years) was observed in three cases (2.8%). The cumulative incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicities (grade 2/3) were 10.5% and 5.8% at 5 years, and 14.7% and 5.8% at 10 years, respectively. No patient developed grade 4/5 GU toxicities or grade 3-5 GI toxicities. CONCLUSION IMRT at a dose up to 78 Gy combined with short-term neoadjuvant ADT resulted in excellent long-term disease-free outcomes with acceptable morbidities among patients with IR PCa. In addition, the incidence of late recurrence was very low. Further investigation is warranted to confirm our findings.
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Shakespeare TP, Eggert E, Wood M, Westhuyzen J, Turnbull K, Rutherford N, Aherne N. PSMA-PET guided dose-escalated volumetric arc therapy (VMAT) for newly diagnosed lymph node positive prostate cancer: Efficacy and toxicity outcomes at two years. Radiother Oncol 2019; 141:188-191. [PMID: 31668514 DOI: 10.1016/j.radonc.2019.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE/OBJECTIVES There are no published reports of prostate specific membrane antigen (PSMA) positron emission tomography (PET) guided dose-escalated intensity-modulated radiation therapy (DE-IMRT) in newly diagnosed lymph node (LN) positive prostate cancer. We report early toxicity and efficacy outcomes with this approach. MATERIALS/METHODS Patients with newly diagnosed high-risk prostate cancer were staged using PSMA PET, computed tomography (CT) and bone scans. Patients with LN positive-only metastases were offered curative therapy using 3 months androgen deprivation therapy (ADT) followed by DE-IMRT (using volumetric arc therapy), and 3 years adjuvant ADT. All patients had fiducial marker insertion, with privately insured patients having spacer hydrogel insertion. PET and prostate magnetic resonance imaging were fused with the planning CT. We aimed to deliver 81 Gy in 45 fractions (Fx) to the prostate and PET-positive LNs, and 60 Gy in 45Fx to bilateral elective pelvic LNs. RESULTS In all, 46 patients were treated, with 83% Gleason 8-10, 67% T3/T4, median number of LNs 2 (range 1-6), and median PET-positive LN volume 1.14 cc (range 0.15-4.14). LNs were outside of standard contouring guidelines in 37% of patients. The mean PET-positive LN clinical target volume dose ranged from 73.3 to 85.9 Gy (median 83.6 Gy). With 24 months median follow-up, two year failure-free survival was 100%, and 2 year overall survival 95.7%. Acute grade 1 and 2 GI toxicity occurred in 48 and 11% of patients, and GU toxicity in 72 and 24%. Late grade 1, 2 and 3 GI toxicity occurred in 13, 2 and 0%, and GU toxicity 28, 13 and 4%. No toxicity was attributable to the high dose LN boost. CONCLUSIONS PSMA PET-guided DE-IMRT up to 81 Gy to the prostate and involved LNs, and long term ADT, is a promising approach for newly diagnosed LN positive prostate cancer. LN contouring guidelines require re-evaluation in the era of PSMA PET imaging.
