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Singh M, Maitre P, Krishnan A, Adsul K, Mini Sreekumar S, Chauhan H, Bishnu PN, Phurailatpam R, Singh P, Kamble D, Bakshi G, Pal M, Arora A, Misra A, Prakash G, Murthy V. Late Urinary Toxicity After Extreme or Moderate Hypofractionated Prostate Radiation Therapy in Patients With Prior Transurethral Resection of Prostate. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00737-5. [PMID: 38908410 DOI: 10.1016/j.ijrobp.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE To study the late urinary toxicity in patients with prostate cancer with prior transurethral resection of prostate (TURP) and treated with hypofractionated prostate radiation therapy. METHODS AND MATERIALS Patients diagnosed with prostate cancer, with a prior TURP, and treated with moderate or extreme hypofractionated intensity-modulated radiation therapy (moderate hypofractionated radiation therapy [MHRT], stereotactic body radiation therapy [SBRT]), were included in this study. Severity and duration of urinary symptoms observed during serial follow-up after at least 3 months from radiation therapy were graded per National Cancer Institute Common Terminology Criteria for Adverse Events v5.0 using information from a prospectively maintained institutional database. Impact of hypofractionation and other potential contributory factors on cumulative grade 2+ late urinary toxicity was analyzed with univariable and multivariable binary logistic regression. RESULTS A total of 203 eligible patients were included (MHRT = 114, 64-68 Gy/25#; SBRT = 89, 35-37.5 Gy/5#). Median time from TURP to radiation therapy was 10 months (IQR, 7-16 months), similar for MHRT and SBRT. Overall, mean cavity volume was 1.17 cc (IQR, 0.5-1.35 cc), whereas in MHRT and SBRT groups it was 1.03 cc (IQR, 0.4-1.15 cc) and 1.27 cc (IQR, 0.5-1.4 cc), respectively. At a median follow-up of 37 months, cumulative grade 3 and grade 2 late urinary toxicity was 8.4% (n = 17) and 23.2% (n = 47), respectively. Grade 3 symptoms were observed at median 29 months (IQR, 19-62 months) after radiation therapy completion, lasting for a median duration of 8 months (IQR, 2-14 months). Hematuria (6.4%) and urinary obstruction (3.4%) were the chief grade 3 symptoms. Multivariable analysis for age, diabetes, pelvic radiation therapy, fraction size, prostate volume, TURP to radiation therapy duration, and TURP cavity volume showed no significant association with late grade 2+ urinary toxicity. CONCLUSIONS In this large cohort of patients with prior TURP and treated with hypofractionated prostate radiation therapy, incidence of severe late urinary adverse effects was <10%, mainly hematuria or urinary obstruction. Most of these were temporary, and no significant contributory factors were identified for late urinary morbidity after TURP and radiation therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ganesh Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ankit Misra
- Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
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2
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Neerhut T, Grills R, Lynch R, Preece PD, McLeod K. Genitourinary toxicity in patients receiving TURP prior to hypofractionated radiotherapy for clinically localized prostate cancer: A scoping review. Urol Oncol 2024; 42:165-174. [PMID: 38503591 DOI: 10.1016/j.urolonc.2024.02.011] [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: 12/17/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND When compared with conventional external beam radiotherapy, hypofractionated radiotherapy has led to less treatment sessions and improved quality of life without compromising oncological outcomes for men with prostate cancer. Evidence has shown transurethral prostatic resection prior to brachytherapy and external beam radiotherapy is associated with worsening genitourinary toxicity. However, there is no review of genitourinary toxicity when TURP occurs prior to definitive hypofractionated radiotherapy. In this review, we seek to illustrate the genitourinary outcomes for men with localized prostate cancer who underwent transurethral resection of the prostate prior to receiving definitive hypofractionated radiotherapy. Genitourinary outcomes are explored, and any predictive risk factors for increased genitourinary toxicity are described. METHODS PubMed, Medline (Ovid), EMBASE and Cochrane Library were all searched for relevant articles published in English within the last 25 years. This scoping review identified a total of 579 articles. Following screening by authors, 11 articles were included for analysis. RESULTS Five studies reported on acute and late toxicity. One article reported only acute toxicity while 5 documented late toxicity only. While most articles found no increased risk of acute toxicity, the risk of late toxicity, particularly hematuria was noted to be significant. Risk factors including poor baseline urinary function, prostate volume, number of prior transurethral prostatic resections, timing of radiotherapy following transurethral prostatic resection, volume of the intraprostatic resection cavity and mean dose delivered to the cavity were all found to influence genitourinary outcomes. CONCLUSION For those who have undergone prior TURP hypofractionated radiotherapy may increase the risk of late urinary toxicity, particularly hematuria. Those with persisting bladder dysfunction following TURP are at greatest risk and careful management of these men is required. Close collaboration between urologists and radiation oncologists is recommended to discuss the management of patients with residual baseline bladder dysfunction prior to commencing hypofractionated radiotherapy.
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Affiliation(s)
- Thomas Neerhut
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia.
| | - Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Rod Lynch
- Department of Radiation Oncology, Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Patrick Daniel Preece
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Cloître M, Benkhaled S, Boughdad S, Schaefer N, Prior JO, Zeverino M, Berthold D, Tawadros T, Meuwly JY, Martel P, Rohner C, Heym L, Duclos F, Vallet V, Valerio M, Bourhis J, Herrera F. Spatial Distribution of Recurrence and Long-Term Toxicity Following Dose Escalation to the Dominant Intra-Prostatic Nodule for Intermediate-High-Risk Prostate Cancer: Insights from a Phase I/II Study. Cancers (Basel) 2024; 16:2097. [PMID: 38893216 PMCID: PMC11171188 DOI: 10.3390/cancers16112097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: We investigated spatial patterns between primary and recurrent tumor sites and assessed long-term toxicity after dose escalation stereotactic body radiation therapy (SBRT) to the dominant intra-prostatic nodule (DIN). Materials and methods: In 33 patients with intermediate-high-risk prostate cancer (PCa), doses up to 50 Gy were administered to the DIN. Recurrence sites were determined and compared to the original tumor development sites through multiparametric MRI and 68Ga-labeled prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) images. Overlap rates, categorized as 75% or higher for full overlap, and 25-74% for partial overlap, were assessed. Long-term toxicity is reported. Results: All patients completed treatment, with only one receiving concomitant androgen deprivation therapy (ADT). Recurrences were diagnosed after a median of 33 months (range: 17-76 months), affecting 13 out of 33 patients (39.4%). Intra-prostatic recurrences occurred in 7 patients (21%), with ≥75% overlap in two, a partial overlap in another two, and no overlap in the remaining three patients. Notably, five patients with intra-prostatic recurrences had synchronous bone and/or lymph node metastases, while six patients had isolated bone or lymph node metastasis without intra-prostatic recurrences. Extended follow-up revealed late grade ≥ 2 GU and GI toxicity in 18% (n = 6) and 6% (n = 2) of the patients. Conclusions: Among patients with intermediate-high-risk PCa undergoing focal dose-escalated SBRT without ADT, DIN recurrences were infrequent. When present, these recurrences were typically located at the original site or adjacent to the initial tumor. Conversely, relapses beyond the DIN and in extra-prostatic (metastatic) sites were prevalent, underscoring the significance of systemic ADT in managing this patient population. Advances in knowledge: Focal dose-escalated prostate SBRT prevented recurrences in the dominant nodule; however, extra-prostatic recurrence sites were frequent.
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Affiliation(s)
- Minna Cloître
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Sofian Benkhaled
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Sarah Boughdad
- Department of Medical Imaging, Nuclear Medicine Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (S.B.); (N.S.); (J.O.P.)
| | - Niklaus Schaefer
- Department of Medical Imaging, Nuclear Medicine Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (S.B.); (N.S.); (J.O.P.)
| | - John O. Prior
- Department of Medical Imaging, Nuclear Medicine Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (S.B.); (N.S.); (J.O.P.)
| | - Michele Zeverino
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Dominik Berthold
- Department of Oncology, Medical Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland;
| | - Thomas Tawadros
- Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (T.T.); (P.M.); (C.R.); (M.V.)
| | - Jean-Yves Meuwly
- Department of Medical Imaging, Radiology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland;
| | - Paul Martel
- Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (T.T.); (P.M.); (C.R.); (M.V.)
| | - Chantal Rohner
- Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (T.T.); (P.M.); (C.R.); (M.V.)
| | - Leonie Heym
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Frederic Duclos
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Véronique Vallet
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Massimo Valerio
- Department of Surgery, Urology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (T.T.); (P.M.); (C.R.); (M.V.)
| | - Jean Bourhis
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
| | - Fernanda Herrera
- Department of Oncology, Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland; (M.C.); (S.B.); (M.Z.); (L.H.); (F.D.); (V.V.); (J.B.)
- Ludwig Cancer Research Center Lausanne, 1005 Lausanne, Switzerland
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4
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Borzillo V, Scipilliti E, Pezzulla D, Serra M, Ametrano G, Quarto G, Perdonà S, Rossetti S, Pignata S, Crispo A, Di Gennaro P, D’Alesio V, Arrichiello C, Buonanno F, Mercogliano S, Russo A, Tufano A, Di Franco R, Muto P. Stereotactic body radiotherapy with CyberKnife ® System for low- and intermediate-risk prostate cancer: clinical outcomes and toxicities of CyPro Trial. Front Oncol 2023; 13:1270498. [PMID: 38023175 PMCID: PMC10660677 DOI: 10.3389/fonc.2023.1270498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Simple summary Stereotactic body radiotherapy (SBRT) of 35-36.25 Gy in five fractions with the CyberKnife System yields excellent control with low toxicity in low-intermediate-risk prostate cancer patients. We found no differences in biochemical control and overall survival in relation to dose. There were no significant differences in toxicity or quality of life between the two groups. Aims Stereotactic body radiotherapy (SBRT) is an emerging therapeutic approach for low- and intermediate-risk prostate cancer. We present retrospective data on biochemical control, toxicity, and quality of life of CyPro Trial. Materials and methods A total of 122 patients with low- and intermediate-risk prostate cancer were treated with the CyberKnife System at a dose of 35 Gy or 36.25 Gy in five fractions. Biochemical failure (BF)/biochemical disease-free survival (bDFS) was defined using the Phoenix method (nadir + 2 ng/ml). Acute/late rectal and urinary toxicities were assessed by the Radiation Therapy Oncology Group (RTOG) toxicity scale. Quality of life (QoL) was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and PR25. International Erectile Function Index-5 (IIEF5) and International Prostate Symptom Score (IPSS) questionnaires were administered at baseline, every 3 months after treatment during the first years, and then at 24 months and 36 months. Results The 1-, 2-, and 5-year DFS rates were 92.9%, 92.9%, and 92.3%, respectively, while the 1-, 2-, and 5-year bDFS rates were 100%, 100%, and 95.7%, respectively. With regard to risk groups or doses, no statistically significant differences were found in terms of DFS or bDFS. Grade 2 urinary toxicity was acute in 10% and delayed in 2% of patients. No Grade 3 acute and late urinary toxicity was observed. Grade 2 rectal toxicity was acute in 8% and late in 1% of patients. No Grade 3-4 acute and late rectal toxicity was observed. Grade 2 acute toxicity appeared higher in the high-dose group (20% in the 36.25-Gy group versus 3% in the 35-Gy group) but was not statistically significant. Conclusion Our study confirms that SBRT of 35-36.25 Gy in five fractions with the CyberKnife System produces excellent control with low toxicity in patients with low-intermediate-risk prostate cancer. We found no dose-related differences in biochemical control and overall survival. Further confirmation of these results is awaited through the prospective phase of this study, which is still ongoing.
