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Mitchell J, McLaren DB, Burns Pollock D, Wright J, Killean A, Trainer M, Adamson S, McKernan L, Nailon WH. Clinical implementation of real time motion management for prostate SBRT: A radiation therapist's perspective. Tech Innov Patient Support Radiat Oncol 2024; 31:100267. [PMID: 39220550 PMCID: PMC11363481 DOI: 10.1016/j.tipsro.2024.100267] [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: 03/30/2024] [Revised: 07/10/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
Background and purpose The adoption of hypo-fractionated stereotactic body radiotherapy (SBRT) for treating prostate cancer has led to an increase in specialised techniques for monitoring prostate motion. The aim of this study was to comprehensively review a radiation therapist (RTT) led treatment process in which two such systems were utilised, and present initial findings on their use within a SBRT prostate clinical trial. Materials and Methods 18 patients were investigated, nine were fitted with the Micropos RayPilotTM (RP) system (Micropos Medical, Gothenburg, SE) and nine were fitted with the Micropos Raypilot Hypocath TM (HC) system. 36.25 Gray (Gy) was delivered in 5 fractions over 7 days with daily pre- and post-treatment cone beam computed tomography (CBCT) images acquired. Acute toxicity was reported on completion of treatment at six- and 12-weeks post-treatment, using the Radiation Therapy Oncology Group (RTOG) grading system and vertical (Vrt), longitudinal (Lng) and lateral (Lat) transmitter displacements recorded. Results A significant difference was found in the Lat displacement between devices (P=0.003). A more consistent bladder volume was reported in the HC group (68.03 cc to 483.7 cc RP, 196.11 cc to 313.85 cc HC). No significant difference was observed in mean dose to the bladder, rectum and bladder dose maximum between the groups. Comparison of the rectal dose maximum between the groups reported a significant result (P=0.09). Comparing displacements with toxicity endpoints identified two significant correlations: Grade 2 Genitourinary (GU) at 6 weeks, P=0.029; and no toxicity, Gastrointestinal (GI) at 12 weeks P=0.013. Conclusion Both the directly implanted RP device and the urinary catheter-based HC device are capable of real time motion monitoring. Here, the HC system was advantageous in the SBRT prostate workflow.
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Affiliation(s)
- Joanne Mitchell
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- College of Medicine and Veterinary Medicine, the University of Edinburgh, UK
| | - Duncan B. McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Donna Burns Pollock
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Joella Wright
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Angus Killean
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Michael Trainer
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Susan Adamson
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Laura McKernan
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - William H. Nailon
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- School of Engineering, the University of Edinburgh, the King’s Buildings, Mayfield Road, Edinburgh EH9 3JL, UK
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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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Zhao Y, Haworth A, Reynolds HM, Williams SG, Finnegan R, Rowshanfarzad P, Ebert MA. Towards optimal heterogeneous prostate radiotherapy dose prescriptions based on patient-specific or population-based biological features. Med Phys 2024; 51:3766-3781. [PMID: 38224317 DOI: 10.1002/mp.16936] [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: 06/11/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Escalation of prescribed dose in prostate cancer (PCa) radiotherapy enables improvement in tumor control at the expense of increased toxicity. Opportunities for reduction of treatment toxicity may emerge if more efficient dose escalation can be achieved by redistributing the prescribed dose distribution according to the known heterogeneous, spatially-varying characteristics of the disease. PURPOSE To examine the potential benefits, limitations and characteristics of heterogeneous boost dose redistribution in PCa radiotherapy based on patient-specific and population-based spatial maps of tumor biological features. METHOD High-resolution prostate histology images, from a cohort of 63 patients, annotated with tumor location and grade, provided patient-specific "maps" and a population-based "atlas" of cell density and tumor probability. Dose prescriptions were derived for each patient based on a heterogeneous redistribution of the boost dose to the intraprostatic lesions, with the prescription maximizing patient tumor control probability (TCP). The impact on TCP was assessed under scenarios where the distribution of population-based biological data was ignored, partially included, or fully included in prescription generation. Heterogeneous dose prescriptions were generated for three combinations of maps and atlas, and for conventional fractionation (CF), extreme hypo-fractionation (EH), moderate hypo-fractionation (MH), and whole Pelvic RT + SBRT Boost (WPRT + SBRT). The predicted efficacy of the heterogeneous prescriptions was compared with equivalent homogeneous dose prescriptions. RESULTS TCPs for heterogeneous dose prescriptions were generally higher than those for homogeneous dose prescriptions. TCP escalation by heterogeneous dose prescription was the largest for CF. When only using population-based atlas data, the generated heterogeneous dose prescriptions of 55 to 58 patients (out of 63) had a higher TCP than for the corresponding homogeneous dose prescriptions. The TCPs of the heterogeneous dose prescriptions generated with the population-based atlas and tumor probability maps did not differ significantly from those using patient-specific biological information. The generated heterogeneous dose prescriptions achieved significantly higher TCP than homogeneous dose prescriptions in the posterior section of the prostate. CONCLUSION Heterogeneous dose prescriptions generated via biologically-optimized dose redistribution can produce higher TCP than the homogeneous dose prescriptions for the majority of the patients in the studied cohort. For scenarios where patient-specific biological information was unavailable or partially available, the generated heterogeneous dose prescriptions can still achieve TCP improvement relative to homogeneous dose prescriptions.
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Affiliation(s)
- Yutong Zhao
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, The University of Sydney, Camperdown, New South Wales, Australia
| | - Hayley M Reynolds
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Scott G Williams
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Robert Finnegan
- Institute of Medical Physics, School of Physics, The University of Sydney, Camperdown, New South Wales, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- 5D Clinics, Claremont, Western Australia, Australia
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4
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Santoso AP, Vinogradskiy Y, Robin TP, Goodman KA, Schefter TE, Miften M, Jones BL. Clinical and Dosimetric Impact of 2D kV Motion Monitoring and Intervention in Liver Stereotactic Body Radiation Therapy. Adv Radiat Oncol 2024; 9:101409. [PMID: 38298328 PMCID: PMC10828584 DOI: 10.1016/j.adro.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024] Open
Abstract
Purpose Positional errors resulting from motion are a principal challenge across all disease sites in radiation therapy. This is particularly pertinent when treating lesions in the liver with stereotactic body radiation therapy (SBRT). To achieve dose escalation and margin reduction for liver SBRT, kV real-time imaging interventions may serve as a potential solution. In this study, we report results of a retrospective cohort of liver patients treated using real-time 2D kV-image guidance SBRT with emphasis on the impact of (1) clinical workflow, (2) treatment accuracy, and (3) tumor dose. Methods and Materials Data from 33 patients treated with 41 courses of liver SBRT were analyzed. During treatment, planar kV images orthogonal to the treatment beam were acquired to determine treatment interventions, namely treatment pauses (ie, adequacy of gating thresholds) or treatment shifts. Patients were shifted if internal markers were >3 mm, corresponding to the PTV margin used, from the expected reference condition. The frequency, duration, and nature of treatment interventions (ie, pause vs shift) were recorded, and the dosimetric impact associated with treatment shifts was estimated using a machine learning dosimetric model. Results Of all fractions delivered, 39% required intervention, which took on average 1.9 ± 1.6 minutes and occurred more frequently in treatments lasting longer than 7 minutes. The median realignment shift was 5.7 mm in size, and the effect of these shifts on minimum tumor dose in simulated clinical scenarios ranged from 0% to 50% of prescription dose per fraction. Conclusion Real-time kV-based imaging interventions for liver SBRT minimally affect clinical workflow and dosimetrically benefit patients. This potential solution for addressing positional errors from motion addresses concerns about target accuracy and may enable safe dose escalation and margin reduction in the context of liver SBRT.
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Affiliation(s)
- Andrew P. Santoso
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tyler P. Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Karyn A. Goodman
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tracey E. Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L. Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Lischalk JW, Akerman M, Repka MC, Sanchez A, Mendez C, Santos VF, Carpenter T, Wise D, Corcoran A, Lepor H, Katz A, Haas JA. High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation. Front Oncol 2024; 14:1325200. [PMID: 38410097 PMCID: PMC10895712 DOI: 10.3389/fonc.2024.1325200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose Modern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer. Methods and materials A large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan-Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes. Results A total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir. Conclusion Utilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.
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Affiliation(s)
- Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Meredith Akerman
- Division of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, Mineola, NY, United States
| | - Michael C. Repka
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Astrid Sanchez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Christopher Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Vianca F. Santos
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - David Wise
- Department of Medical Oncology, Perlmutter Cancer Center at New York University Langone Health - Manhattan, New York, NY, United States
| | - Anthony Corcoran
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Herbert Lepor
- Department of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, NY, United States
| | - Aaron Katz
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Jonathan A. Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
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Deshpande SR, Podder TK, Grubb W, Zhang Y, Zheng Y, Towe C, Linden P, Avril N, Biswas T. Pretreatment and Posttreatment Tumor Metabolic Activity Assessed by FDG-PET/CT as Predictors of Tumor Recurrence and Survival Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy. Adv Radiat Oncol 2024; 9:101313. [PMID: 38260218 PMCID: PMC10801655 DOI: 10.1016/j.adro.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/09/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is considered the standard of care for medically inoperable early-stage non-small cell lung cancer. There is mixed evidence on the prognostic significance of tumor metabolic activity assessed by positron emission tomography combined with computed tomography (PET/CT) using F-18 fluorodeoxyglucose (FDG). The objectives of this study were to evaluate the maximum standardized uptake value (SUVmax) pretreatment and at 3 and 6 months after SBRT for prediction of tumor control and survival outcomes. Methods and Materials Consecutive patients from a single institution with T12N0M0 non-small cell lung cancer receiving primary treatment with SBRT with pretreatment FDG-PET/CT (n = 163) and follow-up FDG-PET/CT at 3 or 6 months (n = 71) were included. Receiver operator characteristic analysis was performed to dichotomize variables for Kaplan-Meier survival analysis. Multivariate analysis was performed with Cox proportional hazards regression. Results Median follow-up was 19 months. For the whole cohort, 1-year and 2-year local control, progression-free survival (PFS), and overall survival (OS) were 95.0% and 80.3%, 87.1% and 75.4%, and 67.0% and 49.6% respectively. The following pre-SBRT SUVmax cutoffs were significant: SUV > 4.0 for distant failure-free survival (adjusted hazard ratio [aHR], 3.33, P = .006), >12.3 for PFS (aHR, 2.80, P = .011), and >12.6 for OS (aHR, 3.00, P = .003). SUVmax decreases of at least 45% at 3 months (aHR, 0.15, P = .018), and 53% at 6 months (aHR, 0.12, P = .046) were associated with improved local failure-free survival. Conclusions Pre-SBRT SUVmax cutoffs can predict distant failure, PFS, and OS. At both 3 and 6 months after SBRT, cutoffs for percentage change in SUVmax can potentially stratify risk of local recurrence.
