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Galienne M, Risbourg S, Lacornerie T, Taillez A, Lartigau E, Barthoulot M, Pasquier D. Extreme hypofractionated stereotactic radiotherapy for localized prostate Cancer: Efficacy and late urinary toxicity according to transurethral resection of the prostate history. Clin Transl Radiat Oncol 2024; 46:100779. [PMID: 38681137 PMCID: PMC11047194 DOI: 10.1016/j.ctro.2024.100779] [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: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background and purpose Extreme hypofractionated stereotactic body radiotherapy (SBRT) is a therapeutic alternative for localized low- or intermediate-risk prostate cancer. Despite the availability of several studies, the toxicity profile of SBRT has not been comprehensively described. This real-world evidence study assessed the efficacy and toxicities associated with this regimen, and potential prognosis factors for genitourinary toxicities. Materials and methods This retrospective study included 141 consecutive patients with localized prostatic adenocarcinoma treated with CyberKnife™ SBRT, as primary irradiation, at the Oscar Lambret Center between 2010 and 2020. The prescribed dose was 36.25 Gy in 5 fractions. Acute and late toxicities were graded according to the CTCAE (version 5.0). Biochemical recurrence-free survival (bRFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The cumulative incidence of biochemical recurrence (cBR) was estimated using the Kalbfleisch-Prentice method. Results Among the included patients, 13.5 % had a history of transurethral resection of the prostate (TURP). The median follow-up was 48 months. At 5 years, bRFS, cBR, and OS were 72 % (95 %CI: 61-81), 7 % (95 %CI: 3-14), and 82 % (95 %CI: 73-89), respectively. Twenty-nine patients experienced at least one late toxicity of grade ≥ 2; genitourinary (N = 29), including 3 cases of chronic hematuria, and/or gastrointestinal (N = 1). The cumulative incidence of late urinary toxicity of grade ≥ 2 was 20.6 % at 5 years (95 %CI: 13.9-28.1). Multivariate analysis revealed that a history of TURP was significantly associated with late urinary toxicity of grade ≥ 2, after adjusting for clinical target volume (Odds Ratio = 3.06; 95%CI: 1.05-8.86; P = 0.04). Conclusion Extreme hypofractionated SBRT is effective for localized prostate cancer with a low risk of late toxicity. A history of TURP is associated with a higher risk of late urinary toxicity. These findings may contribute to the optimal management of patients treated with this regimen, particularly those with a history of TURP.
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Affiliation(s)
- Maxime Galienne
- University of Picardie Jules Verne, Amiens, France
- Department of Radiotherapy, Amiens-Picardie University Hospital (South Site), Amiens, France
| | - Séverine Risbourg
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | | | | | - Eric Lartigau
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
| | - Maël Barthoulot
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | - David Pasquier
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
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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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Greco C, Pares O, Pimentel N, Louro V, Santiago I, Vieira S, Stroom J, Mateus D, Soares A, Marques J, Freitas E, Coelho G, Seixas M, Lopez-Beltran A, Fuks Z. Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer: Results From the PROSINT Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:700-708. [PMID: 33704378 DOI: 10.1001/jamaoncol.2021.0039] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Ultra-high single-dose radiotherapy (SDRT) represents a potential alternative to curative extreme hypofractionated stereotactic body radiotherapy (SBRT) in organ-confined prostate cancer. Objective To compare toxic effect profiles, prostate-specific antigen (PSA) responses, and quality-of-life end points of SDRT vs extreme hypofractionated SBRT. Design, Setting, and Participants The PROSINT single-institution phase 2 randomized clinical trial accrued, between September 2015 and January 2017, 30 participants with intermediate-risk prostate cancer to receive SDRT or extreme hypofractionated SBRT. Androgen deprivation therapy was not permitted. Data were analyzed from March to May 2020. Interventions Patients were randomized in a 1:1 ratio to receive 5 × 9 Gy SBRT (control arm) or 24 Gy SDRT (test arm). Main Outcomes and Measures The primary end point was toxic effects; the secondary end points were PSA response, PSA relapse-free survival, and patient-reported quality of life measured with the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaires. Results A total of 30 men were randomized; median (interquartile range) age was 66.3 (61.2-69.9) and 73.6 (64.7-75.9) years for the SBRT and SDRT arms, respectively. Time to appearance and