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Zhou Z, Zhou Q, Zhao J, Hou X, Yan J, Sun X, Yang Z, Ma J, Zhang F, Zhan L, Hu K. Rebalancing TGF-β/PGE 2 breaks RT-induced immunosuppressive barriers by enhancing tumor-infiltrated dendritic cell homing. Int J Biol Sci 2024; 20:367-386. [PMID: 38164187 PMCID: PMC10750293 DOI: 10.7150/ijbs.87867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
A better understanding of how tumor microenvironments shape immune responses after radiotherapy (RT) is required to improve patient outcomes. This study focuses on the observation that dendritic cells (DCs) infiltrating irradiated cervical tumors are retained in transforming growth factor (TGF)-β-abundant regions. We report that TGF-β secretion from cervical cancer cells was increased by irradiation in a dose-dependent manner and that this significantly suppressed the expression of allostimulatory markers and Th1 cytokines in DCs. To investigate further, we blocked the TGF-β signal in DCs and observed that RT had a dose-dependent immune-promoting effect, improving DC maturation. This suggested that proinflammatory mediators may also be induced by RT, but their effects were being counteracted by the simultaneously increased levels of TGF-β. Prostaglandin E2 (PGE2), a proinflammatory molecule, was shown to be one such mediator. Adjusting the TGF-β/PGE2 ratio by inhibiting TGF-β rebooted RT-induced DC cytoskeletal organization by stimulating myosin light chain (MLC) phosphorylation. Consequently, the homing of intra-tumorally infiltrated DCs to tumor-draining lymph nodes was enhanced, leading to the induction of more robust cytotoxic T cells. Ultimately, rebalancing the TGF-β/PGE2 ratio amplified the therapeutic effects of RT, resulting in increased intra-tumoral infiltration and activation of CD8+ T cells, and improved tumor control and overall survival rate in mice. DC depletion experiments verified that the improvement in tumor control is directly correlated with the involvement of DCs via the PGE2-MLC pathway. This study emphasizes the importance of maintaining a balanced cytokine environment during RT, particularly hypofractionated RT; and it is advisable to block TGF-β while preserving PGE2 in the tumor microenvironment in order to better stimulate DC homing and DC -T priming.
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Affiliation(s)
- Ziqi Zhou
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qianqian Zhou
- Institute of Health Service and Transfusion Medicine, Tai Ping Road, Beijing 100850, People's Republic of China
| | - Jing Zhao
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junfang Yan
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiansong Sun
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhiwei Yang
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiabin Ma
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Linsheng Zhan
- Institute of Health Service and Transfusion Medicine, Tai Ping Road, Beijing 100850, People's Republic of China
| | - Ke Hu
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy. Cancers (Basel) 2022; 14:cancers14061425. [PMID: 35326574 PMCID: PMC8946271 DOI: 10.3390/cancers14061425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.
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Maree SC, Bosman PAN, van Wieringen N, Niatsetski Y, Pieters BR, Bel A, Alderliesten T. Automatic bi-objective parameter tuning for inverse planning of high-dose-rate prostate brachytherapy. ACTA ACUST UNITED AC 2020; 65:075009. [DOI: 10.1088/1361-6560/ab7362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu X, Li J, Schild SE, Schild MH, Wong W, Vora S, Herman MG, Fatyga M. Modeling of Acute Rectal Toxicity to Compare Two Patient Positioning Methods for Prostate Cancer Radiotherapy: Can Toxicity Modeling be Used for Quality Assurance? ACTA ACUST UNITED AC 2019; 7. [PMID: 30775161 PMCID: PMC6376967 DOI: 10.4172/2167-7964.1000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: Intensity Modulated Radiation Therapy (IMRT) allows for significant dose reductions to organs at risk in prostate cancer patients. However, the accurate delivery of IMRT plans can be compromised by patient positioning errors. The purpose of this study was to determine if the modeling of grade ≥ 2 acute rectal toxicity could be used to monitor the quality of IMRT protocols. Materials and Methods: 79 patients treated with Image and Fiducial Markers Guided IMRT (FMIGRT) and 302 patients treated with trans-abdominal ultrasound guided IMRT (USGRT) was selected for this study. Treatment plans were available for the FMIGRT group, and hand recorded dosimetric indices were available for both groups. We modeled toxicity in the FMIGRT group using the Lyman Kutcher Burman (LKB) and Univariate Logistic Regression (ULR) models, and we modeled toxicity in USGRT group using the ULR model. We performed Receiver Operating Characteristics (ROC) analysis on all of the models and compared the Area under the ROC curve (AUC) for the FMIGRT and the USGRT groups. Results: The observed Incidence of grade ≥ 2 rectal toxicity was 20% in FMIGRT patients and 54% in USGRT patients. LKB model parameters in the FMIGRT group were TD50=56.8 Gy, slope m=0.093, and exponent n=0.131. The most predictive indices in the ULR model for the FMIGRT group were D25% and V50 Gy. AUC for both models in the FMIGRT group was similar (AUC=0.67). The FMIGRT URL model predicted less than a 37% incidence of grade ≥ 2 acute rectal toxicity in the USGRT group. A fit of the ULR model to USGRT data did not yield a predictive model (AUC=0.5). Conclusion: Modeling of acute rectal toxicity provided a quantitative measure of the correlation between planning dosimetry and this clinical endpoint. Our study suggests that an unusually weak correlation may indicate a persistent patient positioning error.