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Affiliation(s)
- Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Giuseppe Quarto
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sisto Perdonà
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sandro Pignata
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Valentina D’Alesio
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Cecilia Arrichiello
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | | | - Simona Mercogliano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Antonio Russo
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Naples, Napoli, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
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Kissel M, Créhange G, Graff P. Stereotactic Radiation Therapy versus Brachytherapy: Relative Strengths of Two Highly Efficient Options for the Treatment of Localized Prostate Cancer. Cancers (Basel) 2022; 14:2226. [PMID: 35565355 PMCID: PMC9105931 DOI: 10.3390/cancers14092226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has become a valid option for the treatment of low- and intermediate-risk prostate cancer. In randomized trials, it was found not inferior to conventionally fractionated external beam radiation therapy (EBRT). It also compares favorably to brachytherapy (BT) even if level 1 evidence is lacking. However, BT remains a strong competitor, especially for young patients, as series with 10-15 years of median follow-up have proven its efficacy over time. SBRT will thus have to confirm its effectiveness over the long-term as well. SBRT has the advantage over BT of less acute urinary toxicity and, more hypothetically, less sexual impairment. Data are limited regarding SBRT for high-risk disease while BT, as a boost after EBRT, has demonstrated superiority against EBRT alone in randomized trials. However, patients should be informed of significant urinary toxicity. SBRT is under investigation in strategies of treatment intensification such as combination of EBRT plus SBRT boost or focal dose escalation to the tumor site within the prostate. Our goal was to examine respective levels of evidence of SBRT and BT for the treatment of localized prostate cancer in terms of oncologic outcomes, toxicity and quality of life, and to discuss strategies of treatment intensification.
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Affiliation(s)
| | | | - Pierre Graff
- Department of Radiation Oncology, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France; (M.K.); (G.C.)
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6
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Lapierre A, Hennequin C, Beneux A, Belhomme S, Benziane N, Biston MC, Crehange G, de Crevoisier R, Dumas JL, Fawzi M, Lisbona A, Pasquier D, Pelissier S, Graff-Cailleaud P, Pommier P, Sargos P, Simon JM, Supiot S, Tantot F, Chapet O. Highly hypofractionated schedules for localized prostate cancer: Recommendations of the GETUG radiation oncology group. Crit Rev Oncol Hematol 2022; 173:103661. [PMID: 35341986 DOI: 10.1016/j.critrevonc.2022.103661] [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: 06/04/2020] [Revised: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has become treatment option for localized prostate cancer but the evidence base remains incomplete. Several clinical studies, both prospective and retrospective, have been published. However, treatment techniques, target volumes and dose constraints lack consistency between studies. Based on the current available literature, the French Genito-Urinary Group (GETUG) suggests that.
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Affiliation(s)
- Ariane Lapierre
- Ariane Lapierre: Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - Christophe Hennequin
- Christophe Hennequin: Department of Radiation Oncology, Hôpital Saint-Louis, 75475, Paris, France
| | - Amandine Beneux
- Amandine Beneux: Service de Physique Médicale et de Radioprotection, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - Sarah Belhomme
- Sarah Belhomme: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Nicolas Benziane
- Nicolas Benziane: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Marie-Claude Biston
- Marie-Claude Biston: Léon Bérard Cancer Center, University of Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA, Lyon, France
| | - Gilles Crehange
- Gilles Crehange: Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Renaud de Crevoisier
- Renaud de Crevoisier: Département de Radiothérapie, Centre Eugène Marquis, Rennes
| | - Jean-Luc Dumas
- Jean-luc Dumas: Institut Curie, Radiotherapy department / Medical physics, 26 rue d'Ulm, 75005 PARIS cedex, France
| | - Maher Fawzi
- Maher Fawzi: Institut Curie, Site Saint Cloud, Service de Radiotherapie, 35, rue Dailly 92210 Saint Cloud
| | - Albert Lisbona
- Albert Lisbona: Medical Physics Department Institut de Cancérologie de l'Ouest, Bd J. Monod, 44805 Saint Herblain France
| | - David Pasquier
- David Pasquier: Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille; CRIStAL UMR 9189, Lille University
| | | | - Pierre Graff-Cailleaud
- Pierre Graff-Cailleaud: University Institute of Cancer Toulouse-Oncopôle, Toulouse, France
| | - Pascal Pommier
- Pascal Pommier: Radiotherapy Department, Centre Léon Bérard, Lyon, France
| | - Paul Sargos
- Paul Sargos: Radiation Oncology Department, Bergonie Institute, Bordeaux, France
| | - Jean-Marc Simon
- Jean-Marc Simon: Department of Radiotherapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
| | - Stéphane Supiot
- Stéphane Supiot: Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | | | - Olivier Chapet
- Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
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7
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The Journey of Radiotherapy Dose Escalation in High Risk Prostate Cancer; Conventional Dose Escalation to Stereotactic Body Radiotherapy (SBRT) Boost Treatments. Clin Genitourin Cancer 2021; 20:e25-e38. [PMID: 34740548 DOI: 10.1016/j.clgc.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/08/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
High risk prostate cancer (HR-PrCa) is a subset of localized PrCa with significant potential for morbidity and mortality associated with disease recurrence and metastasis. Radiotherapy combined with Androgen Deprivation Therapy has been the standard of care for many years in HR-PrCa. In recent years, dose escalation, hypo-fractionation and high precision delivery with immobilization and image-guidance have substantially changed the face of modern PrCa radiotherapy, improving treatment convenience and outcomes. Ultra-hypo-fractionated radiotherapy delivered with high precision in the form of stereotactic body radiation therapy (SBRT) combines delivery of high biologically equivalent dose radiotherapy with the convenience of a shorter treatment schedule, as well as the promise of similar efficacy and reduced toxicity compared to conventional radiotherapy. However, rigorous investigation of SBRT in HR-PrCa remains limited. Here, we review the changes in HR-PrCa radiotherapy through dose escalation, hypo- and ultra-hypo-fractionated radiotherapy boost treatments, and the radiobiological basis of these treatments. We focus on completed and on-going trials in this disease utilizing SBRT as a sole radiation modality or as boost therapy following pelvic radiation.
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8
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Lucchini R, Panizza D, Colciago RR, Vernier V, Daniotti MC, Faccenda V, Arcangeli S. Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking. Radiat Oncol 2021; 16:180. [PMID: 34535168 PMCID: PMC8447697 DOI: 10.1186/s13014-021-01908-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE/OBJECTIVES To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilotÒ System) to account for intra-fractional organ motion. MATERIAL/METHODS Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. RESULTS All patients completed the treatment in the expected time (10.2 +/- 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of the fractions, either during setup or beam delivery. CONCLUSIONS Our preliminary findings show that dose intensified SBRT for unfavorable prostate tumors does not come at the cost of an increased toxicity, provided that a reliable technique for real time prostate monitoring is ensured. Fast FFF beams contributed to reduce intra-fractional motion. These observations need to be confirmed on a larger scale and a longer follow up.
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Affiliation(s)
- Raffaella Lucchini
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Radiation Oncology Department, ASST Monza, Monza, Italy
| | - Denis Panizza
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Medical Physics Department, ASST Monza, Monza, Italy
| | - Riccardo Ray Colciago
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
- Radiation Oncology Department, ASST Monza, Monza, Italy.
| | - Veronica Vernier
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Valeria Faccenda
- Medical Physics Department, ASST Monza, Monza, Italy
- Department of Physics, University of Milan, Milan, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Radiation Oncology Department, ASST Monza, Monza, Italy
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9
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Prospective validation of stringent dose constraints for prostatic stereotactic radiation monotherapy: results of a single-arm phase II toxicity-oriented trial. Strahlenther Onkol 2021; 197:1001-1009. [PMID: 34424351 DOI: 10.1007/s00066-021-01832-y] [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: 05/08/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There are no safety-focused trials on stereotactic body radiotherapy (SBRT) for localized prostate cancer. This prospective 3‑year phase II trial used binomial law to validate the safety and efficacy of SBRT with stringent organ at risk dose constraints that nevertheless permitted high planning target volume doses. METHODS All consecutive ≥ 70-year-old patients with localized prostate adenocarcinoma who underwent SBRT between 2014 and 2018 at the National Radiotherapy Center in Luxembourg were included. Patients with low Cancer of Prostate Risk Assessment (CAPRA) scores (0-2) and intermediate scores (3-5) received 36.25 Gy. High-risk (6-10) patients received 37.5 Gy. Radiation was delivered in 5 fractions over 9 days with Cyberknife-M6™ (Accuray, Sunnyvale, CA, USA). Primary study outcome was Common Terminology Criteria for Adverse Events version 4 (CTCAEv4) genitourinary and rectal toxicity scores at last follow-up. Based on binomial law, SRBT was considered safe in this cohort of 110 patients if there were ≤ 2 severe toxicity (CTCAEv4 grade ≥ 3) cases. Secondary outcomes were biochemical progression-free survival (bPFS) and patient quality of life (QOL), as determined by the IPPS and the Urinary Incontinence QOL questionnaire. RESULTS The first 110 patients who were accrued in a total cohort of 150 patients were included in this study and had a median follow-up of 36 months. Acute grade ≥ 3 toxicity never occurred. One transient late grade 3 case was observed. Thus, our SBRT program had an estimated severe toxicity rate of < 5% and was safe at the p < 0.05 level. Overall bPFS was 90%. QOL did not change relative to baseline. CONCLUSION The trial validated our SBRT regimen since it was both safe and effective.
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10
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Graff P, Crehange G. [Ultra-hypofractionated radiotherapy for the treatment of localized prostate cancer: Results, limits and prospects]. Cancer Radiother 2021; 25:684-691. [PMID: 34274223 DOI: 10.1016/j.canrad.2021.06.028] [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: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Still an emerging approach a few years ago, stereotactic body radiation therapy (SBRT) has ranked as a valid option for the treatment of localized prostate cancer. Inherent properties of prostatic adenocarcinoma (low α/β) make it the perfect candidate. We propose a critical review of the literature trying to put results into perspective to identify their strengths, limits and axes of development. Technically sophisticated, the stereotactic irradiation of the prostate is well tolerated. Despite the fact that median follow-up of published data is still limited, ultra-hypofractionated radiotherapy seems very efficient for the treatment of low and intermediate risk prostate cancers. Data seem satisfying for high-risk cancers as well. New developments are being studied with a main interest in treatment intensification for unfavorable intermediate risk and high-risk cancers. Advantage is taken of the sharp dose gradient of stereotactic radiotherapy to offer safe reirradiation to patients with local recurrence in a previously irradiated area.
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Affiliation(s)
- P Graff
- Département d'oncologie radiothérapie, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - G Crehange
- Département d'oncologie radiothérapie, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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11
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Acute side effects after definitive stereotactic body radiation therapy (SBRT) for patients with clinically localized or locally advanced prostate cancer: a single institution prospective study. Radiol Oncol 2021; 55:474-481. [PMID: 34253001 PMCID: PMC8647800 DOI: 10.2478/raon-2021-0031] [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: 03/10/2021] [Accepted: 05/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of the study was to evaluate acute side effects after extremely hypofractionated intensity-modulated radiotherapy (IMRT) with stereotactic body radiation therapy (SBRT) for definitive treatment of prostate cancer patients. Patients and methods Between February 2018 and August 2019, 205 low-, intermediate- and high-risk prostate cancer patients were treated with SBRT using “CyberKnife M6” linear accelerator. In low-risk patients 7.5–8 Gy was delivered to the prostate gland by each fraction. For intermediate- and high-risk disease a dose of 7.5–8 Gy was delivered to the prostate and 6–6.5 Gy to the seminal vesicles by each fraction with a simultaneous integrated boost (SIB) technique. A total of 5 fractions (total dose 37.5–40 Gy) were given on every second working day. Acute radiotherapy-related genitourinary (GU) and gastrointestinal (GI) side effects were assessed using Radiation Therapy Oncology Group (RTOG) scoring system. Results Of the 205 patients (28 low-, 115 intermediate-, 62 high-risk) treated with SBRT, 203 (99%) completed the radiotherapy as planned. The duration of radiation therapy was 1 week and 3 days. The frequencies of acute radiotherapy-related side effects were as follows: GU grade 0 – 17.1%, grade I – 30.7%, grade II – 50.7%, grade III – 1.5%; and GI grade 0 – 62.4%, grade I–31.7%, grade II–5.9%, grade III–0%. None of the patients developed grade ≥ 4 acute toxicity. Conclusions SBRT with a total dose of 37.5–40 Gy in 5 fractions appears to be a safe and well tolerated treatment option in patients with prostate cancer, associated with slight or moderate early side effects. Longer follow-up is needed to evaluate long-term toxicity and biochemical control.