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Affiliation(s)
| | - Elizabeth Eggert
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, Australia
| | - Maree Wood
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, Australia
| | - Kirsty Turnbull
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, Australia
| | - Natalie Rutherford
- Nuclear Medicine and PET Department, John Hunter Hospital, Newcastle, Australia
| | - Noel Aherne
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, Australia; Faculty of Medicine, University of New South Wales, Australia
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Tanaka H, Nakashima Y, Ito M, Yamaguchi T, Esaki K, Kamei S, Ishihara S, Hayashi M, Ogawa S, Goshima S, Matsuo M. Intensity-modulated radiation therapy for elderly patients (aged ≥75 years) with localized prostate cancer: Comparison with younger patients (aged <75 years). Mol Clin Oncol 2019; 10:476-480. [PMID: 30931121 DOI: 10.3892/mco.2019.1810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/12/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study was to evaluate the efficacy and safety of intensity-modulated radiation therapy (IMRT) for elderly patients with prostate cancer (age ≥75 years) compared with younger patients (<75 years). The numbers of patients enrolled into the elderly and younger groups were 238 and 853, respectively. More than half of the patients in the elderly group were high-risk, and the total risk of the elderly group was higher than that of younger group. The median follow-up periods for the elderly and younger groups were 42 (range, 2-108) and 49 (range, 2-120) months, respectively. All patients were treated with IMRT at a dose of 74-78 Gy with or without androgen-deprivation therapy. The biochemical failure-free rates (BFFRs) at 3-year follow-up for the elderly and younger groups were 93.3 and 95.7%, respectively; there was no significant difference between the 2 groups in regard to the BFFR. The clinical failure-free rates (CFFR) at 3-year follow-up for the elderly and younger groups was 95.8 and 98.5%, respectively; the 2 groups did not differ significantly in regard to the CFFR. The cumulative incidence rates of gastrointestinal toxicity (grade ≥2) and genitourinary toxicity (grade ≥2) at 3-year follow-up were 10.5 and 1.3%, respectively; there was no significant difference between the elderly and younger groups. It was concluded that in prostate cancer patients aged 75 years or older, IMRT has a treatment effect equivalent to that in patients <75 years old; adverse events are also comparable.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
| | - Yuka Nakashima
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
| | - Masaya Ito
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
| | | | - Kae Esaki
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
| | - Shingo Kamei
- Department of Urology, Kizawa Memorial Hospital, Minokamo, Gifu 505-8503, Japan
| | - Satoshi Ishihara
- Department of Urology, Kizawa Memorial Hospital, Minokamo, Gifu 505-8503, Japan
| | - Masahide Hayashi
- Department of Radiology, Kizawa Memorial Hospital, Minokamo, Gifu 505-8503, Japan
| | - Shinichi Ogawa
- Department of Radiology, Kizawa Memorial Hospital, Minokamo, Gifu 505-8503, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
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11
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Greenham S, Manley S, Turnbull K, Hoffmann M, Fonseca A, Westhuyzen J, Last A, Aherne NJ, Shakespeare TP. Application of an incident taxonomy for radiation therapy: Analysis of five years of data from three integrated cancer centres. Rep Pract Oncol Radiother 2018; 23:220-227. [PMID: 29760597 PMCID: PMC5948319 DOI: 10.1016/j.rpor.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/05/2018] [Accepted: 04/08/2018] [Indexed: 10/16/2022] Open
Abstract
AIM To develop and apply a clinical incident taxonomy for radiation therapy. BACKGROUND Capturing clinical incident information that focuses on near-miss events is critical for achieving higher levels of safety and reliability. METHODS AND MATERIALS A clinical incident taxonomy for radiation therapy was established; coding categories were prescription, consent, simulation, voluming, dosimetry, treatment, bolus, shielding, imaging, quality assurance and coordination of care. The taxonomy was applied to all clinical incidents occurring at three integrated cancer centres for the years 2011-2015. Incidents were managed locally, audited and feedback disseminated to all centres. RESULTS Across the five years the total incident rate (per 100 courses) was 8.54; the radiotherapy-specific coded rate was 6.71. The rate of true adverse events (unintended treatment and potential patient harm) was 1.06. Adverse events, where no harm was identified, occurred at a rate of 2.76 per 100 courses. Despite workload increases, overall and actual rates both exhibited downward trends over the 5-year period. The taxonomy captured previously unidentified quality assurance failures; centre-specific issues that contributed to variations in incident trends were also identified. CONCLUSIONS The application of a taxonomy developed for radiation therapy enhances incident investigation and facilitates strategic interventions. The practice appears to be effective in our institution and contributes to the safety culture. The ratio of near miss to actual incidents could serve as a possible measure of incident reporting culture and could be incorporated into large scale incident reporting systems.