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Affiliation(s)
- Saarang R. Deshpande
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tarun K. Podder
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - William Grubb
- Department of Radiation Oncology, Medical College of Georgia, Augusta, Georgia
| | - Yuxia Zhang
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Yiran Zheng
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Christopher Towe
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Cardiothoracic Surgery, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, Ohio
| | - Philip Linden
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Cardiothoracic Surgery, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, Ohio
| | - Norbert Avril
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Radiology, Nuclear Medicine, University Hospitals, Cleveland, Ohio
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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7
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Waters M, Price A, Laugeman E, Henke L, Hugo G, Stowe H, Andruska N, Brenneman R, Hao Y, Green O, Robinson C, Gay H, Michalski J, Baumann BC. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 2024; 44:100693. [PMID: 38021093 PMCID: PMC10663731 DOI: 10.1016/j.ctro.2023.100693] [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: 01/04/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is an emerging treatment modality for clinically localized prostate cancer (PCa). Online daily adaptive radiotherapy (ART) could potentially improve the therapeutic ratio of prostate SBRT by accounting for inter-fraction variation in target and OAR volumes. To our knowledge, no group has evaluated the clinical utility of a novel AI-augmented CT-based ART system for prostate SBRT. In this study we hypothesized that adaptive prostate SBRT plans would result in improved target coverage and lower dose to OARs in comparison to unadapted treatment plans. Methods Seven patients with favorable intermediate to oligometastatic PCa treated with 5-fx prostate adaptive SBRT were retrospectively reviewed. Patients were treated with 3625 cGy to the prostate and seminal vesicles. 6 patients additionally received 2500 cGy to the pelvic nodes, 5 patients underwent a boost to 4000 cGy to the prostate. For each fraction, a CBCT was acquired and OARs (rectum, bladder, bowel, sigmoid, femurs) were segmented/deformed using AI. CTVs were rigidly registered. Volumes were adjusted manually and PTV expansions added. Adaptive treatment plans were developed based on the contoured targets and OARs and dose to these volumes for the adapted vs. initial plans were compared for each fraction. V100 and the D0.03 cc between scheduled and adapted treatment plans were compared using a Student's t-test, with significance threshold of P < 0.05. Results Seven patients completed 35 Fx's of adaptive RT. Daily adaptation resulted in a statistically significant mean improvement in PTV V100 for all targets: [21.4 % ± 4.3 % for PTV 4000 (p < 0.0001); 8.7 % ± 1.1 % for PTV 3625 (p < 0.0001); and 11.5 % ± 3.1 % for PTV 2500 (p = 0.0013)]. Mean rectal D0.03 was significantly reduced by 38.8 cGy ± 5.95 cGy (p < 0.0001) per fraction (194 cGy/5 fractions) compared to the initial plans. There was a modest increase in bladder dose of 10.9 cGy ± 4.93 cGy per fraction (p = 0.0424) for the adaptive plans. The adaptive plans met bladder constraints for every fraction. There were no statistically significant differences between sigmoid or bowel dose for adapted vs. initial plans. No patients experienced acute CTCAE grade ≥ 3 GI/GU adverse events (median F/U 9.5 months). All statistically significant differences were maintained in the presence and absence of rectal hydrogel spacer (p < 0.05). Conclusions CT-based online adaptive SBRT resulted in statistically significant and clinically meaningful improvements in PTV coverage and D0.03 cc dose to the rectum. A trial evaluating CT adaptive whole-pelvis prostate SBRT is underway.
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Affiliation(s)
- Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Geoff Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
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8
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Qureshy SA, Diven MA, Ma X, Marciscano AE, Hu JC, McClure TD, Barbieri C, Nagar H. Differential Use of Radiotherapy Fractionation Regimens in Prostate Cancer. JAMA Netw Open 2023; 6:e2337165. [PMID: 37815829 PMCID: PMC10565603 DOI: 10.1001/jamanetworkopen.2023.37165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023] Open
Abstract
Importance Technical advances in treatment of prostate cancer and a better understanding of prostate cancer biology have allowed for hypofractionated treatment courses using a higher dose per fraction. Use of ultrahypofractionated stereotactic body radiotherapy (SBRT) has also been characterized. Objective To characterize US national trends of different RT fractionation schemes across risk groups of prostate cancer. Design, Setting, and Participants This retrospective cohort study used data collected by the National Cancer Database (NCDB) to characterize the fractionation regimens used for 302 035 patients diagnosed as having prostate cancer from January 1, 2004, to December 31, 2020, who underwent definitive RT. The analysis was performed between February 1 and April 30, 2023. Exposure Stereotactic body RT or ultrahypofractionation, defined as 5 or fewer fractions of external beam RT (EBRT), moderate hypofractionation, defined as 20 to 28 fractions of EBRT, or conventional fractionation, defined as all remaining EBRT fractionation schemes. Main Outcomes and Measures Temporal trends and clinical and sociodemographic factors associated with SBRT, moderate hypofractionation, and conventional fractionation use. Results A total of 302 035 men receiving EBRT for localized prostate cancer between 2004 and 2020 were identified (40.1% aged 60-69 years). Black patients comprised 17.6% of this cohort; White patients, 77.9%; and other races and ethnicities, 4.5%. Patients with low-risk disease comprised 17.5% of the cohort; favorable intermediate-risk disease, 23.5%; unfavorable intermediate-risk disease, 23.9%; and high-risk disease, 35.1%. Treatment consisted of conventional fractionation for 81.2%, moderate hypofractionation for 12.9%, and SBRT for 6.0%. The rate of increase over time in patients receiving SBRT compared with conventional fractionation was higher (adjusted odds ratio [AOR] for 2005 vs 2004, 3.18 [95% CI, 2.04-4.94; P < .001]; AOR for 2020 vs 2004, 264.69 [95% CI, 179.33-390.68; P < .001]) than the rate of increase in patients receiving moderate hypofractionation compared with conventional fractionation (AOR for 2005 vs 2004, 1.05 [95% CI, 0.98-1.12; P = .19]; AOR for 2020 vs 2004, 4.41 [95% CI, 4.15-4.69; P < .001]). Compared with White patients, Black patients were less likely to receive SBRT compared with conventional fractionation or moderate hypofractionation (AOR for conventional fractionation, 0.84 [95% CI, 0.80-0.89; P < .001]; AOR for moderate hypofractionation, 0.77 [95% CI, 0.72-0.81; P < .001]). Compared with 2019, patients treated with all fractionation regimens declined in 2020 by 24.4%. Conclusions and Relevance In this hospital-based cohort study of patients with prostate cancer treated with definitive EBRT, use of moderate hypofractionation and SBRT regimens for definitive prostate cancer treatment has increased from 2004 to 2020. Despite this increasing trend, findings suggest potential health care disparities for Black patients receiving EBRT for localized prostate cancer. The number of patients treated with EBRT in the year 2020 decreased, coinciding with official onset of the COVID-19 pandemic in March 2020.
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Affiliation(s)
- Sarah A. Qureshy
- currently a medical student at Weill Cornell Medicine, New York, New York
| | - Marshall A. Diven
- New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Xiaoyue Ma
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, New York
| | - Ariel E. Marciscano
- Department of Radiation Oncology, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York
| | - Jim C. Hu
- New York Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Tim D. McClure
- Department of Urology, Weill Cornell Medicine, New York, New York
| | | | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York
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9
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Wang F, Yao J, Chen J, Zeng H, Wang X. A pilot study of stereotactic body radiotherapy combined with pelvic radiotherapy and GTVp boost based on multiparameter magnetic resonance image in patients with high-risk prostate cancer. Medicine (Baltimore) 2023; 102:e35260. [PMID: 37773877 PMCID: PMC10545171 DOI: 10.1097/md.0000000000035260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023] Open
Abstract
This pilot study aimed to explore the preliminary effects and safety of stereotactic body radiotherapy (SBRT) combined with preventive pelvic radiotherapy and primary gross tumor volumes (GTVp) boost in patients with high-risk prostate cancer based on multiparameter magnetic resonance image (mpMRI). Tumors were contoured as GTVp based on mpMRI. The prostate and proximal seminal vesicles were considered as the clinical target volume1. The pelvic lymphatic drainage area constituted clinical target volume 2. Radiation doses were 40Gy or 45Gy/5fractions to planning target volume of primary tumor, 37.5Gy/5f to prostate, seminal vesicle, and positive pelvic lymph nodes, and 25Gy/5f to pelvic synchronously. The treatment was delivered 3 times per week. Volumetric modulated arc radiotherapy and intensity-modulated radiotherapy were used to complete SBRT. The genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated. Quality of life data was also captured. A total of 15 patients were enrolled in this study with a median age of 78 (56-87) from 2017 to 2020. All patients received SBRT. At 3 months after radiotherapy, the proportion of PSA < 0.006 ng/mL was 66.7% (10/15). The 2-year biochemical relapse-free survival was 93.3%. The incidence of grade 1 acute GU side effects was 80% (12/15); the incidence of acute grade 1 GI toxicity was 66.7% (10/15); and no grade 2 or higher acute GU and GI side effects was observed. Two patients presented with temporary late grade 2 GI toxicity. International Prostatic System Score increased rapidly after a transient increase at 1 week (P = .001). There were no significant differences in EORTC quality of life scores in all domains except global health status. In this pilot study, it was revealed that SBRT combined with preventive pelvic radiotherapy and GTVp boost based on mpMRI image was effective and well tolerated for patients with high-risk prostate cancer.
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Affiliation(s)
- Fang Wang
- Department of Abdominal Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Yao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Junru Chen
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Wang
- Department of Abdominal Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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10
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Wegener E, Samuels J, Sidhom M, Trada Y, Sridharan S, Dickson S, McLeod N, Martin JM. Virtual HDR Boost for Prostate Cancer: Rebooting a Classic Treatment Using Modern Tech. Cancers (Basel) 2023; 15:cancers15072018. [PMID: 37046680 PMCID: PMC10093761 DOI: 10.3390/cancers15072018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Prostate cancer (PC) is the most common malignancy in men. Internal radiotherapy (brachytherapy) has been used to treat PC successfully for over a century. In particular, there is level-one evidence of the benefits of using brachytherapy to escalate the dose of radiotherapy compared with standard external beam radiotherapy approaches. However, the use of PC brachytherapy is declining, despite strong evidence for its improved cancer outcomes. A method using external beam radiotherapy known as virtual high-dose-rate brachytherapy boost (vHDRB) aims to noninvasively mimic a brachytherapy boost radiation dose plan. In this review, we consider the evidence supporting brachytherapy boosts for PC and the continuing evolution of vHDRB approaches, culminating in the current generation of clinical trials, which will help define the role of this emerging modality.