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12
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Foerster R, Zwahlen DR, Buchali A, Tang H, Schroeder C, Windisch P, Vu E, Akbaba S, Bostel T, Sprave T, Zamboglou C, Zilli T, Stelmes JJ, Telkhade T, Murthy V. Stereotactic Body Radiotherapy for High-Risk Prostate Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13040759. [PMID: 33673077 PMCID: PMC7918664 DOI: 10.3390/cancers13040759] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is an established, potentially curative treatment option for all risk constellations of localized prostate cancer (PCA). Androgen deprivation therapy (ADT) and dose-escalated RT can further improve outcome in high-risk (HR) PCA. In recent years, shorter RT schedules based on hypofractionated RT have shown equal outcome. Stereotactic body radiotherapy (SBRT) is a highly conformal RT technique enabling ultra-hypofractionation which has been shown to be safe and efficient in patients with low- and intermediate-risk PCA. There is a paucity of data on the role of SBRT in HR PCA. In particular, the need for pelvic elective nodal irradiation (ENI) needs to be addressed. Therefore, we conducted a systematic review to analyze the available data on observed toxicities, ADT prescription practice, and oncological outcome to shed more light on the value of SBRT in HR PCA. METHODS We searched the PubMed and Embase electronic databases for the terms "prostate cancer" AND "stereotactic" AND "radiotherapy" in June 2020. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. RESULTS After a rigorous selection process, we identified 18 individual studies meeting all selection criteria for further analyses. Five additional studies were included because their content was judged as relevant. Three trials have reported on prostate SBRT including pelvic nodes; 2 with ENI and 1 with positive pelvic nodes only. The remaining studies investigated SBRT of the prostate only. Grade 2+ acute genitourinary (GU) toxicity was between 12% and 46.7% in the studies investigating pelvic nodes irradiation and ranged from 0% to 89% in the prostate only studies. Grade 2+ chronic GU toxicity was between 7% and 60% vs. 2% and 56.7%. Acute gastrointestinal (GI) grade 2+ toxicity was between 0% to 4% and 0% to 18% for studies with and without pelvic nodes irradiation, respectively. Chronic GI grade 2+ toxicity rates were between 4% and 50.1% vs. 0% and 40%. SBRT of prostate and positive pelvic nodes only showed similar toxicity rates as SBRT for the prostate only. Among the trials that reported on ADT use, the majority of HR PCA patients underwent ADT for at least 2 months; mostly neoadjuvant and concurrent. Biochemical control rates ranged from 82% to 100% after 2 years and 56% to 100% after 3 years. Only a few studies reported longer follow-up data. CONCLUSION At this point, SBRT with or without pelvic ENI cannot be considered the standard of care in HR PCA, due to missing level 1 evidence. Treatment may be offered to selected patients at specialized centers with access to high-precision RT. While concomitant ADT is the current standard of care, the necessary duration of ADT in combination with SBRT remains unclear. Ideally, all eligible patients should be enrolled in clinical trials.
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Affiliation(s)
- Robert Foerster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-52-266-31-40
| | - Daniel Rudolf Zwahlen
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Andre Buchali
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
| | - Hongjian Tang
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Christina Schroeder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
- Center for Proton Therapy, Paul Scherrer Institute (PSI), ETH Domain, 5232 Villingen, Switzerland
| | - Paul Windisch
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen (KSSG), 9007 St. Gallen, Switzerland;
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Thomas Zilli
- Department of Radiation Oncology, University Hospital Geneva (HUG), 1205 Geneva, Switzerland;
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland (IOSI), Cantonal Hospitals (EOC), 6500 Bellinzona, Switzerland;
| | - Tejshri Telkhade
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
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13
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Wang K, Mavroidis P, Royce TJ, Falchook AD, Collins SP, Sapareto S, Sheets NC, Fuller DB, El Naqa I, Yorke E, Grimm J, Jackson A, Chen RC. Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response. Int J Radiat Oncol Biol Phys 2020; 110:237-248. [PMID: 33358229 DOI: 10.1016/j.ijrobp.2020.09.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Ultrahypofractionationed radiation therapy for prostate cancer is increasingly studied and adopted. The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiotherapy therefore aimed to review studies examining toxicity and quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer and model its effect. METHODS AND MATERIALS We performed a systematic PubMed search of prostate SBRT studies published between 2001 and 2018. Those that analyzed factors associated with late urinary, bowel, or sexual toxicity and/or quality of life were included and reviewed. Normal tissue complication probability modelling was performed on studies that contained detailed dose/volume and outcome data. RESULTS We found 13 studies that examined urinary effects, 6 that examined bowel effects, and 4 that examined sexual effects. Most studies included patients with low-intermediate risk prostate cancer treated to 35-40 Gy. Most patients were treated with 5 fractions, with several centers using 4 fractions. Endpoints were heterogeneous and included both physician-scored toxicity and patient-reported quality of life. Most toxicities were mild-moderate (eg, grade 1-2) with a very low overall incidence of severe toxicity (eg, grade 3 or higher, usually <3%). Side effects were associated with both dosimetric and non-dosimetric factors. CONCLUSIONS Prostate SBRT appears to be overall well tolerated, with determinants of toxicity that include dosimetric factors and patient factors. Suggested dose constraints include bladder V(Rx Dose)Gy <5-10 cc, urethra Dmax <38-42 Gy, and rectum Dmax <35-38 Gy, though current data do not offer firm guidance on tolerance doses. Several areas for future research are suggested.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sean P Collins
- Department of Radiation Oncology, Georgetown University Hospital, Washington, DC
| | - Stephen Sapareto
- Department of Medical Physics, Banner Health System, Phoenix, Arizona
| | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, Florida
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas.
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14
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Turna M, Akboru H, Ermis E, Oskeroglu S, Dincer S, Altin S. Stereotactic body radiotherapy as a boost after external beam radiotherapy for high-risk prostate cancer patients. Indian J Cancer 2020; 58:518-524. [PMID: 33402584 DOI: 10.4103/ijc.ijc_377_19] [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: 11/04/2022]
Abstract
Background The effect of high-dose-rate (HDR) brachytherapy after external radiation in high-risk prostate cancer patients has been proven. Stereotactic body radiotherapy as a less invasive method has similar dosimetric results with HDR brachytherapy. This study aims to evaluate the prostate-specific antigen (PSA) response, acute side effects, and quality of life of patients who underwent stereotactic body radiotherapy (SBRT) as a boost after pelvic radiotherapy (RT). Methods A total of 34 patients diagnosed with high-risk prostate cancer treated with SBRT boost (21 Gy in three fractions) combined with whole pelvic RT (50 Gy in 25 fractions) were evaluated. Biochemical control has been evaluated with PSA before, and after treatment, acute adverse events were evaluated with radiation therapy oncology group (RTOG) grading scale and quality of life with the Expanded Prostate Cancer Index Composite (EPIC) scoring system. Results The mean follow-up of 34 patients was 41.2 months (range 7-52). The mean initial PSA level was 22.4 ng/mL. None of the patients had experienced a biochemical or clinical relapse of the disease. Grade 2 and higher acute gastrointestinal (GI) was observed in 14%, and genitourinary (GU) toxicity was observed in 29%. None of the patients had grade 3-4 late toxicity. Conclusions SBRT boost treatment after pelvic irradiation has been used with a good biochemical control and acceptable toxicity in high-risk prostate cancer patients. More extensive randomized trial results are needed on the subject.
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Affiliation(s)
- Menekse Turna
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Halil Akboru
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Ekin Ermis
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Sedenay Oskeroglu
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Selvi Dincer
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Suleyman Altin
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
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15
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Byun DJ, Gorovets DJ, Jacobs LM, Happersett L, Zhang P, Pei X, Burleson S, Zhang Z, Hunt M, McBride S, Kollmeier MA, Zelefsky MJ. Strict bladder filling and rectal emptying during prostate SBRT: Does it make a dosimetric or clinical difference? Radiat Oncol 2020; 15:239. [PMID: 33066781 PMCID: PMC7565753 DOI: 10.1186/s13014-020-01681-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate inter-fractional variations in bladder and rectum during prostate stereotactic body radiation therapy (SBRT) and determine dosimetric and clinical consequences. Methods Eighty-five patients with 510 computed tomography (CT) images were analyzed. Median prescription dose was 40 Gy in 5 fractions. Patients were instructed to maintain a full bladder and empty rectum prior to simulation and each treatment. A single reviewer delineated organs at risk (OARs) on the simulation (Sim-CT) and Cone Beam CTs (CBCT) for analyses. Results Bladder and rectum volume reductions were observed throughout the course of SBRT, with largest mean reductions of 86.9 mL (19.0%) for bladder and 6.4 mL (8.7%) for rectum noted at fraction #5 compared to Sim-CT (P < 0.01). Higher initial Sim-CT bladder volumes were predictive for greater reduction in absolute bladder volume during treatment (ρ = − 0.69; P < 0.01). Over the course of SBRT, there was a small but significant increase in bladder mean dose (+ 4.5 ± 12.8%; P < 0.01) but no significant change in the D2cc (+ 0.8 ± 4.0%; P = 0.28). The mean bladder trigone displacement was in the anterior direction (+ 4.02 ± 6.59 mm) with a corresponding decrease in mean trigone dose (− 3.6 ± 9.6%; P < 0.01) and D2cc (− 6.2 ± 15.6%; P < 0.01). There was a small but significant increase in mean rectal dose (+ 7.0 ± 12.9%, P < 0.01) but a decrease in rectal D2cc (− 2.2 ± 10.1%; P = 0.04). No significant correlations were found between relative bladder volume changes, bladder trigone displacements, or rectum volume changes with rates of genitourinary or rectal toxicities. Conclusions Despite smaller than expected bladder and rectal volumes at the time of treatment compared to the planning scans, dosimetric impact was minimal and not predictive of detrimental clinical outcomes. These results cast doubt on the need for excessively strict bladder filling and rectal emptying protocols in the context of image guided prostate SBRT and prospective studies are needed to determine its necessity.
