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Takemura R, Ishii K, Hosokawa Y, Morimoto H, Matsuda S, Ogino R, Shibuya K. Long-term outcomes of whole-pelvis radiation therapy using volumetric modulated arc therapy for high-risk prostate cancer†. JOURNAL OF RADIATION RESEARCH 2023; 64:850-856. [PMID: 37658697 PMCID: PMC10516725 DOI: 10.1093/jrr/rrad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/31/2023] [Indexed: 09/03/2023]
Abstract
This study investigated the outcomes of whole-pelvis radiation therapy (WPRT) using volumetric modulated arc therapy (VMAT) for high-risk prostate cancer. We retrospectively analysed 112 patients with high-risk prostate cancer who started WPRT at our hospital between August 2011 and August 2015. The prescribed dose was 78 Gy in 39 fractions to the prostate and 46.8 Gy in 26 fractions to the pelvic lymph node (LN) area. All patients received long-term androgen deprivation therapy. We evaluated late gastrointestinal (GI) and genitourinary (GU) toxicities using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for censored cases was 97 (interquartile range [IQR] = 85-108) months. The median age was 72 (IQR = 67-75) years. The high-risk and very-high-risk groups included 41 (36.6%) and 71 patients (63.4%), respectively. The median risk of LN invasion calculated by the Roach formula was 36.9 (IQR = 26.6-56.3) %. The 8-year overall survival, biochemical failure-free survival, disease-free survival and distant metastasis-free survival rates were 88.4, 91.9, 83.8 and 98.0%, respectively. Only one patient experienced common iliac LN recurrence, which was outside the pelvic irradiation area. All patients with recurrent disease were categorized into the very-high-risk group. The 8-year cumulative rates of ≥Grade 2 late GI and GU toxicities were 12.8 and 11.8%, respectively. No patients experienced Grade 4 or higher toxicities. WPRT using VMAT for high-risk prostate cancer was well tolerated and effective.
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Affiliation(s)
- Reiko Takemura
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan
| | - Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan
| | - Yukinari Hosokawa
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan
| | - Hideyuki Morimoto
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka-shi, Osaka 550-0025, Japan
| | - Shogo Matsuda
- Department of Radiation Oncology, Izumi City General Hospital, 4-5-1 Wake-cho, Izumi-shi, Osaka 594-0073, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-0051, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-0051, Japan
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Niwa M, Tomita N, Takaoka T, Takano H, Makita C, Matsuo M, Adachi S, Oshima Y, Yamamoto S, Kuno M, Miyakawa A, Okazaki D, Torii A, Kita N, Takano S, Nakamura M, Kato H, Morita A, Hiwatashi A. Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study. Cancers (Basel) 2023; 15:3696. [PMID: 37509356 PMCID: PMC10378060 DOI: 10.3390/cancers15143696] [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: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60-70 Gy in 28-35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan-Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71-80 years), with a median follow-up of 17 months (IQR 11-42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03-5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08-5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03-5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.
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Affiliation(s)
- Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hirota Takano
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Masayuki Matsuo
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Shintaro Yamamoto
- Department of Radiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya 457-8510, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Torii A, Tomita N, Kuno M, Nishio M, Yamada Y, Takaoka T, Okazaki D, Niwa M, Kita N, Takano S, Murao T, Ogawa Y, Hiwatashi A. Intensity-modulated radiation therapy with the central shielding technique for patients with uterine cervical cancer†. JOURNAL OF RADIATION RESEARCH 2023:rrad039. [PMID: 37321676 DOI: 10.1093/jrr/rrad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/25/2023] [Indexed: 06/17/2023]
Abstract
We aimed to examine outcomes and toxicities of intensity-modulated radiation therapy (IMRT) with the central shielding (CS) technique for patients with uterine cervical cancer. This retrospective study included 54 patients with International Federation of Gynecology and Obstetrics IB-IVA cancer. Whole pelvic radiotherapy or extended-field radiotherapy were performed at the dose of 50.4 Gy in 28 fractions with helical tomotherapy (HT). Six patients had para-aortic lymph node metastases. The CS technique with HT was utilized after a total dose of 28.8-41.4 Gy to reduce doses to the rectum and bladder. The prescribed dose of intracavitary brachytherapy was mainly 18-24 Gy in three or four fractions at point A. Concurrent chemotherapy was used for 47 patients (87%). Median follow-up time was 56 months. Seventeen patients (31%) developed recurrence. The recurrence of the cervix was observed in two patients (4%). The 5-year rates of the locoregional control, progression-free survival (PFS) and overall survival were 79, 66 and 82%, respectively. Among several factors evaluated, histological type of adenocarcinoma was only a significantly worse prognostic factor for PFS by multivariate analysis (hazard ratio, 4.9 [95% confidence interval, 1.3-18], P = 0.018). Grade 2 or higher late toxicities were observed in nine patients (17%). Two patients (4%) each had grade 3 proctitis and grade 3 ileus, respectively. No grade 4 toxicity or treatment-related death was observed. The results suggest that IMRT with the CS technique allows a high local control without increasing the risk of complications for cervical cancer patients.