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Affiliation(s)
- Eric Wegener
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Maitland, NSW 2323, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
- Correspondence:
| | - Justin Samuels
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
| | - Samuel Dickson
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Nicholas McLeod
- Department of Urology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Jarad M. Martin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Maitland, NSW 2323, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
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11
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Integrating external beam and prostate seed implant dosimetry for intermediate and high-risk prostate cancer using biologically effective dose: Impact of image registration technique. Brachytherapy 2022; 21:853-863. [PMID: 35922366 DOI: 10.1016/j.brachy.2022.07.002] [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: 01/21/2022] [Revised: 06/02/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Combining external beam radiation therapy (EBRT) and prostate seed implant (PSI) is efficacious in treating intermediate- and high-risk prostate cancer at the cost of increased genitourinary toxicity. Accurate combined dosimetry remains elusive due to lack of registration between treatment plans and different biological effect. The current work proposes a method to convert physical dose to biological effective dose (BED) and spatially register the dose distributions for more accurate combined dosimetry. METHODS AND MATERIALS A PSI phantom was CT scanned with and without seeds under rigid and deformed transformations. The resulting CTs were registered using image-based rigid registration (RI), fiducial-based rigid registration (RF), or b-spline deformable image registration (DIR) to determine which was most accurate. Physical EBRT and PSI dose distributions from a sample of 91 previously-treated combined-modality prostate cancer patients were converted to BED and registered using RI, RF, and DIR. Forty-eight (48) previously-treated patients whose PSI occurred before EBRT were included as a "control" group due to inherent registration. Dose-volume histogram (DVH) parameters were compared for RI, RF, DIR, DICOM, and scalar addition of DVH parameters using ANOVA or independent Student's t tests (α = 0.05). RESULTS In the phantom study, DIR was the most accurate registration algorithm, especially in the case of deformation. In the patient study, dosimetry from RI was significantly different than the other registration algorithms, including the control group. Dosimetry from RF and DIR were not significantly different from the control group or each other. CONCLUSIONS Combined dosimetry with BED and image registration is feasible. Future work will utilize this method to correlate dosimetry with clinical outcomes.
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12
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Magnetic resonance imaging analysis predicts nanoparticle concentration delivered to the brain parenchyma. Commun Biol 2022; 5:964. [PMID: 36109574 PMCID: PMC9477799 DOI: 10.1038/s42003-022-03881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Ultrasound in combination with the introduction of microbubbles into the vasculature effectively opens the blood brain barrier (BBB) to allow the passage of therapeutic agents. Increased permeability of the BBB is typically demonstrated with small-molecule agents (e.g., 1-nm gadolinium salts). Permeability to small-molecule agents, however, cannot reliably predict the transfer of remarkably larger molecules (e.g., monoclonal antibodies) required by numerous therapies. To overcome this issue, we developed a magnetic resonance imaging analysis based on the ΔR2* physical parameter that can be measured intraoperatively for efficient real-time treatment management. We demonstrate successful correlations between ΔR2* values and parenchymal concentrations of 3 differently sized (18 nm–44 nm) populations of liposomes in a rat model. Reaching an appropriate ΔR2* value during treatment can reflect the effective delivery of large therapeutic agents. This prediction power enables the achievement of desirable parenchymal drug concentrations, which is paramount to obtaining effective therapeutic outcomes. ΔR2* values from MRI analysis correlate with concentrations of liposomes in the size range of 18–44 nm in a rat model.
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13
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Fuller DB, Crabtree T, Kane BL, Medbery CA, Pfeffer R, Gray JR, Peddada A, Royce TJ, Chen RC. High Dose “HDR-Like” Prostate SBRT: PSA 10-Year Results From a Mature, Multi-Institutional Clinical Trial. Front Oncol 2022; 12:935310. [PMID: 35965547 PMCID: PMC9373838 DOI: 10.3389/fonc.2022.935310] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose/Objective(s) Although ample intermediate-term prostate stereotactic body radiotherapy (SBRT) outcomes have been reported, 10-year results remain relatively sparse. Materials/Methods Eighteen institutions enrolled 259 low- and intermediate-risk patients. Median follow-up is 5.5 years, with 66 patients followed ≥ 10 years. This SBRT regimen specifically emulated an existing HDR brachytherapy dose schedule and isodose morphology, prescribed to 38 Gy/4 fractions, delivered daily by robotic SBRT, mandating > 150% dose escalation in the peripheral zone. Androgen deprivation therapy was not allowed, and a hydrogel spacer was not available at that time. Results Median pre-SBRT PSA 5.12 ng/mL decreased to 0.1 ng/mL by 3.5 years, with further decrease to a nadir of < 0.1 ng/mL by 7 years, maintained through 10 years. Ten-year freedom from biochemical recurrence measured 100% for low-risk, 84.3% for favorable intermediate risk (FIR), and 68.4% for unfavorable intermediate (UIR) cases. Multivariable analysis revealed that the UIR group bifurcated into two distinct prognostic subgroups. Those so classified by having Gleason score 4 + 3 and/or clinical stage T2 (versus T1b/T1c) had a significantly poorer 10 year freedom from biochemical recurrence rate, 54.8% if either or both factors were present, while UIR patients without these specific factors had a 94.4% 10-year freedom from biochemical recurrence rate. The cumulative incidence of grade 2 GU toxicity modestly increased over time – 16.3% at 5 years increased to 19.2% at 10 years-- while the incidence of grade 3+ GU and GI toxicity remained low and stable to 10 years - 2.6% and 0%, respectively. The grade 2 GI toxicity incidence also remained low and stable to 10 years – 4.1% with no further events after year 5. Conclusion This HDR-like SBRT regimen prescribing 38 Gy/4 fractions but delivering much higher intraprostatic doses on a daily basis is safe and effective. This treatment achieves a median PSA nadir of <0.1 ng/mL and provides high long-term disease control rates without ADT except for a subgroup of unfavorable intermediate-risk patients.
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Affiliation(s)
- Donald B. Fuller
- CyberKnife Centers of San Diego, San Diego, CA, United States
- *Correspondence: Donald B. Fuller, ; Ronald C. Chen,
| | - Tami Crabtree
- Advance Research Associates, Santa Clara, CA, United States
| | | | | | - Robert Pfeffer
- Benefis Sletten Cancer Institute, Great Falls, MT, United States
| | - James R. Gray
- Sarah Cannon Research Institute, Nashville, TN, United States
| | - Anuj Peddada
- Penrose-St. Francis Health Services, Colorado Springs, CO, United States
| | - Trevor J. Royce
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ronald C. Chen
- University of Kansas, Kansas City, KS, United States
- *Correspondence: Donald B. Fuller, ; Ronald C. Chen,
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14
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Dur MP, Celik N, Seven N. Evaluation of the changes in physical properties and mineral content of enamel exposed to radiation after treating with remineralization agent. Clin Oral Investig 2022; 26:5673-5685. [PMID: 35552532 DOI: 10.1007/s00784-022-04524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of different remineralization agents on the physical properties and elemental content of enamel exposed to radiation. MATERIAL AND METHOD The enamel surfaces of impacted third molar teeth were prepared, and six study groups were created (n = 6). Next, 60 Gy radiation was applied to each group. Between applications, each group except for the control group was treated with a different remineralization agent (sodium fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium phosphate with fluorite (CPP-ACFP), bioactive glass, or chitosan). The results were evaluated in terms of pre- and post-radiation values and the difference between the two. The paired-samples t test and analysis of variance test were used in the analysis of normally distributed hardness and roughness values, while Wilcoxon's signed ranks test, and the Kruskal Wallis and Mann-Whitney U tests were used in the analysis of elemental content without normal distribution. RESULTS A statistically significant decrease was observed in microhardness measurements in all groups. Intragroup evaluation revealed a statistically significant difference between the NaF and bioactive glass groups (p < 0.05). No significant difference was observed between the groups' roughness measurements (p < 0.05). Intergroup evaluation of surface roughness revealed a significant difference in the CPP-ACFP and chitosan groups (p < 0.05). Pre- and post-radiation oxygen, magnesium, and potassium levels and Ca/P ratios also differed significantly (p < 0.05). CONCLUSION Radiation caused a statistically significant difference in the microhardness and elemental content of enamel. However, no significant difference was observed in enamel roughness. The applied remineralizing agents have a partial ameliorating effect on the adverse impacts of radiation. CLINICAL RELEVANCE Radiation causes changes in the mechanical properties and elemental content of tooth enamel. Remineralizing agent application is a promising option in reducing the adverse effects of irradiation.
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Affiliation(s)
- Merve Pelin Dur
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey.
| | - Neslihan Celik
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
| | - Nilgun Seven
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
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15
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Gaudreault M, Chang D, Hardcastle N, Jackson P, Kron T, Hanna GG, Hofman MS, Siva S. Utility of Biology-Guided Radiotherapy to De Novo Metastases Diagnosed During Staging of High-Risk Biopsy-Proven Prostate Cancer. Front Oncol 2022; 12:854589. [PMID: 35494012 PMCID: PMC9039647 DOI: 10.3389/fonc.2022.854589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Biology-guided radiotherapy (BgRT) uses real-time functional imaging to guide radiation therapy treatment. Positron emission tomography (PET) tracers targeting prostate-specific membrane antigen (PSMA) are superior for prostate cancer detection than conventional imaging. This study aims at describing nodal and distant metastasis distribution from prostate cancer and at determining the proportion of metastatic lesions suitable for BgRT. Methods A single-institution patient subset from the ProPSMA trial (ID ACTRN12617000005358) was analysed. Gross tumour volumes (GTV) were delineated on the CT component of a PSMA PET/CT scan. To determine the suitability of BgRT tracking zones, the normalized SUV (nSUV) was calculated as the ratio of SUVmax inside the GTV to the SUVmean of adjacent three-dimensional shells of thickness 5 mm/10 mm/20 mm as a measure of signal to background contrast. Targets were suitable for BgRT if (1) nSUV was larger than an nSUV threshold and (2) non-tumour tissue inside adjacent shell was free of PET-avid uptake. Results Of this cohort of 84 patients, 24 had at least one pelvic node or metastatic site disease, 1 to 13 lesions per patient, with a total of 98 lesions (60 pelvic nodes/38 extra-pelvic nodal diseases and haematogenous metastases). Target volumes ranged from 0.08 to 9.6 cm3 while SUVmax ranged from 2.1 to 55.0. nSUV ranged from 1.9 to 15.7/2.4 to 25.7/2.5 to 34.5 for the 5 mm/10 mm/20 mm shell expansion. Furthermore, 74%/68%/34% of the lesions had nSUV ≥ 3 and were free of PSMA PET uptake inside the GTV outer shell margin expansion of 5 mm/10 mm/20 mm. Adjacent avid organs were another lesion, bladder, bowel, ureter, prostate, and liver. Conclusions The majority of PSMA PET/CT-defined radiotherapy targets would be suitable for BgRT by using a 10-mm tracking zone in prostate cancer. A subset of lesions had adjacent non-tumour uptake, mainly due to the proximity of ureter or bladder, and may require exclusion from emission tracking during BgRT.