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Affiliation(s)
- David J Byun
- Department of Radiation Oncology, NYU Langone Health, 160 East 34th St, New York, NY, USA
| | - Daniel J Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Lauren M Jacobs
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Xin Pei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Sarah Burleson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
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16
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Ricco A, Barbera G, Lanciano R, Feng J, Hanlon A, Lozano A, Good M, Arrigo S, Lamond J, Yang J. Favorable Biochemical Freedom From Recurrence With Stereotactic Body Radiation Therapy for Intermediate and High-Risk Prostate Cancer: A Single Institutional Experience With Long-Term Follow-Up. Front Oncol 2020; 10:1505. [PMID: 33102201 PMCID: PMC7545336 DOI: 10.3389/fonc.2020.01505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose/Objective(s): The current study reports long-term overall survival (OS) and biochemical freedom from recurrence (BFFR) after stereotactic body radiation therapy (SBRT) for men with intermediate and high-risk prostate cancer in a single community hospital setting with early adoption. Materials/Methods: Ninety-seven consecutive men with intermediate and high-risk prostate cancer treated with SBRT between 2007 and 2015 were retrospectively studied. Categorical variables for analysis included National Comprehensive Cancer Network risk group, race, Gleason grade group, T stage, use of androgen deprivation therapy, and planning target volume dose. Continuous variables for analysis included pretreatment prostate-specific antigen (PSA), percent cores positive, age at diagnosis, PSA nadir, prostate volume, percent prostate that received 40 Gy, and minimum dose to 0.03 cc of prostate (Dmin). BFFR was assessed using the Phoenix nadir +2 definition. OS and BFFR were estimated using Kaplan-Meier (KM) methodology with comparisons accomplished using log-rank statistics. Multivariable analysis (MVA) was accomplished with a backwards selection Cox proportional-hazards model with statistical significance taken at the p < 0.05 level. Results: Median FU is 78.4 months. Five- and ten-year OS KM estimates are 90.9 and 73.2%, respectively, with 19 deaths recorded. MVA reveals pretreatment PSA (p = 0.032), percent prostate 40 Gy (p = 0.003), and race (p = 0.031) were predictive of OS. Five- and nine-year BFFR KM estimates are 92.1 and 87.5%, respectively, with 10 biochemical failures recorded. MVA revealed PSA nadir (p < 0.001) was the only factor predictive of BFFR. Specifically, for every one-unit increase in PSA nadir, there was a 4.2-fold increased odds of biochemical failure (HR = 4.248). No significant differences in BFFR were found between favorable intermediate, unfavorable intermediate, and high-risk prostate cancer (p = 0.054) with 7-year KM estimates of 96.6, 81.0, and 85.7%, respectively. Conclusions: Favorable OS and BFFR can be expected after SBRT for intermediate and high-risk prostate cancer with non-significant differences seen for BFFR between favorable intermediate, unfavorable intermediate, and high-risk groups. Our 5-year BFFR compares favorably with the HYPO-RT-PC trial of 84%. PSA nadir was predictive of biochemical failure. This study is ultimately limited by the small absolute number of high-risk patients included.
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Affiliation(s)
- Anthony Ricco
- Virginia Commonwealth University Health System, Richmond, VA, United States
| | - Gabrielle Barbera
- College of Medicine, Drexel University, Philadelphia, PA, United States
| | - Rachelle Lanciano
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Jing Feng
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Alexandra Hanlon
- Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Alicia Lozano
- Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Michael Good
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Stephen Arrigo
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - John Lamond
- Radiation Oncology, Crozer-Keystone Health System, Springfield, PA, United States
- Philadelphia CyberKnife Center, Havertown, PA, United States
| | - Jun Yang
- Philadelphia CyberKnife Center, Havertown, PA, United States
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17
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Royce TJ, Mavroidis P, Wang K, Falchook AD, Sheets NC, Fuller DB, Collins SP, El Naqa I, Song DY, Ding GX, Nahum AE, Jackson A, Grimm J, Yorke E, Chen RC. Tumor Control Probability Modeling and Systematic Review of the Literature of Stereotactic Body Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 110:227-236. [PMID: 32900561 DOI: 10.1016/j.ijrobp.2020.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation. The evolving treatment approach of ultrahypofractionation with stereotactic body radiation therapy (SBRT) allows possible further biological dose escalation (biologically equivalent dose [BED]) and shortened treatment time. METHODS AND MATERIALS The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiation Therapy/SBRT included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse. Results were stratified by prostate cancer risk group. RESULTS Twenty-five published cohorts were identified for inclusion, with a total of 4821 patients (2235 with low-risk, 1894 with intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up of more than 5 years. Dosing regimens ranged from 32 to 50 Gy in 4 to 5 fractions, with total BED (α/β = 1.5 Gy) between 183.1 and 383.3 Gy. At 5 years, we found that in patients with low-intermediate risk disease, an equivalent doses of 2 Gy per fraction (EQD2) of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of 97 Gy (37.6 Gy in 5 fractions) can achieve a TCP of 90% and an EQD2 of 102 Gy (38.7 Gy in 5 fractions) can achieve a TCP of 95%. CONCLUSIONS We found significant variation in the published literature on target delineation, margins used, dose/fractionation, and treatment schedule. Despite this variation, TCP was excellent. Most prescription doses range from 35 to 40 Gy, delivered in 4 to 5 fractions. The literature did not provide detailed dose-volume data, and our dosimetric analysis was constrained to prescription doses. There are many areas in need of continued research as SBRT continues to evolve as a treatment modality for prostate cancer, including the durability of local control with longer follow-up across risk groups, the efficacy and safety of SBRT as a boost to intensity modulated radiation therapy (IMRT), and the impact of incorporating novel imaging techniques into treatment planning.
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Affiliation(s)
- Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald B Fuller
- Division of Genesis Healthcare Partners Inc, Genesis CyberKnife, San Diego, California
| | - Sean P Collins
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Issam El Naqa
- Machine Learning Department, Moffitt Cancer Center, Tampa, Florida
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alan E Nahum
- Department of Physics, University of Liverpool, United Kingdom and Henley-on-Thames, United Kingdom
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas
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18
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D'Agostino GR, Mancosu P, Di Brina L, Franzese C, Pasini L, Iftode C, Comito T, De Rose F, Guazzoni GF, Scorsetti M. Stereotactic Body Radiation Therapy for Intermediate-risk Prostate Cancer With VMAT and Real-time Electromagnetic Tracking: A Phase II Study. Am J Clin Oncol 2020; 43:628-635. [PMID: 32889832 DOI: 10.1097/coc.0000000000000721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Stereotactic body radiation treatment represents an intriguing therapeutic option for patients with early-stage prostate cancer. In this phase II study, stereotactic body radiation treatment was delivered by volumetric modulated arc therapy with flattening filter free beams and was gated using real-time electromagnetic transponder system to maximize precision of radiotherapy and, potentially, to reduce toxicities. MATERIALS AND METHODS Patients affected by histologically proven prostate adenocarcinoma and National Comprehensive Cancer Network (NCCN) intermediate class of risk were enrolled in this phase II study. Beacon transponders were positioned transrectally within the prostate parenchyma 7 to 10 days before simulation computed tomography scan. The radiotherapy schedule was 38 Gy in 4 fractions delivered every other day. Toxicity assessment was performed according to Common Terminology Criteria for Adverse Events (CTCAE), v4.0. RESULTS Thirty-six patients were enrolled in this study. Median initial prostate-specific antigen was 7.0 ng/mL (range: 2.3 to 14.0 ng/mL). Median nadir-prostate-specific antigen after treatment was 0.2 ng/mL (range: 0.006 to 4.8 ng/mL). A genitourinary acute toxicity was observed in 21 patients (dysuria grade [G] 1: 41.7%, G2: 16.7%). Gastrointestinal acute toxicity was found in 9 patients (proctitis G1: 19.4%, G2: 5.6%). Late toxicity was mild (genitourinary toxicity G1: 30.6%; G2: 8.3%; gastrointestinal toxicity G1: 13.9%; G2: 19.4%). At a median follow-up time of 41 months, 3 biochemical recurrences were observed (2 local recurrences, 1 distant metastasis). Three-year biochemical recurrence-free survival was 89.8% (International Society of Urologic Pathology Grade Group 2: 100%, Grade Group 3: 77.1%, P=0.042). CONCLUSION Ultrahypofractionated radiotherapy, delivered with flattening filter free-volumetric modulated arc therapy and gated by electromagnetic transponders, is a valid option for intermediate-risk prostate cancer.
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Affiliation(s)
| | | | | | - Ciro Franzese
- Departments of Radiotherapy and Radiosurgery
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | | | | | | | | | - Giorgio F Guazzoni
- Urology, Humanitas Clinical and Research Center
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | - Marta Scorsetti
- Departments of Radiotherapy and Radiosurgery
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
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Darwis NDM, Oike T, Kubo N, Gondhowiardjo SA, Ohno T. Characteristics of PSA Bounce after Radiotherapy for Prostate Cancer: A Meta-Analysis. Cancers (Basel) 2020; 12:cancers12082180. [PMID: 32764448 PMCID: PMC7465291 DOI: 10.3390/cancers12082180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
The rate and characteristics of prostate-specific antigen (PSA) bounce post-radiotherapy remain unclear. To address this issue, we performed a meta-analysis. Reports of PSA bounce post-radiotherapy with a cutoff of 0.2 ng/mL were searched by using Medline and Web of Science. The primary endpoint was the occurrence rate, and the secondary endpoints were bounce characteristics such as amplitude, time to occurrence, nadir value, and time to nadir. Radiotherapy modality, age, risk classification, androgen deprivation therapy, and the follow-up period were extracted as clinical variables. Meta-analysis and univariate meta-regression were performed with random-effect modeling. Among 290 search-positive studies, 50 reports including 26,258 patients were identified. The rate of bounce was 31%; amplitude was 1.3 ng/mL; time to occurrence was 18 months; nadir value was 0.5 ng/mL; time to nadir was 33 months. Univariate meta-regression analysis showed that radiotherapy modality (29.7%), age (20.2%), and risk classification (12.2%) were the major causes of heterogeneity in the rate of bounce. This is the first meta-analysis of PSA bounce post-radiotherapy. The results are useful for post-radiotherapy surveillance of prostate cancer patients.
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Affiliation(s)
- Narisa Dewi Maulany Darwis
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, DKI Jakarta 10430, Indonesia;
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
- Correspondence:
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
| | - Soehartati A Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, DKI Jakarta 10430, Indonesia;
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
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20
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Campostrini F, Remo A, Astati L, Zorzi M, Capodaglio G, Buffoli A, Moretti G, Della Monica B, Zanella C, Verlato G. Association between acute histopathological changes of rectal walls and late radiation proctitis following radiotherapy for prostate cancer. Strahlenther Onkol 2020; 196:617-627. [PMID: 32166451 DOI: 10.1007/s00066-020-01590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The impact of acute histopathological changes (HC) of the rectum on development of late clinical proctitis (LCP) after external radiotherapy (RT) for prostate cancer is poorly explored and was the primary end point of this prospective study. METHODS In 70 patients, 15 HC of early rectal biopsies after RT were identified, whereby RT was conventional 2D RT in 41 cases and conformational 3D RT in 29. Associations of HC in anterior and posterior rectal walls (ARW, PRW) with LCP, acute endoscopic (AEP) and acute clinical proctitis (ACP) were statistically evaluated considering as explicative variables the patient general characteristics and the HC. RESULTS The mean patients' follow-up was 123.5 months (24-209). The median prostatic dose was 72 Gy (2 Gy/fraction). For the 41 and 29 patients the ARW and PRW doses were 64 and 49 Gy vs. 63 and 50 Gy, respectively. The incidence of LCP ≥ grade 2 at 10 years was 12.9%. The univariate (p = 0.02) and Kaplan-Meyer methods (p = 0.007) showed that the gland (or crypts) loss in the ARW was significantly associated with LCP. AEP and ACP occurred in 14.3 and 55.7% of cases. At multivariate level AEP significantly correlated with hemorrhoids (p = 0.014) and neutrophilia in ARW (p = 0.042). CONCLUSIONS Early after RT, substantial gland loss in ARW is predictive of LCP. To reduce this complication with conventional fractionation, we suggest keeping the mean dose to ARW ≤48-52 Gy.
