1
|
Fulton MD, Najahi-Missaoui W. Liposomes in Cancer Therapy: How Did We Start and Where Are We Now. Int J Mol Sci 2023; 24:ijms24076615. [PMID: 37047585 PMCID: PMC10095497 DOI: 10.3390/ijms24076615] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Since their first discovery in the 1960s by Alec Bangham, liposomes have been shown to be effective drug delivery systems for treating various cancers. Several liposome-based formulations received approval by the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA), with many others in clinical trials. Liposomes have several advantages, including improved pharmacokinetic properties of the encapsulated drug, reduced systemic toxicity, extended circulation time, and targeted disposition in tumor sites due to the enhanced permeability and retention (EPR) mechanism. However, it is worth noting that despite their efficacy in treating various cancers, liposomes still have some potential toxicity and lack specific targeting and disposition. This explains, in part, why their translation into the clinic has progressed only incrementally, which poses the need for more research to focus on addressing such translational limitations. This review summarizes the main properties of liposomes, their current status in cancer therapy, and their limitations and challenges to achieving maximal therapeutic efficacy.
Collapse
Affiliation(s)
- Melody D. Fulton
- Department of Chemistry, College of Arts and Sciences, Washington State University, Pullman, WA 99164, USA
| | - Wided Najahi-Missaoui
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
2
|
Bryant JM, Weygand J, Keit E, Cruz-Chamorro R, Sandoval ML, Oraiqat IM, Andreozzi J, Redler G, Latifi K, Feygelman V, Rosenberg SA. Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions. Cancers (Basel) 2023; 15:2081. [PMID: 37046741 PMCID: PMC10093051 DOI: 10.3390/cancers15072081] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (J.M.B.)
| |
Collapse
|
3
|
Patient-reported Quality of Life After SBRT, LDR, and HDR Brachytherapy for Prostate Cancer: A Comparison of Outcomes. Am J Clin Oncol 2021; 44:131-136. [PMID: 33577175 DOI: 10.1097/coc.0000000000000796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to compare changes in patient-reported quality of life (PRQOL) following stereotactic body radiation therapy (SBRT), high dose rate (HDR), and low dose rate (LDR) brachytherapy for prostate cancer. MATERIALS AND METHODS International Prostate Symptom Score (IPSS), Sexual Health Inventory For Men (SHIM), and Expanded Prostate cancer Index Composite Short Form (EPIC-26) were prospectively collected for men with low/intermediate-risk cancer treated at a single institution. We used Generalized Estimating Equations to identify associations between variables and early (3 to 6 mo) or late (1 to 2 y) PRQOL scores. Minimally important differences (MID) were compared with assess clinical relevance. RESULTS A total of 342 LDR, 159 HDR, and 112 SBRT patients treated from 2001 to 2018 were eligible. Gleason score, PSA, and age were lower among LDR patients compared with HDR/SBRT. Unadjusted baseline IPSS score was similar among all groups. Adjusted IPSS worsened at all time points compared with baseline after LDR/HDR. At early/late time points, rates of IPSS MID after LDR were higher compared to HDR/SBRT. There were no IPSS differences between SBRT and HDR. All modalities showed early and late SHIM worsening. There were no temporal differences in SHIM between SBRT and brachytherapy. There were no differences in EPIC subdomains between HDR and SBRT. Bowel symptoms worsened early after SBRT, whereas urinary irritative/obstructive symptoms worsened late after HDR. Among all domains, MID after SBRT and HDR were similar. CONCLUSIONS In a cohort of patients treated with modern radiotherapy techniques, HDR and SBRT resulted in clinically meaningful improved urinary PRQOL compared with LDR.