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Affiliation(s)
- Stuart Greenham
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Stephen Manley
- Department of Radiation Oncology, Northern New South Wales Cancer Institute, Lismore, New South Wales, Australia
| | - Kirsty Turnbull
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Matthew Hoffmann
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Amara Fonseca
- Department of Radiation Oncology, Northern New South Wales Cancer Institute, Lismore, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Noel J. Aherne
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Thomas P. Shakespeare
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, New South Wales, Australia
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12
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James M, McLean G, Williams S, Robinson B, Yi M. Complications of curative radiation treatment for early prostate cancer. Asia Pac J Clin Oncol 2018; 14:e392-e398. [PMID: 29336525 DOI: 10.1111/ajco.12839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
AIM To report the incidence of urological complications following curative radiation treatment for early prostate cancer, including minimally invasive urological procedures (MUIP), hospital admissions and open surgical procedures. Second malignancies following radiation are also reported and compared with patients undergoing a prostatectomy. METHODS Included were patients receiving curative intent external beam radiation treatment for early prostate cancer between January 1, 2002, and December 31, 2009. Medical records were reviewed for baseline characteristics, treatment details and outcomes. Kaplan-Meier methods were used to derive the 5-year cumulative incidence of the urological outcomes and second malignancy. RESULTS There were 439 patients identified. The median follow-up was 6.96 years. The median age was 69. A total of 56 patients developed a radiation related urological complication, 25 requiring hospital admission. The 5-year cumulative incidence for an MIUP and admission was 3.95% (95% confidence interval (CI), 2.47-6.28) and 2.24% (95% CI, 1.17-4.27), respectively. There were no open surgical procedures. Further malignancy developed in 27 patients during the 5- to 9-year posttreatment period with a cumulative incidence of 10.7% (95% CI, 7.31-15.51). Of the comparator prostatectomy group, of the 265 eligible patients analyzed, 19 patients developed a second malignancy with a cumulative incidence of 9.92% (95% CI, 6.28-15.48). On log-rank testing, there was no difference in the cumulative incidence rates of second malignancy between 5 and 9 years, following respective treatments (P = 0.8554). CONCLUSIONS The incidence of MUIP, hospital admissions and open surgical procedures following radiation is reassuringly low. The second malignancy rates are also low and similar to the rates in patients treated with a prostatectomy.
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Affiliation(s)
- Melissa James
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand.,University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand
| | - Gabrielle McLean
- University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand
| | - Stephen Williams
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand
| | - Bridget Robinson
- Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand.,University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand
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13
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Chin S, Aherne NJ, Last A, Assareh H, Shakespeare TP. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines. J Med Imaging Radiat Oncol 2017. [PMID: 28623847 DOI: 10.1111/1754-9485.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. METHODS Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. RESULTS Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. CONCLUSIONS Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT.
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Affiliation(s)
- Stephen Chin
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Hassan Assareh
- Department of Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
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14
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Te Velde BL, Westhuyzen J, Awad N, Wood M, Shakespeare TP. Can a peri-rectal hydrogel spaceOAR programme for prostate cancer intensity-modulated radiotherapy be successfully implemented in a regional setting? J Med Imaging Radiat Oncol 2017; 61:528-533. [PMID: 28151584 DOI: 10.1111/1754-9485.12580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/11/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate whether the implementation of a hydrogel spacer (SpaceOAR) programme for patients treated with 81 Gy prostate intensity-modulated radiotherapy (IMRT) in a regional setting can reduce rectal doses and toxicity. METHODS In this retrospective study, 125 patients with localised prostate cancer treated between April 2014 (programme commencement) and June 2015 were compared: 65 with SpaceOAR (inserted by five different urologists) and 60 patients treated over the same time period without SpaceOAR. Patients were treated with 81 Gy in 45Fx of IMRT over 9 weeks. Planning aims included restricting rectal doses to V40 Gy < 35%, V65 Gy < 17%, V75 Gy < 10%. Acute toxicity was assessed weekly during radiotherapy and at 12 weeks. RESULTS Rectal volume parameters were all significantly lower in the SpaceOAR group, with an associated reduction in acute diarrhoea (13.8% vs 31.7%). There were no significant differences in the very low rates of acute and late faecal incontinence or proctitis, however, there was a trend towards increased haemorrhoid rate in the SpaceOAR group (11.7% vs 3.1%, P = 0.09). CONCLUSION A SpaceOAR programme in a regional setting with urologists performing low volumes of insertions (<1 per month on average) is of clinical benefit, and was associated with significantly lower radiation doses to the rectum and lower rates of acute diarrhoea.