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Affiliation(s)
- Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia
| | - David Chang
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Price Jackson
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Molecular Imaging and Therapeutic Nuclear Medicine, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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16
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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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17
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A comparative study of patient-reported outcomes after contemporary radiation techniques for prostate cancer. Radiother Oncol 2022; 171:164-172. [DOI: 10.1016/j.radonc.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022]
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18
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Zhou H, Li J, Li A, Qiu X, Shen Z, Ge Y. Diagnostic Application and Systematic Evaluation of Image Registration Software in External Radiotherapy. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2022. [DOI: 10.1166/jmihi.2022.3928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Analyze the clinical application of MIM maestro in cancer radiotherapy and evaluate the advantage of the software compare to the clinical applied tools. Materials and Methods: Potentially relevant studies published were identified through a pubmed and web of science
search using words “MIM Maestro,” “Atlas,” “image registration,” “dose accumulation,” “irradiation.” Combinations of words were also searched as were bibliographies of downloaded papers in order to avoid missing relevant publications.
Results: In many patients with cancer radiotherapy, multiple types of images are demanded, MIM Maestro is a multi-modality image information processing system for radiotherapy. Contour atlas and image registration among dose accumulation and individual fractions is beneficial for radiotherapy.
Overall 34 papers were enrolled for analysis. The MIM appears to provide excellent clinical applications such as the function of contour altas, image fusion and registration, dose accumulation in radiotherapy compared to the other software. Conclusions: The regular optimization of radiotherapy
technology and the development of image technology, improve the clinical efficiency. The current paper give a systematic review of MIM Maestro multi-modality image processing software.
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Affiliation(s)
- Han Zhou
- School of Electronic Science and Engineering, Nanjing University, Jiangsu, 210046, China
| | - Jing Li
- Department of Radiation Oncology, Nanjing University, Jinling Hospital, School of Medicine, Nanjing, 210002, China
| | - AoMei Li
- Department of Radiation Oncology, Nanjing University, Jinling Hospital, School of Medicine, Nanjing, 210002, China
| | - XiangNan Qiu
- Department of Radiation Oncology, Nanjing University, Jinling Hospital, School of Medicine, Nanjing, 210002, China
| | - ZeTian Shen
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210013, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Jiangsu, 210046, China
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Overview of the current role of stereotactic body radiotherapy in the treatment of unfavorable intermediate- and high-risk prostate cancer. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:95-103. [PMID: 36275129 PMCID: PMC9489076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/17/2022] [Indexed: 01/03/2023]
Abstract
Stereotactic body radiotherapy (SBRT) is well accepted for low- and intermediate-favorable risk prostate cancer. Available evidence about the application of SBRT in unfavorable- and high-risk prostate cancer is less solid. During last year's multiple variations in treatment, techniques have been reported making comparisons more complicated. This review's objective is to review current evidence in application of SBRT in intermediate unfavourable and high-risk prostate cancer and to outline variations in SBRT treatment techniques and relevant results.
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20
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Hannan R, Salamekh S, Desai NB, Garant A, Folkert MR, Costa DN, Mannala S, Ahn C, Mohamad O, Laine A, Kim DWN, Dickinson T, Raj GV, Shah RB, Wang J, Jia X, Choy H, Roehrborn CG, Lotan Y, Timmerman RD. SAbR for High-Risk Prostate Cancer-A Prospective Multilevel MRI-Based Dose Escalation Trial. Int J Radiat Oncol Biol Phys 2021; 113:290-301. [PMID: 34774676 DOI: 10.1016/j.ijrobp.2021.10.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/15/2021] [Accepted: 10/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Radiation dose intensification improves outcome in men with high-risk prostate cancer (HR-PCa). A prospective trial was conducted to determine safety, feasibility, and maximal tolerated dose of multilevel magnetic resonance imaging (MRI)-based 5-fraction SAbR in patients with HR-PCa. METHODS AND MATERIALS This phase I clinical trial enrolled patients with HR-PCa with grade group ≥4, prostate-specific antigen (PSA) ≥20 ng/mL, or radiographic ≥T3, and well-defined prostatic lesions on multiparametric MRI (mpMRI) into 4 dose-escalation cohorts. The initial cohort received 47.5 Gy to the prostate, 50 Gy to mpMRI-defined intraprostatic lesion(s), and 22.5 Gy to pelvic lymph nodes in 5 fractions. Radiation doses were escalated for pelvic nodes to 25 Gy and mpMRI lesion(s) to 52.5 Gy and then 55 Gy. Escalation was performed sequentially according to rule-based trial design with 7 to 15 patients per cohort and a 90-day observation period. All men received peri-rectal hydrogel spacer, intraprostatic fiducial placement, and 2 years of androgen deprivation. The primary endpoint was maximal tolerated dose according to a 90-day acute dose-limiting toxicity (DLT) rate <33%. DLT was defined as National Cancer Institute Common Toxicity Criteria for Adverse Events ≥grade 3 treatment-related toxicity. Secondary outcomes included acute and delayed gastrointestinal (GI)/genitourinary (GU) toxicity graded with Common Toxicity Criteria for Adverse Events. RESULTS Fifty-five of the 62 enrolled patients were included in the analysis. Dose was escalated through all 4 cohorts without observing any DLTs. Median overall follow-up was 18 months, with a median follow-up of 42, 24, 12, and 7.5 months for cohorts 1 to 4 respectively. Acute and late grade 2 GU toxicities were 25% and 20%, while GI were 13% and 7%, respectively. Late grade 3 GU and GI toxicities were 2% and 0%, respectively. CONCLUSIONS SAbR dose for HR-PCa was safely escalated with multilevel dose painting of 47.5 Gy to prostate, 55 Gy to mpMRI-defined intraprostatic lesions, and 25 Gy to pelvic nodal region in 5 fractions. Longer and ongoing follow-up will be required to assess late toxicity.
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Affiliation(s)
| | | | | | | | | | | | | | - Chul Ahn
- Population and Data Science, Comprehensive Cancer Center, University of Texas at Southwestern Medical Center, Dallas, Texas
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Aaron Laine
- The Center for Cancer and Blood Disorders, Fort Worth, Texas
| | | | | | | | | | | | - Xun Jia
- Departments of Radiation Oncology
| | - Hak Choy
- Departments of Radiation Oncology
| | | | | | - Robert D Timmerman
- Departments of Radiation Oncology; Neurosurgery, Simmons Comprehensive Cancer Center, University of Texas at Southwestern Medical Center, Dallas, Texas
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21
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Sweeping-beam technique with electrons for large treatment areas as total skin irradiation : Dosimetric and technical aspects of a modified Stanford technique. Strahlenther Onkol 2021; 198:47-55. [PMID: 34729625 DOI: 10.1007/s00066-021-01859-1] [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: 05/24/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Total skin electron beam therapy (TSEBT) is still a technical and therapeutic challenge today. Thus, we developed TSEBT using a sweeping-beam technique. METHODS For treatment delivery, a linear accelerator Versa HD (ELEKTA, Stockholm, Sweden) with high-dose-rate electrons (HDRE) was used with a dose rate of 9000 MU/min. Dosimetry quality assurance was performed by multiple measurements with film dosimetry, 2D array, and Roos chamber. RESULTS Clinical experience shows that treatment durations of 75 to 90 min are usual for the Stanford technique without using HDRE. With this new sweeping-beam irradiation technique, the total treatment time of a daily fraction could be reduced to 20 min while keeping over- and underdosing low. The treatment area is about 60 cm × 200 cm and the dose distribution is uniform within 2% and 5% in vertical and horizontal directions, respectively. Initially, the electron energy of 6 MeV is reduced to 3.2 MeV by 1‑cm polymethylmethacrylat (PMMA) scatter and the irradiation conditions of a source-surface distance (SSD) of 350 cm. The photon contamination drops to under 1%. CONCLUSION These results show that the mean dose to total skin varies between 1.3 and 1.8 Gy. The sweeping-beam technique with electrons has a homogeneous dose distribution in connection with a short treatment time.
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22
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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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Glicksman RM, Liu SK, Cheung P, Vesprini D, Chu W, Chung HT, Morton G, Deabreu A, Davidson M, Ravi A, Musunuru HB, Helou J, Ho L, Zhang L, Loblaw A. Elective nodal ultra hypofractionated radiation for prostate cancer: Safety and efficacy from four prospective clinical trials. Radiother Oncol 2021; 163:159-164. [PMID: 34487764 DOI: 10.1016/j.radonc.2021.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The role of elective nodal irradiation (ENI) in localized prostate cancer (PCa) is controversial. With increasing use of SBRT to the prostate, data is needed regarding the safety and efficacy of ENI using ultra-hypofractionated radiation (UHRT). MATERIALS AND METHODS Between 2013-2020, 4 prospective clinical trials of intermediate or high-risk PCa receiving dose-escalated RT to the prostate (via HDR brachytherapy or SBRT boost) and ENI using UHRT (25 Gy in 5 weekly fractions) were conducted. Primary endpoints included acute genitourinary and gastrointestinal toxicities (CTCAE v3.0/4.0), and secondary endpoints included late genitourinary and gastrointestinal toxicities, patient-reported quality of life (EPIC) and biochemical failure (Phoenix definition). RESULTS One-hundred sixty-five patients were enrolled, of whom 98 (59%) had high-risk disease. ADT was used in 141 (85%). Median follow-up was 38 months (IQR 10-63). The worst acute genitourinary and gastrointestinal toxicities respectively were 48% and 7.5% for grade 2, and 2.7% and 0% for grade 3. Cumulative incidence of late grade 2+ genitourinary and gastrointestinal toxicities at 36 months were 58% and 11.3% and for late grade 3+ toxicities were 1% and 0%, respectively. No grade 4+ acute or late toxicities were observed. Bowel and sexual toxicity significantly worsened up to 1-year compared to baseline. Over time, urinary (p < 0.0001), bowel (p = 0.0018) and sexual (p < 0.0001) scores significantly improved. The 3-year biochemical recurrence-free survival was 98%. CONCLUSION ENI using UHRT is associated with low incidence of grade 3+ toxicity, while grade 1-2 acute genitourinary and gastrointestinal toxicity is common. Randomized phase 3 trials are needed.
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Affiliation(s)
| | - Stanley K Liu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Hans T Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Gerard Morton
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Andrea Deabreu
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada
| | - Melanie Davidson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Ananth Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | | | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Canada; Princess Margaret Cancer Centre, Canada
| | - Ling Ho
- Department of Radiation Oncology, University of Toronto, Canada
| | - Liying Zhang
- Clinical Trials and Epidemiology Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, Canada.