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Affiliation(s)
- X Liu
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - J Li
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M H Schild
- Department of Pathology, Duke University School of Medicine, USA
| | - W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - S Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M G Herman
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
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Gutiérrez C, Slocker A, Najjari D, Modolell I, Ferrer F, Boladeras A, Suárez JF, Guedea F. Single-Fraction HDR Boost. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cui S, Després P, Beaulieu L. A multi-criteria optimization approach for HDR prostate brachytherapy: I. Pareto surface approximation. ACTA ACUST UNITED AC 2018; 63:205004. [DOI: 10.1088/1361-6560/aae24c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Adibi A, Salari E. Spatiotemporal radiotherapy planning using a global optimization approach. ACTA ACUST UNITED AC 2018; 63:035040. [DOI: 10.1088/1361-6560/aaa729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Prostate: High-Dose Rate Brachytherapy in the Treatment of Clinically Organ-Confined Prostate Cancer. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andrzejewski P, Kuess P, Knäusl B, Pinker K, Georg P, Knoth J, Berger D, Kirisits C, Goldner G, Helbich T, Pötter R, Georg D. Feasibility of dominant intraprostatic lesion boosting using advanced photon-, proton- or brachytherapy. Radiother Oncol 2015; 117:509-14. [DOI: 10.1016/j.radonc.2015.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 05/22/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022]
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Chao MW, Grimm P, Yaxley J, Jagavkar R, Ng M, Lawrentschuk N. Brachytherapy: state-of-the-art radiotherapy in prostate cancer. BJU Int 2015; 116 Suppl 3:80-8. [DOI: 10.1111/bju.13252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Peter Grimm
- Prostate Cancer Center of Seattle; Seattle WA USA
| | | | - Raj Jagavkar
- St Vincent's Hospital; Darlinghurst NSW Australia
| | - Michael Ng
- Radiation Oncology Victoria; Epping Vic. Australia
| | - Nathan Lawrentschuk
- Department of Surgery and Olivia Newton John Cancer Research Institute; Austin Hospital; Heidelberg Vic. Australia
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
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Boladeras A, Santorsa L, Gutierrez C, Martinez E, Pera J, Pino F, Suarez JF, Ferrer F, Díaz A, Polo A, Guedea F. External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol 2014; 112:227-32. [PMID: 25174299 DOI: 10.1016/j.radonc.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. METHODS AND MATERIALS From 2002 to July 2012, 377 pts with a diagnosis of intermediate or high-risk prostate cancer were treated with EBRT plus HDRB. Median patient age was 66 years (range, 41-86). Most patients (347 pts; 92%) were classified as high-risk (stage T2c-T3, or PSA>20 ng/mL, or GS ⩾ 8), with 30 patients (8%) considered intermediate risk. All patients underwent EBRT at a prescribed dose of 60.0 Gy (range, 45-70 Gy) to the prostate and seminal vesicles. A total of 120 pts (31%) received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Most patients (353; 94%) were prescribed complete androgen deprivation therapy (ADT). Overall survival (OS), cause-specific survival (CSS), and biochemical relapse-free survival (BRFS) rates were calculated. In the case of BRFS, patients with <26 months of follow-up (n=106) were excluded to minimize the impact of ADT. RESULTS The median follow-up for the entire sample was 50 months (range, 12-126), with 5-year actuarial OS and CSS, respectively, of 88% (95% confidence interval [CI]: 84-92) and 98% (95% CI: 97-99). The 5-year BRFS was 91% (95% CI: 87-95) in the 271 pts with ⩾ 26 months (median, 60 months) of follow-up. Late toxicity included grade 2 and 3 gastrointestinal toxicity in 17 (4.6%) and 6 pts (1.6%), respectively, as well as grades 2 and 3 genitourinary toxicity in 46 (12.2%) and 3 pts (0.8%), respectively. CONCLUSION These long-term outcomes confirm that EBRT plus a single-fraction HDRB boost provides good results in treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, patient discomfort and risks associated with anaesthesia. We believe these findings support the use of single-fractionation boost techniques.