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Affiliation(s)
- Bridget L Te Velde
- Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Justin Westhuyzen
- Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Nader Awad
- Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Maree Wood
- Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Thomas P Shakespeare
- Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
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15
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Dwyer PM, Aherne NJ, Tahir ARM, Hill J, Masoud-Rahbari R, Shakespeare TP. Rural radiation therapy ine(quality): Time to bust an urban myth. J Med Imaging Radiat Oncol 2016; 60:781-783. [DOI: 10.1111/1754-9485.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Patrick M Dwyer
- Northern NSW Local Health District; Lismore New South Wales Australia
| | - Noel J Aherne
- Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Abdul Rahim M Tahir
- Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Jacques Hill
- Radiation Oncology; Port Macquarie Base Hospital; Port Macquarie New South Wales Australia
| | - Reza Masoud-Rahbari
- Radiation Oncology; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Thomas P Shakespeare
- Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
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16
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Choong ES, Hruby G, Yang J, Kwong C, Patanjali N. 78Gy with Fiducial Marker Image-Guided Radiotherapy in Prostate Cancer: Single Center Analysis of 301 Patients. Asia Pac J Clin Oncol 2016; 13:e356-e363. [PMID: 27863019 DOI: 10.1111/ajco.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/02/2016] [Indexed: 12/31/2022]
Abstract
AIM In prostate cancer, fiducial marker image-guided radiotherapy (FMIGRT) allows correction of setup errors and interfraction physiological motion resulting in improved accuracy of target and sparing of at risk organs. We aim to report outcomes and toxicities observed in patients treated with dose escalation to 78Gy with FMIGRT in our center. METHODS AND MATERIALS Retrospective review of consecutive patients with histologically confirmed T1-4N0M0 localized prostate cancer treated with dose escalation to 78Gy with FMIGRT in our center. All patients had 3-D conformal radiotherapy. Duration of androgen deprivation therapy use was tailored to risk group. Toxicity was scored according to CTCAE.v04. Kaplan-Meier analysis was performed for freedom from biochemical failure (FFBF), prostate cancer-specific survival and overall survival. RESULTS Median follow-up was 48.6 months. Median duration of androgen deprivation therapy was 6 and 23 months in the intermediate- and high-risk group, respectively. FFBF at 5 years was 88.8%. FFBFs when stratified to risk groups were 100% for low risk, 88.9% for low-intermediate risk, 89.9% for high-intermediate risk and 85.4% for high risk, respectively. Acute severe toxicity (grade≥3) rate for both genitourinary (GU) and gastrointestinal (GI) was 1%. Late moderate-to-severe toxicity (grade≥2) rates for GU and GI were 15% and 17%, respectively, with severe (grade≥3) toxicity rate for GU and GI at 2% and 3%, respectively. CONCLUSION Dose escalation to 78Gy with FMIGRT in our series achieved good FFBF at 5 years with low acute and late toxicity rates. These results provide a good comparator cohort to our current use of image-guided intensity modulated radiotherapy.