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Affiliation(s)
- Franco Campostrini
- Department of Radiation Oncology, "Mater Salutis" Hospital, Legnago, Italy.
| | - Andrea Remo
- Department of Pathology, "Mater Salutis" Hospital, Via Gianella 1, 37045, Legnago, Italy.
| | - Laura Astati
- Department of Pathology, "Mater Salutis" Hospital, Via Gianella 1, 37045, Legnago, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | | | - Alberto Buffoli
- Radiotherapy Department, Istituto Clinico S. Anna, Brescia, Italy
| | - Gaia Moretti
- Radiotherapy Department, Istituto Clinico S. Anna, Brescia, Italy
| | | | - Caterina Zanella
- Department of Pathology, "Mater Salutis" Hospital, Via Gianella 1, 37045, Legnago, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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21
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Abstract
Stereotactic ablative radiotherapy (SABR) is a relatively novel form of high precision radiotherapy. For low- and intermediate risk patients, ultrahypofractionation (UHF - more than 5 Gy per day) has been compared to conventionally fractionated or moderately hypofractionated radiotherapy in two large randomized studies. A third smaller randomized study examined the question of the optimal frequency of treatments. The results of these studies will be reviewed. SABR for high risk prostate cancer has been shown to be feasible and is well tolerated with careful planning and setup techniques. However, there is currently insufficient data supporting its use for high-risk patients to offer SABR outside of a clinical trial. SABR costs less to the radiotherapydepartments and, the patient, as well as increasing system capacity. Therefore, it has the potential to be widely adopted in the next few years.
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22
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Alayed Y, Davidson M, Liu S, Chu W, Tseng E, Cheung P, Vesprini D, Cheung H, Morton G, Musunuru HB, Ravi A, Korol R, Deabreu A, Ho L, Commisso K, Bhounr Z, D'Alimonte L, Mittmann N, Dragomir A, Zhang L, Loblaw A. Evaluating the Tolerability of a Simultaneous Focal Boost to the Gross Tumor in Prostate SABR: A Toxicity and Quality-of-Life Comparison of Two Prospective Trials. Int J Radiat Oncol Biol Phys 2020; 107:136-142. [PMID: 31987962 DOI: 10.1016/j.ijrobp.2019.12.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Dose-escalated stereotactic ablative radiotherapy (SABR) to the whole prostate may be associated with better outcomes but has a risk of increased toxicity. An alternative approach is to focally boost the dominant intraprostatic lesion (DIL) seen on magnetic resonance imaging. We report the toxicity and quality-of-life (QOL) outcomes of 2 phase 2 trials of prostate and pelvic SABR, with or without a simultaneous DIL boost. METHODS AND MATERIALS The first trial treated patients with high-risk prostate cancer to a dose of 40 Gy to the prostate and 25 Gy to the pelvis in 5 fractions. The second trial treated patients with intermediate-risk and high-risk prostate cancer to a dose of 35 Gy to the prostate, 25 Gy to the pelvis, and a DIL boost up to 50 Gy in 5 fractions. Acute toxicities, late toxicities, and QOL were assessed. RESULTS Thirty patients were enrolled in each trial. In the focal boost cohort, the median DIL D90% was 48.3 Gy. There was no significant difference in acute grade ≥2 gastrointestinal or genitourinary toxicity between the 2 trials or in cumulative worst late gastrointestinal or genitourinary toxicity up to 24 months. There was no significant difference in QOL domain scores or minimally clinical important change between the 2 trials. CONCLUSIONS Prostate and pelvic SABR with a simultaneous DIL boost was feasible. Acute grade ≥2 toxicity, late toxicity, and QOL seemed to be comparable to a cohort that did not receive a focal boost. Further follow-up will be required to assess long-term outcomes, and randomized data are required to confirm these findings.
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Affiliation(s)
- Yasir Alayed
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Melanie Davidson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Stanley Liu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Eric Tseng
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Hans Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gerard Morton
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - H B Musunuru
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anath Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Renee Korol
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Deabreu
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ling Ho
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kristina Commisso
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zeeba Bhounr
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura D'Alimonte
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Mittmann
- Cancer Care Ontario, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Alice Dragomir
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Liang Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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23
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Draulans C, De Roover R, van der Heide UA, Haustermans K, Pos F, Smeenk RJ, De Boer H, Depuydt T, Kunze-Busch M, Isebaert S, Kerkmeijer L. Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus. Radiother Oncol 2019; 140:131-142. [PMID: 31276989 DOI: 10.1016/j.radonc.2019.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) is gaining interest by the recent publication of the first phase III trials on prostate SBRT and the promising results of many other phase II trials. Before long term results became available, the major concern for implementing SBRT in PCa in daily clinical practice was the potential risk of late genitourinary (GU) and gastrointestinal (GI) toxicity. A number of recently published trials, including late outcome and toxicity data, contributed to the growing evidence for implementation of SBRT for PCa in daily clinical practice. However, there exists substantial variability in delivering SBRT for PCa. The aim of this topical review is to present a number of prospective trials and retrospective analyses of SBRT in the treatment of PCa. We focus on the treatment strategies and techniques used in these trials. In addition, recent literature on a simultaneous integrated boost to the tumor lesion, which could create an additional value in the SBRT treatment of PCa, was described. Furthermore, we discuss the multicenter consensus of the FLAME consortium on SBRT for PCa with a focal boost to the macroscopic intraprostatic tumor nodule(s).
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Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Hans De Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Tom Depuydt
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Linda Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
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24
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Lapierre A, Horn S, Créhange G, Enachescu C, Latorzeff I, Supiot S, Sargos P, Hennequin C, Chapet O. Radiothérapie stéréotaxique extracrânienne : quelle machine pour quelle indication ? Stéréotaxie prostatique. Cancer Radiother 2019; 23:651-657. [DOI: 10.1016/j.canrad.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
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25
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Moderate hypofractionation and stereotactic body radiation therapy in the treatment of prostate cancer. Urol Oncol 2019; 37:619-627. [DOI: 10.1016/j.urolonc.2019.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/02/2019] [Accepted: 01/13/2019] [Indexed: 01/03/2023]
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26
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Loi M, Wortel RC, Francolini G, Incrocci L. Sexual Function in Patients Treated With Stereotactic Radiotherapy For Prostate Cancer: A Systematic Review of the Current Evidence. J Sex Med 2019; 16:1409-1420. [DOI: 10.1016/j.jsxm.2019.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
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27
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[Moderate or extreme hypofractionation and localized prostate cancer: The times are changing]. Cancer Radiother 2019; 23:503-509. [PMID: 31471253 DOI: 10.1016/j.canrad.2019.07.139] [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: 07/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
There are many treatment options for localized prostate cancers, including active surveillance, brachytherapy, external beam radiotherapy, and radical prostatectomy. Quality of life remains a primary objective in the absence of superiority of one strategy over another in terms of specific survival with similar long-term biochemical control rates. Despite a significant decrease in digestive and urinary toxicities thanks to IMRT and IGRT, external radiotherapy remains a treatment that lasts approximately 2 months or 1.5 months, when combined with a brachytherapy boost. Given the specific radiosensitivity of this tumor, several randomized studies have shown that a hypofractionated scheme is not inferior in terms of biochemical control and toxicities, allowing to divide the number of fractions by a factor 2 to 8. Given that SBRT becomes a validated therapeutic option for a selected population of patients with localized prostate cancer, extreme hypofractionation is becoming a strong challenger of conventional external radiotherapy or brachytherapy.
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28
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Hwang ME, Mayeda M, Liz M, Goode-Marshall B, Gonzalez L, Elliston CD, Spina CS, Padilla OA, Wenske S, Deutsch I. Stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer: toxicity profile and early oncologic outcomes. Radiat Oncol 2019; 14:136. [PMID: 31375119 PMCID: PMC6679492 DOI: 10.1186/s13014-019-1346-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Multiple phase I-II clinical trials have reported on the efficacy and safety of prostate stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer. However, few have reported outcomes for prostate SBRT using periprostatic hydrogel spacer (SpaceOAR; Augmenix). Herein, we report safety and efficacy outcomes from our institutional prostate SBRT experience with SpaceOAR placement. Methods Fifty men with low- or intermediate-risk prostate cancer treated at a single institution with linear accelerator-based SBRT to 3625 cGy in 5 fractions, with or without androgen deprivation therapy (ADT) were included. All patients underwent SpaceOAR and fiducial marker placement followed by pre-treatment MRI. Toxicity assessments were conducted at least weekly while on treatment, 1 month after treatment, and every follow-up visit thereafter. Post-treatment PSA measurements were obtained 4 months after SBRT, followed by every 3–6 months thereafter. Acute toxicity was documented per RTOG criteria. Results Median follow up time was 20 (range 4–44) months. Median PSA at time of diagnosis was 7.4 (2.7–19.5) ng/ml. Eighteen men received 6 months of ADT for unfavorable intermediate risk disease. No PSA failures were recorded. Median PSA was 0.9 ng/mL at 20 months; 0.08 and 1.32 ng/mL in men who did and did not receive ADT, respectively. Mean prostate-rectum separation achieved with SpaceOAR was 9.6 ± 4 mm at the prostate midgland. No grade ≥ 3 GU or GI toxicity was recorded. During treatment, 30% of men developed new grade 2 GU toxicity (urgency or dysuria). These symptoms were present in 30% of men at 1 month and in 12% of men at 1 year post-treatment. During treatment, GI toxicity was limited to grade 1 symptoms (16%), although 4% of men developed grade 2 symptoms during the first 4 weeks after SBRT. All GI symptoms were resolving by the 1 month post-treatment assessment and no acute or late rectal toxicity was reported > 1 month after treatment. Conclusions Periprostatic hydrogel placement followed by prostate SBRT resulted in minimal GI toxicity, and favorable early oncologic outcomes. These results indicate that SBRT with periprostatic spacer is a well-tolerated, safe, and convenient treatment option for localized prostate cancer. Electronic supplementary material The online version of this article (10.1186/s13014-019-1346-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark E Hwang
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Mark Mayeda
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Maria Liz
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Brenda Goode-Marshall
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Lissette Gonzalez
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Carl D Elliston
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Catherine S Spina
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Oscar A Padilla
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, New York, 10032, USA
| | - Israel Deutsch
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA.
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Abstract
PURPOSE OF REVIEW To summarize recent evidence concerning the use of moderately hypofractionated external beam radiotherapy, defined as 2.4-3.4 Gy per fraction, and ultrahypofractionated external beam radiotherapy (also known as stereotactic body radiotherapy [SBRT]), defined as at least 5 Gy per fraction, in men with localized prostate cancer. RECENT FINDINGS Taken together, a number of recently completed randomized trials show that moderately hypofractionated radiotherapy confers similar biochemical control compared to conventionally fractionated radiotherapy without increasing late toxicity. These effects appear to extend across all baseline clinical risk groups. Several single-arm phase II studies, as well as a recently published large-scale randomized trial comparing SBRT with conventional fractionation, show very promising biochemical control and favorable acute and late treatment-related morbidity with the use of SBRT in predominantly low- and intermediate-risk prostate cancer. As it is associated with similar prostate cancer control and toxicity while improving patient convenience and reducing cost, moderate hypofractionation is a preferred alternative to conventional fractionation in a majority of men with localized prostate cancer choosing radiotherapy as their primary treatment modality. To date, studies conducted largely in low- and intermediate-risk prostate cancer report encouraging oncologic outcomes and acceptable toxicity with SBRT. Mature results of phase III trials evaluating five-fraction SBRT regimens are eagerly awaited.