duration of acute and late toxic effects were similar in the 2 trial arms. Cumulative late actuarial urinary toxic effects did not differ for grade 1 (hazard ratio [HR], 0.41; 90% CI, 0.13-1.27) and grade 2 or greater (HR, 1.07; 90% CI, 0.21-5.57). Actuarial grade 1 late gastrointestinal (GI) toxic effects were comparable (HR, 0.37; 90% CI, 0.07-1.94) and there were no grade 2 or greater late GI toxic effects. Declines in PSA level to less than 0.5 ng/mL occurred by 36 months in both study arms. No PSA relapses occurred in favorable intermediate-risk disease, while in the unfavorable category, the actuarial 4-year PSA relapse-free survival values were 75.0% vs 64.0% (HR, 0.76; 90% CI, 0.17-3.31) for SBRT vs SDRT, respectively. The EPIC-26 median summary scores for the genitourinary and GI domains dropped transiently at 1 month and returned to pretreatment scores by 3 months in both arms. The IPSS-derived transient late urinary flare symptoms occurred at 9 to 18 months in 20% (90% CI, 3%-37%) of patients receiving SDRT. Conclusions and Relevance In this randomized clinical trial among patients with intermediate-risk prostate cancer, SDRT was safe and associated with low toxicity, and the tumor control and quality-of-life end points closely match the SBRT arm outcomes. Further studies are encouraged to explore indications for SDRT in the cure of prostate cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02570919.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Santiago
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - João Marques
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elda Freitas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Graça Coelho
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Manuela Seixas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
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Kishan AU, Dang A, Katz AJ, Mantz CA, Collins SP, Aghdam N, Chu FI, Kaplan ID, Appelbaum L, Fuller DB, Meier RM, Loblaw DA, Cheung P, Pham HT, Shaverdian N, Jiang N, Yuan Y, Bagshaw H, Prionas N, Buyyounouski MK, Spratt DE, Linson PW, Hong RL, Nickols NG, Steinberg ML, Kupelian PA, King CR. Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer. JAMA Netw Open 2019; 2:e188006. [PMID: 30735235 PMCID: PMC6484596 DOI: 10.1001/jamanetworkopen.2018.8006] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/13/2018] [Indexed: 02/05/2023] Open
Abstract
Importance Stereotactic body radiotherapy harnesses improvements in technology to allow the completion of a course of external beam radiotherapy treatment for prostate cancer in the span of 4 to 5 treatment sessions. Although mounting short-term data support this approach, long-term outcomes have been sparsely reported. Objective To assess long-term outcomes after stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. Design, Setting, and Participants This cohort study analyzed individual patient data from 2142 men enrolled in 10 single-institution phase 2 trials and 2 multi-institutional phase 2 trials of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer between January 1, 2000, and December 31, 2012. Statistical analysis was performed based on follow-up from January 1, 2013, to May 1, 2018. Main Outcomes and Measures The cumulative incidence of biochemical recurrence was estimated using a competing risk framework. Physician-scored genitourinary and gastrointestinal toxic event outcomes were defined per each individual study, generally by Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. After central review, cumulative incidences of late grade 3 or higher toxic events were estimated using a Kaplan-Meier method. Results A total of 2142 men (mean [SD] age, 67.9 [9.5] years) were eligible for analysis, of whom 1185 (55.3%) had low-risk disease, 692 (32.3%) had favorable intermediate-risk disease, and 265 (12.4%) had unfavorable intermediate-risk disease. The median follow-up period was 6.9 years (interquartile range, 4.9-8.1 years). Seven-year cumulative rates of biochemical recurrence were 4.5% (95% CI, 3.2%-5.8%) for low-risk disease, 8.6% (95% CI, 6.2%-11.0%) for favorable intermediate-risk disease, 14.9% (95% CI, 9.5%-20.2%) for unfavorable intermediate-risk disease, and 10.2% (95% CI, 8.0%-12.5%) for all intermediate-risk disease. The crude incidence of acute grade 3 or higher genitourinary toxic events was 0.60% (n = 13) and of gastrointestinal toxic events was 0.09% (n = 2), and the 7-year cumulative incidence of late grade 3 or higher genitourinary toxic events was 2.4% (95% CI, 1.8%-3.2%) and of late grade 3 or higher gastrointestinal toxic events was 0.4% (95% CI, 0.2%-0.8%). Conclusions and Relevance In this study, stereotactic body radiotherapy for low-risk and intermediate-risk disease was associated with low rates of severe toxic events and high rates of biochemical control. These data suggest that stereotactic body radiotherapy is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.