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Affiliation(s)
- Ee Siang Choong
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Sydney, New South Wales, Australia
| | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
| | - Jean Yang
- School of Mathematics and Statistics, University of Sydney, Sydney, New South Wales, Australia
| | - Carol Kwong
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Sydney, New South Wales, Australia
| | - Nitya Patanjali
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Sydney, New South Wales, Australia
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17
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Wood M, Fonseca A, Sampson D, Kovendy A, Westhuyzen J, Shakespeare T, Turnbull K. Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer. Rep Pract Oncol Radiother 2016; 21:567-570. [PMID: 27721671 DOI: 10.1016/j.rpor.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/02/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022] Open
Abstract
AIM The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA). BACKGROUND Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner. MATERIALS AND METHODS Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit (n = 20); Stage 3, template review (n = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients. RESULTS The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency. CONCLUSION It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.
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Affiliation(s)
- Maree Wood
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia
| | - Amara Fonseca
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - David Sampson
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - Andrew Kovendy
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia
| | - Thomas Shakespeare
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia
| | - Kirsty Turnbull
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia
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18
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Shakespeare TP, Chin S, Manuel L, Wen S, Hoffman M, Wilcox SW, Aherne NJ. Long-term decision regret after post-prostatectomy image-guided intensity-modulated radiotherapy. J Med Imaging Radiat Oncol 2016; 61:141-145. [DOI: 10.1111/1754-9485.12508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas P Shakespeare
- Department of Radiation Oncology; Mid North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School; The University of New South Wales; Coffs Harbour New South Wales Australia
| | - Stephen Chin
- Department of Radiation Oncology; Mid North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Lucy Manuel
- Rural Clinical School; The University of New South Wales; Coffs Harbour New South Wales Australia
| | - Shelly Wen
- Rural Clinical School; The University of New South Wales; Coffs Harbour New South Wales Australia
| | - Matthew Hoffman
- Department of Radiation Oncology; Mid North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Shea W Wilcox
- Department of Radiation Oncology; Mid North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Noel J Aherne
- Department of Radiation Oncology; Mid North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School; The University of New South Wales; Coffs Harbour New South Wales Australia
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19
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Shakespeare TP, Wilcox SW, Aherne NJ. Can we avoid high levels of dose escalation for high-risk prostate cancer in the setting of androgen deprivation? Onco Targets Ther 2016; 9:2819-24. [PMID: 27274277 PMCID: PMC4869660 DOI: 10.2147/ott.s105174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim Both dose-escalated external beam radiotherapy (DE-EBRT) and androgen deprivation therapy (ADT) improve outcomes in patients with high-risk prostate cancer. However, there is little evidence specifically evaluating DE-EBRT for patients with high-risk prostate cancer receiving ADT, particularly for EBRT doses >74 Gy. We aimed to determine whether DE-EBRT >74 Gy improves outcomes for patients with high-risk prostate cancer receiving long-term ADT. Patients and methods Patients with high-risk prostate cancer were treated on an institutional protocol prescribing 3–6 months neoadjuvant ADT and DE-EBRT, followed by 2 years of adjuvant ADT. Between 2006 and 2012, EBRT doses were escalated from 74 Gy to 76 Gy and then to 78 Gy. We interrogated our electronic medical record to identify these patients and analyzed our results by comparing dose levels. Results In all, 479 patients were treated with a 68-month median follow-up. The 5-year biochemical disease-free survivals for the 74 Gy, 76 Gy, and 78 Gy groups were 87.8%, 86.9%, and 91.6%, respectively. The metastasis-free survivals were 95.5%, 94.5%, and 93.9%, respectively, and the prostate cancer-specific survivals were 100%, 94.4%, and 98.1%, respectively. Dose escalation had no impact on any outcome in either univariate or multivariate analysis. Conclusion There was no benefit of DE-EBRT >74 Gy in our cohort of high-risk prostate patients treated with long-term ADT. As dose escalation has higher risks of radiotherapy-induced toxicity, it may be feasible to omit dose escalation beyond 74 Gy in this group of patients. Randomized studies evaluating dose escalation for high-risk patients receiving ADT should be considered.