Collapse
|
4
|
Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
Collapse
Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| |
Collapse
|
5
|
Chen C, Chen Z, Wang K, Hu L, Xu R, He X. Comparisons of health-related quality of life among surgery and radiotherapy for localized prostate cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:99057-99065. [PMID: 29228751 PMCID: PMC5716791 DOI: 10.18632/oncotarget.21519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 01/20/2023] Open
Abstract
The objective of this study is to compare health-related quality of life (QOL) outcomes between radical prostatectomy (RP) and external beam radiation therapy (EBRT) for localized prostate cancer. PubMed, EMBASE, the Cochrane Library and Web of Science (to July 2017) were searched. Pooled analysis of each domain-specific score was calculated in relevant studies, and its change with follow-up time was explored by sub-group analysis. A total of six studies containing 4423 patients were included. Men underwent RP was associated with worse urinary and sexual domain score than EBRT (standardized mean difference (SMD) = -0.59, -0.58; 95% confidence interval (CI) = -0.73 to -0.45, -0.72 to -0.44). In contrast, EBRT group had lower bowel domain score than RP group (SMD = 0.42, 95% CI = 0.33 to 0.52). The sub-group analysis revealed the most severe urinary and sexual QOL in RP as well as bowel QOL in EBRT group all happened in the first month post operation. The different performance of two treatments in three QOL domains diminished afterwards. Health-related QOL should be considered comprehensively when planning follow-up for men after RP or EBRT for localized prostate cancer.
Collapse
Affiliation(s)
- Cheng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Kun Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Linkun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| |
Collapse
|
6
|
Zhou Y, Yang H, Xia W, Cui L, Xu R, Lu H, Xue Z, Zhang B, Tian Z, Cao Y, Xing Z, Yin S, Wang K, Shi Q, He X. Isolation and identification of cancer stem cells from PC3 human prostate carcinoma cell line. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:8377-8382. [PMID: 31966689 PMCID: PMC6965485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/30/2017] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Morphological differences of PC3 clones were dynamically observed, and the expression of CD44 in different clones was detected to compare the tumorigenic ability of different clone cells in nude mice and identify the clones containing prostate cancer stem cells. MATERIALS AND METHODS Clone formation assay was used for observing and classifying PC3 clones and calculating the cloning efficiency and the proportion of each clone. CD44 expression in different clones was detected by immunofluorescence technique. In addition, different morphologies of clones were isolated to measure the ability of self-renewing, and inoculated into nude mice to observe the tumorigenic ability. RESULTS PC3 cells could form three morphologies of clones, namely holoclone, meroclone, and paraclone. The cloning efficiency was 10.23%±0.91%, and the proportion of the three clones was 11.7%, 50.0% and 38.3%, respectively. Immunofluorescence showed that the expression of CD44 in holoclone was significantly stronger than meroclone and paraclone. Holoclone had self-renewing ability and strong tumorigenic ability in nude mice. CONCLUSION There are differences in morphologies and differentiation of PC3 clones. Moreover, prostate cancer stem cells are abundant in holoclone.
Collapse
Affiliation(s)
- Yaojun Zhou
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Hongqiong Yang
- Department of Geriatric Medicine, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Wei Xia
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Li Cui
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Renfang Xu
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Hao Lu
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Zhong Xue
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Bo Zhang
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Zinong Tian
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Yunjie Cao
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Zhaoyu Xing
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Shuai Yin
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Kun Wang
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Qianqian Shi
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Surgical Urology, The Third Affiliated Hospital of Soochow UniversityChangzhou, Jiangsu, China
| |
Collapse
|
7
|
Banerji JS, Hurwitz LM, Cullen J, Wolff EM, Levie KE, Rosner IL, Brand TC, LʼEsperance JO, Sterbis JR, Porter CR. A prospective study of health-related quality-of-life outcomes for patients with low-risk prostate cancer managed by active surveillance or radiation therapy. Urol Oncol 2017; 35:234-242. [DOI: 10.1016/j.urolonc.2016.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/06/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
|
8
|
Whiting PF, Moore TH, Jameson CM, Davies P, Rowlands MA, Burke M, Beynon R, Savovic J, Donovan JL. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. BJU Int 2016; 118:193-204. [DOI: 10.1111/bju.13499] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Penny F. Whiting
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Theresa H.M. Moore
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | | | - Philippa Davies
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Mari-Anne Rowlands
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Margaret Burke
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Rebecca Beynon
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Jelena Savovic
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Jenny L. Donovan