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Affiliation(s)
- Ana Boladeras
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Luigina Santorsa
- Department of Radiation Oncology, Policlinico di Bari, Universitá degli Studi di Bari, Italy
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Evelyn Martinez
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Joan Pera
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Francisco Pino
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | | | - Ferran Ferrer
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Aurora Díaz
- Department of Radiation Oncology, Grupo Quirón, Madrid, Spain
| | - Alfredo Polo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
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Dose escalation to high-risk sub-volumes based on non-invasive imaging of hypoxia and glycolytic activity in canine solid tumors: a feasibility study. Radiat Oncol 2013; 8:262. [PMID: 24199939 PMCID: PMC3827870 DOI: 10.1186/1748-717x-8-262] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/03/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Glycolytic activity and hypoxia are associated with poor prognosis and radiation resistance. Including both the tumor uptake of 2-deoxy-2-[18 F]-fluorodeoxyglucose (FDG) and the proposed hypoxia tracer copper(II)diacetyl-bis(N4)-methylsemithio-carbazone (Cu-ATSM) in targeted therapy planning may therefore lead to improved tumor control. In this study we analyzed the overlap between sub-volumes of FDG and hypoxia assessed by the uptake of 64Cu-ATSM in canine solid tumors, and evaluated the possibilities for dose redistribution within the gross tumor volume (GTV). MATERIALS AND METHODS Positron emission tomography/computed tomography (PET/CT) scans of five spontaneous canine solid tumors were included. FDG-PET/CT was obtained at day 1, 64Cu-ATSM at day 2 and 3 (3 and 24 h pi.). GTV was delineated and CT images were co-registered. Sub-volumes for 3 h and 24 h 64Cu-ATSM (Cu3 and Cu24) were defined by a threshold based method. FDG sub-volumes were delineated at 40% (FDG40) and 50% (FDG50) of SUVmax. The size of sub-volumes, intersection and biological target volume (BTV) were measured in a treatment planning software. By varying the average dose prescription to the tumor from 66 to 85 Gy, the possible dose boost (DB) was calculated for the three scenarios that the optimal target for the boost was one, the union or the intersection of the FDG and 64Cu-ATSM sub-volumes. RESULTS The potential boost volumes represented a fairly large fraction of the total GTV: Cu3 49.8% (26.8-72.5%), Cu24 28.1% (2.4-54.3%), FDG40 45.2% (10.1-75.2%), and FDG50 32.5% (2.6-68.1%). A BTV including the union (∪) of Cu3 and FDG would involve boosting to a larger fraction of the GTV, in the case of Cu3∪FDG40 63.5% (51.8-83.8) and Cu3∪FDG50 48.1% (43.7-80.8). The union allowed only a very limited DB whereas the intersection allowed a substantial dose escalation. CONCLUSIONS FDG and 64Cu-ATSM sub-volumes were only partly overlapping, suggesting that the tracers offer complementing information on tumor physiology. Targeting the combined PET positive volume (BTV) for dose escalation within the GTV results in a limited DB. This suggests a more refined dose redistribution based on a weighted combination of the PET tracers in order to obtain an improved tumor control.
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Challapalli A, Jones E, Harvey C, Hellawell GO, Mangar SA. High dose rate prostate brachytherapy: an overview of the rationale, experience and emerging applications in the treatment of prostate cancer. Br J Radiol 2013; 85 Spec No 1:S18-27. [PMID: 23118099 DOI: 10.1259/bjr/15403217] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The technological advances in real-time ultrasound image guidance for high dose rate (HDR) prostate brachytherapy places this treatment modality at the forefront of innovation in radiotherapy. This review article will explore the rationale for HDR brachytherapy as a highly conformal method of dose delivery and safe dose escalation to the prostate, in addition to the particular radiobiological advantages it has over low dose rate and external beam radiotherapy. The encouraging outcome data and favourable toxicity profile will be discussed before looking at emerging applications for the future and how this procedure will feature alongside stereotactic radiosurgery.