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Affiliation(s)
- Thomas P Shakespeare
- Department of Radiation Oncology, North Coast Cancer Institute, University of New South Wales, Coffs Harbour, NSW, Australia; Rural Clinical School, Faculty of Medicine, University of New South Wales, Coffs Harbour, NSW, Australia
| | - Shea W Wilcox
- Department of Radiation Oncology, North Coast Cancer Institute, University of New South Wales, Coffs Harbour, NSW, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, North Coast Cancer Institute, University of New South Wales, Coffs Harbour, NSW, Australia; Rural Clinical School, Faculty of Medicine, University of New South Wales, Coffs Harbour, NSW, Australia
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20
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Shakespeare TP. Adjuvant radiotherapy after radical prostatectomy: A failure of marketing-based medicine? J Med Imaging Radiat Oncol 2016; 60:239-43. [PMID: 27062263 DOI: 10.1111/1754-9485.12431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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21
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Tward JD, Jarosek S, Chu H, Thorpe C, Shrieve DC, Elliott S. Time Course and Accumulated Risk of Severe Urinary Adverse Events After High- Versus Low-Dose-Rate Prostate Brachytherapy With or Without External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:1443-1453. [PMID: 27325475 DOI: 10.1016/j.ijrobp.2016.03.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence, and radiation cystitis. We compared the incidence of grade 3 UAEs, according to the Common Terminology Criteria for Adverse Events, after low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy, as well as after LDR plus external beam radiation therapy (EBRT) and HDR plus EBRT. METHODS AND MATERIALS Men aged >65 years with nonmetastatic prostate cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare database who were treated with LDR (n=12,801), HDR (n=685), LDR plus EBRT (n=8518), or HDR plus EBRT (n=2392). The populations were balanced by propensity weighting, and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared with those in a cohort of men not treated for prostate cancer. RESULTS Median follow-up was 4.3 years. At 8 years, the propensity-weighted cumulative UAE incidence was highest after HDR plus EBRT (26.6% [95% confidence interval, 23.8%-29.7%]) and lowest after LDR (15.7% [95% confidence interval, 14.8%-16.6%]). The absolute excess risk over nontreated controls at 8 years was 1.9%, 3.8%, 8.4%, and 12.9% for LDR, HDR, LDR plus EBRT, and HDR plus EBRT, respectively. These represent numbers needed to harm of 53, 26, 12, and 8 persons, respectively. The additional risk of development of a UAE related to treatment for LDR, LDR plus EBRT, and HDR plus EBRT was greatest within the 2 years after treatment and then continued to decline over time. Beyond 4 years, the risk of development of a new severe UAE matched the baseline risk of the control population for all treatments. CONCLUSIONS Toxicity differences were observed between LDR and HDR, but the differences did not meet statistical significance. However, combination radiation therapy (either HDR plus EBRT or LDR plus EBRT) increases the risk of severe UAEs compared with HDR alone or LDR alone. The highest increased risk of urinary toxicity occurs within the 2 years after therapy and then declines to an approximately 1% increase in incidence per year.
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Affiliation(s)
- Jonathan D Tward
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
| | | | - Haitao Chu
- University of Minnesota, Minneapolis, Minnesota
| | - Cameron Thorpe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Dennis C Shrieve
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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22
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Shakespeare TP, Wilcox SW, Aherne NJ. Can we avoid dose escalation for intermediate-risk prostate cancer in the setting of short-course neoadjuvant androgen deprivation? Onco Targets Ther 2016; 9:1635-9. [PMID: 27073327 PMCID: PMC4806761 DOI: 10.2147/ott.s102327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Both dose-escalated external beam radiotherapy (DE-EBRT) and androgen deprivation therapy (ADT) improve the outcomes in patients with intermediate-risk prostate cancer. Despite this, there are only few reports evaluating DE-EBRT for patients with intermediate-risk prostate cancer receiving neoadjuvant ADT, and virtually no studies investigating dose escalation >74 Gy in this setting. We aimed to determine whether DE-EBRT >74 Gy improved the outcomes for patients with intermediate-risk prostate cancer who received neoadjuvant ADT. Findings In our institution, patients with intermediate-risk prostate cancer were treated with neoadjuvant ADT and DE-EBRT, with doses sequentially increasing from 74 Gy to 76 Gy and then to 78 Gy between 2006 and 2012. We identified 435 patients treated with DE-EBRT and ADT, with a median follow-up of 70 months. For the 74 Gy, 76 Gy, and 78 Gy groups, five-year biochemical disease-free survival rates were 95.0%, 97.8%, and 95.3%, respectively; metastasis-free survival rates were 99.1%, 100.0%, and 98.6%, respectively; and prostate cancer-specific survival rate was 100% for all three dose levels. There was no significant benefit for dose escalation either on univariate or multivariate analysis for any outcome. Conclusion There was no benefit for DE-EBRT >74 Gy in our cohort of intermediate-risk prostate cancer patients treated with neoadjuvant ADT. Given the higher risks of toxicity associated with dose escalation, it may be feasible to omit dose escalation in this group of patients. Randomized studies evaluating dose de-escalation should be considered.