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Petersen PM, Mikhaeel NG, Ricardi U, Brady JL. Harnessing benefit of highly conformal RT techniques for lymphoma patients. Br J Radiol 2021; 94:20210469. [PMID: 34379521 DOI: 10.1259/bjr.20210469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This status article describes current state-of-the-art radiotherapy for lymphomas and new emerging techniques. Current state-of-the-art radiotherapy is sophisticated, individualised, CT-based, intensity-modulated treatment, using PET/CT to define the target. The concept of involved site radiotherapy should be used, delineating the target using the exact same principles as for solid tumours. The optimal treatment delivery includes motion management and online treatment verification systems, which reduce intra- and interfractional anatomical variation. Emerging radiotherapy techniques in lymphomas include adaptive radiotherapy in MR- and CT-based treatment systems and proton therapy. The next generation linear accelerators have the capability to deliver adaptive treatment and allow relatively quick online adaptation to the daily variations of the anatomy. The computer systems use machine leaning to facilitate rapid automatic contouring of the target and organs-at-risk. Moreover, emerging MR-based planning and treatment facilities allow target definition directly from MR scans and allow intra-fractional tracking of structures recognisable on MR. Proton facilities are now being widely implemented. The benefits of proton therapy are due to the physical properties of protons, which in many cases allow sparing of normal tissue. The variety of techniques in modern radiotherapy means that the radiation oncologist must be able to choose the right technique for each patient. The choice is mainly based on experience and standard protocols, but new systems calculating risks for the patients with a specific treatment plan and also systems integrating clinical factors and risk factors into the planning process itself are emerging.
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Affiliation(s)
- Peter Meidahl Petersen
- Department of Oncology, The Finsen Centre, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - N George Mikhaeel
- Guy's Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Jessica L Brady
- Guy's Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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Extreme Hypofractionation with SBRT in Localized Prostate Cancer. Curr Oncol 2021; 28:2933-2949. [PMID: 34436023 PMCID: PMC8395496 DOI: 10.3390/curroncol28040257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer among men around the world. Radiotherapy is a standard of care treatment option for men with localized prostate cancer. Over the years, radiation delivery modalities have contributed to increased precision of treatment, employing radiobiological insights to shorten the overall treatment time, improving the control of the disease without increasing toxicities. Stereotactic body radiation therapy (SBRT) represents an extreme form of hypofractionated radiotherapy in which treatment is usually delivered in 1–5 fractions. This review assesses the main efficacy and toxicity data of SBRT in non-metastatic prostate cancer and discusses the potential to implement this scheme in routine clinical practice.
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26
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Hill CS, Han-Oh S, Cheng Z, Wang KKH, Meyer JJ, Herman JM, Narang AK. Fiducial-based image-guided SBRT for pancreatic adenocarcinoma: Does inter-and intra-fraction treatment variation warrant adaptive therapy? Radiat Oncol 2021; 16:53. [PMID: 33741015 PMCID: PMC7980583 DOI: 10.1186/s13014-021-01782-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Variation in target positioning represents a challenge to set-up reproducibility and reliability of dose delivery with stereotactic body radiation therapy (SBRT) for pancreatic adenocarcinoma (PDAC). While on-board imaging for fiducial matching allows for daily shifts to optimize target positioning, the magnitude of the shift as a result of inter- and intra-fraction variation may directly impact target coverage and dose to organs-at-risk. Herein, we characterize the variation patterns for PDAC patients treated at a high-volume institution with SBRT. Methods We reviewed 30 consecutive patients who received SBRT using active breathing coordination (ABC). Patients were aligned to bone and then subsequently shifted to fiducials. Inter-fraction and intra-fraction scans were reviewed to quantify the mean and maximum shift along each axis, and the shift magnitude. A linear regression model was conducted to investigate the relationship between the inter- and intra-fraction shifts. Results The mean inter-fraction shift in the LR, AP, and SI axes was 3.1 ± 1.8 mm, 2.9 ± 1.7 mm, and 3.5 ± 2.2 mm, respectively, and the mean vector shift was 6.4 ± 2.3 mm. The mean intra-fraction shift in the LR, AP, and SI directions were 2.0 ± 0.9 mm, 2.0 ± 1.3 mm, and 2.3 ± 1.4 mm, respectively, and the mean vector shift was 4.3 ± 1.8 mm. A linear regression model showed a significant relationship between the inter- and intra-fraction shift in the AP and SI axis and the shift magnitude. Conclusions Clinically significant inter- and intra-fraction variation occurs during treatment of PDAC with SBRT even with a comprehensive motion management strategy that utilizes ABC. Future studies to investigate how these variations could lead to variation in the dose to the target and OAR should be investigated. Strategies to mitigate the dosimetric impact, including real time imaging and adaptive therapy, in select cases should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01782-w.
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Affiliation(s)
- Colin S Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA.
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Jeffrey J Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Joseph M Herman
- Radiation Medicine, Zucker School of Medicine At Hofstra/Northwell, Lake Success, USA
| | - Amol K Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
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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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Peyraga G, Lizee T, Khalifa J, Blais E, Mauriange-Turpin G, Supiot S, Krhili S, Tremolieres P, Graff-Cailleaud P. Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa). Cancer Radiother 2021; 25:400-409. [PMID: 33478838 DOI: 10.1016/j.canrad.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.
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Affiliation(s)
- G Peyraga
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France; Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France.
| | - T Lizee
- Radiation therapy department, Integrated centre of oncology (Paul Papin), Angers, France
| | - J Khalifa
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France
| | - E Blais
- Radiation therapy department, Groupe de radiotherapie et d'oncologie des Pyrénées, chemin de l'Ormeau, 65000 Tarbes, France
| | - G Mauriange-Turpin
- Radiation therapy department, University hospital centre, Limoges, France
| | - S Supiot
- Radiation therapy department, Integrated centre of oncology (Rene Gauducheau), Saint-Herblain, France
| | - S Krhili
- Radiation therapy department, Curie Institute, Paris, France
| | - P Tremolieres
- Radiation therapy department, Integrated centre of oncology (Paul Papin), Angers, France
| | - P Graff-Cailleaud
- Radiation department, Toulouse university institute of cancer, Oncopôle, Toulouse, France
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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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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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Kim YJ, Ahn H, Kim CS, Kim YS. Phase I/IIa trial of androgen deprivation therapy, external beam radiotherapy, and stereotactic body radiotherapy boost for high-risk prostate cancer (ADEBAR). Radiat Oncol 2020; 15:234. [PMID: 33032643 PMCID: PMC7542889 DOI: 10.1186/s13014-020-01665-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the clinical outcomes of combination of androgen deprivation therapy (ADT), whole pelvic radiotherapy (WPRT), and stereotactic body radiotherapy (SBRT) boost in high-risk prostate cancer patients. Methods This prospective phase I/IIa study was conducted between 2016 and 2017. Following WPRT of 44 Gy in 20 fractions, patients were randomized to two boost doses, 18 Gy and 21 Gy, in 3 fractions using the Cyberknife system. Primary endpoints were incidences of acute toxicities and short-term biochemical recurrence-free survival (BCRFS). Secondary endpoints included late toxicities and short-term clinical progression-free survival (CPFS). Results A total of 26 patients were enrolled. Twelve patients received a boost dose of 18 Gy, and the rest received 21 Gy. The Median follow-up duration was 35 months. There were no grade ≥ 3 genitourinary (GU) or gastrointestinal (GI) toxicities. Sixty-one and 4% of patients experienced grade 1–2 acute GU and GI toxicities, respectively. There were 12% late grade 1–2 GU toxicities and 8% late grade 1–2 GI toxicities. Patient-reported outcomes of urinary symptoms were aggravated after WPRT and SBRT boost. However, they resolved at 1 month and returned to the baseline level at 4 months. Three-year BCRFS was 88.1%, and CPFS was 92.3%. Conclusions The present study protocol demonstrated that the combination of ADT, WPRT, and SBRT boosts for high-risk prostate cancer is safe and feasible, and may reduce total treatment time to 5 weeks. Boost dose of 21 Gy in 3 fractions seems appropriate. Trial registration ClinicalTrials.gov, ID; NCT03322020 - Retrospectively registered on 26 October 2017.
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Affiliation(s)
- Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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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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Mahase SS, D'Angelo D, Kang J, Hu JC, Barbieri CE, Nagar H. Trends in the Use of Stereotactic Body Radiotherapy for Treatment of Prostate Cancer in the United States. JAMA Netw Open 2020; 3:e1920471. [PMID: 32022878 DOI: 10.1001/jamanetworkopen.2019.20471] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Stereotactic body radiotherapy is a hypofractionated, cost-effective treatment option for localized prostate cancer. OBJECTIVE To characterize US national trends and the clinical and socioeconomic factors associated with the use of stereotactic body radiotherapy in prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data collected by the National Cancer Database to assess the clinical and socioeconomic factors among 106 926 men diagnosed as having prostate cancer from 2010 to 2015 who underwent definitive radiotherapy and the trends in the use of this therapy. The initial analysis was performed between January and February 2018, with final updates performed August 2019. EXPOSURE Stereotactic body radiotherapy, defined as 5 fractions of radiotherapy. MAIN OUTCOMES AND MEASURES Temporal trends and clinical and sociodemographic factors associated with stereotactic body radiotherapy use. RESULTS In total, 106 926 patients diagnosed as having localized prostate cancer between 2010 and 2015 and receiving definitive radiotherapy were identified. White patients composed 77.3% of this cohort, whereas black patients composed 18.7%. Government-issued insurance was used by 61.2% of patients. More than 80% of patients had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to ≥3, with lower numbers indicating fewer comorbidities). In the study population, 25.7% had low-risk disease; 26.3%, favorable intermediate-risk disease; 23.3%, unfavorable intermediate-risk disease; and 24.7%, high-risk disease. The proportion of patients who underwent radiotherapy and received stereotactic body radiotherapy (a total of 5395 patients) increased from 3.1% in 2010 to 7.2% in 2015 (odds ratio, 0.36; 95% CI, 0.33-0.40; P < .001). Among the entire cohort, patients received a median dose of 36.25 Gy (range, 30.00-50.00 Gy). Androgen deprivation therapy use increased significantly as disease risk level increased among all patients receiving radiotherapy (9.5% with low risk to 76.6% with high risk; P = .02) and among those receiving stereotactic body radiotherapy (4.1% with low risk to 33.2% with high risk; P = .04) or not receiving stereotactic body radiotherapy (9.9% with low risk to 77.6% with high risk; P = .04). Patients treated at an academic center, living in an urban area, or possessing higher incomes and those who were healthier, white individuals, or were diagnosed as having lower-risk prostate cancer had higher odds of receiving stereotactic body radiotherapy. CONCLUSIONS AND RELEVANCE This study found that stereotactic body radiotherapy use in prostate cancer more than doubled from 2010 to 2015 but accounted for less than 10% of all patients undergoing radiotherapy. Androgen deprivation therapy use increased with disease risk among patients overall, regardless of receiving stereotactic body radiotherapy. Socioeconomic and clinical determinants of stereotactic body radiotherapy included risk category, Charlson-Deyo Comorbidity Index score, facility type and location, income, race/ethnicity, and year of diagnosis. These results are hypothesis generating; further studies evaluating potential disparities in stereotactic body radiotherapy use in localized prostate cancer are warranted.