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30
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Jackson WC, Silva J, Hartman HE, Dess RT, Kishan AU, Beeler WH, Gharzai LA, Jaworski EM, Mehra R, Hearn JWD, Morgan TM, Salami SS, Cooperberg MR, Mahal BA, Soni PD, Kaffenberger S, Nguyen PL, Desai N, Feng FY, Zumsteg ZS, Spratt DE. Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6,000 Patients Treated On Prospective Studies. Int J Radiat Oncol Biol Phys 2019; 104:778-789. [PMID: 30959121 PMCID: PMC6770993 DOI: 10.1016/j.ijrobp.2019.03.051] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 03/31/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Utilization of stereotactic body radiation therapy (SBRT) for treatment of localized prostate cancer is increasing. Guidelines and payers variably support the use of prostate SBRT. We therefore sought to systematically analyze biochemical recurrence-free survival (bRFS), physician-reported toxicity, and patient-reported outcomes after prostate SBRT. METHODS AND MATERIALS A systematic search leveraging Medline via PubMed and EMBASE for original articles published between January 1990 and January 2018 was performed. This was supplemented by abstracts with sufficient extractable data from January 2013 to March 2018. All prospective series assessing curative-intent prostate SBRT for localized prostate cancer reporting bRFS, physician-reported toxicity, and patient-reported quality of life with a minimum of 1-year follow-up were included. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were performed with random-effect modeling. Extent of heterogeneity between studies was determined by the I2 and Cochran's Q tests. Meta-regression was performed using Hartung-Knapp methods. RESULTS Thirty-eight unique prospective series were identified comprising 6116 patients. Median follow-up was 39 months across all patients (range, 12-115 months). Ninety-two percent, 78%, and 38% of studies included low, intermediate, and high-risk patients. Overall, 5- and 7-year bRFS rates were 95.3% (95% confidence interval [CI], 91.3%-97.5%) and 93.7% (95% CI, 91.4%-95.5%), respectively. Estimated late grade ≥3 genitourinary and gastrointestinal toxicity rates were 2.0% (95% CI, 1.4%-2.8%) and 1.1% (95% CI, 0.6%-2.0%), respectively. By 2 years post-SBRT, Expanded Prostate Cancer Index Composite urinary and bowel domain scores returned to baseline. Increasing dose of SBRT was associated with improved biochemical control (P = .018) but worse late grade ≥3 GU toxicity (P = .014). CONCLUSIONS Prostate SBRT has substantial prospective evidence supporting its use, with favorable tumor control, patient-reported quality of life, and levels of toxicity demonstrated. SBRT has sufficient evidence to be supported as a standard treatment option for localized prostate cancer while ongoing trials assess its potential superiority.
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Affiliation(s)
- William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jessica Silva
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Holly E Hartman
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Whitney H Beeler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jason W D Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Brandon A Mahal
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Neil Desai
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Felix Y Feng
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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31
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Greco C, Vazirani AA, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Vasconcelos AL, Antunes I, Kociolek J, Fuks Z. The evolving role of external beam radiotherapy in localized prostate cancer. Semin Oncol 2019; 46:246-253. [DOI: 10.1053/j.seminoncol.2019.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/07/2019] [Indexed: 12/30/2022]
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Roy S, Loblaw A, Cheung P, Chu W, Chung HT, Vesprini D, Ong A, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Helou J, Zhang L, Mamedov A, Deabreu A, Quon HC. Prostate-specific Antigen Bounce After Stereotactic Body Radiotherapy for Prostate Cancer: A Pooled Analysis of Four Prospective Trials. Clin Oncol (R Coll Radiol) 2019; 31:621-629. [PMID: 31126725 DOI: 10.1016/j.clon.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
AIMS We conducted a pooled analysis of four prospective stereotactic body radiotherapy (SBRT) trials of low- and intermediate-risk prostate cancer to evaluate the incidence of prostate-specific antigen (PSA) bounce and its correlation with the time-dose-fraction schedule. The correlation between bounce with PSA response at 4 years (nadir PSA < 0.4 ng/ml) and biochemical failure-free survival (BFFS) was also explored. MATERIALS AND METHODS The study included four treatment groups: 35 Gy/five fractions once per week (QW) (TG-1; n = 84); 40 Gy/five fractions QW (TG-2; n = 100); 40 Gy/five fractions every other day (TG-3; n = 73); and 26 Gy/two fractions QW (TG-4; n = 30). PSA bounce was defined as a rise in PSA by 0.2 ng/ml (nadir + 0.2) or 2 ng/ml (nadir + 2.0) above nadir followed by a decrease back to nadir. Patients with fewer than three follow-up PSA tests were excluded from the pooled analysis. RESULTS In total, 287 patients were included, with a median follow-up of 5.0 years. The pooled 5-year cumulative incidence of bounce by nadir + 2.0 was 8%. The 2-year cumulative incidences of PSA bounce by nadir + 0.2 were 28.9, 21, 19.6 and 16.7% (P = 0.12) and by nadir + 2.0 were 7.2, 8, 2.7 and 6.7% (P = 0.32) for TG-1 to TG-4, respectively. Multivariable analysis revealed that for nadir + 2.0, pre-treatment PSA (odds ratio 0.49; 95% confidence interval 0.26-0.97) correlated with PSA bounce. Although PSA bounce by nadir + 0.2 (odds ratio 0.10; 95% confidence interval 0.04-0.24) and nadir + 2.0 (odds ratio 0.29; 95% confidence interval 0.09-0.93) was associated with a lower probability of PSA response at 4 years, there was no association between bounce by nadir + 0.2 (hazard ratio 0.36; 95% confidence interval 0.08-1.74) or nadir + 2 (hazard ratio 1.77; 95% confidence interval 0.28-11.07) with BFFS. CONCLUSION The incidence of PSA bounce was independent of time-dose-fraction schedule for prostate SBRT. One in 13 patients experienced a bounce high enough to be misinterpreted as biochemical failure, and clinicians should avoid early salvage interventions in these patients. There was no association between PSA bounce and BFFS.
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Affiliation(s)
- S Roy
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada
| | - A Loblaw
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - P Cheung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - W Chu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H T Chung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - D Vesprini
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ong
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - A Chowdhury
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | | | - G Pang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - R Korol
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - M Davidson
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ravi
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - B McCurdy
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - J Helou
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - L Zhang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Mamedov
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Deabreu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H C Quon
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada.
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33
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Pinitpatcharalert A, Happersett L, Kollmeier M, McBride S, Gorovets D, Tyagi N, Varghese M, Zelefsky MJ. Early Tolerance Outcomes of Stereotactic Hypofractionated Accelerated Radiation Therapy Concomitant with Pelvic Node Irradiation in High-risk Prostate Cancer. Adv Radiat Oncol 2019; 4:337-344. [PMID: 31011679 PMCID: PMC6460324 DOI: 10.1016/j.adro.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose This study aimed to evaluate the toxicity of prostate and pelvic lymph node stereotactic body radiation therapy (SBRT) for high-risk prostate cancer. Methods and Materials Twenty-three patients with high-risk or lymph node-positive prostate cancer were treated with SBRT that delivered 37.5 to 40 Gy in 5 fractions to the prostate and seminal vesicles, with concomitant treatment of the pelvic nodes to 25 Gy. In general, patients received neoadjuvant, concurrent, and adjuvant androgen deprivation therapy for a duration of 18 months. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events, version 3.0. The median follow-up was 19 months (range, 3-48 months). Results Acute grade 1 gastrointestinal (GI) toxicities were noted in 2 patients (9.1%). No patient experienced acute grade ≥2 GI toxicity. Acute genitourinary (GU) grade 1, 2, and 3 toxicities were observed in 7 patients (31.8%), 8 patients (36.4%), and 1 patient (4.5%), respectively. Late grade 2 GI and GU toxicities were observed in 2 patients (9.1%) and 6 patients (27.3%), respectively. No late grade ≥3 GI toxicity was noted. Late grade ≥3 GU (hemorrhagic cystitis) was noted in 1 patient (4.5%), which responded to laser fulguration. Conclusions SBRT with pelvic lymph node radiation therapy was feasible and well tolerated. The incidence of grade ≥3 GU and GI toxicities was uncommon. Continued follow-up will be required to determine the long-term safety and efficacy of this approach for high-risk patients.
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Affiliation(s)
| | - Laura Happersett
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marisa Kollmeier
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Gorovets
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neelam Tyagi
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Varghese
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael J Zelefsky
- Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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Haridass A. Developments in Stereotactic Body Radiotherapy. Cancers (Basel) 2018; 10:E497. [PMID: 30544488 PMCID: PMC6316669 DOI: 10.3390/cancers10120497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy is the technique of accurately delivering high doses of radiotherapy to small volume targets in a single or small number of sessions. The high biological effective dose of this treatment is reflected in the high rates of local control achieved across multiple tumour sites. Toxicity of the treatment can be significant and ongoing prospective trials will help define the utility of this treatment as an alternative to surgery in treating primary tumours and oligometastatic disease. Longer follow-up and survival data from prospective trials will be essential in determining the value of this resource-intensive treatment. The opportunity to combine this treatment with systemic therapies and its potential synergy with immunotherapy opens up interesting avenues for research in the future.
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35
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Patient and Dosimetric Predictors of Genitourinary and Bowel Quality of Life After Prostate SBRT: Secondary Analysis of a Multi-institutional Trial. Int J Radiat Oncol Biol Phys 2018; 102:1430-1437. [DOI: 10.1016/j.ijrobp.2018.07.191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
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36
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Alayed Y, Cheung P, Vesprini D, Liu S, Chu W, Chung H, Musunuru HB, Davidson M, Ravi A, Ho L, Deabreu A, D'Alimonte L, Bhounr Z, Zhang L, Commisso K, Loblaw A. SABR in High-Risk Prostate Cancer: Outcomes From 2 Prospective Clinical Trials With and Without Elective Nodal Irradiation. Int J Radiat Oncol Biol Phys 2018; 104:36-41. [PMID: 30445172 DOI: 10.1016/j.ijrobp.2018.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE There is limited data on stereotactic ablative radiation therapy (SABR) in high-risk prostate cancer (PCa), especially regarding the role of elective nodal irradiation (ENI). This study compares 2 prospective phase 2 trials using SABR in high-risk PCa, with and without ENI. METHODS AND MATERIALS Patients had high-risk PCa. Those in trial 1 received 40 Gy in 5 fractions to the prostate and 30 Gy in 5 fractions to the seminal vesicles. Patients in trial 2 received 40 Gy in 5 fractions to the prostate and 25 Gy in 5 fractions to the pelvis and seminal vesicles. National Cancer Institute Common Terminology Criteria for Adverse Events toxicities were collected. Biochemical failure (BF) was defined as nadir + 2, and the 4-year prostate-specific antigen (PSA) response rate (4yPSARR) was <0.4 ng/mL. RESULTS Sixty patients were included (trial 1, n = 30; trial 2, n = 30). Median follow-up was 5.6 years and 4.0 years. The median nadir PSA was 0.02 ng/mL for both trials. Six patients had BF, all from trial 1. The BF rate was 14.6% at 5 years in trial 1 and 0% in trial 2. Sixty-three percent of patients in trial 1 and 93% in trial 2 had a 4yPSARR. Two patients died in trial 1, 1 from metastatic disease. One patient in trial 2 died of other causes. No other patients developed metastatic disease, and 1 patient in trial 1 had castrate resistant PCa. Overall survival at 5 years was 93.2% and 96.7% (P = .86). There was significantly worse late gastrointestinal and sexual toxicity in trial 1, but there was no difference in late genitourinary toxicity. CONCLUSIONS SABR in high-risk PCa yields biochemical control rates that may be comparable to that of other radiation therapy modalities. ENI using SABR is feasible and may lead to a significant improvement in biochemical control and in 4yPSARR, without an increase in late gastrointestinal or genitourinary toxicity. Longer follow-up would provide a better assessment of biochemical control. Well-conducted phase 3 trials are needed to fully establish the role of SABR and ENI in high-risk PCa.
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Affiliation(s)
- Yasir Alayed
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Division of Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Stanley Liu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hima Bindu Musunuru
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Melanie Davidson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ananth Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ling Ho
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Deabreu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Laura D'Alimonte
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zeeba Bhounr
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Kristina Commisso
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Canada.