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Affiliation(s)
- Thomas P Shakespeare
- Department of Radiation Oncology, North Coast Cancer Institute, The University of New South Wales, Coffs Harbour, New South Wales, Australia; Faculty of Medicine, Rural Clinical School, The University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Shea W Wilcox
- Department of Radiation Oncology, North Coast Cancer Institute, The University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, North Coast Cancer Institute, The University of New South Wales, Coffs Harbour, New South Wales, Australia; Faculty of Medicine, Rural Clinical School, The University of New South Wales, Coffs Harbour, New South Wales, Australia
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23
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Mizowaki T, Norihisa Y, Takayama K, Ikeda I, Inokuchi H, Nakamura K, Kamba T, Inoue T, Kamoto T, Ogawa O, Hiraoka M. Ten-year outcomes of intensity-modulated radiation therapy combined with neoadjuvant hormonal therapy for intermediate- and high-risk patients with T1c-T2N0M0 prostate cancer. Int J Clin Oncol 2016; 21:783-790. [PMID: 26843024 DOI: 10.1007/s10147-016-0954-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to analyze the 10-year outcomes of intensity-modulated radiation therapy (IMRT) combined with neoadjuvant hormonal therapy (HT) for patients with intermediate- and high-risk T1c-T2N0M0 prostate cancer. METHODS Fifty patients with T1c-T2N0M0 prostate cancer, who were treated with high-dose IMRT combined with neoadjuvant HT, were evaluated. Of these patients, 19 and 31 were classified into the intermediate- and high-risk groups, respectively. Neoadjuvant HT was administered over a median duration of 6 months; 74 and 78 Gy in 2 Gy per fraction were essentially delivered to the intermediate- and high-risk cases, respectively. Adjuvant HT was not administered to any of the patients after the completion of IMRT. RESULTS Over a median follow-up period of 118 months, the 10-year prostate-specific antigen failure-free survival, prostate-specific antigen failure-free, salvage hormonal therapy-free, prostate cancer-specific survival, and overall survival rates were 70.2 %, 78.7 %, 89.2 %, 100 %, and 88.8 %, respectively. No grade 3 or higher acute or late toxicities were observed. The 10-year likelihoods of developing grade 2 late urinary and rectal toxicities were 13.7 % and 4.2 %, respectively. Compared with the outcomes of a cohort of historical controls who were locally irradiated with 70 Gy by three-dimensional conformal radiotherapy, the prostate-specific antigen failure-free rate was significantly better in the IMRT groups (78.7 % vs. 53.4 % at 10 years; p = 0.027). CONCLUSIONS High-dose IMRT combined with neoadjuvant HT achieved not only high prostate-specific antigen control, but also excellent survival outcomes with acceptable morbidities, for a Japanese cohort of intermediate- and high-risk T1c-T2N0M0 prostate cancer patients, and these results warrant further investigation.
