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Tiruye T, O'Callaghan M, Ettridge K, Moretti K, Jay A, Higgs B, Santoro K, Kichenadasse G, Beckmann K. Clinical and functional outcomes for risk-appropriate treatments for prostate cancer. BJUI COMPASS 2024; 5:109-120. [PMID: 38179028 PMCID: PMC10764171 DOI: 10.1002/bco2.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives To describe real-world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category. Subjects and methods Men diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry-a multi-institutional prospective clinical registry-were studied. The main outcome measures were overall survival, cancer-specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes. Results Of the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/- ADT) in 22% of the cohort. Five-year overall survival was above 91%, and 5-year prostate cancer-specific survival was above 97% in the low- and intermediate-risk categories across all treatments. Five-year prostate cancer-specific survival in the active surveillance group was 100%. About 37% of men with high-risk disease treated with RP and 17% of men treated with EBRT +/- ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/- ADT. Conclusion This contemporary real-world evidence on risk-appropriate treatment outcomes helps inform treatment decision-making for clinicians and patients.
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Affiliation(s)
- Tenaw Tiruye
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- Public Health DepartmentDebre Markos UniversityDebre MarkosEthiopia
| | - Michael O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes CollaborativeAdelaideAustralia
- Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
- Discipline of MedicineUniversity of AdelaideAdelaideAustralia
- Flinders Medical CentreBedford ParkAustralia
| | - Kerry Ettridge
- Health Policy CentreSouth Australian Health and Medical Research InstituteAdelaideAustralia
- School of Public HealthUniversity of AdelaideAdelaideAustralia
| | - Kim Moretti
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- South Australian Prostate Cancer Clinical Outcomes CollaborativeAdelaideAustralia
- Discipline of SurgeryUniversity of AdelaideAdelaideAustralia
| | - Alex Jay
- Flinders Medical CentreBedford ParkAustralia
| | - Braden Higgs
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideAustralia
| | - Kerry Santoro
- Southern Adelaide Local Health NetworkAdelaideAustralia
| | - Ganessan Kichenadasse
- Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
- Flinders Medical CentreBedford ParkAustralia
| | - Kerri Beckmann
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human PerformanceUniversity of South AustraliaAdelaideAustralia
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Zhong J, Kobus M, Maitre P, Datta A, Eccles C, Dubec M, McHugh D, Buckley D, Scarsbrook A, Hoskin P, Henry A, Choudhury A. MRI-guided Pelvic Radiation Therapy: A Primer for Radiologists. Radiographics 2023; 43:e230052. [PMID: 37796729 DOI: 10.1148/rg.230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Radiation therapy (RT) is a core pillar of oncologic treatment, and half of all patients with cancer receive this therapy as a curative or palliative treatment. The recent integration of MRI into the RT workflow has led to the advent of MRI-guided RT (MRIgRT). Using MRI rather than CT has clear advantages for guiding RT to pelvic tumors, including superior soft-tissue contrast, improved organ motion visualization, and the potential to image tumor phenotypic characteristics to identify the most aggressive or treatment-resistant areas, which can be targeted with a more focal higher radiation dose. Radiologists should be familiar with the potential uses of MRI in planning pelvic RT; the various RT techniques used, such as brachytherapy and external beam RT; and the impact of MRIgRT on treatment paradigms. Current clinical experience with and the evidence base for MRIgRT in the settings of prostate, cervical, and bladder cancer are discussed, and examples of treated cases are illustrated. In addition, the benefits of MRIgRT, such as real-time online adaptation of RT (during treatment) and interfraction and/or intrafraction adaptation to organ motion, as well as how MRIgRT can decrease toxic effects and improve oncologic outcomes, are highlighted. MRIgRT is particularly beneficial for treating mobile pelvic structures, and real-time adaptive RT for tumors can be achieved by using advanced MRI-guided linear accelerator systems to spare organs at risk. Future opportunities for development of biologically driven adapted RT with use of functional MRI sequences and radiogenomic approaches also are outlined. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Jim Zhong
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Marta Kobus
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Priyamvada Maitre
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Anubhav Datta
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Cynthia Eccles
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Michael Dubec
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Damien McHugh
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - David Buckley
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Andrew Scarsbrook
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Peter Hoskin
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ann Henry
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ananya Choudhury
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
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Guo W, Sun YC, Zhang LY, Yin XM. Gastrointestinal/genitourinary adverse event after intensity modulated versus three-dimensional primary radiation therapy in the treatment of prostate cancer: systematic review and meta-analysis. J Cancer 2023; 14:2878-2888. [PMID: 37781069 PMCID: PMC10539562 DOI: 10.7150/jca.87626] [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: 06/29/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Objective: Prostate cancer (PCa) is one of the most common cancers in the world. The potential benefits of intensity modulated radiation therapy (IMRT) over three-dimensional conformal radiation therapy (3D-CRT) for PCa primary radiation therapy treatment have not yet been clarified. Therefore, this meta-analysis was conducted to assess whether IMRT could improve clinical outcomes in comparison with 3D-CRT in patients diagnosed with PCa. Materials and methods: Relevant studies were identified through searching related databases till December, 2022. Hazard ratio (HR) or risk ratio (RR) with its corresponding 95% confidence interval (CI) was used as pooled statistics for all analyses. Results: The incidence of grade 2 or worse acute adverse gastrointestinal (GI) event was analyzed and the pooled data revealed a clear decreasing trend in the IMRT compared with 3D-CRT (RR=0.62, 95% CI: 0.45-0.84, p=0.002). IMRT slightly increased the grade ≥ 2 acute genitourinary (GU) adverse event in comparison with the 3D-CRT (RR=1.10, 95% CI: 1.02-1.19, p=0.015). The IMRT and the 3D-CRT of patients showed no substantial differences in grade ≥ 2 late GI adverse event (RR =0.62, 95% CI: 0.36-1.09, p=0.1). In those included studies, there was no significant difference between IMRT and 3D-CRT in grade 2-4 late GU adverse event (RR =1.08, 95% CI: 0.77-1.51, p=0.65). There was a significant difference in biochemical control favoring IMRT (RR =1.13, 95% CI: 1.05-1.22, p=0.002). IMRT showed modest increase in biochemical control in comparison with 3D-CRT. Conclusion: In general, based on the above results, IMRT should be considered as a better choice for the treatment of PCa. More randomized controlled trials are needed to determine the subset of patients diagnosed with PCa.