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Affiliation(s)
- Amar U. Kishan
- Department of Urology, University of California, Los Angeles
- Department of Radiation Oncology, University of California, Los Angeles
| | - Audrey Dang
- Department of Radiation Oncology, University of California, Los Angeles
| | - Alan J. Katz
- Flushing Radiation Oncology Services, Flushing, New York
| | | | - Sean P. Collins
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Nima Aghdam
- Department of Radiation Oncology, Georgetown University, Washington, DC
| | - Fang-I Chu
- Department of Radiation Oncology, University of California, Los Angeles
| | - Irving D. Kaplan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Limor Appelbaum
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Donald B. Fuller
- Division of Genesis Healthcare Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | | | - D. Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Huong T. Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles
- Now with Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naomi Jiang
- Department of Radiation Oncology, University of California, Los Angeles
| | - Ye Yuan
- Department of Radiation Oncology, University of California, Los Angeles
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nicolas Prionas
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Mark K. Buyyounouski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
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Barillot I, Antoni D, Bellec J, Biau J, Giraud P, Jenny C, Lacornerie T, Lisbona A, Marchesi V, Mornex F, Supiot S, Thureau S, Noel G. Bases référentielles de la radiothérapie en conditions stéréotaxiques pour les tumeurs ou métastases bronchopulmonaires, hépatiques, prostatiques, des voies aérodigestives supérieures, cérébrales et osseuses. Cancer Radiother 2018; 22:660-681. [DOI: 10.1016/j.canrad.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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Meier RM, Bloch DA, Cotrutz C, Beckman AC, Henning GT, Woodhouse SA, Williamson SK, Mohideen N, Dombrowski JJ, Hong RL, Brachman DG, Linson PW, Kaplan ID. Multicenter Trial of Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: Survival and Toxicity Endpoints. Int J Radiat Oncol Biol Phys 2018; 102:296-303. [PMID: 30191864 DOI: 10.1016/j.ijrobp.2018.05.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/08/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The radiobiology of prostate cancer may favor the extreme hypofractionation inherent in stereotactic body radiation therapy (SBRT); however, data from a large multicenter study are lacking. We therefore examined the hypothesis that dose-escalated SBRT can be safely administered across multiple institutions, with favorable 5-year disease-free survival (DFS) rates compared with historical controls. METHODS AND MATERIALS Twenty-one centers enrolled 309 patients with prostate adenocarcinoma: 172 with low-risk (LR) and 137 with intermediate-risk (IR) disease. All were treated with a non-coplanar robotic SBRT platform using real-time tracking of implanted fiducials. The prostate was prescribed 40 Gy in 5 fractions of 8 Gy. We assessed toxicities using Common Terminology Criteria for Adverse Events (CTCAE) version 3 and biochemical failure using the "nadir + 2" definition. The study population yielded 90% power to identify excessive (>10%) rates of grade ≥3 genitourinary (GU) or gastrointestinal toxicities and, in the LR group, 80% power to show superiority in DFS over a 93% historical comparison rate. RESULTS At a median follow-up of 61 months, 2 LR patients (1.2%) and 2 IR patients (1.5%) experienced grade 3 GU toxicities, far below the 10% toxicity rate deemed excessive (upper limits of 95% confidence interval, 3.5% and 4.3%, respectively). No grade 4 or 5 toxicities occurred. All grade 3 toxicities were GU, occurring 11 to 51 months after treatment. For the entire group, the actuarial 5-year overall survival rate was 95.6% and the DFS rate was 97.1%. The 5-year DFS rate was 97.3% for LR patients (superior to the 93% DFS rate for historical controls; P = .0008; lower limit of 95% confidence interval, 94.6%) and 97.1% for IR patients. CONCLUSIONS Dose-escalated prostate SBRT was administered with minimal toxicity in this multi-institutional study. Relapse rates compared favorably with historical controls. SBRT is a suitable option for LR and IR prostate cancer.