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Affiliation(s)
- Sean S Mahase
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Debra D'Angelo
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Josephine Kang
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
| | | | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
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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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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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Stereotactic Body Radiation Therapy Boost for Intermediate-Risk Prostate Cancer: A Phase 1 Dose-Escalation Study. Int J Radiat Oncol Biol Phys 2019; 104:1066-1073. [PMID: 31002941 DOI: 10.1016/j.ijrobp.2019.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE High-dose-rate brachytherapy boost plus external beam radiation therapy is an established option for intermediate-risk prostate cancer (PCa). Stereotactic body radiation therapy (SBRT) boost can potentially mimic high-dose-rate boost and could be a viable alternative. Here we report the long-term outcomes of a phase 1 dose-escalation trial of single-fraction SBRT boost. METHODS AND MATERIALS Patients had intermediate-risk PCa and were accrued to 3 different SBRT single-fraction dose-level cohorts (10 Gy, 12.5 Gy, and 15 Gy). All received supplemental radiation therapy afterwards (37.5 Gy in 15 fractions). Three gold fiducials were implanted for image guidance. Patients were simulated and treated with a foley catheter and intrarectal balloon. A T2 magnetic resonance imaging scan was used for contouring, and a cine magnetic resonance imaging scan was used to calculate patient-specific internal target volume margins. Toxicity and quality-of-life data were collected using Common Terminology Criteria for Adverse Events v3.0 and the Expanded Prostate Cancer Index Composite. RESULTS 30 patients were accrued, 10 in each cohort. Median follow-up was 72 months. 60% had unfavorable intermediate-risk PCa. Two patients in the 15 Gy cohort developed late grade ≥3 gastrointestinal and genitourinary toxicity, with 1 patient suffering from a grade-4 rectal fistula after a rectal ulcer was biopsied repeatedly. Two patients had biochemical failure. Median PSA nadir was 0.4 ng/mL with 10 Gy, 0.09 ng/mL with 12.5 Gy and 0.07 ng/mL with 15 Gy. Median PSA at 4 years as well as proportion achieving a nadir <0.2 ng/mL improved significantly with higher doses. There was no significant change in quality of life from baseline in any of the domains, and the minimal clinically important change was not statistically different between the 3 cohorts. CONCLUSIONS Other than a grade 4 toxicity, which may in part be due to repeated biopsies of a rectal ulcer, single-fraction SBRT boost was feasible and well tolerated. Larger studies are warranted to better document the outcomes of such an approach.
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Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F, Debus J, Guckenberger M, Hörner-Rieber J, Lagerwaard FJ, Mazzola R, Palacios MA, Philippens MEP, Raaijmakers CPJ, Terhaard CHJ, Valentini V, Niyazi M. MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 2019; 14:92. [PMID: 31167658 PMCID: PMC6551911 DOI: 10.1186/s13014-019-1308-y] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.
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Affiliation(s)
- S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - F. Alongi
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - C. Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - L. Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - F. Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F. J. Lagerwaard
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - R. Mazzola
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - M. A. Palacios
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - M. E. P. Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. P. J. Raaijmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. H. J. Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V. Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Pryor D, Sidhom M, Arumugam S, Bucci J, Gallagher S, Smart J, Grand M, Greer P, Keats S, Wilton L, Martin J. Phase 2 Multicenter Study of Gantry-Based Stereotactic Radiotherapy Boost for Intermediate and High Risk Prostate Cancer (PROMETHEUS). Front Oncol 2019; 9:217. [PMID: 31001481 PMCID: PMC6454110 DOI: 10.3389/fonc.2019.00217] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives: To report feasibility, early toxicity, and PSA kinetics following gantry-based, stereotactic radiotherapy (SBRT) boost within a prospective, phase 2, multicenter study (PROMETHEUS: ACTRN12615000223538). Methods: Patients were treated with gantry-based SBRT, 19–20 Gy in two fractions delivered 1 week apart, followed by conventionally fractionated IMRT (46 Gy in 23 fractions). The study mandated MRI fusion for RT planning, rectal displacement, and intrafraction image guidance. Toxicity was prospectively graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). Results: Between March 2014 and July 2018, 135 patients (76% intermediate, 24% high-risk) with a median age of 70 years (range 53–81) were treated across five centers. Short course (≤6 months) androgen deprivation therapy (ADT) was used in 36% and long course in 18%. Rectal displacement method was SpaceOAR in 59% and Rectafix in 41%. Forty-two and ninety-three patients were treated at the 19 Gy and 20 Gy dose levels, respectively. Median follow-up was 24 months. Acute grade 2 gastrointestinal (GI) and urinary toxicity occurred in 4.4 and 26.6% with no acute grade 3 toxicity. At 6, 12, 18, 24, and 36 months post-treatment the prevalence of late grade ≥2 gastrointestinal toxicity was 1.6, 3.7, 2.2, 0, and 0%, respectively, and the prevalence of late grade ≥2 urinary toxicity was 0.8, 11, 12, 7.1, and 6.3%, respectively. Three patients experienced grade 3 late toxicity at 12 to 18 months which subsequently resolved to grade 2 or less. For patients not receiving ADT the median PSA value pre-treatment was 7.6 ug/L (1.1–20) and at 12, 24, and 36 months post-treatment was 0.86, 0.36, and 0.20 ug/L. Conclusions: Delivery of a gantry-based SBRT boost is feasible in a multicenter setting, is well-tolerated with low rates of early toxicity and is associated with promising PSA responses. A second transient peak in urinary toxicity was observed at 18 months which subsequently resolved. Follow-up is ongoing to document late toxicity, long-term patient reported outcomes, and tumor control with this approach.
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Affiliation(s)
- David Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark Sidhom
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Ingham Institute, Sydney, NSW, Australia
| | - Joseph Bucci
- University of New South Wales, Sydney, NSW, Australia.,St George Hospital, Cancer Care Centre, Sydney, NSW, Australia
| | - Sarah Gallagher
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Joanne Smart
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Melissa Grand
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,Ingham Institute, Sydney, NSW, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | - Sarah Keats
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Lee Wilton
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
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Xiang H, Chen Y. Energy-Converting Nanomedicine. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1805339. [PMID: 30773837 DOI: 10.1002/smll.201805339] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/22/2019] [Indexed: 05/12/2023]
Abstract
Serious side effects to surrounding normal tissues and unsatisfactory therapeutic efficacy hamper the further clinic applications of conventional cancer-therapeutic strategies, such as chemotherapy and surgery. The fast development of nanotechnology provides unprecedented superiorities for cancer therapeutics. Externally activatable therapeutic modalities mediated by nanomaterials, relying on highly effective energy transformation to release therapeutic elements/effects (cytotoxic reactive oxygen species, thermal effect, photoelectric effect, Compton effect, cavitation effect, mechanical effect or chemotherapeutic drug) for cancer therapies, categorized and termed as "energy-converting nanomedicine," have arouse considerable concern due to their noninvasiveness, desirable tissue-penetration depth, and accurate modulation of therapeutic dose. This review summarizes the recent advances in the engineering of intelligent functional nanotherapeutics for energy-converting nanomedicine, including photo-based, radiation-based, ultrasound-based, magnetic field-based, microwave-based, electric field-based, and radiofrequency-based nanomedicines, which are enabled by external stimuli (light, radiation, ultrasound, magnetic field, microwave, electric field, and radiofrequency). Furthermore, biosafety issues of energy-converting nanomedicine related to future clinical translation are also addressed. Finally, the potential challenges and prospects of energy-converting nanomedicine for future clinical translation are discussed.
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Affiliation(s)
- Huijing Xiang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Yu Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
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Feasibility of a novel dose fractionation strategy in TMI/TMLI. Radiat Oncol 2018; 13:248. [PMID: 30558631 PMCID: PMC6296054 DOI: 10.1186/s13014-018-1201-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background To report our experience in planning and delivering total marrow irradiation (TMI) and total marrow and lymphatic irradiation (TMLI) in patients with hematologic malignancies. Methods Twenty-seven patients undergoing bone marrow transplantation were treated with TMI/TMLI using Helical Tomotherapy (HT). All skeletal bones exclusion of the mandible comprised the treatment target volume and, for TMLI, lymph node chains, liver, spleen and/or brain were also included according to the clinical indication. Planned dose of 8Gy in 2 fractions was delivered over 1 day for TMI while 10Gy in 2 fractions BID was used for TMLI. Organs at risk (OAR) contoured included the brain, brainstem, lens, eyes, optic nerves, parotids, oral cavity, lungs, heart, liver, kidneys, stomach, small bowel, bladder and rectum. In particular, a simple method to avoid hot or cold doses in the overlapping region was implemented and the plan sum was adopted to evaluate dose inhomogeneity. Furthermore, setup errors from 54 treatments were summarized to gauge the effectiveness of immobilization. Results During the TMI/TMLI treatment, no acute adverse effects occurred during the radiation treatment. Two patients suffered nausea or vomiting right after radiation course. For the 9 patients treated with TMI, the median dose reduction of major organs varied 30–65% of the prescribed dose, substantially lower than the traditional total body irradiation (TBI). Meanwhile, average biological equivalent doses to OARs with 8Gy/2F TMI approach were not different from the conventional 12Gy/6F TMI approach. In the dose junction region, the 93% of PTV was covered by the prescribed dose without obvious hotspots. For the 27 patients, the overall setup corrections were lower than 3 mm except those in the SI direction for abdomen-pelvis region, demonstrating excellent immobilization. Conclusion The present study confirmed the technical feasibility of HT-based TMI/TMLI delivering 8-10Gy in 2 fractions over 1 day. For patients undergoing hematopoietic cell transplantation the proposed 8Gy/2F TMI (or 10Gy/2F TMLI) strategy may be a novel approach to improve delivery efficiency, increase effective radiation dose to target while maintaining low risk of severe organ toxicities.