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37
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Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, Bentzen S, Chang M, Efstathiou J, Greany P, Halvorsen P, Koontz BF, Lawton C, Leyrer CM, Lin D, Ray M, Sandler H. Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline. J Clin Oncol 2018; 36:JCO1801097. [PMID: 30307776 PMCID: PMC6269129 DOI: 10.1200/jco.18.01097] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Scott C. Morgan
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Karen Hoffman
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. Andrew Loblaw
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark K. Buyyounouski
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Caroline Patton
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Barocas
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Soren Bentzen
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Chang
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason Efstathiou
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Patrick Greany
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Per Halvorsen
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Bridget F. Koontz
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Colleen Lawton
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - C. Marc Leyrer
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Lin
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Ray
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard Sandler
- Scott C. Morgan, The Ottawa Hospital and University of Ottawa, Ottawa; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Karen Hoffman, MD Anderson Cancer Center, Houston, TX; Mark K. Buyyounouski, Stanford University, Stanford; Palto Alto VA Health System, Palo Alto, CA; Caroline Patton, American Society for Radiation Oncology, Arlington, VA; Daniel Barocas, Vanderbilt University Medical Center, Nashville, TN; Soren Bentzen, University of Maryland School of Medicine, Baltimore, MD; Michael Chang, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, VA; Jason Efstathiou, Massachusetts General Hospital, Boston MA; Patrick Greany, Patient representative, Tallahassee, FL; Per Halvorsen, Lahey Hospital and Medical Center, Burlington, MA; Bridget F. Koontz, Duke University Medical Center, Durham, NC; Colleen Lawton, Medical College of Wisconsin, Milwaukee, WI; C. Marc Leyrer, Wake Forest University, Winston-Salem, NC; Daniel Lin, University of Washington, Seattle, WA; Michael Ray, Radiology Associates of Appleton, ThedaCare Regional Cancer Center, Appleton, WI; and Howard Sandler, Cedars-Sinai Medical Center, Los Angeles, CA
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Stereotactic body radiation therapy (SBRT) for high-risk prostate cancer: Where are we now? Pract Radiat Oncol 2018; 8:185-202. [DOI: 10.1016/j.prro.2017.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 11/23/2022]
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The Role of Stereotactic Ablative Radiotherapy in Oncological and Non-Oncological Clinical Settings: Highlights from the 7th Meeting of AIRO – Young Members Working Group (AIRO Giovani). TUMORI JOURNAL 2018. [DOI: 10.1177/1778.19280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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40
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Henderson DR, Tree AC, Harrington KJ, van As NJ. Dosimetric Implications of Computerised Tomography-Only versus Magnetic Resonance-Fusion Contouring in Stereotactic Body Radiotherapy for Prostate Cancer. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E32. [PMID: 29621134 PMCID: PMC6023312 DOI: 10.3390/medicines5020032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 12/31/2022]
Abstract
Background: Magnetic resonance (MR)-fusion contouring is the standard of care in prostate stereotactic body radiotherapy (SBRT) for target volume localisation. However, the planning computerised tomography (CT) scan continues to be used for dose calculation and treatment planning and verification. Discrepancies between the planning MR and CT scans may negate the benefits of MR-fusion contouring and it adds a significant resource burden. We aimed to determine whether CT-only contouring resulted in a dosimetric detriment compared with MR-fusion contouring in prostate SBRT planning. Methods: We retrospectively compared target volumes and SBRT plans for 20 patients treated clinically with MR-fusion contouring (standard of care) with those produced by re-contouring using CT data only. Dose was 36.25 Gy in 5 fractions. CT-only contouring was done on two occasions blind to MR data and reviewed by a separate observer. Primary outcome was the difference in rectal volume receiving 36 Gy or above. Results: Absolute target volumes were similar: 63.5 cc (SD ± 27.9) versus 63.2 (SD ± 26.5), Dice coefficient 0.86 (SD ± 0.04). Mean difference in apex superior-inferior position was 1.1 (SD ± 3.5; CI: −0.4–2.6). Small dosimetric differences in favour of CT-only contours were seen, with the mean rectal V36 Gy 0.3 cc (95% CI: 0.1–0.5) lower for CT-only contouring. Conclusions: Prostate SBRT can be successfully planned without MR-fusion contouring. Consideration can be given to omitting MR-fusion from the prostate SBRT workflow, provided reference to diagnostic MR imaging is available. Development of MR-only work flow is a key research priority to gain access to the anatomical fidelity of MR imaging.
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Affiliation(s)
- Daniel R Henderson
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK.
- The Cancer Centre, University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK.
| | - Alison C Tree
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK.
| | - Kevin J Harrington
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK.
| | - Nicholas J van As
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK.
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41
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Implementation of hypofractionated prostate radiation therapy in the United States: A National Cancer Database analysis. Pract Radiat Oncol 2018; 7:270-278. [PMID: 28673554 DOI: 10.1016/j.prro.2017.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Preclinical and clinical research over the past several decades suggests that hypofractionated (HFxn) radiation therapy schedules produce similar treatment outcomes compared with conventionally fractionated (CFxn) radiation therapy for definitive treatment of localized prostate cancer (PCa). We sought to evaluate national trends and identify factors associated with HFxn utilization using the US National Cancer Database. METHODS AND MATERIALS We queried the National Cancer Database for men diagnosed with localized (N0,M0) PCa from 2004 through 2013 treated with external beam radiation therapy. Patients were grouped by dose per fraction (DpF) in Gray: CFxn was defined as DpF ≤2.0, moderate HFxn as DpF >2.0 but <5.0, and extreme HFxn as DpF ≥5.0. Men receiving DpF <1.5 or >15.0 were excluded, as were those receiving <25 or >90 Gy total dose. Multiple logistic regression was performed to identify demographic, clinical, and treatment factor associations. RESULTS A total of 132,403 men were identified, with 120,055 receiving CFxn, 7264 moderate HFxn, and 5084 extreme HFxn. Although CFxn was by far the most common approach over the analysis period, HFxn use increased from 6.2% in 2004 to 14.2% in 2013 (P < .01). Extreme HFxn use increased the most (from 0.3% to 8.5%), whereas moderate HFxn utilization was unchanged (from 5.9% to 5.7%). HFxn use was independently associated with younger age, later year of diagnosis, non-black race, non-Medicaid insurance, non-Western residence, higher income, academic treatment facility, greater distance from treatment facility, low-risk disease group (by National Comprehensive Cancer Network criteria), and nonreceipt of hormone therapy. CONCLUSIONS Although CFxn remains the most common radiation therapy schedule for localized PCa, use of HFxn appears to be increasing in the United States as a result of increased extreme HFxn use. Financial and logistical factors may accelerate adoption of shorter schedules. Considering the multiple demographic and prognostic differences identified between these groups, randomized outcome data comparing extreme HFxn to alternatives are desirable.
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42
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Syed YA, Patel-Yadav AK, Rivers C, Singh AK. Stereotactic radiotherapy for prostate cancer: A review and future directions. World J Clin Oncol 2017; 8:389-397. [PMID: 29067275 PMCID: PMC5638714 DOI: 10.5306/wjco.v8.i5.389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer affects over 200000 men annually in the United States alone. The role of conventionally fractionated external beam radiation therapy (RT) is well established as a treatment option for eligible prostate cancer patients; however, the use of stereotactic body radiotherapy (SBRT) in this setting is less well defined. Within the past decade, there have been a number of studies investigating the feasibility of SBRT as a potential treatment option for prostate cancer patients. SBRT has been well studied in other disease sites, and the shortened treatment course would allow for greater convenience for patients. There may also be implications for toxicity as well as disease control. In this review we present a number of prospective and retrospective trials of SBRT in the treatment of prostate cancer. We focus on factors such as biochemical progression-free survival, prostate specific antigen (PSA) response, and toxicity in order to compare SBRT to established treatment modalities. We also discuss future steps that the clinical community can take to further explore this new treatment approach. We conclude that initial studies examining the use of SBRT in the treatment of prostate cancer have demonstrated impressive rates of biochemical recurrence-free survival and PSA response, while maintaining a relatively favorable acute toxicity profile, though long-term follow-up is needed.
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Affiliation(s)
- Yusef A Syed
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30342, United States
| | - Ami K Patel-Yadav
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Charlotte Rivers
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Anurag K Singh
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
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43
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Duvergé L, Castelli J, Lizée T, de Crevoisier R, Azria D. [Doses to organs at risk for conformational and stereotactic radiotherapy: Bladder]. Cancer Radiother 2017; 21:597-603. [PMID: 28882511 DOI: 10.1016/j.canrad.2017.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022]
Abstract
Bladder dose constraints in case of conformational radiotherapy/intensity-modulated radiotherapy and stereotactic radiotherapy are reported from the literature, in particular from the French radiotherapy society RECORAD recommendations, according to the treated pelvic tumor sites. The dose-volume effect on urinary toxicity is not clearly demonstrated, making difficult to establish absolute dose constraints for the bladder. In case of high-dose prostate cancer radiotherapy, the bladder dose constraints are: V60Gy<50% and maximum dose<80Gy for standard fractionation and V60Gy<5%, V48Gy<25% and V41Gy<50% for moderate hypofractionation (20 fractions of 3Gy). In case of prostate stereotactic radiotherapy (five fractions of 7.25Gy), the most frequent dose constraints in the literature are V37Gy<10cm3 and V18Gy<40%. In case of conformational radiotherapy of cervix cancer, postoperative endometrium, anal canal and rectum, the recommendations are V40Gy<40% and D2% lower than the prescribed dose.
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Affiliation(s)
- L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France.
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest, site Paul-Papin, 2, rue Moll, 49100 Angers, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - D Azria
- Département de cancérologie radiothérapie, CRLC Val-d'Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34000 Montpellier, France
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44
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Gnep K, Lizée T, Campillo-Gimenez B, Delpon G, Droupy S, Perrier L, de Crevoisier R. [Toxicity and quality of life comparison of iodine 125 brachytherapy and stereotactic radiotherapy for prostate cancers]. Cancer Radiother 2017; 21:478-490. [PMID: 28888746 DOI: 10.1016/j.canrad.2017.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
Quality of life is a major issue for good prognostic prostate cancer, for which brachytherapy is one of the reference treatments. Stereotactic Body Radiotherapy (SBRT) is a recent alternative however not yet validated as a standard treatment. This review of the literature reports and compares the toxicities and the quality of life, either after exclusive brachytherapy with iodine 125 or after SBRT. The comparison is made with the limitations of the absence of randomized trial comparing the two treatment techniques. Acute toxicity appears to be lower after SBRT compared to brachytherapy (from 10 to 40 % versus 30 to 40 %, respectively). Conversely, acute and late gastrointestinal toxicity (from 0 to 21 % and from 0 to 10 % of grade 2, respectively) appears more frequent with SBRT. Late urinary toxicity seems identical between both techniques (from 20 to 30 % of grade 2), with a possible urinary flare syndrome. Both treatments have an impact on erectile dysfunction, although it is not possible to conclude that a technique is superior because of the limited data on SBRT. SBRT has better bowel and urinary (irritation or obstruction) quality of life scores than brachytherapy; while sexual and urinary incontinence remain the same. The absence of randomized trial comparing SBRT with brachytherapy for prostate cancers does not allow to conclude on the superiority of one technique over another, thus justifying a phase III medicoeconomic evaluation.