- School of Social and Community Medicine; University of Bristol; Bristol UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| |
Collapse
|
9
|
Sio TT, Atherton PJ, Birckhead BJ, Schwartz DJ, Sloan JA, Seisler DK, Martenson JA, Loprinzi CL, Griffin PC, Morton RF, Anders JC, Stoffel TJ, Haselow RE, Mowat RB, Wittich MAN, Bearden JD, Miller RC. Repeated measures analyses of dermatitis symptom evolution in breast cancer patients receiving radiotherapy in a phase 3 randomized trial of mometasone furoate vs placebo (N06C4 [alliance]). Support Care Cancer 2016; 24:3847-55. [PMID: 27075674 DOI: 10.1007/s00520-016-3213-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Radiotherapy-related dermatological toxicities over time have not been well quantified. We examined during and immediately following radiation therapy skin toxicities over time in a randomized study of mometasone furoate vs placebo during breast radiotherapy. MATERIAL AND METHODS Patients with breast cancer undergoing radiotherapy to the breast or chest wall were randomized. Symptoms related to skin toxicity were addressed weekly using provider-reported Common Terminology Criteria for Adverse Events (CTCAE v3.0) and 4 patient-reported outcomes (PRO) surveys. We applied repeated measures and risk analysis methodologies. RESULTS One hundred seventy-six patients were enrolled. By CTCAE, significant differences favoring mometasone were detected over time in all toxicities except skin striae, atrophy, and infection. Statistically significant differences between arms at baseline but not over time occurred for all Linear Analog Self-Assessment. Statistically significant differences occurred for all symptoms in the temporal profile of symptoms as measured by PRO surveys (all P < .001). CONCLUSIONS The use of longitudinal methods enhanced the ability of PRO tools to detect differences between study arms. Our results strengthened the conclusions of the original report that mometasone reduced acute skin toxicities. PRO surveys can accurately assess patients' experiences of symptom type and intensity over time and should be included in future clinical trials. For radiotherapy-related dermatological toxicity, we hypothesized that clinically significant differences over time, if any, can be found by repeated measures. We examined the acute skin toxicities in a randomized study of mometasone vs placebo during breast radiotherapy. For secondary end points, we showed that longitudinal methods enhanced the detection of differences between study arms and strengthened the conclusions from the original report. Frequent patient-reported outcome surveys over time should be included in future clinical trials.
Collapse
Affiliation(s)
- Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - David J Schwartz
- Department of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Jeff A Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Drew K Seisler
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - James A Martenson
- Department of Radiation Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Charles L Loprinzi
- Department of Oncology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Patricia C Griffin
- Upstate Carolina Community Clinical Oncology Program, Spartanburg, SC, USA
| | - Roscoe F Morton
- Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA, USA
| | - Jon C Anders
- Wichita Community Clinical Oncology Program, Wichita, KS, USA
| | - Thomas J Stoffel
- Cedar Rapids Oncology Project Community Clinic Oncology Program, Cedar Rapids, IA, USA
| | - Robert E Haselow
- Metro-Minnesota Community Clinical Oncology Program, St. Louis Park, MN, USA
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program CCOP, Toledo, OH, USA
| | | | - James D Bearden
- Upstate Carolina Community Clinical Oncology Program, Spartanburg, SC, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
| |
Collapse
|
10
|
Oliai C, Bernetich M, Brady L, Yang J, Hanlon A, Lamond J, Arrigo S, Good M, Mooreville M, Garber B, Lanciano R. Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer. ACTA ACUST UNITED AC 2016; 5:187-195. [PMID: 27335630 PMCID: PMC4893387 DOI: 10.1007/s13566-015-0237-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Objective Stereotactic body radiation therapy (SBRT) is an attractive option for prostate cancer due to its short treatment duration and cost. In this report, we compare the efficacy and toxicity outcomes of prostate cancer patients treated with SBRT to those who received intensity-modulated radiation therapy (IMRT). Methods Two hundred sixty-three patients with localized prostate adenocarcinoma were included, ranging from clinically very low- to high-risk groups. We retrospectively compare consecutive patients treated with SBRT with consecutive patients treated with conventionally fractionated IMRT. For most patients, SBRT was delivered to a total dose of 36.25 Gy in five fractions and IMRT to 75.6 Gy in 42 fractions. To minimize selection bias, we perform propensity score analyses. Results The treatment groups became similar after propensity matching with absolute standard bias reduced to ≤0.19. For the first analysis, 5-year actuarial survival was 90.8 and 88.1 % in SBRT and IMRT groups, respectively (p = 0.7260), while FFBF was 88.7 and 95.5 %, respectively (p = 0.1720). For the second analysis (accounting for risk group), actuarial 5-year survival was 96.7 and 87.1 % in the SBRT and IMRT groups, respectively (p = 0.3025), while FFBF was 89.7 and 90.3 %, respectively (p = 0.6446). Toxicity did not exceed grade 3 in any of the studied patients. The highest recorded genitourinary toxicity at the time of latest follow-up was grade 2. Conclusion Our data support the hypothesis that SBRT has non-inferior efficacy and toxicity rates as IMRT. Given the lower cost and convenience for patients, SBRT may be considered as an alternative treatment for localized prostate cancer.