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Park Y, Park HJ, Jang WI, Jeong BK, Kim HJ, Chang AR. Long-term results and PSA kinetics after robotic SBRT for prostate cancer: multicenter retrospective study in Korea (Korean radiation oncology group study 15-01). Radiat Oncol 2018; 13:230. [PMID: 30470253 PMCID: PMC6251151 DOI: 10.1186/s13014-018-1182-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the treatment outcome and prostate-specific antigen (PSA) change after stereotactic body radiotherapy (SBRT) for localized prostate cancer. METHODS Patients with localized prostate cancer treated with SBRT at three academic hospitals were enrolled. Treatment was delivered using Cyberknife with dose range from 35 to 37.5 Gy in 5 fractions. Biochemical failure (BCF) was assessed with Phoenix definition and toxicities were scored with Radiation Therapy Oncology Group (RTOG) toxicity criteria. The PSA kinetics were analyzed in patients who received no androgen deprivation therapy (ADT) and showed no recurrence. RESULTS Of the total 88 patients, 14 patients (15.9%) received ADT. After median follow-up of 63.8 months, the 5-year BCF free survival (BCFFS) was 94.7%. Two patients experienced late grade ≥ 3 GI toxicities (2.2%). The median nadir PSA was 0.12 ng/mL (range, 0.00-2.62 ng/mL) and the median time to nadir was 44.8 months (range, 0.40-85.7 months). Patients who reached nadir before 24 months showed poorer BCFFS than the others. The rate of PSA decline was maximum in the first year after treatment and gradually decreased with time. The pattern of PSA change was significantly different according to the risk groups (p = 0.011) with the slope of - 0.139, - 0.161 and - 0.253 ng/mL/month in low-, intermediate- and high-risk groups, respectively. CONCLUSION SBRT for localized prostate cancer showed favorable efficacy with minimal toxicities. The time to PSA nadir was significantly associated with treatment outcome. PSA revealed rapid initial decline and slower decrease with longer follow-up and the patterns of PSA changes were different according to the risk groups.
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Affiliation(s)
- Younghee Park
- Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hun-Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea.
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Zilli T, Scorsetti M, Zwahlen D, Franzese C, Förster R, Giaj-Levra N, Koutsouvelis N, Bertaut A, Zimmermann M, D'Agostino GR, Alongi F, Guckenberger M, Miralbell R. ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial. Radiat Oncol 2018; 13:166. [PMID: 30180867 PMCID: PMC6123974 DOI: 10.1186/s13014-018-1112-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/22/2018] [Indexed: 11/14/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, question of how far can the number of fractions with SBRT be reduced is a challenging research matter. As already explored by some authors in the context of brachytherapy, monotherapy appears to be feasible with an acceptable toxicity profile and a promising outcome. The aim of this multicenter phase I/II prospective trialis to demonstrate early evidence of safety and efficacy of a single-fraction SBRT approach for the treatment of localized disease. Methods Patients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone will be treated with a single SBRT fraction of 19 Gy to the whole prostate gland with urethra-sparing (17 Gy). Intrafractional motion will be monitored with intraprostatic electromagnetic transponders. The primary endpoint of the phase I part of the study will be safety as assessed by CTCAE 4.03 grading scale, while biochemical relapse-free survival will be the endpoint for the phase II. The secondary endpoints include acute and late toxicity, quality of life, progression-free survival, and prostate-cancer specific survival. Discussion This is the first multicenter phase I/II trial assessing the efficacy and safety of a single-dose SBRT treatment for patients with localized prostate cancer. If positive, results of ONE SHOT may help to design subsequent phase III trials exploring the role of SBRT monotherapy in the exclusive radiotherapy treatment of localized disease. Trial registration Clinicaltrials.gov identifier: NCT03294889; Registered 27 September 2017.
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Affiliation(s)
- Thomas Zilli
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland. .,Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Marta Scorsetti
- Radiation Oncology, Humanitas University, Rozzano, Milan, Italy.,Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Daniel Zwahlen
- Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Ciro Franzese
- Radiation Oncology, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Robert Förster
- Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Aurelie Bertaut
- Methodology and biostatistic unit, Centre Georges François Leclerc, Dijon, France
| | | | | | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don-Calabria, Negrar, Italy.,Faculty of Medecine, University of Brescia, Brescia, Italy
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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Musunuru HB, D'Alimonte L, Davidson M, Ho L, Cheung P, Vesprini D, Liu S, Chu W, Chung H, Ravi A, Deabreu A, Zhang L, Commisso K, Loblaw A. Phase 1-2 Study of Stereotactic Ablative Radiotherapy Including Regional Lymph Node Irradiation in Patients With High-Risk Prostate Cancer (SATURN): Early Toxicity and Quality of Life. Int J Radiat Oncol Biol Phys 2018; 102:1438-1447. [PMID: 30071295 DOI: 10.1016/j.ijrobp.2018.07.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/02/2018] [Accepted: 07/22/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Five-fraction stereotactic ablative radiation therapy appears to be gaining popularity in treatment of prostate cancer, but it has not been extensively tested in the context of pelvic radiation. The objective of this prospective prostate and pelvic SABR study is to report the acute toxicity, late toxicity, and quality of life (QoL) after study completion. METHODS AND MATERIALS A phase 1/2 study was conducted for patients with high-risk prostate cancer. Radiation therapy was planned to deliver 25 Gy to pelvis and seminal vesicles (SV) and a simultaneous integrated boost (SIB) of up to 40 Gy to the prostate in 5 fractions, weekly, over 29 days. Androgen deprivation therapy was used for 12 to 18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess worst acute and late toxicities. QoL data was captured using the Expanded Prostate Cancer Index Composite questionnaire (EPIC). RESULTS Thirty patients completed the planned treatment with a median follow-up of 25.7 months (range, 18.5-30.7 months). The following "worst" acute and late toxicities were observed: grade 2 genitourinary toxicity, 46.7% and 52%, respectively; grade 2 gastrointestinal toxicity, 3.3% and 32%, respectively. No grade 3 or higher toxicities were noted. Mean (95% confidence interval) EPIC urinary QoL scores were 86.6 (81.9-91.3), 87.1 (81.4-92.6), and 87.9 (80.1-95.7) at baseline, 3 months and 24 months; bowel scores were 94.1 (91.3-97.0), 93.2 (89.1-97.2), and 92.4 (87.7- 97.1), respectively. CONCLUSIONS This gantry-based novel fractionation schedule incorporating pelvic radiation for high-risk prostate cancer in combination with androgen deprivation therapy is feasible and well tolerated.
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Affiliation(s)
| | - Laura D'Alimonte
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Davidson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ling Ho
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 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
| | - Daniel Vesprini
- 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
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ananth Ravi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Deabreu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kristina Commisso
- 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; Department of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Canada.
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Ippolito E, Guido A, Macchia G, Deodato F, Giaccherini L, Farioli A, Arcelli A, Cuicchi D, Frazzoni L, Cilla S, Buwenge M, Mantini G, Alitto AR, Nuzzo M, Valentini V, Ingrosso M, Morganti AG, Fuccio L. Predictive Factors of Late-onset Rectal Mucosal Changes After Radiotherapy of Prostate Cancer. ACTA ACUST UNITED AC 2018; 31:961-966. [PMID: 28882966 DOI: 10.21873/invivo.11154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM The Vienna Rectoscopy Score (VRS; from 0, absence of rectal mucosal changes, to 5) assessed 1 year after radiotherapy is a surrogate end-point of late rectal toxicity. The aim of this study was to investigate the association between treatment-related factors and 1-year VRS. PATIENTS AND METHODS We performed a retrospective analysis of prospectively collected data. Patients with prostate adenocarcinoma treated with definitive or postoperative radiotherapy (RT) underwent endoscopy 1 year after RT. Relationships between VRS of 2 or more and treatment parameters were investigated by univariate and multivariate logistic analyses. RESULTS One hundred and ninety-five patients (mean age=69 years; range=43-81 years) were considered eligible for the study. At univariate analysis, patients treated with hypofractionation plus radiosurgery boost (p<0.001) and an equivalent dose in 2 Gy per fraction (EQD2) (α/β=3) ≥75 Gy (p<0.001) was associated with a significantly higher incidence of VRS ≥2 after 1 year of follow-up. At multivariate analysis, radiosurgery boost was an independent risk factor for developing rectal mucosal lesions (VRS ≥2), yielding an odds ratio (OR) of 4.14 (95% confidence interval (CI)=1.2-13.8), while pelvic surgery was inversely associated with VRS ≥2 (OR=0.39; 95% CI=0.17-0.94). CONCLUSION Hypofractionation followed by radiosurgery boost significantly increased the risk of developing late-onset rectal mucosal changes. Therefore, special care and preventative treatment strategies are needed when using radiosurgery boost after hypofractionated RT.
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Affiliation(s)
- Edy Ippolito
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Guido
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Lucia Giaccherini
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Giovanna Mantini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Anna R Alitto
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marianna Nuzzo
- Radiotherapy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Vincenzo Valentini
- Department of Radiotherapy, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marcello Ingrosso
- Endoscopy Unit, Giovanni Paolo II Research and Care Foundation, Campobasso, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine DIMES, University of Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Seyedmahmoud R, Wang Y, Thiagarajan G, Gorski JP, Reed Edwards R, McGuire JD, Walker MP. Oral cancer radiotherapy affects enamel microhardness and associated indentation pattern morphology. Clin Oral Investig 2018; 22:1795-1803. [PMID: 29151196 PMCID: PMC5908727 DOI: 10.1007/s00784-017-2275-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study is to determine the effects of in vitro and in vivo high-dose radiotherapy on microhardness and associated indentation pattern morphology of enamel. MATERIALS AND METHODS The inner, middle, and outer microhardness of enamel was evaluated using three experimental groups: control (non-radiated); in vitro irradiated; in vivo irradiated. In vitro specimens were exposed to simulated radiotherapy, and in vivo specimens were extracted teeth from oral cancer patients previously treated with radiotherapy. Indentations were measured via SEM images to calculate microhardness values and to assess the mechanomorphological properties of enamel before and after radiotherapy. RESULTS Middle and outer regions of enamel demonstrated a significant decrease in microhardness after in vitro and in vivo irradiation compared to the control group (p < 0.05). Two indentation patterns were observed: pattern A-presence of microcracks around indent periphery, which represents local dissipation of deformation energy; pattern B-clean, sharp indents. The percentage of clean microindentation patterns, compared to controls, was significantly higher following in vitro and in vivo irradiation in all enamel regions. The highest percentage of clean microindentations (65%) was observed in the in vivo irradiated group in the inner region of enamel near the dentin-enamel junction. CONCLUSIONS For the first time, this study shows that in vitro and in vivo irradiation alters enamel microhardness. Likewise, the indentation pattern differences suggest that enamel may become more brittle following in vitro and in vivo irradiation. CLINICAL RELEVANCE The mechanomorphological property changes of enamel following radiation may be a contributory component of pathologic enamel delamination following oral cancer radiotherapy.