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Affiliation(s)
- Akira Torii
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Masahiro Nishio
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Yuki Yamada
- Department of Radiation Oncology, Konan Kosei Hospital, 137 Ohmatsubara, Takaya-cho, Konan, Aichi 483-8704, Japan
| | - Taiki Takaoka
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Takayuki Murao
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Yasutaka Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Akio Hiwatashi
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Sasamura K, Soyano T, Kozuka T, Yuasa T, Yamamoto S, Yonese J, Oguchi M, Yoshimura R, Yoshioka Y. Outcomes of intensity-modulated radiation therapy for intermediate- or high-risk prostate cancer: a single-institutional study. Jpn J Clin Oncol 2022; 52:170-178. [PMID: 34689189 DOI: 10.1093/jjco/hyab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are few reports from Japan about the outcomes of intensity-modulated radiation therapy for localized prostate cancer. This study was aimed at assessing the efficacy and toxicity of intensity-modulated radiation therapy in patients with intermediate- or high-risk prostate cancer. METHODS We conducted a review of the data, retrieved from our institutional database, of patients who had received intensity-modulated radiation therapy for localized prostate cancer at a radiation dose of 78 Gy in 39 fractions. Data of 201 patients with intermediate-risk prostate cancer and 311 patients with high-risk prostate cancer were analyzed. RESULTS The median follow-up period after the completion of intensity-modulated radiation therapy was 100 months (range, 24-154). The rates of cause-specific survival, overall survival, metastasis-free survival and biochemical recurrence-free survival in the intermediate-risk patients were 99, 95, 95 and 94% at 5 years and 99, 91, 90 and 86% at 8 years, respectively; the corresponding rates in the high-risk patients were 100, 97, 91 and 84% at 5 years and 96, 92, 84 and 76% at 8 years, respectively. The crude incidence of late grade 2-3 genitourinary toxicity was 28.1%, and that of late grade 3 genitourinary toxicity was 2.0%. The crude incidence of late grade 2 gastrointestinal toxicity was 5.1%, and there were no cases of late grade 3 gastrointestinal toxicity. CONCLUSIONS Our data demonstrated that intensity-modulated radiation therapy is effective for patients with localized intermediate-risk or high-risk prostate cancer while having minimal toxicity.
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Affiliation(s)
- Kazuma Sasamura
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Soyano
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Takuyo Kozuka
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Oguchi
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Yoshioka
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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5
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Mizuno T, Tomita N, Takaoka T, Tomida M, Fukuma H, Tsuchiya T, Shibamoto Y. Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp. Technol Cancer Res Treat 2021; 20:1533033820985866. [PMID: 33517860 PMCID: PMC7871283 DOI: 10.1177/1533033820985866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: We compared radiotherapy plans among helical tomotherapy (HT),
volumetric-modulated arc therapy (VMAT), and intensity-modulated proton
therapy (IMPT) for angiosarcoma of the scalp (AS). Methods: We conducted a planning study for 19 patients with AS. The clinical target
volume (CTV) 1 and CTV2 were defined as the gross tumor volume with a
specific margin and total scalp, respectively. For HT and VMAT, the planning
target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 0.5-cm
margins, respectively. For IMPT, robust optimization was used instead of a
CTV-PTV margin (i.e. CTV robust). The targets of the HT and VMAT plans were
the PTV, whereas the IMPT plans targeted the CTV robust. In total, 70 Gy and
56 Gy were prescribed as the D95% (i.e. dose to 95% volume) of PTV1 (or CTV1
robust) and PTV2 (or CTV2 robust), respectively, using the simultaneous
integrated boost (SIB) technique. Other constraint goals were also defined
for the target and organs at risk (OAR). Results: All dose constraint parameters for the target and OAR met the goals within
the acceptable ranges for the 3 techniques. The coverage of the targets
replaced by D95% and D98% were almost equivalent among the 3 techniques. The
homogeneity index of PTV1 or CTV1 robust was equivalent among the 3
techniques, whereas that of PTV2 or CTV2 robust was significantly higher in
the IMPT plans than in the other plans. IMPT reduced the Dmean of the brain
and hippocampus by 49% to 95%, and the Dmax of the spinal cord, brainstem,
and optic pathway by 70% to 92% compared with the other techniques. Conclusion: The 3 techniques with SIB methods provided sufficient coverage and
satisfactory homogeneity for the targets, but IMPT achieved the best OAR
sparing.