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Affiliation(s)
- Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yoshiki Norihisa
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kenji Takayama
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Itaru Ikeda
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takahiro Inoue
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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24
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Masoud Rahbari R, Winkley L, Hill J, Tahir ARM, McKay M, Last A, Shakespeare TP, Dwyer P. Definitive intensity-modulated radiotherapy concurrent with systemic therapy for oropharyngeal squamous cell carcinoma: Outcomes from an integrated regional Australian cancer centre. J Med Imaging Radiat Oncol 2016; 60:414-9. [DOI: 10.1111/1754-9485.12432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/06/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Reza Masoud Rahbari
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
| | - Lauren Winkley
- Senior Radiation Therapist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | - Jacques Hill
- Radiation Oncologist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | | | - Michael McKay
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
| | - Andrew Last
- Radiation Oncologist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | - Thomas P Shakespeare
- Radiation Oncologist; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Patrick Dwyer
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
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25
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Shukla N, Wickramasuriya R, Miller A, Perez P. An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:245-256. [PMID: 26310502 DOI: 10.1016/j.cmpb.2015.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/17/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
This paper proposes an integrated modelling approach for location planning of radiotherapy treatment services based on cancer incidence and road network-based accessibility. Previous research efforts have established travel distance/time barriers as a key factor affecting access to cancer treatment services, as well as epidemiological studies have shown that cancer incidence rates vary with population demography. Our study is built on the evidence that the travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the uptake of cancer radiotherapy (RT) services. An integrated service planning approach that combines spatially-explicit cancer incidence projections, and the placement of new RT services based on road network based accessibility measures have never been attempted. This research presents a novel approach for the location planning of RT services, and demonstrates its viability by modelling cancer incidence rates for different age-sex groups in New South Wales, Australia based on observed cancer incidence trends; and estimations of the road network-based access to current NSW treatment centres. Using three indices (General Efficiency, Service Availability and Equity), we show how the best location for a new RT centre may be chosen when there are multiple competing locations.
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Affiliation(s)
- Nagesh Shukla
- SMART Infrastructure Facility, Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Rohan Wickramasuriya
- SMART Infrastructure Facility, Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Andrew Miller
- SMART Infrastructure Facility, Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Pascal Perez
- SMART Infrastructure Facility, Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
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26
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Skvortsova I, Debbage P, Kumar V, Skvortsov S. Radiation resistance: Cancer stem cells (CSCs) and their enigmatic pro-survival signaling. Semin Cancer Biol 2015; 35:39-44. [PMID: 26392376 DOI: 10.1016/j.semcancer.2015.09.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023]
Abstract
Despite the fact that radiation therapy is a highly effective therapeutic approach, a small intratumoral cell subpopulation known as "cancer stem cells" (CSCs) is radiation-resistant and possesses specific molecular properties protecting it against radiation-induced damage. The exact mechanisms of this radioresistance are still not fully elucidated, but they relate to these cells' enhanced DNA repair capacities and their low intracellular ROS concentrations, resulting from their up-regulation of ROS scavengers. The low ROS content is accompanied by disturbances in cell cycle regulation, so it can be assumed that either CSCs are quiescent or dormant themselves, or that this cell population consists of at least two cell subpopulations: the normally and the slowly proliferating cells (quiescent or dormant cells). Slowly dividing CSCs show concomitant dysregulation of the signaling molecules mediating both cell cycle progression and maintenance of cell stemness. Despite a massive accumulation of data concerning the mechanisms underlying DNA damage response in CSCs, it represents a challenge to researchers in the era of personalized medicine to elucidate the role of intracellular ROS and of signaling pathways associated with the radiation resistance of these cells; there is a clear need to understand the molecular mechanisms helping CSCs to survive radiation exposure.
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Affiliation(s)
- Ira Skvortsova
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria.
| | - Paul Debbage
- Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Innsbruck, Austria
| | - Vinod Kumar
- Centre for Chemical and Pharmaceutical Sciences, Central University of Punjab, Bathinda, India
| | - Sergej Skvortsov
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
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