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Affiliation(s)
- Wei Guo
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, Hebei, 061000, China
| | - Yun-Chuan Sun
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, Hebei, 061000, China
| | - Li-Yuan Zhang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiao-Ming Yin
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, Hebei, 061000, China
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4
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Yu C, Yao J, He Y, Huang J, Chen M, Qian M, Lou D, Zhou Z, Chen F. Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains. Cancer Med 2023; 12:18176-18188. [PMID: 37519062 PMCID: PMC10524086 DOI: 10.1002/cam4.6395] [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: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with localized prostate cancer (LPCa) after treatment mainly surgery and radiotherapy (RT) has received increasing attention. The aim of this study is to compare the HRQoL of LPCa after surgery and RT. METHODS Web of Science, Embase, PubMed and Cochrane databases were searched after January 2000 to observe the HRQoL scores after surgery and RT at different treatment time points. RESULTS A total of 28 studies were included in this study, and the results showed that LPCa received surgery had better bowel scores than RT at ≤3 (weighted mean differences [WMD] = 4.18; p = 0.03), 3-6 (WMD = 4.16; p < 0.001), 6-12 (WMD = 2.99; p = 0.004), 24-60 (WMD = 1.87; p = 0.06), and ≥60 (WMD = 4.54; p = 0.02) months. However, LPCa received RT had higher urinary scores at ≤3 (WMD = -7.39; p = 0.02), 3-6 (WMD = -6.03; p = 0.02), 6-12 (WMD = -4.90; p < 0.001), 24-60 (WMD = -3.96; p < 0.001), ≥60 (WMD = -2.95; p < 0.001) months and had better sexual scores at ≤3 (WMD = -13.58; p = 0.09), 3-6 (WMD = -12.32; p = 0.06), 6-12 (WMD = -12.03; p = 0.002), 24-60 (WMD = -11.29; p < 0.001), and ≥60 (WMD = -3.10; p = 0.46) months than surgery. The scores difference between surgery and RT decreased over time. CONCLUSION Overall, for LPCa, surgery was associated with better HRQoL in the bowel domain, whereas RT was associated with better HRQoL in the urinary and sexual domains, with the difference between surgery and RT narrowing over time.
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Affiliation(s)
- Chao Yu
- Department of Urology, Ningbo Medical Center LiHuiLi HospitalNingbo UniversityNingboChina
| | - Jie Yao
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Yujing He
- The Second Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
| | - Jianing Huang
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Meiling Chen
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Mingxia Qian
- School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dandi Lou
- The First Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
| | - Zhizhen Zhou
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Feng Chen
- Urology DepartmentNingbo Yinzhou No. 2 HospitalNingboChina
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Olivero A, Tappero S, Maltzman O, Vecchio E, Granelli G, Secco S, Caviglia A, Bocciardi AM, Galfano A, Dell’Oglio P. Urinary Continence Recovery after Retzius-Sparing Robot Assisted Radical Prostatectomy and Adjuvant Radiation Therapy. Cancers (Basel) 2023; 15:4390. [PMID: 37686666 PMCID: PMC10486940 DOI: 10.3390/cancers15174390] [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: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) allows the preservation of the structures advocated to play a crucial role in the continence mechanism. This study aims to evaluate the association between adjuvant radiation therapy (aRT) and urinary continence (UC) recovery after RS-RARP. For the purpose of the current study, all patients submitted to RS-RARP for prostate cancer (PCa) at a single high-volume European institution between January 2010 and December 2021 were identified. Only patients that harbored pT2 stage with positive surgical margins or pT3/pN1 stage with or without positive surgical margins were included in the analyses. Two groups of patients were identified as follows: patients who had undergone aRT and patients submitted to observation (no-aRT patients). As per definition, aRT was delivered within 1-6 months after surgery. After 1:1 propensity score matching, 124 aRT patients were compared with 124 no-aRT patients who continued standard follow-up protocol after surgery. UC recovery was 81 vs. 84% in aRT vs. no-aRT patients (p = 0.7). In multivariable Cox regression analyses, aRT did not reach the independent predictor status for UC recovery at 12 months. In the subgroup analysis including only aRT patients, only the nerve-sparing technique was independently associated with UC recovery at 12 months. Conversely, the type of aRT (IMRT/VMAT vs. 3D-CRT) did not reach the independent predictor status for UC recovery at 12 months. The current study is the first to address the association between aRT and UC recovery in patients treated with RS-RARP for PCa. Based on our data, aRT is not associated with worse UC recovery. In the cohort of patients treated with aRT, the nerve-sparing technique independently predicted UC recovery.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
- IRCCS Ospedale Policlinico San Martino, University of Genova, 16131 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131 Genova, Italy
| | - Ofir Maltzman
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Enrico Vecchio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
- IRCCS Ospedale Policlinico San Martino, University of Genova, 16131 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131 Genova, Italy
| | - Giorgia Granelli
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
- IRCCS Ospedale Policlinico San Martino, University of Genova, 16131 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131 Genova, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Alberto Caviglia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Aldo Massimo Bocciardi
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
| | - Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.O.); (O.M.); (E.V.); (G.G.); (S.S.); (A.C.); (A.M.B.); (A.G.); (P.D.)
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Rapenburg 70, 2311 EZ Leiden, The Netherlands
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Numakura K, Kobayashi M, Muto Y, Sato H, Sekine Y, Sobu R, Aoyama Y, Takahashi Y, Okada S, Sasagawa H, Narita S, Kumagai S, Wada Y, Mori N, Habuchi T. The Current Trend of Radiation Therapy for Patients with Localized Prostate Cancer. Curr Oncol 2023; 30:8092-8110. [PMID: 37754502 PMCID: PMC10529045 DOI: 10.3390/curroncol30090587] [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: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
A recent approach to radiotherapy for prostate cancer is the administration of high doses of radiation to the prostate while minimizing the risk of side effects. Thus, image-guided radiotherapy utilizes advanced imaging techniques and is a feasible strategy for increasing the radiation dose. New radioactive particles are another approach to achieving high doses and safe procedures. Prostate brachytherapy is currently considered as a combination therapy. Spacers are useful to protect adjacent organs, specifically the rectum, from excessive radiation exposure.