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Affiliation(s)
- A Challapalli
- Department of Clinical Oncology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Comp Plan: A computer program to generate dose and radiobiological metrics from dose-volume histogram files. Med Dosim 2012; 37:305-9. [DOI: 10.1016/j.meddos.2011.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/24/2011] [Accepted: 11/29/2011] [Indexed: 12/25/2022]
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Whalley D, Patanjali N, Jackson M, Lovett A, Chatfield M, Hruby G. HDR brachytherapy combined with external beam radiation for localised prostate cancer: early experience from the Sydney Cancer Centre. J Med Imaging Radiat Oncol 2012; 56:220-6. [PMID: 22498197 DOI: 10.1111/j.1754-9485.2012.02358.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To report the toxicity and early efficacy of high-dose rate brachytherapy (HDR) as a boost to external beam radiation (EBRT) in the treatment of localised prostate cancer. METHODS Between December 2002 and November 2007, 101 consecutive patients with intermediate or high risk prostate cancer were treated with EBRT plus an HDR boost. The HDR boost was initially delivered in three fractions of 6.5 Gy each via one implant; this was subsequently modified to a two-fraction technique with separate implants 2 weeks apart (8.5 Gy each). Most patients also received at least 3 months of androgen ablation. RESULTS Our cohort included 65 intermediate risk and 36 high-risk patients. Sixty-seven patients received the three-fraction regime; 34 the two-fraction schedule. Median follow-up was 56 months, at which time 82% of patients were free from failure. The 4-year disease-free survival for intermediate and high-risk groups was 95% and 66%, respectively (overall 85%). Significant acute toxicities included clot retention (eight patients), one traumatic urethral injury, one case of retention requiring suprapubic catheter placement, one case of new onset atrial fibrillation and three cases of pulmonary emboli. At 4 years, the rate of late grade 2 genitourinary toxicity was 8%; two patients experienced grade 3 toxicity. No late grade 3 gastrointestinal toxicity was observed. Potency was preserved in 72% of those patients reporting normal pre-treatment sexual function. CONCLUSIONS Our cohort experienced toxicity similar to previously published HDR boost series with very promising early efficacy results.
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Affiliation(s)
- Deborah Whalley
- Department of Radiation Oncology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
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Cury FL, Duclos M, Aprikian A, Patrocinio H, Kassouf W, Shenouda G, Faria S, David M, Souhami L. Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiation Therapy in the Treatment of Intermediate-Risk Prostate Cancer – Long Term Results. Int J Radiat Oncol Biol Phys 2012; 82:1417-23. [DOI: 10.1016/j.ijrobp.2011.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/04/2011] [Accepted: 05/12/2011] [Indexed: 11/28/2022]
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A simple method for dose fusion from multimodality treatment of prostate cancer: Brachytherapy to external beam therapy. Brachytherapy 2011; 10:214-20. [PMID: 20843747 DOI: 10.1016/j.brachy.2010.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/14/2010] [Accepted: 08/11/2010] [Indexed: 11/22/2022]
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Huang J, Kestin LL, Ye H, Wallace M, Martinez AA, Vicini FA. Analysis of second malignancies after modern radiotherapy versus prostatectomy for localized prostate cancer. Radiother Oncol 2010; 98:81-6. [PMID: 20951450 DOI: 10.1016/j.radonc.2010.09.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE To clarify the risk of developing second primary cancers (SPCs) after radiotherapy (RT) versus prostatectomy for localized prostate cancer (PCa) in the modern era. METHODS The RT cohort consisted of 2120 patients matched on a 1:1 basis with surgical patients according to age and follow-up time. RT techniques consisted of conventional or two-dimensional RT (2DRT, 36%), three-dimensional conformal RT and/or intensity modulated RT (3DCRT/IMRT, 29%), brachytherapy (BT, 16%), and a combination of 2DRT and BT (BT boost, 19%). RESULTS The overall SPC risk was not significantly different between the matched-pair (HR 1.14, 95% CI 0.94-1.39), but the risk became significant >5years or >10years after RT (HR 1.86, 95% CI 1.36-2.55; HR 4.94, 95% CI 2.18-11.2, respectively). The most significant sites of increased risk were bladder, lymphoproliferative, and sarcoma. Of the different RT techniques, only 2DRT was associated with a significantly higher risk (HR 1.76, 95% CI 1.32-2.35), but not BT boost (HR 0.83, 95% CI 0.50-1.38), 3DCRT/IMRT (HR 0.81, 95% CI 0.55-1.21), or BT (HR 0.53, 95% CI 0.28-1.01). CONCLUSIONS Radiation-related SPC risk varies depending on the RT technique and may be reduced by using BT, BT boost, or 3DCRT/IMRT.
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Affiliation(s)
- Jiayi Huang
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA
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