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Affiliation(s)
- Tomoki Mizuno
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Taiki Takaoka
- Narita Memorial Proton Center, Toyohashi, Aichi, Japan
| | | | - Hiroshi Fukuma
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiro Tsuchiya
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Schumacher LED, Dal Pra A, Hoffe SE, Mellon EA. Toxicity reduction required for MRI-guided radiotherapy to be cost-effective in the treatment of localized prostate cancer. Br J Radiol 2020; 93:20200028. [PMID: 32783629 DOI: 10.1259/bjr.20200028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the toxicity reduction required to justify the added costs of MRI-guided radiotherapy (MR-IGRT) over CT-based image guided radiotherapy (CT-IGRT) for the treatment of localized prostate cancer. METHODS The costs of delivering prostate cancer radiotherapy with MR-IGRT and CT-IGRT in conventional 39 fractions and stereotactic body radiotherapy (SBRT) 5 fractions schedules were determined using literature values and cost accounting from two institutions. Gastrointestinal and genitourinary toxicity rates associated with CT-IGRT were summarized from 20 studies. Toxicity-related costs and utilities were obtained from literature values and cost databases. Markov modeling was used to determine the savings per patient for every 1% relative reduction in acute and chronic toxicities by MR-IGRT over 15 years. The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness. One way sensitivity analyses were performed. Standard $100,000 and $50,000 per QALY ratios were used. RESULTS The added cost of MR-IGRT was $1,459 per course of SBRT and $10,129 per course of conventionally fractionated radiotherapy. Relative toxicity reductions of 7 and 14% are required for SBRT to be cost-effective using $100,000 and $50,000 per QALY, respectively. Conventional radiotherapy requires relative toxicity reductions of 50 and 94% to be cost-effective. CONCLUSION From a healthcare perspective, MR-IGRT can reasonably be expected to be cost-effective. Hypofractionated schedules, such a five fraction SBRT, are most likely to be cost-effective as they require only slight reductions in toxicity (7-14%). ADVANCES IN KNOWLEDGE This is the first detailed economic assessment of MR-IGRT, and it suggests that MR-IGRT can be cost-effective for prostate cancer treatment through toxicity reduction alone.
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Affiliation(s)
- Leif-Erik D Schumacher
- Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alan Dal Pra
- Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Sarah E Hoffe
- Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Eric A Mellon
- Radiation Oncology and Bioengineering, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
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7
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Tomita N, Uchiyama K, Mizuno T, Imai M, Sugie C, Ayakawa S, Niwa M, Matsui T, Otsuka S, Manabe Y, Nomura K, Kondo T, Kosaki K, Miyakawa A, Miyamoto A, Takemoto S, Yasui T, Shibamoto Y. Early salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy: Its impact and optimal candidate. Asia Pac J Clin Oncol 2020; 16:273-279. [PMID: 32519506 DOI: 10.1111/ajco.13341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/18/2020] [Indexed: 12/01/2022]
Abstract
AIM We aimed to identify the optimal candidates for early salvage radiotherapy (SRT) among patients with biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS This multi-institutional retrospective study included 371 patients treated using SRT after RP. The median (range) PSA level at BCR was 0.36 (0.10-2.00) ng/mL. The association between early SRT (ie, starting PSA level < 0.50) and BCR after SRT was tested in each subgroup according to our own risk stratification. RESULTS The median follow-up time was 51 months. By multivariate analysis, pT3b, Gleason score ≥ 8, negative surgical margins, PSA doubling time < 6 months, and non-early SRT were associated with BCR after SRT. Patients were stratified by four risk factors other than non-early SRT: (1) low risk (0 risk factor), (2) intermediate risk (1 risk factor), and (3) high risk (≥2 risk factors). The BCR-free survival was higher in the early SRT group than the nonearly SRT group in the high-risk subgroup (P = 0.020), whereas that was similar between two groups in the low-risk and intermediate-risk subgroups (P = .79 and .18, respectively). Multivariate analysis revealed that early SRT was beneficial for the high-risk subgroup (P = .032), whereas early SRT was not associated with improved outcomes in the low-risk and intermediate-risk subgroups (P = .92 and 1.0, respectively). CONCLUSIONS This study suggested that early SRT seemed to contribute to better biochemical control for patients with more adverse features, whereas no benefit was observed in men with no adverse features.