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Affiliation(s)
- Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yumina Muto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hiromi Sato
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Ryuta Sobu
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yu Aoyama
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yoshiko Takahashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Syuhei Okada
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hajime Sasagawa
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Satoshi Kumagai
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
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7
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Sujenthiran A, Parry MG, Dodkins J, Nossiter J, Morris M, Berry B, Nathan A, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Treatment-related toxicity using prostate bed versus prostate bed and pelvic lymph node radiation therapy following radical prostatectomy: A national population-based study. Clin Transl Radiat Oncol 2023; 40:100622. [PMID: 37152844 PMCID: PMC10159812 DOI: 10.1016/j.ctro.2023.100622] [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: 11/02/2022] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose There is debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation in addition to prostate bed radiotherapy when used to treat disease recurrence following radical prostatectomy. We compared toxicity from radiation therapy (RT) to the prostate bed and pelvic lymph nodes (PBPLN-RT) with prostatebed only radiation therapy (PBO-RT) following radical prostatectomy. Methods and Materials Patients with prostate cancer who underwent post-prostatectomy RT between 2010 and 2016 were identified by using the National Prostate Cancer Audit (NPCA) database. Follow-up data was available up to December 31, 2018. Validated outcome measures, based on a framework of procedural and diagnostic codes, were used to capture ≥Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity. An adjusted competing-risks regression analysis estimated subdistribution hazard ratios (sHR). A sHR > 1 indicated a higher incidence of toxicity with PBPLN-RT than with PBO-RT. Results 5-year cumulative incidences in the PBO-RT (n = 5,087) and PBPLNRT (n = 593) groups was 18.2% and 15.9% for GI toxicity, respectively. For GU toxicity it was 19.1% and 20.7%, respectively. There was no evidence of difference in GI or GU toxicity after adjustment between PBO-RT and PBPLN-RT (GI: adjusted sHR, 0.90, 95% CI, 0.67-1.19; P = 0.45); (GU: adjusted sHR, 1.19, 95% CI, 0.99-1.44; P = 0.09). Conclusions This national population-based study found that including PLNs in the radiation field following radical prostatectomy is not associated with a significant increase in rates of ≥Grade 2 GI or GU toxicity at 5 years.
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Affiliation(s)
- Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Flatiron Health, UK
| | - Matthew G. Parry
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
- Corresponding authors at: Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, England, UK.
| | - Julie Nossiter
- Department of Health Services Research & Policy, LHSTM, UK
| | - Melanie Morris
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Brendan Berry
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Arjun Nathan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
| | - Paul Cathcart
- Department of Urology, Guy’s & St Thomas’ NHS Foundation Trust, UK
| | - Noel W. Clarke
- Department of Urology, The Christie & Salford Royal NHS Foundation Trusts, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | | | - Ajay Aggarwal
- Department of Health Services Research & Policy, LHSTM, UK
- Department of Radiotherapy, Guy’s & St Thomas’ NHS Foundation Trust, UK
- Department of Cancer Epidemiology, Population & Global Health, KCL, UK
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8
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Toxicity of dose-escalated radiotherapy up to 84 Gy for prostate cancer. Strahlenther Onkol 2023; 199:574-584. [PMID: 36930248 DOI: 10.1007/s00066-023-02060-2] [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: 08/11/2022] [Accepted: 02/12/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The outcome of radiotherapy (RT) for prostate cancer (PCA) depends on the delivered dose. While the evidence for dose-escalated RT up to 80 gray (Gy) is well established, there have been only few studies examining dose escalation above 80 Gy. We initiated the present study to assess the safety of dose escalation up to 84 Gy. METHODS In our retrospective analysis, we included patients who received dose-escalated RT for PCA at our institution between 2016 and 2021. We evaluated acute genitourinary (GU) and gastrointestinal (GI) toxicity as well as late GU and GI toxicity. RESULTS A total of 86 patients could be evaluated, of whom 24 patients had received 80 Gy and 62 patients 84 Gy (35 without pelvic and 27 with pelvic radiotherapy). Regarding acute toxicities, no > grade 2 adverse events occurred. Acute GU/GI toxicity of grade 2 occurred in 12.5%/12.5% of patients treated with 80 Gy, in 25.7%/14.3% of patients treated with 84 Gy to the prostate only, and in 51.9%/12.9% of patients treated with 84 Gy and the pelvis included. Late GU/GI toxicity of grade ≥ 2 occurred in 4.2%/8.3% of patients treated with 80 Gy, in 7.1%/3.6% of patients treated with 84 Gy prostate only, and in 18.2%/0% of patients treated with 84 Gy pelvis included (log-rank test p = 0.358). CONCLUSION We demonstrated that dose-escalated RT for PCA up to 84 Gy is feasible and safe without a significant increase in acute toxicity. Further follow-up is needed to assess late toxicity and survival.
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9
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David R, Buckby A, Kahokehr AA, Lee J, Watson DI, Leung J, O'Callaghan ME. Long term genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:8-15. [PMID: 35260794 PMCID: PMC10023565 DOI: 10.1038/s41391-022-00520-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies have shown that radiation-induced pelvic toxicity often requires urological consultation. However, the 10-year incidence of genitourinary toxicity following intensity-modulated radiotherapy (IMRT) amongst patients with localised prostate cancer remains unclear. Hence, we conducted a systematic review and meta-analysis to determine the incidence of late genitourinary toxicity relying on Radiation Therapy Oncology Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE) grade as well as the incidence of specific genitourinary toxicity. Secondary objectives involved quantifing the number of studies reporting 120-month follow-up endpoints, time to event analysis, predictive factors or economic evaluation. METHODS Articles published from January 2008 to December 2021 describing prospective studies were systematically searched in MEDLINE, EMBASE and Cochrane (PROSPERO protocol CRD42019133320). Quality assessment was performed by use of the Cochrane Risk of Bias 2 Tool for RCTs and the Newcastle Ottowa Scale for non-RCTs. Meta-analysis was performed on the 60-month incidence of RTOG and CTCAE Grade ≥2 genitourinary toxicity, haematuria, urinary retention and urinary incontinence. RESULTS We screened 4721 studies and six studies met our inclusion criteria. All included studies involved normofractionation, three included a hypofractionation comparator arm and none involved nodal irradiation. The pooled 60-month cumulative incidence of RTOG and CTCAE Grade ≥2 genitourinary toxicity were 17% (95% CI: 5-20%, n = 678) and 33% (95% CI: 27-38%, n = 153), respectively. The pooled 60-month cumulative incidence of Haematuria was 5% (95% CI: -4-14%, n = 48), Urinary incontinence 12% (95% CI: 6-18%, n = 194), Urinary retention 24% (95% CI: 9-40%, n = 10). One study reported time to event analyses, one reported predictive factors, no studies reported economic analysis or 120-month toxicity. There was considerable heterogeneity amongst the studies. CONCLUSION There are few high-quality studies reporting 60-month toxicity rates after IMRT. Conservative estimates of 60-month toxicity rates are high and there is need for longer follow-up and consistent toxicity reporting standards.