Collapse
Affiliation(s)
- Caspian Oliai
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Matthew Bernetich
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Luther Brady
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Jun Yang
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Alexandra Hanlon
- Claire M Fagin Hall, University of Pennsylvania, 418 Curie Boulevard, 479L, Philadelphia, PA 19104-4217 USA
| | - John Lamond
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Steven Arrigo
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Michael Good
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Michael Mooreville
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Bruce Garber
- Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Rachelle Lanciano
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA ; Department of Radiation Oncology, Delaware County Memorial Hospital, 501 North Lansdowne Avenue, Drexel Hill, PA 19026 USA
| |
Collapse
|
11
|
Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer. Radiother Oncol 2016; 118:99-104. [PMID: 26755165 DOI: 10.1016/j.radonc.2015.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This multi-institutional phase I/II trial explored patient-assessed tolerance of increasingly hypofractionated (HPFX) radiation for low/intermediate risk prostate cancer. METHODS 347 patients enrolled from 2002 to 2010. Three increasing dose-per-fraction schedules of 64.7 Gy/22 fx, 58.08 Gy/16 fx and 51.6 Gy/12 fx were each designed to yield equivalent predicted late toxicity. Three quality of life (QoL) surveys were administered prior to treatment and annually upto 3 years. RESULTS Bowel QoL data at 3years revealed no significant difference among regimens (p=0.469). Bowel QoL for all regimens declined transiently, largely recovering by three years, with only the 22 fraction decrement reaching significance. Bladder outcomes at 3 years were comparable (p=0.343) although, for all patients combined, a significant decline was observed from the baseline (p=0.008). Spitzer quality of life data revealed similarly excellent, 3-year means (p=0.188). International erectile function data also revealed no significant differences at 3 years although all measures except intercourse satisfaction worsened post-treatment. CONCLUSIONS Three-year QoL changes for bowel, bladder and SQLI were modest and similar for 3 HPFX regimens spanning 2.94-4.3 Gy per fraction. These favorable patient-scored outcomes demonstrate the safety and tolerability of such regimens and may be leveraged to support further implementation of mild to moderately hypofractionated radiotherapy in the setting of low and intermediate-risk prostate cancer.
Collapse
|
12
|
Eisemann N, Nolte S, Schnoor M, Katalinic A, Rohde V, Waldmann A. The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study. BMC Urol 2015; 15:28. [PMID: 25885890 PMCID: PMC4404598 DOI: 10.1186/s12894-015-0025-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. Methods The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data. Results The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values. Conclusions Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0025-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nora Eisemann
- Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Sandra Nolte
- Medical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Maike Schnoor
- Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Alexander Katalinic
- Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. .,Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Volker Rohde
- Medical Practice of Urology, Auguststr. 4, 23611, Bad Schwartau, Germany. .,Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany.
| | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| |
Collapse
|
13
|
Tan TJ, Siva S, Foroudi F, Gill S. Stereotactic body radiotherapy for primary prostate cancer: a systematic review. J Med Imaging Radiat Oncol 2014; 58:601-11. [PMID: 25155286 DOI: 10.1111/1754-9485.12213] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
Stereotactic body radiotherapy (SBRT) for prostate cancer allows overall treatment times to be reduced to as little as 1 week while maintaining a non-invasive approach. This study provides a comprehensive summary of the literature relating to SBRT in prostate cancer. A systematic review of the relevant literature was performed using structured search terms. Fourteen phase I-II trials and retrospective studies using SBRT for the treatment of prostate cancer were used. Three studies were identified which addressed cost. Dose fractionation, radiotherapy procedures, biochemical progression-free survival, toxicity, cost and quality of life were critically appraised. A total of 1472 patients were examined across studies. Median follow-up ranged from 11 to 60 months. The most common dose fractionation was 35-36.25 Gy in five fractions, used in nine out of 14 studies. Ten of 14 studies used CyberKnife. The overall biochemical progression-free survival ranged 81-100%. Acute grade 2 urinary and rectal toxicities were reported in 5-42% and 0-27% of patients, respectively. Acute grade 3 or more urinary and rectal toxicity were 0.5% and 0%, respectively. Late grade 2 urinary toxicity was reported in 0-29% of patients, while 1.3% had a late grade 3 urinary toxicity. There were no late grade 4 urinary toxicities seen. Late grade 2 rectal toxicity was reported in 0-11%, while 0.5% had a late grade 3 rectal toxicity. Late grade 4 rectal toxicity was reported in 0.2% of patients.
Collapse
Affiliation(s)
- Tze-Jian Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
14
|
Quero L, Hennequin C. [Stereotactic radiotherapy for prostate cancer]. Cancer Radiother 2014; 18:332-6. [PMID: 24958683 DOI: 10.1016/j.canrad.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/18/2014] [Indexed: 01/10/2023]
Abstract
Stereotactic radiotherapy is a new option in the treatment of prostate cancer. However, only retrospective series and a few prospective phase II trials are available at this moment, including a few thousands of patients with a short follow-up. Most of the protocols delivered 33 to 38 Gy in four or five fractions. Acute toxicity seems to be similar to the one observed after conventional radiotherapy. Late toxicity is less evaluable because of the short follow-up: the rate of radiation-induced proctitis seems low in the published series. Urinary toxicities are not properly evaluated: some series reported a high incidence of urinary complications grade or higher. Most of the patients belong to the D'Amico's favourable group: biochemical controls are equivalent to those observed after conventional irradiation, but the follow-up is often shorter than 5 years and no definitive conclusion could be made about the efficiency of the technique. Data for the intermediate and high risk groups are not mature. In conclusion, stereotactic radiotherapy could strongly modified the management of prostate cancer: some phase III trials have started to confirm the good results reported in preliminary series.
Collapse
Affiliation(s)
- L Quero
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris-Diderot Paris VII, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris-Diderot Paris VII, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
| |
Collapse
|
15
|
King CR, Collins S, Fuller D, Wang PC, Kupelian P, Steinberg M, Katz A. Health-Related Quality of Life After Stereotactic Body Radiation Therapy for Localized Prostate Cancer: Results From a Multi-institutional Consortium of Prospective Trials. Int J Radiat Oncol Biol Phys 2013; 87:939-45. [DOI: 10.1016/j.ijrobp.2013.08.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/17/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
|
16
|
Norkus D, Karklelyte A, Engels B, Versmessen H, Griskevicius R, De Ridder M, Storme G, Aleknavicius E, Janulionis E, Valuckas KP. A randomized hypofractionation dose escalation trial for high risk prostate cancer patients: interim analysis of acute toxicity and quality of life in 124 patients. Radiat Oncol 2013; 8:206. [PMID: 24007322 PMCID: PMC3846611 DOI: 10.1186/1748-717x-8-206] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/03/2013] [Indexed: 12/01/2022] Open
Abstract