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Mahal BA, Chen YW, Sethi RV, Padilla OA, Yang DD, Chavez J, Muralidhar V, Hu JC, Feng FY, Hoffman KE, Martin NE, Spratt DE, Yu JB, Orio PF, Nguyen PL. Travel distance and stereotactic body radiotherapy for localized prostate cancer. Cancer 2017; 124:1141-1149. [DOI: 10.1002/cncr.31190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/29/2017] [Accepted: 11/10/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Brandon A. Mahal
- Harvard Radiation Oncology Program; Harvard University; Boston Massachusetts
| | - Yu-Wei Chen
- Department of Internal Medicine; Cleveland Clinic; Cleveland Ohio
| | - Roshan V. Sethi
- Harvard Radiation Oncology Program; Harvard University; Boston Massachusetts
| | | | | | - Janice Chavez
- Department of Social Work; Brigham and Women's Hospital; Boston Massachusetts
| | - Vinayak Muralidhar
- Harvard Radiation Oncology Program; Harvard University; Boston Massachusetts
| | - Jim C. Hu
- Department of Urology; Weill Cornell Medicine; New York New York
| | - Felix Y. Feng
- Department of Radiation Oncology; University of California at San Francisco; San Francisco California
| | - Karen E. Hoffman
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Neil E. Martin
- Department of Radiation Oncology; Dana-Farber Cancer Institute, Brigham and Women's Hospital; Boston Massachusetts
| | - Daniel E. Spratt
- Department of Radiation Oncology; University of Michigan Health System; Ann Arbor Michigan
| | - James B. Yu
- Department of Therapeutic Radiology/Radiation Oncology; Yale University; New Haven Connecticut
| | - Peter F. Orio
- Department of Radiation Oncology; Dana-Farber Cancer Institute, Brigham and Women's Hospital; Boston Massachusetts
| | - Paul L. Nguyen
- Department of Radiation Oncology; Dana-Farber Cancer Institute, Brigham and Women's Hospital; Boston Massachusetts
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Dess RT, Jackson WC, Suy S, Soni PD, Lee JY, Abugharib AE, Zumsteg ZS, Feng FY, Hamstra DA, Collins SP, Spratt DE. Predictors of multidomain decline in health-related quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer. Cancer 2016; 123:1635-1642. [PMID: 28001303 DOI: 10.1002/cncr.30519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) for localized prostate cancer involves high-dose-per-fraction radiation treatments. Its use is increasing, but concerns remain about treatment-related toxicity. The authors assessed the incidence and predictors of a global decline in health-related quality of life (HRQOL) after prostate SBRT. METHODS From 2008 to 2014, 713 consecutive men with localized prostate cancer received treatment with SBRT according to a prospective institutional protocol. Expanded Prostate Cancer Index Composite (EPIC-26) HRQOL data were collected at baseline and longitudinally for 5 years. EPIC-26 is comprised of 5 domains. The primary endpoint was defined as a decline exceeding the clinically detectable threshold in ≥4 EPIC-26 domains, termed multidomain decline. RESULTS The median age was 69 years, 46% of patients had unfavorable intermediate-risk or high-risk disease, and 20% received androgen-deprivation therapy. During 1 to 3 months and 6 to 60 months after SBRT, 8% to 15% and 10% to 11% of patients had multidomain declines, respectively. On multivariable