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Affiliation(s)
- Rowan David
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia.
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia.
| | - Alex Buckby
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
| | - Arman A Kahokehr
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Discipline of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
| | - Jason Lee
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
| | - David I Watson
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
| | - John Leung
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- GenesisCare, Adelaide, SA, Australia
| | - Michael E O'Callaghan
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
- Discipline of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, SA, Australia
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10
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Moll M, Weiß M, Stanisav V, Zaharie A, Goldner G. Effects of gold fiducial marker implantation on tumor control and toxicity in external beam radiotherapy of prostate cancer. Radiol Oncol 2023; 57:95-102. [PMID: 36653352 PMCID: PMC10039472 DOI: 10.2478/raon-2023-0004] [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: 07/13/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Evidence regarding the effects of fiducials in image-guided radiotherapy (IGRT) for tumor control and acute and late toxicity is sparse. PATIENTS AND METHODS Patients with primary low- and intermediate-risk prostate cancer, 40 with and 21 without gold fiducial markers (GFM), and treated between 2010 and 2015 were retrospectively included. The decision for or against GFM implantation took anaesthetic evaluation and patient choice into account. IGRT was performed using electronic portal imaging devices. The prescribed dose was 78 Gy, with 2 Gy per fraction. Biochemical no evidence of disease (bNED) failure was defined using the Phoenix criteria. Acute and late gastrointestinal (GI) and genitourinary toxicity (GU) were assessed using the Radiation Therapy Oncology Group criteria. RESULTS Most patients did not receive GFM due to contraindications for anaesthesia or personal choice (60% and 25%). Regarding tumor control, no significant differences were found regarding bNED and overall and disease-specific survival (p = 0.61, p = 0.56, and p > 0.9999, respectively). No significant differences in acute and late GI (p = 0.16 and 0.64) and GU toxicity (p = 0.58 and 0.80) were observed. CONCLUSIONS We were unable to detect significant benefits in bNED or in early or late GI and GU side effects after GFM implantation.
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Affiliation(s)
- Matthias Moll
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Magdalena Weiß
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Vladimir Stanisav
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alexandru Zaharie
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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11
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Cardoso M, Sidhom M, Udovitch M, Young T, Arumugam S. Implementing online position monitoring for prostate radiotherapy using an in-house position monitoring system: User experience and impact on workforce. J Med Imaging Radiat Oncol 2023; 67:111-118. [PMID: 36537583 DOI: 10.1111/1754-9485.13499] [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: 03/31/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To evaluate the feasibility of prostate intrafraction motion monitoring using the SeedTracker real-time image guidance system in order to improve targeting accuracy in prostate radiotherapy. METHODS SeedTracker was used to monitor prostate gold fiducial seeds with kV x-ray imaging during radiotherapy in 30 patients. Feedback from radiation therapists was collected via the use of a user evaluation form. The impact on treatment time was established by using a record and verify system. The effective dose and a risk of exposure-induced cancer death (REID) were estimated for a 60-year-old patient when using the SeedTracker system. RESULTS A total of 22 radiation therapists completed user evaluation forms. The time taken to prepare a reference data set for one patient varied with three (13.6%) radiation therapists taking less than 2 min, 10 (45.5%) between 2 and 4 min, eight (36.4%) between 4 and 6 min and one (4.5%) between 6 and 8 min. The useability of the SeedTracker system was reported as 'easy' by 21 (95.5%) radiation therapists and 'hard' by 1 (4.5%) radiation therapist. Mean treatment time changed from 6 to 7 min with prostate-only radiotherapy treatment and from 6.9 to 10.2 min with prostate and whole pelvis radiotherapy treatments. The maximum effective dose with the SeedTracker was 1.6276 mSv, and increase in REID was 0.007%. CONCLUSION The SeedTracker real-time image guidance system is a feasible tool to use in radiotherapy departments to monitor and correct for prostate intrafraction motion.
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Affiliation(s)
- Michael Cardoso
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Sidhom
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Udovitch
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, New South Wales, Australia
| | - Tony Young
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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12
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Tiruye T, O’Callaghan M, Moretti K, Jay A, Higgs B, Santoro K, Boyle T, Ettridge K, Beckmann K. Patient-reported functional outcome measures and treatment choice for prostate cancer. BMC Urol 2022; 22:169. [PMID: 36335325 PMCID: PMC9637295 DOI: 10.1186/s12894-022-01117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this study was to describe changes in patient-reported functional outcome measures (PROMs) comparing pre-treatment and 12 months after radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy and active surveillance (AS). Methods Men enrolled from 2010 to 2019 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry a prospective clinical registry were studied. Urinary, bowel, and sexual functions were measured using Expanded Prostate Cancer Index Composite (EPIC-26) at baseline and 12 months post-treatment. Higher scores on the EPIC-26 indicate better function. Multivariable regression models were applied to compare differences in function and extent of bother by treatment. Results Of the 4926 eligible men, 57.0% underwent RP, 20.5% EBRT, 7.0% brachytherapy and 15.5% AS. While baseline urinary and bowel function varied little across treatment groups, sexual function differed greatly (adjusted mean scores: RP = 56.3, EBRT = 45.8, brachytherapy = 61.4, AS = 52.8; p < 0.001). Post-treatment urinary continence and sexual function declined in all treatment groups, with the greatest decline for sexual function after RP (adjusted mean score change − 28.9). After adjustment for baseline differences, post-treatment sexual function scores after EBRT (6.4; 95%CI, 0.9–12.0) and brachytherapy (17.4; 95%CI, 9.4–25.5) were higher than after RP. Likewise, urinary continence after EBRT (13.6; 95%CI, 9.0-18.2), brachytherapy (10.6; 95%CI, 3.9–17.3) and AS (10.6; 95%CI, 5.9–15.3) were higher than after RP. Conversely, EBRT was associated with lower bowel function (− 7.9; 95%CI, − 12.4 to − 3.5) than RP. EBRT and AS were associated with lower odds of sexual bother (OR 0.51; 95%CI, 0.29–0.89 and OR 0.60; 95%CI, 0.38–0.96, respectively), and EBRT with higher odds of bowel bother (OR 2.01; 95%CI, 1.23–3.29) compared with RP. Conclusion The four common treatment approaches for prostate cancer were associated with different patterns of patient-reported functional outcomes, both pre- and 12 months post-treatment. However, after adjustment, RP was associated with a greater decline in urinary continence and sexual function than other treatments. This study underscores the importance of collecting baseline PROMs to interpret post-treatment functional outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01117-1.