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Affiliation(s)
- R Seyedmahmoud
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - Y Wang
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
| | - G Thiagarajan
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
- Department of Civil and Mechanical Engineering, School of Computing and Engineering, University of Missouri-Kansas City, Kansas City, MO, USA
| | - J P Gorski
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - R Reed Edwards
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - J D McGuire
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - M P Walker
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
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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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Murthy V, Gupta M, Mulye G, Maulik S, Munshi M, Krishnatry R, Phurailatpam R, Mhatre R, Prakash G, Bakshi G. Early Results of Extreme Hypofractionation Using Stereotactic Body Radiation Therapy for High-risk, Very High-risk and Node-positive Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:442-447. [PMID: 29571936 DOI: 10.1016/j.clon.2018.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
AIMS Stereotactic body radiotherapy (SBRT) in low- and intermediate-risk prostate cancer has shown encouraging results. However, its use in high-risk patients is limited due to lack of data regarding adequate radiotherapy dose, need for pelvic nodal treatment and androgen deprivation therapy. Herein we report our experience of SBRT in this subgroup. MATERIALS AND METHODS Analysis of a prospectively maintained database of 68 consecutive patients of the National Comprehensive Cancer Network (NCCN) high-risk, very high-risk and node-positive adenocarcinoma prostate treated with SBRT was undertaken. All patients were treated with rotational intensity-modulated radiotherapy with daily image guidance. The dose delivered to the prostate and gross node was 35-37.5 Gy in 5 alternate day fractions. Node-positive patients received 25 Gy to pelvic nodal regions until the common iliac nodes. Treatment was delivered in 7-10 days. All patients received long-term androgen deprivation therapy (79% medical and 21% surgical). RESULTS Most patients (65%) had a Gleason score ≥ 8. The median prostate-specific antigen was 42. Twenty patients were high risk (30%), 11 (16%) very high risk and 37 (54%) node positive. No acute Radiation Therapy Oncology Group grade ≥ 3 genitourinary or gastrointestinal toxicity was noted. Acute grade 2 genitourinary and gastrointestinal toxicity were 12% and 3%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity was 3% and 0%, respectively. There was no increase in acute or late gastrointestinal toxicity with prophylactic pelvic nodal radiotherapy. Prior transurethral resection of prostate (n = 11) did not increase toxicity. At a median follow-up of 18 months, 97% patients were alive and 94% were biochemically controlled. CONCLUSION SBRT is safe in the treatment of high-risk, very high-risk and node-positive prostate cancer, even with prophylactic pelvic radiotherapy or prior transurethral resection of prostate. Longer follow-up is required to determine efficacy.
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Affiliation(s)
- V Murthy
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India.
| | - M Gupta
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - G Mulye
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Maulik
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - M Munshi
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - R Krishnatry
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - R Phurailatpam
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - R Mhatre
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - G Prakash
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
| | - G Bakshi
- Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra, India
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Kothari G, Loblaw A, Tree AC, van As NJ, Moghanaki D, Lo SS, Ost P, Siva S. Stereotactic Body Radiotherapy for Primary Prostate Cancer. Technol Cancer Res Treat 2018; 17:1533033818789633. [PMID: 30064301 PMCID: PMC6069023 DOI: 10.1177/1533033818789633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 12/25/2022] Open
Abstract
Prostate cancer is the most common non-cutaneous cancer in males. There are a number of options for patients with localized early stage disease, including active surveillance for low-risk disease, surgery, brachytherapy, and external beam radiotherapy. Increasingly, external beam radiotherapy, in the form of dose-escalated and moderately hypofractionated regimens, is being utilized in prostate cancer, with randomized evidence to support their use. Stereotactic body radiotherapy, which is a form of extreme hypofractionation, delivered with high precision and conformality typically over 1 to 5 fractions, offers a more contemporary approach with several advantages including being non-invasive, cost-effective, convenient for patients, and potentially improving patient access. In fact, one study has estimated that if half of the patients currently eligible for conventional fractionated radiotherapy in the United States were treated instead with stereotactic body radiotherapy, this would result in a total cost savings of US$250 million per year. There is also a strong radiobiological rationale to support its use, with prostate cancer believed to have a low α/β ratio and therefore being preferentially sensitive to larger fraction sizes. To date, there are no published randomized trials reporting on the comparative efficacy of stereotactic body radiotherapy compared to alternative treatment modalities, although multiple randomized trials are currently accruing. Yet, early results from the randomized phase III study of HYPOfractionated RadioTherapy of intermediate risk localized Prostate Cancer (HYPO-RT-PC) trial, as well as multiple single-arm phase I/II trials, indicate low rates of late adverse effects with this approach. In patients with low- to intermediate-risk disease, excellent biochemical relapse-free survival outcomes have been reported, albeit with relatively short median follow-up times. These promising early results, coupled with the enormous potential cost savings and implications for resource availability, suggest that stereotactic body radiotherapy will take center stage in the treatment of prostate cancer in the years to come.
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Affiliation(s)
- Gargi Kothari
- Royal Marsden NHS Foundation Trust, London, United Kingdom
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Alison C. Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Drew Moghanaki
- Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Simon S. Lo
- University of Washington School of Medicine, Seattle, WA, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
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Pasquier D, Nickers P, Peiffert D, Maingon P, Pommier P, Lacornerie T, Martinage G, Tresch E, Lartigau E. Hypofractionated stereotactic boost in intermediate risk prostate carcinoma: Preliminary results of a multicenter phase II trial (CKNO-PRO). PLoS One 2017; 12:e0187794. [PMID: 29190707 PMCID: PMC5708754 DOI: 10.1371/journal.pone.0187794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Dose escalation may improve curability in intermediate-risk prostate carcinoma. A multicenter national program was developed to assess toxicity and tumor response with hypofractionated stereotactic boost after conventional radiotherapy in intermediate-risk prostate cancer. METHODS AND MATERIAL Between August 2010 and April 2013, 76 patients with intermediated-risk prostate carcinoma were included in the study. A first course delivered 46 Gy by IMRT (68.4% of patients) or 3D conformal radiotherapy (31.6% of patients). The second course delivered a boost of 18 Gy (3x6Gy) within 10 days. Gastrointestinal (GI) and genitourinary (GU) toxicities were evaluated as defined by NCI-CTCAE (v4.0). Secondary outcome measures were local control, overall and metastasis-free survival, PSA kinetics, and patient functional status (urinary and sexual) according to the IIEF5 and IPSS questionnaires. RESULTS The overall treatment time was 45 days (median, range 40-55). Median follow-up was 26.4 months (range, 13.6-29.9 months). Seventy-seven per cent (n = 58) of patients presented a Gleason score of 7. At 24 months, biological-free survival was 98.7% (95% CI, 92.8-99.9%) and median PSA 0.46 ng/mL (range, 0.06-6.20 ng/mL). Grade ≥2 acute GI and GU toxicities were 13.2% and 23.7%, respectively. Grade ≥2 late GI and GU toxicities were observed in 6.6% and 2.6% of patients, respectively. No grade 4 toxicity was observed. CONCLUSIONS Hypofractionated stereotactic boost is effective and safely delivered for intermediate-risk prostate carcinoma after conventional radiation. Mild-term relapse-free survival and tolerance results are promising, and further follow-up is warranted to confirm the results at long term. TRIAL REGISTRATION ClinicalTrials.gov NCT01596816.
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Affiliation(s)
- David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, University Lille II, Lille, France
- CRISTAL UMR CNRS 9189, Université Lille1, M3, Avenue Carl Gauss, Villeneuve-d'Ascq, France
| | - Philippe Nickers
- Centre Oscar Lambret, Academic Department of Radiation Oncology, University Lille II, Lille, France
| | - Didier Peiffert
- Institut de Cancérologie de Lorraine-Alexis Vautrin, Nancy, France
| | | | - Pascal Pommier
- Centre Leon Berard, Department of Radiation Oncology, Lyon, France
| | - Thomas Lacornerie
- Centre Oscar Lambret, Academic Department of Radiation Oncology, University Lille II, Lille, France
| | - Geoffrey Martinage
- Centre Oscar Lambret, Academic Department of Radiation Oncology, University Lille II, Lille, France
| | | | - Eric Lartigau
- Centre Oscar Lambret, Academic Department of Radiation Oncology, University Lille II, Lille, France
- CRISTAL UMR CNRS 9189, Université Lille1, M3, Avenue Carl Gauss, Villeneuve-d'Ascq, France
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Ricco A, Hanlon A, Lanciano R. Propensity Score Matched Comparison of Intensity Modulated Radiation Therapy vs Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Survival Analysis from the National Cancer Database. Front Oncol 2017; 7:185. [PMID: 28913176 PMCID: PMC5583523 DOI: 10.3389/fonc.2017.00185] [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: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE No direct comparisons between extreme hypofractionation and conventional fractionation have been reported in randomized trials for the treatment of localized prostate cancer. The goal of this study is to use a propensity score matched (PSM) analysis with the National Cancer Database (NCDB) for the comparison of stereotactic body radiation therapy (SBRT) and intensity modulated radiation therapy (IMRT) for organ confined prostate cancer. METHODS Men with localized prostate cancer treated with radiation dose ≥72 Gy for IMRT and ≥35 Gy for SBRT to the prostate only were abstracted from the NCDB. Men treated with previous surgery, brachytherapy, or proton therapy were excluded. Matching was performed to eliminate confounding variables via PSM. Simple 1-1 nearest neighbor matching resulted in a matched sample of 5,430 (2,715 in each group). Subset analyses of men with prostate-specific antigen (PSA) > 10, GS = 7, and GS > 7 yielded matched samples of 1,020, 2,194, and 247, respectively. RESULTS No difference in survival was noted between IMRT and SBRT at 8 years (p = 0.65). Subset analyses of higher risk men with PSA > 10 or GS = 7 histology or GS > 7 histology revealed no difference in survival between IMRT and SBRT (p = 0.58, p = 0.68, and p = 0.62, respectively). Variables significant for survival for the matched group included: age (p < 0.0001), primary payor (p = 0.0001), Charlson/Deyo Score (p = 0.0002), PSA (p = 0.0013), Gleason score (p < 0.0001), and use of hormone therapy (p = 0.02). CONCLUSION Utilizing the NCDB, there is no difference in survival at 8 years comparing IMRT to SBRT in the treatment of localized prostate cancer. Subset analysis confirmed no difference in survival even for intermediate- and high-risk patients based on Gleason Score and PSA.
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Affiliation(s)
- Anthony Ricco
- Philadelphia Cyberknife, Havertown, PA, United States
- Crozer Keystone Health Care System, Springfield, PA, United States
| | - Alexandra Hanlon
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Rachelle Lanciano
- Philadelphia Cyberknife, Havertown, PA, United States
- Crozer Keystone Health Care System, Springfield, PA, United States
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