analysis, lower baseline bowel HRQOL (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) and baseline depression (odds ratio, 5.7; 95% confidence interval, 1.3-24.3; P = .02) independently predicted for multidomain decline. Only 3% to 4% of patients had long-term multidomain declines exceeding twice the clinical threshold, and 30% of such declines appeared to be related to prostate cancer treatment or progression of disease. CONCLUSIONS Prostate SBRT has minimal long-term impact on multidomain decline, and the majority of more significant multidomain declines appear to be unrelated to treatment. This emphasizes the importance of focusing not only on the side effects of prostate cancer treatment but also on other comorbid illnesses that contribute to overall HRQOL. Cancer 2017;123:1635-1642. © 2017 American Cancer Society.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Simeng Suy
- Department of Radiation Oncology, Georgetown University, Washington, District of Columbia
| | - Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jae Y Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Felix Y Feng
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California
| | | | - Sean P Collins
- Department of Radiation Oncology, Georgetown University, Washington, District of Columbia
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Qi XS, Wang JP, Gomez CL, Shao W, Xu X, King C, Low DA, Steinberg M, Kupelian P. Plan quality and dosimetric association of patient-reported rectal and urinary toxicities for prostate stereotactic body radiotherapy. Radiother Oncol 2016; 121:113-117. [PMID: 27587270 DOI: 10.1016/j.radonc.2016.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE To study the association between dosimetric parameters with patient-reported quality-of-life (QOL) in urinary irritative/incontinency and bowel functions for prostate stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS The patient-reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-26). According to the progression in QOL score over 12months, patients were assigned to one of three subgroups: score decrement, no change, or increment. The dosimetric parameters were cross-compared among subgroups in urinary and bowel domains using univariate Analysis of Variance (ANOVA). The evaluated dosimetric metrics included target volume, V100 (volume receiving 100% prescription dose); rectal volume/dose-volume endpoints, maximum/mean doses; bladder volume/dose-volume endpoints, and maximum/mean doses. RESULTS Patients with consistent QOL reduction in urinary irritation function were significantly associated with greater mean bladder dose, greater V85/V90/V95/V100 and D2cc/D10cc. Patients with QOL reduction in urinary incontinence were marginally associated with greater mean bladder dose (p=0.06). None of the evaluated dosimetric parameters showed a significant correlation with QOL score change in bowel function. CONCLUSIONS Patients with large prostate size were more susceptible to QOL decrements for urinary irritative and incontinency functions. Large bladder V85/V90/V95/V100 was associated with QOL decrements in the urinary irritative domain at 1-year after prostate SBRT.
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Affiliation(s)
- X Sharon Qi
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA.