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Affiliation(s)
- Tenaw Tiruye
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,grid.449044.90000 0004 0480 6730Public Health Department,, Debre Markos University,, Debre Markos, Ethiopia
| | - Michael O’Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia ,grid.1014.40000 0004 0367 2697Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Discipline of Medicine, University of Adelaide, Adelaide, South Australia , Urology Unit, Southern Adelaide Local Health Network, Adelaide, South Australia
| | - Kim Moretti
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Discipline of Surgery, University of Adelaide, Adelaide, South Australia
| | - Alex Jay
- grid.414925.f0000 0000 9685 0624Flinders Medical Centre, Bedford Park, South Australia
| | - Braden Higgs
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,grid.416075.10000 0004 0367 1221 Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Kerry Santoro
- Urology Unit, Southern Adelaide Local Health Network, Adelaide, South Australia
| | - Terry Boyle
- grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia
| | - Kerry Ettridge
- grid.430453.50000 0004 0565 2606Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304School of Public Health, University of Adelaide, Adelaide, South Australia
| | - Kerri Beckmann
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia
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13
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Advancements in the radiooncological treatment of high-risk prostate cancer: a quarter century of achievements. Radiol Oncol 2022; 56:365-370. [PMID: 35502906 PMCID: PMC9400444 DOI: 10.2478/raon-2022-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the development of treatment of primary high-risk prostate cancer in regards to biochemical no evidence of disease (bNED), acute and late gastrointestinal (GI) and genitourinary (GU) side effects. PATIENTS AND METHODS Primary high-risk prostate cancer patients treated between 1994 and 2016 were included. Applied doses ranged from 60 to 80 Gy, with a dose of 1.8 or 2 Gy per fraction. Techniques were either 3D conformal or intensity modulated radiotherapy and volumetric intensity modulated arc therapy. RESULTS 142 patients were treated with doses up to 70 Gy (median dose 66 Gy; 66 Gy group), 282 with doses between 70 and 76 Gy (median dose 74 Gy; 74 Gy group), and 141 with doses >76 Gy (median dose 78 Gy; 78 Gy group). The median follow-up was 48 months. The bNED rates were 50% after 5 years and 44% after 9 years in the 66 Gy group; 65% and 54%, respectively, in the 74 Gy group; and 83% and 66%, respectively, in the 78 Gy group (p = 0.03 vs. 74 Gy and p < 0.0001 vs. 66 Gy). We found a higher rate of acute GI side effects in the 78 Gy group compared to the other groups, but not in maximum acute GU side effects and late maximum GI and GU effects. CONCLUSIONS High-risk prostate cancer patients treated with doses of 78 Gy had significantly better bNED rates. Compared to the historical 66 Gy group, 50% more patients achieved bNED after a follow-up of 9 years.
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14
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Li SW, Chiu AW, Huang AC, Lai YW, Leu JD, Hsiao YC, Chen SS, Hsueh TY. Ten-years outcome analysis in patients with clinically localized prostate cancer treated by radical prostatectomy or external beam radiation therapy. Front Surg 2022; 9:966025. [PMID: 35965869 PMCID: PMC9372291 DOI: 10.3389/fsurg.2022.966025] [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: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Since there was no consensus on treatment options for localized prostate cancer, we performed a retrospective study to compare the long-term survival benefit of radiotherapy (RT) versus laparoscopic radical prostatectomy (LRP) in Taiwan. Methods 218 patients with clinically localized prostate cancer treated between 2008 and 2017 (64 with LRP and 154 with RT) were enrolled in this study. The outcomes of RT and LRP were assessed after patients were stratified according to Gleason score, stage, and risk group. Crude survival, prostate cancer-specific survival, and metastasis-free survival were evaluated using the log-rank test. Results The 5-year crude survival rate was 93.3% in the LRP group and 59.3% in the RT group. A significant survival benefit was found in the LRP group compared with the RT group (p = 0.004). Furthermore, significant differences were found in disease-specific survival (93.3% vs. 64.7%, p = 0.022) and metastasis-free survival (48% vs. 40.2%, p = 0.045) between the LRP and RT groups. Conclusions Men with localized prostate cancer treated initially with LRP had a lower risk of prostate cancer-specific death and metastases compared with those treated with RT.
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Affiliation(s)
- Shu-Wen Li
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
| | - Allen W. Chiu
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Urology, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Andy C. Huang
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Yu-Wei Lai
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Jyh-Der Leu
- Division of Radiation Oncology, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Yi-Chun Hsiao
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
| | - Shiou-Sheng Chen
- Department of Urology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Correspondence: Thomas Y. Hsueh
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15
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Ong AL, Knight K, Panettieri V, Dimmock M, Tuan JK, Tan HQ, Wright C. Dose-volume analysis of planned versus accumulated dose as a predictor for late gastrointestinal toxicity in men receiving radiotherapy for high-risk prostate cancer. Phys Imaging Radiat Oncol 2022; 23:97-102. [PMID: 35879938 PMCID: PMC9307677 DOI: 10.1016/j.phro.2022.07.001] [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: 03/20/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Interfractional variations in organs at risk were observed in prostate radiotherapy. Rectal accumulated dose was significantly higher at the intermediate-high dose region. Rectal planned dose was significantly higher at the very high dose region. Dose>78.2 Gy to 0.03 cc of rectum was predictive of late Grade 2 toxicity. Patient age>72 years was predictive of late Grade 2 rectal toxicity.