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Affiliation(s)
- Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kaoru Uchiyama
- Department of Radiology, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Tomoki Mizuno
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Department of Radiology, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Mikiko Imai
- Department of Radiology, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Shiho Ayakawa
- Department of Radiation Oncology, Chukyo Hospital, Nagoya, Aichi, Japan
| | - Masanari Niwa
- Department of Radiation Oncology, Suzuka General Hospital, Suzuka, Mie, Japan
| | - Tooru Matsui
- Department of Radiology, Konan Kosei Hospital, Konan, Aichi, Japan
| | - Shinya Otsuka
- Department of Radiology, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Yoshihiko Manabe
- Department of Radiation Oncology, Nanbu Tokushukai General Hospital, Shimajiri, Okinawa, Japan
| | - Kento Nomura
- Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Aichi, Japan
| | - Takuhito Kondo
- Department of Radiology, Narita Memorial Hospital, Toyohashi, Aichi, Japan
| | - Katsura Kosaki
- Department of Radiation Oncology, Kasugai Municipal Hospital, Kasugai, Aichi, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Akihiko Miyamoto
- Department of Radiation Oncology, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Shinya Takemoto
- Department of Radiology, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Takahiro Yasui
- Department of Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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8
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Li CC, Liang JA, Chen WTL, Chien CR. Effectiveness of image-guided radiotherapy for rectal cancer patients treated with neoadjuvant concurrent chemoradiotherapy: A population-based propensity score-matched analysis. Asia Pac J Clin Oncol 2019; 15:e197-e203. [PMID: 31250970 DOI: 10.1111/ajco.13196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/12/2019] [Indexed: 12/29/2022]
Abstract
AIM The effects of image-guided radiotherapy (IGRT, an advanced RT technology) have been debated in the literature. We compared the outcomes of locally advanced rectal cancer (LARC) patients treated with neoadjuvant concurrent chemoradiotherapy (NCCRT; with vs without IGRT) in a large population-based propensity score (PS)-matched analysis. METHODS We identified LARC patients diagnosed between 2007 and 2015 via the Taiwan cancer registry (TCR) and constructed a PS-matched cohort to balance observable potential confounders. Outcomes (R0 resection, overall survival, incidence of local regional recurrence [ILRR], rectal cancer mortality [IRCM], other cancer mortality [IOCM] and cardiovascular mortality [ICVM]) were obtained from TCR and the national death registry. We compared the hazard ratio (HR) of death and other endpoints between IGRT and non-IGRT groups. We performed supplementary analysis (SA) to evaluate the robustness of these results in a subgroup, taking an additional potential confounder into account. RESULTS Our study population comprised of 586 patients that were balanced with regard to observed covariables. There was no significant difference in HR for death (0.99; 95% confidence interval 0.70-1.39; P = 0.94) between IGRT and non-IGRT groups. There were also no significant differences in R0 resection, ILRR, IRCM, IOCM or ICVM. The results of our SA were consistent with these findings. CONCLUSION For LARC patients treated with NCCRT, the treatment outcome was not significantly different among patients treated with and without IGRT. Further study is needed to clarify these results with consideration to additional potential confounding factors and toxicity profiles at endpoints.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - William Tzu-Liang Chen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
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