| | - Jason P Wang
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Caitlin L Gomez
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Weber Shao
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Xiaoqing Xu
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Christopher King
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Michael Steinberg
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
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10
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Oliai C, Bernetich M, Brady L, Yang J, Hanlon A, Lamond J, Arrigo S, Good M, Mooreville M, Garber B, Lanciano R. Propensity score matched comparison of SBRT versus IMRT for the treatment of localized prostate cancer. ACTA ACUST UNITED AC 2016; 5:187-195. [PMID: 27335630 PMCID: PMC4893387 DOI: 10.1007/s13566-015-0237-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Objective Stereotactic body radiation therapy (SBRT) is an attractive option for prostate cancer due to its short treatment duration and cost. In this report, we compare the efficacy and toxicity outcomes of prostate cancer patients treated with SBRT to those who received intensity-modulated radiation therapy (IMRT). Methods Two hundred sixty-three patients with localized prostate adenocarcinoma were included, ranging from clinically very low- to high-risk groups. We retrospectively compare consecutive patients treated with SBRT with consecutive patients treated with conventionally fractionated IMRT. For most patients, SBRT was delivered to a total dose of 36.25 Gy in five fractions and IMRT to 75.6 Gy in 42 fractions. To minimize selection bias, we perform propensity score analyses. Results The treatment groups became similar after propensity matching with absolute standard bias reduced to ≤0.19. For the first analysis, 5-year actuarial survival was 90.8 and 88.1 % in SBRT and IMRT groups, respectively (p = 0.7260), while FFBF was 88.7 and 95.5 %, respectively (p = 0.1720). For the second analysis (accounting for risk group), actuarial 5-year survival was 96.7 and 87.1 % in the SBRT and IMRT groups, respectively (p = 0.3025), while FFBF was 89.7 and 90.3 %, respectively (p = 0.6446). Toxicity did not exceed grade 3 in any of the studied patients. The highest recorded genitourinary toxicity at the time of latest follow-up was grade 2. Conclusion Our data support the hypothesis that SBRT has non-inferior efficacy and toxicity rates as IMRT. Given the lower cost and convenience for patients, SBRT may be considered as an alternative treatment for localized prostate cancer.
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Affiliation(s)
- Caspian Oliai
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Matthew Bernetich
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Luther Brady
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Jun Yang
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Alexandra Hanlon
- Claire M Fagin Hall, University of Pennsylvania, 418 Curie Boulevard, 479L, Philadelphia, PA 19104-4217 USA
| | - John Lamond
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Steven Arrigo
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Michael Good
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Michael Mooreville
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA
| | - Bruce Garber
- Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA
| | - Rachelle Lanciano
- Philadelphia Cyberknife Center, 2010 West Chest Pike, Suite 115, Havertown, PA 19083 USA ; Department of Radiation Oncology, Drexel University College of Medicine, 230 North Broad Street, Philadelphia, PA 19102 USA ; Department of Radiation Oncology, Delaware County Memorial Hospital, 501 North Lansdowne Avenue, Drexel Hill, PA 19026 USA
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11
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Evans JR, Zhao S, Daignault S, Sanda MG, Michalski J, Sandler HM, Kuban DA, Ciezki J, Kaplan ID, Zietman AL, Hembroff L, Feng FY, Suy S, Skolarus TA, McLaughlin PW, Wei JT, Dunn RL, Finkelstein SE, Mantz CA, Collins SP, Hamstra DA. Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy. Radiother Oncol 2015; 116:179-84. [DOI: 10.1016/j.radonc.2015.07.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/08/2015] [Indexed: 01/26/2023]
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12
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A Phase 1/2 Trial of Brief Androgen Suppression and Stereotactic Radiation Therapy (FASTR) for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 92:856-62. [DOI: 10.1016/j.ijrobp.2015.02.046] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
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13
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Stereotactic body radiation therapy: Let’s not give up on progress. Pract Radiat Oncol 2015; 5:193-196. [DOI: 10.1016/j.prro.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022]
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14
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Quan K, Rajagopalan MS, Heron DE. Stereotactic body radiation therapy is a cost-effective alternative to intensity-modulated radiation therapy. J Clin Oncol 2014; 32:3451. [PMID: 25185091 DOI: 10.1200/jco.2014.56.6737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kimmen Quan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Dwight E Heron
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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15
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D'Amico AV. Reply to K. Quan et Al, S.P. Collins et al, C.R. King et al, s. Arcangeli et al, d.B. Fuller, and D. Vordermark. J Clin Oncol 2014; 32:3457. [PMID: 25185103 DOI: 10.1200/jco.2014.57.6116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony V D'Amico
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
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16
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Kavanagh BD. Stereotactic body radiation therapy as a derivative of stereotactic radiosurgery: clinically independent but with enduring common themes. J Clin Oncol 2014; 32:2827-31. [PMID: 25113758 DOI: 10.1200/jco.2014.56.7362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Brian D Kavanagh
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
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