Background and purpose Significant dose deviations have been reported between planned (DP) and accumulated (DA) dose in prostate radiotherapy. This study aimed to develop multivariate analysis (MVA) models associating Grade 1 and 2 gastrointestinal (GI) toxicity with clinical and DP or DA dosimetric variables separately. Materials and methods Dose volume (DV) metrics were compared between DA and DP for 150 high-risk prostate cancer patients. MV models were generated from significant clinical and dosimetric variables (p < 0.05) at univariate level. Dose-based-region of interest (DB-ROI) metrics were included. Model performance was measured, and additional subgroup analysis were performed. Results Rectal DA demonstrated a higher intermediate-high dose (V30-65 Gy and DB-ROI at 15–50 mm) compared to DP. Conversely, at the very high dose region, rectal DA (V75 Gy and DB-ROI at 5–10 mm) were significantly lower. In MVA, rectal DB-ROI at 10 mm was predictive for Grade ≥ 1 GI toxicity for DA and DP. Age, rectal DA for D0.03 cc, and rectal DP for DB-ROI 10 mm were predictors for Grade 2 GI toxicity. Subgroup analysis revealed that patients ≥ 72 years old and a rectal DA of ≥ 78.2 Gy were highly predictive of Grade 2 GI toxicity. Conclusions The dosimetric impact of a higher dose rectal dose in DA due to volumetric changes was minimal and was not predictive of detrimental clinical toxicity apart from rectal D0.03 cc ≥ 78.2 Gy for Grade 2 GI toxicity. The use of the DB-ROI method can provide equivalent predictive power as the DV method in toxicity prediction.
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Hassan IM, Attalla EM, El-Gohary MI. Impact of 3D conformal and Intensity Modulated Radiotherapy on secondary cancer risk for patients with early prostate cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Ghosh S, Hazra J, Pal K, Nelson VK, Pal M. Prostate cancer: Therapeutic prospect with herbal medicine. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100034. [PMID: 34909665 PMCID: PMC8663990 DOI: 10.1016/j.crphar.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PCa) is a major cause of morbidity and mortality in men worldwide. A geographic variation on the burden of the disease suggested that the environment, genetic makeup, lifestyle, and food habits modulate one's susceptibility to the disease. Although it has been generally thought to be an older age disease, and awareness and timely execution of screening programs have managed to contain the disease in the older population over the last decades, the incidence is still increasing in the population younger than 50. Existing treatment is efficient for PCa that is localized and responsive to androgen. However, the androgen resistant and metastatic PCa are challenging to treat. Conventional radiation and chemotherapies are associated with severe side effects in addition to being exorbitantly expensive. Many isolated phytochemicals and extracts of plants used in traditional medicine are known for their safety and diverse healing properties, including many with varying levels of anti-PCa activities. Many of the phytochemicals discussed here, as shown by many laboratories, inhibit tumor cell growth and proliferation by interfering with the components in the pathways responsible for the enhanced proliferation, metabolism, angiogenesis, invasion, and metastasis in the prostate cells while upregulating the mechanisms of cell death and cell cycle arrest. Notably, many of these agents simultaneously target multiple cellular pathways. We analyzed the available literature and provided an update on this issue in this review article. Prostate cancer in a major cause of death in older population worldwide. Efficacies of current treatment options are limited in many cases. Phytochemicals and extracts isolated from plants show anti-prostate cancer activity with unique mechanisms. Certain phytochemicals alone or in combination with current chemotherapy show therapeutic promise.
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Affiliation(s)
- Suvranil Ghosh
- Division of Molecular Medicine, Bose Institute, Kolkata, West Bengal, India
| | - Joyita Hazra
- Department of Biotechnology, Indian Institute of Technology Madras, Tamil Nadu, India
| | | | - Vinod K Nelson
- Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India
| | - Mahadeb Pal
- Division of Molecular Medicine, Bose Institute, Kolkata, West Bengal, India
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18
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Dinçer S, Uysal E, Berber T, Akboru MH. The efficacy and tolerability of ultra-hypofractionated radiotherapy in low-intermediate risk prostate cancer patients: single center experience. Aging Male 2021; 24:50-57. [PMID: 34233569 DOI: 10.1080/13685538.2021.1948992] [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] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We aimed to investigate the efficacy and tolerability of ultra-hypofractionated radiotherapy (UHRT) in the treatment of low and intermediate-risk prostate cancer patients. METHODS This retrospective study was conducted using data derived from 44 patients who underwent UHRT, and toxicity assessment and clinical response were investigated. Treatment consisted of 35-36.25 Gy in 5 fractions using stereotactic ablative radiotherapy (SABR) with the Linac-based delivery system. RESULTS The median duration of follow-up was 52 months (8-68 months) and the median age was 71.5 years (54-85 years). Twenty-seven patients were assigned as intermediate-risk, whereas 17 patients had low-risk. The 5-year overall survival rate was 87.8%, while the 5-year biochemical recurrence-free survival (bRFS) rate was 97.4%. Acute grade 3 genitourinary (GU) side effect was not observed in any patient, whereas acute gastrointestinal (GI) system grade 3 side effect was seen in 6.8% of the patients. Late grade 3 GU and GI side effects were seen in 4.6% and 6.8% of the patients, respectively. In patients with planning target volume (PTV) ≥85 ml, acute grade ≥2 GU side effects were more common (p=.034). CONCLUSION Our data demonstrated that UHRT administered with volumetric arc therapy (VMAT) can be recommended for selected patients with low-intermediate risk prostate cancer. Further prospective, multicentric, controlled trials on larger series are warranted to reach more accurate conclusions.