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Affiliation(s)
- K Gnep
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France.
| | - T Lizée
- Département de radiothérapie, centre régional de lutte contre le cancer Paul-Papin, institut de cancérologie de l'Ouest, 49100 Angers, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - B Campillo-Gimenez
- Direction de la recherche clinique, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - G Delpon
- Département de radiothérapie, centre régional de lutte contre le cancer René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - S Droupy
- Département d'urologie, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - L Perrier
- Centre Léon-Bérard, université Lyon, direction de la recherche clinique et de l'innovation GATE L-SE UMR 5824, 69008 Lyon, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
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45
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Cosset JM. [Hypofractionated irradiation of prostate cancer: What is the radiobiological understanding in 2017?]. Cancer Radiother 2017; 21:447-453. [PMID: 28847464 DOI: 10.1016/j.canrad.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
For prostate cancer, hypofractionation has been based since 1999 on radiobiological data, which calculated a very low alpha/beta ratio (1.2 to 1.5Gy). This suggested that a better local control could be obtained, without any toxicity increase. Consequently, two types of hypofractionated schemes were proposed: "moderate" hypofractionation, with fractions of 2.5 to 4Gy, and "extreme" hypofractionation, utilizing stereotactic techniques, with fractions of 7 to 10Gy. For moderate hypofractionation, the linear-quadratic (LQ) model has been used to calculate the equivalent doses of the new protocols. The available trials have often shown a "non-inferiority", but no advantage, while the equivalent doses calculated for the hypofractionated arms were sometimes very superior to the doses of the conventional arms. This finding could suggest either an alpha/beta ratio lower than previously calculated, or a negative impact of other radiobiological parameters, which had not been taken into account. For "extreme" hypofractionation, the use of the LQ model is discussed for high dose fractions. Moreover, a number of radiobiological questions are still pending. The reduced overall irradiation time could be either a positive point (better local control) or a negative one (reduced reoxygenation). The prolonged duration of the fractions could lead to a decrease of efficacy (because allowing for reparation of sublethal lesions). Finally, the impact of the large fractions on the microenvironment and/or immunity remains discussed. The reported series appear to show encouraging short to mid-term results, but the results of randomized trials are still awaited. Today, it seems reasonable to only propose those extreme hypofractionated schemes to well-selected patients, treating small volumes with high-level stereotactic techniques.
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Affiliation(s)
- J-M Cosset
- GIE Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France.
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46
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Abstract
Stereotactic body radiation therapy (SBRT) has become a viable treatment option for the many patients who receive a diagnosis of localized prostate cancer each year. Technological advancements have led to tight target conformality, allowing for high-dose-per-fraction delivery without untoward normal tissue toxicity. Biochemical control, now reported up to 5 years, appears to compare favorably with dose-escalated conventionally fractionated radiotherapy. Moreover, toxicity and quality of life follow-up data indicate genitourinary and gastrointestinal toxicities are likewise comparable to conventional radiation therapy. Nevertheless, because of the long natural history of prostate cancer, extended follow-up will be necessary to confirm these impressive initial results. Within this prostate SBRT review, we explore the detailed rationale for SBRT treatment, the diverse SBRT techniques utilized and their unique technical considerations, and finally data for SBRT clinical efficacy and treatment-related toxicity.
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47
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Di Franco R, Borzillo V, Ravo V, Ametrano G, Falivene S, Cammarota F, Rossetti S, Romano FJ, D'Aniello C, Cavaliere C, Iovane G, Piscitelli R, Berretta M, Muto P, Facchini G. Rectal/urinary toxicity after hypofractionated vs conventional radiotherapy in low/intermediate risk localized prostate cancer: systematic review and meta analysis. Oncotarget 2017; 8:17383-17395. [PMID: 28129649 PMCID: PMC5370048 DOI: 10.18632/oncotarget.14798] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this review was to compare radiation toxicity in Localized Prostate Cancer (LPC) patients who underwent conventional fractionation (CV), hypofractionated (HYPO) or extreme hypofractionated (eHYPO) radiotherapy. We analyzed the impact of technological innovation on the management of prostate cancer, attempting to make a meta-analysis of randomized trials. Methods PubMed database has been explored for studies concerning acute and late urinary/gastrointestinal toxicity in low/intermediate risk LPC patients after receiving radiotherapy. Studies were then gathered into 5 groups: detected acute and chronic toxicity data from phase II non randomized trials were analyzed and Odds Ratio (OR) was calculated by comparing the number of patients with G0-1 toxicity and those with toxicity > G2 in the studied groups. A meta-analysis of prospective randomized trials was also carried out. Results The initial search yielded 575 results, but only 32 manuscripts met all eligibility requirements: in terms of radiation-induced side effects, such as gastrointestinal and genitourinary acute and late toxicity, hypofractionated 3DCRT seemed to be more advantageous than 3DCRT with conventional fractionation as well as IMRT with conventional fractionation compared to 3DCRT with conventional fractionation; furthermore, IMRT hypofractionated technique appeared more advantageous than IMRT with conventional fractionation in late toxicities. Randomized trials meta-analysis disclosed an advantage in terms of acute gastrointestinal and late genitourinary toxicity for Hypofractionated schemes. Conclusions Although our analysis pointed out a more favorable toxicity profile in terms of gastrointestinal acute side effects of conventional radiotherapy schemes compared to hypofractionated ones, prospective randomized trials are needed to better understand the real incidence of rectal and urinary toxicity in patients receiving radiotherapy for localized prostate cancer.
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Affiliation(s)
- Rossella Di Franco
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Valentina Borzillo
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Vincenzo Ravo
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Gianluca Ametrano
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Sara Falivene
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Fabrizio Cammarota
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Sabrina Rossetti
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Francesco Jacopo Romano
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Carmine D'Aniello
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, A.O.R.N. dei COLLI "Ospedali Monaldi-Cotugno-CTO", Napoli
| | - Carla Cavaliere
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy
| | - Gelsomina Iovane
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
| | - Raffaele Piscitelli
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, Aviano, Italy
| | - Paolo Muto
- Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Napoli, Italy
| | - Gaetano Facchini
- Progetto ONCONET2.0 - Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo - Regione Campania, Italy.,Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
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48
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Koskela K, Palmgren JE, Heikkilä J, Virsunen H, Sailas L, Auvinen P, Seppälä J, Kataja V. Hypofractionated stereotactic body radiotherapy for localized prostate cancer - first Nordic clinical experience. Acta Oncol 2017; 56:978-983. [PMID: 28514930 DOI: 10.1080/0284186x.2017.1288923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of hypofractionated stereotactic body radiotherapy (SBRT) as primary treatment modality in clinically localized prostate cancer (PCa) is emerging, because the low α/β-ratio favors the use of high dose per fraction in PCa. There is a need for more data about SBRT, especially in high-risk PCa patients. The purpose of this retrospective study was to evaluate the safety and the short-term efficacy of robotic SBRT in a clinical patient cohort with localized PCa including also high-risk patients (D'Amico risk stratification). MATERIALS AND METHODS A total of 240 consecutive patients with clinically localized PCa were treated primarily with SBRT to total doses of 35 Gy or 36.25 Gy in 5 fractions using a robotic SBRT device (CyberKnife®). All risk groups (D'Amico risk stratification) were represented as follows: 48 (22%), 59 (27%) and 111 (51%) of the patients representing low-, intermediate- and high-risk group, respectively. Data on acute and intermediate-term toxicities and early PSA responses were analyzed. RESULTS Neither acute grade 3 or higher GU nor rectal toxicity was observed. Regardless of the fact that 29 (13.3%) patients experienced intermediate-term toxicity requiring diagnostic interventions, the rates of intermediate-term grade 3 GU, rectal and infectious toxicity were low, 1.8%, 0.9% and 1.4%, respectively. A biochemical relapse was observed in ten (4.6%) patients. With the median follow-up time of 23 months the biochemical relapse-free survival (bRFS) rate was 100%, 96.6% and 92.8% in low-, intermediate- and high-risk group, respectively. CONCLUSIONS The toxicity of robotic SBRT in a large clinical cohort of PCa patients was tolerable and the early PSA response was good in all risk groups. The hypofractionated SBRT offers a possibility to high dose per fraction and to provide the whole radiotherapy treatment within two to three weeks.
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Affiliation(s)
| | | | - Janne Heikkilä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Heli Virsunen
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Liisa Sailas
- North Karelia Central Hospital, Joensuu, Finland
| | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jan Seppälä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Central Hospital, Jyväskylä, Finland
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49
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P Weiner J, Schwartz D, Shao M, Osborn V, Choi K, Schreiber D. Stereotactic radiotherapy of the prostate: fractionation and utilization in the United States. Radiat Oncol J 2017; 35:137-143. [PMID: 28712283 PMCID: PMC5518450 DOI: 10.3857/roj.2017.02026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/25/2017] [Accepted: 02/06/2017] [Indexed: 01/19/2023] Open
Abstract
Purpose To analyze the utilization and fractionation of extreme hypofractionation via stereotactic body radiotherapy (SBRT) in the treatment of prostate cancer. Materials and Methods Data was analyzed on men diagnosed with localized prostate cancer between 2004–2012 and treated with definitive-intent radiation therapy, as captured in the National Cancer Database. This database is a hospital-based registry that collects an estimated 70% of all diagnosed malignancies in the United States. Results There were 299,186 patients identified, of which 4,962 (1.7%) were identified as receiving SBRT as primary treatment. Of those men, 2,082 had low risk disease (42.0%), 2,201 had intermediate risk disease (44.4%), and 679 had high risk disease (13.7%). The relative utilization of SBRT increased from 0.1% in 2004 to 4.0% in 2012. Initially SBRT was more commonly used in academic programs, though as time progressed there was a shift to favor an increased absolute number of men treated in the community setting. Delivery of five separate treatments was the most commonly utilized fractionation pattern, with 4,635 patients (91.3%) receiving this number of treatments. The most common dosing pattern was 725 cGy × 5 fractions (49.6%) followed by 700 cGy × 5 fractions (21.3%). conclusions Extreme hypofractionation via SBRT is slowly increasing acceptance. Currently 700-725 cGy × 5 fractions appears to be the most commonly employed scheme. As further long-term data regarding the safety and efficacy emerges, the relative utilization of this modality is expected to continue to increase.
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Affiliation(s)
- Joseph P Weiner
- Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, USA
| | - David Schwartz
- Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Meng Shao
- Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Virginia Osborn
- Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Kwang Choi
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schreiber
- Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.,Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Leroy T, Lacornerie T, Bogart E, Nickers P, Lartigau E, Pasquier D. Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center. Radiat Oncol 2017; 12:95. [PMID: 28599663 PMCID: PMC5466739 DOI: 10.1186/s13014-017-0833-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Currently, there is no standard option for local salvage treatment for local prostate cancer recurrence after radiotherapy. Our objective was to investigate the feasibility and efficiency of Robotic Stereotactic Body Radiation Therapy (SBRT) in this clinical setting. METHODS/MATERIALS We retrospectively reviewed patients who were treated at our institution with SBRT for local prostate cancer recurrence after External Beam Radiation Therapy (EBRT) or brachytherapy. Multidisciplinary staff approved the treatment, and recurrence was biopsy-proven when feasible. A dose of 36 Gy was prescribed in six fractions. Treatment was delivered every other day. RESULTS Between August 2011 and February 2014, 23 patients were treated with SBRT for intra-prostate cancer recurrence with a median follow up of 22 months (6 to 40). Twenty patients had biopsy-proven recurrence. For 19 patients, EBRT was the initial treatment and in four patients, brachytherapy was the initial treatment; the median relapse-time from initial treatment was 65 months (28 to 150). At relapse, 10 patients had an extra-capsular extension. Fourteen patients were treated with androgen deprivation that could be stopped after a median of 1 month after SBRT (range 0-24). A PSA decrease occurred in 82.6% of the patients after SBRT. The 2-year disease-free survival and overall survival rates were 54 and 100%, respectively. Disease progression was observed for nine patients (39.1%) (five local, three metastatic and one nodal progression) after a median of 20 months (7-40 months). The median nadir PSA was 0.35 ng/ml and was achieved after a median of 8 months (1 to 30) after treatment. We observed no grade 4 or 5 toxicity. Two patients presented with grade 3 toxicities (two Cystitis and one neuralgia). Other toxicities included urinary toxicities (five grade 2 and nine grade 1) and rectal toxicities (two grade 2 and two grade 1). CONCLUSION SBRT for local prostate cancer recurrence seems feasible and well tolerated with a short follow up. Prospective evaluation is needed.
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Affiliation(s)
- Thomas Leroy
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Thomas Lacornerie
- Department of Radiation Physics, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Emilie Bogart
- Department of Statistic, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Philippe Nickers
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Eric Lartigau
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
| | - David Pasquier
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
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