Background The α/β ratio for prostate cancer is postulated being in the range of 0.8 to 2.2 Gy, giving rise to the hypothesis that there may be a therapeutic advantage to hypofractionation. To do so, we carried out a randomized trial comparing hypofractionated and conventionally fractionated image-guided intensity modulated radiotherapy (IG-IMRT) in high-risk prostate cancer. Here, we report on acute toxicity and quality of life (QOL) for the first 124 randomized patients. Methods The trial compares 76 Gy in 38 fractions (5 fractions/week) (Arm 1) to 63 Gy in 20 fractions (4 fractions/week) (Arm 2) (IG-IMRT). Prophylactic pelvic lymph node irradiation with 46 Gy in 23 fractions sequentially (Arm 1) and 44 Gy in 20 fractions simultaneously (Arm 2) was applied. All patients had long term androgen deprivation therapy (ADT) started before RT. Both physician-rated acute toxicity and patient-reported QOL using EPIC questionnaire are described. Results There were no differences in overall maximum acute gastrointestinal (GI) or genitourinary (GU) toxicity. Compared to conventional fractionation (Arm 1), GI and GU toxicity both developed significantly earlier but also disappeared earlier in the Arm 2, reaching significant differences from Arm 1 at week 8 and 9. In multivariate analyses, only parameter shown to be related to increased acute Grade ≥1 GU toxicity was the study Arm 2 (p = 0.049). There were no statistically significant differences of mean EPIC scores in any domain and sub-scales. The clinically relevant decrease (CRD) in EPIC urinary domain was significantly higher in Arm 2 at month 1 with a faster recovery at month 3 as compared to Arm 1. Conclusions Hypofractionation at 3.15 Gy per fraction to 63 Gy within 5 weeks was well tolerated. The GI and GU physician-rated acute toxicity both developed earlier but recovered faster using hypofractionation. There was a correlation between acute toxicity and bowel and urinary QOL outcomes. Longer follow-up is needed to determine the significance of these associations with late toxicity.
Collapse
Affiliation(s)
- Darius Norkus
- Department of Radiotherapy, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Macias VA, Blanco ML, Perez-Romasanta LA. Initial experience with stereotactic body radiation therapy for localized prostate cancer using helical tomotherapy. Clin Transl Oncol 2013; 16:380-5. [DOI: 10.1007/s12094-013-1089-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
|
18
|
Katz AJ, Santoro M, Diblasio F, Ashley R. Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years. Radiat Oncol 2013; 8:118. [PMID: 23668632 PMCID: PMC3674983 DOI: 10.1186/1748-717x-8-118] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/10/2013] [Indexed: 12/30/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) may yield disease control for prostate cancer in a brief, hypofractionated treatment regimen without increasing treatment toxicity. Our report presents a 6-year update from 304 low- (n = 211), intermediate- (n = 81), and high-risk (n = 12) prostate cancer patients who received CyberKnife SBRT. Methods The median PSA at presentation was 5.8 ng/ml. Fifty-seven patients received neoadjuvant hormonal therapy for up to one year. The first 50 patients received a total dose of 35 Gy in 5 fractions of 7 Gy. The subsequent 254 patients received a total dose of 36.25 Gy in 5 fractions of 7.25 Gy. Toxicity was assessed with the Expanded Prostate Cancer Index Composite questionnaire and the Radiation Therapy Oncology Group urinary and rectal toxicity scale. Biochemical failure was assessed using the nadir + 2 definition. Results No patients experienced Grade III or IV acute complications. Fewer than 5% of patients experienced any acute Grade II urinary or rectal toxicities. Late urinary Grade II complications were observed in 4% of patients treated to 35 Gy and 9% of patients treated to 36.25 Gy. Five (2%) late Grade III urinary toxicities occurred in patients who were treated with 36.25 Gy. Late Grade II rectal complications were observed in 2% of patients treated to 35 Gy and 5% of patients treated to 36.25 Gy. Bowel and urinary quality of life (QOL) scores initially decreased, but later returned to baseline values. An overall decrease of 20% in the sexual QOL score was observed. QOL in each domain was not differentially affected by dose. For patients that were potent prior to treatment, 75% stated that they remained sexually potent. Actuarial 5-year biochemical recurrence-free survival was 97% for low-risk, 90.7% for intermediate-risk, and 74.1% for high-risk patients. PSA fell to a median of 0.12 ng/ml at 5 years; dose did not influence median PSA levels. Conclusions In this large series with long-term follow-up, we found excellent biochemical control rates and low and acceptable toxicity, outcomes consistent with those reported for from high dose rate brachytherapy (HDR BT). Provided that measures are taken to account for prostate motion, SBRT’s distinct advantages over HDR BT include its noninvasiveness and delivery to patients without anesthesia or hospitalization.
Collapse
|