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Affiliation(s)
- Selvi Dinçer
- Department of Radiation Oncology, University of Health Science Prof. Dr. CemilTascioglu City Hospital, Istanbul, Turkey
| | - Emre Uysal
- Department of Radiation Oncology, University of Health Science Prof. Dr. CemilTascioglu City Hospital, Istanbul, Turkey
| | - Tanju Berber
- Department of Radiation Oncology, University of Health Science Prof. Dr. CemilTascioglu City Hospital, Istanbul, Turkey
| | - Mustafa Halil Akboru
- Department of Radiation Oncology, University of Health Science Prof. Dr. CemilTascioglu City Hospital, Istanbul, Turkey
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Makino T, Izumi K, Iwamoto H, Mizokami A. Treatment Strategies for High-Risk Localized and Locally Advanced and Oligometastatic Prostate Cancer. Cancers (Basel) 2021; 13:cancers13174470. [PMID: 34503280 PMCID: PMC8430548 DOI: 10.3390/cancers13174470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The definitions of locally advanced and oligometastatic prostate cancer are ambiguous, and there are no standard treatments for these. Although multidisciplinary treatment combining systemic and local treatment may be effective, there are many unresolved issues such as the choice of local treatment, use of new endocrine agents and chemotherapy, and selection of optimal patients. The present article discusses the definitions, diagnoses, and treatment of very high-risk prostate cancer and oligometastatic prostate cancer. Abstract Despite the significant advances in the treatment of high-risk prostate cancer, patients with very high-risk features such as being locally advanced (clinical stage T3–4 or minimal nodal involvement), having a high Gleason pattern, or with oligometastasis may still have a poor prognosis despite aggressive treatment. Multidisciplinary treatment with both local and systemic therapies is thought to be effective, however, unfortunately, there is still no standard treatment. However, in recent years, local definitive therapy using a combination of radiotherapy and androgen deprivation is being supported by several randomized clinical trials. This study reviews the current literature with a focus on the definition of very high-risk prostate cancer, the role of modern imaging, and its treatment options.
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Affiliation(s)
- Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Ishikawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Correspondence: ; Tel.: +81-76-265-2393; Fax: +81-76-234-4263
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
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20
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Srinivasan S, Kunder S, Maitre P, Murthy V. Immediate or salvage radiotherapy after radical prostatectomy: Do we finally know? THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:282-284. [PMID: 35593236 DOI: 10.25259/nmji_127_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Shashank Srinivasan
- Department of Radiation Oncology ACTREC and TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shreya Kunder
- Department of Radiation Oncology ACTREC and TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Priyamvada Maitre
- Department of Radiation Oncology ACTREC and TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology ACTREC and TMH, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Chen H, Schneiders FL, Bruynzeel AME, Lagerwaard FJ, van Sörnsen de Koste JR, Cobussen P, Bohoudi O, Slotman BJ, Louie AV, Senan S. Impact of daily plan adaptation on organ-at-risk normal tissue complication probability for adrenal lesions undergoing stereotactic ablative radiation therapy. Radiother Oncol 2021; 163:14-20. [PMID: 34343546 DOI: 10.1016/j.radonc.2021.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) can achieve good local control for metastatic adrenal lesions. Magnetic resonance (MR)-guidance with daily on-table plan adaptation can augment the delivery of SABR with greater dose certainty. The goal of this study was to quantify the potential clinical benefit MR-guided daily-adaptive adrenal SABR using the normal tissue complication probability (NTCP) framework. METHODS Patients treated with adrenal MR-guided SABR at a single institution were retrospectively reviewed. Lyman-Kutcher-Burman NTCP models were used to calculate the NTCP of upper abdominal organs-at-risk (OARs) at simulation and both before and after daily on-table plan adaptation. Differences in OAR NTCPs were assessed using signed-rank tests. Potential predictors of the benefits of adaptation were assessed by linear regression. RESULTS Fifty-two adrenal MR-guided SABR courses were analyzed. The baseline simulation plan underestimated the absolute stomach NTCP by 10.0% on average (95% confidence interval: 4.7-15.2%, p < 0.001). Daily on-table adaptation lowered absolute NTCP by 8.7% (4.2-13.2%, p < 0.001). The most significant predictor of the benefits of adaptation was lesion laterality (p = 0.018), with left-sided lesions benefitting more (13.3% [6.3-20.4%], p < 0.001) than right-sided lesions (2.1% [-1.6-5.7%], p = 0.25). Sensitivity analyses did not change the statistical significance of the findings. CONCLUSION NTCP analysis revealed that patients with left adrenal tumors were more likely to benefit from MR-guided daily on-table adaptive SABR using current dose/fractionation regimens due to reductions in predicted gastric toxicity. Right-sided adrenal lesions may be considered for dose escalation due to low predicted NTCP.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands.
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - John R van Sörnsen de Koste
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Paul Cobussen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Omar Bohoudi
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
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22
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Wall PDH, Fontenot JD. Quality assurance-based optimization (QAO): Towards improving patient-specific quality assurance in volumetric modulated arc therapy plans using machine learning. Phys Med 2021; 87:136-143. [PMID: 33775567 DOI: 10.1016/j.ejmp.2021.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Previous literature has shown general trade-offs between plan complexity and resulting quality assurance (QA) outcomes. However, existing solutions for controlling this trade-off do not guarantee corresponding improvements in deliverability. Therefore, this work explored the feasibility of an optimization framework for directly maximizing predicted QA outcomes of plans without compromising the dosimetric quality of plans designed with an established knowledge-based planning (KBP) technique. MATERIALS AND METHODS A support vector machine (SVM) was developed - using a database of 500 previous VMAT plans - to predict gamma passing rates (GPRs; 3%/3mm percent dose-difference/distance-to-agreement with local normalization) based on selected complexity features. A heuristic, QA-based optimization (QAO) framework was devised by utilizing the SVM model to iteratively modify mechanical treatment features most commonly associated with suboptimal GPRs. Specifically, leaf gaps (LGs) <50 mm were widened by random amounts, which impacts all aperture-based complexity features. 13 prostate KBP-guided VMAT plans were optimized via QAO using user-specified maximum LG displacements before corresponding changes in predicted GPRs and dose were assessed. RESULTS Predicted GPRs increased by an average of 1.14 ± 1.25% (p = 0.006) with QAO using a 3 mm maximum random LG displacement. There were small differences in dose, resulting in similarly small changes in tumor control probability (maximum increase = 0.05%) and normal tissue complication probabilities in the bladder, rectum, and femoral heads (maximum decrease = 0.2% in the rectum). CONCLUSION This study explored the feasibility of QAO and warrants future investigations of further incorporating QA endpoints into plan optimization.
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Affiliation(s)
- Phillip D H Wall
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA.
| | - Jonas D Fontenot
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA; Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA
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Valero J, Montero A, Hernando O, Izquierdo M, Sánchez E, García-Aranda M, López M, Ciérvide R, Martí J, Álvarez B, Alonso R, Chen-Zhao X, Fernández-Letón P, Rubio C. Moderate hypofractionated post-prostatectomy radiation therapy is feasible and well tolerated: experience from a single tertiary cancer centre. Clin Transl Oncol 2021; 23:1452-1462. [PMID: 33433839 DOI: 10.1007/s12094-020-02543-z] [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: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Conventional post-prostatectomy radiation therapy comprises 6.5-8 weeks of treatment, therefore, hypofractionated and shortened schemes arouse increasing interest. We describe our experience regarding feasibility and clinical outcome of a post-prostatectomy moderate hypofractionated image-guided radiotherapy schedule MATERIALS AND METHODS: From Oct 2015-Mar 2020, 113 patients, median age of 62 years-old (range 45-76) and prostate adenocarcinoma of low risk (30%), intermediate risk (49%) and high risk (21%) were included for adjuvant (34%) or salvage radiation therapy (66%) after radical prostatectomy (RP). All patients underwent radiotherapy with image-guided IMRT/VMAT to a total dose of 62.5 Gy in 2.5 Gy/fraction in 25 fractions. Sixteen patients (14%) received concomitant androgen deprivation therapy. RESULTS With a median follow-up of 29 months (range 3-60 months) all patients but three are alive. Eleven patients (10%) developed exclusive biochemical relapse while 19 patients (17%) presented macroscopically visible relapse: prostatectomy bed in two patients (2%), pelvic lymph nodes in 13 patients (11.5%) and distant metastases in four patients (4%). The 3 years actuarial rates for OS, bFRS, and DMFS were 99.1, 91.1 and 91.2%, respectively. Acute and late tolerance was satisfactory. Maximal acute genitourinary (AGU) toxicity was G2 in 8% of patients; maximal acute gastrointestinal (AGI) toxicity was G2 in 3.5% of patients; maximal late genitourinary (LGU) toxicity was G3 in 1% of patients and maximal late gastrointestinal (LGI) toxicity was G2 in 2% of patients. There were no cases of severe acute or late toxicity. No relationship was found between acute or late GI/GU adverse effects and dosimetric parameters, age, presence of comorbidities or concomitant treatments. CONCLUSIONS Hypofractionated radiotherapy (62.5 Gy in 25 2.5 Gy fractions) is feasible and well tolerated with low complication rates allowing for a moderate dose-escalation that offers encouraging clinical results for biochemical control and survival in patients with prostate cancer after radical prostatectomy.
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Affiliation(s)
- J Valero
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - A Montero
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain.
| | - O Hernando
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M Izquierdo
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - E Sánchez
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M García-Aranda
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M López
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - R Ciérvide
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - J Martí
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - B Álvarez
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - R Alonso
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - X Chen-Zhao
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | | | - C Rubio
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
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Radiotherapy challenges in COVID era. BIOMEDICAL ENGINEERING TOOLS FOR MANAGEMENT FOR PATIENTS WITH COVID-19 2021. [PMCID: PMC8192315 DOI: 10.1016/b978-0-12-824473-9.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pandemic caused by the new coronavirus (SARS-CoV-2) associated with a disease named COVID-19 by the World Health Organization that began in late 2019 in Wuhan city has become a global public health problem. Only 2 months later, the new virus affected most countries of the world, the consequence being an overload of health systems, especially Intensive Care Units. Considered a category of patients at high risk of developing severe forms of the disease, cancer patients can develop a severe form of the disease, complicated by acute respiratory distress syndrome requiring mechanical ventilation. Radiotherapy, as a treatment included in the multidisciplinary management of cancer for both curative and palliative purposes, is also affected by the COVID-19 pandemic. COVID-19-positive or -suspected patients are a special category for which the decision to postpone treatment should be made based on the particularities of tumor biology and the radiobiological effect of a gap in radiation fractions delivery. Emergencies including spinal cord compressions, tumor bleeding, and brain metastases not responsive to corticosteroid treatment, should be considered a priority but the palliative treatment should be limited from one single fraction to maximum five fractions for spinal cord compression and whole brain radiotherapy. Radiotherapy for brain metastases does not bring a benefit in terms of overall survival for patients with life expectancy of days or weeks and dexamethasone treatment is the correct choice in this situation. In all settings, the approach of radiotherapy treatment must be adapted for both scenarios of an outbreak pandemic, when general measures of social distancing and protection by specific equipment of patients and radiotherapy staff are a priority, but also for a long period of coexistence with the virus with possible new “pandemic waves.”
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Barra S, Guarnieri A, di Monale E Bastia MB, Marcenaro M, Tornari E, Belgioia L, Magrini SM, Ricardi U, Corvò R. Short fractionation radiotherapy for early prostate cancer in the time of COVID-19: long-term excellent outcomes from a multicenter Italian trial suggest a larger adoption in clinical practice. LA RADIOLOGIA MEDICA 2021; 126:142-146. [PMID: 32415472 PMCID: PMC7227177 DOI: 10.1007/s11547-020-01216-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate stereotactic body radiotherapy (SBRT) in low-risk Prostate Cancer patients as preferred treatment option in emergency health conditions. MATERIALS AND METHODS From April 2013 to September 2015, 28 patients with low-risk prostate cancer were prospectively enrolled. The SBRT prescribed dose was 36.25 Gy in 5 fractions, twice a week. Primary endpoints were acute and late toxicity. Secondary endpoints were biochemical recurrence free survival (bRFS) and overall survival. RESULTS Median follow-up was 65.5 months (range 52-81). No acute G3 or G4 toxicity was recorded. Acute G1 or G2 genitourinary (GU) toxicity occurred in 43% and acute G1-G2 gastrointestinal (GI) toxicity in 14%. Late G1 and G3 GU toxicity in 18% and 3.5%, respectively. The G3 toxicity was not directly attributable to radiotherapy. Late G1 GI toxicity occurred in 18%. 5yy bRFS was 96.5% (95% CI 82.3-99.4%). CONCLUSIONS Stereotactic body radiotherapy for early prostate cancer reported safe toxicity profile and a good clinical outcome at the median follow-up of 5 years. It may be an useful option if radiotherapy is required in emergency medical conditions.
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Affiliation(s)
- Salvina Barra
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessia Guarnieri
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | | | - Michela Marcenaro
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Tornari
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy.
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - Umberto Ricardi
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | - Renzo Corvò
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy
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Belkacemi Y, Latorzeff I, Hasbini A, Coraggio G, Pasquier D, Toledano A, Hennequin C, Bossi A, Chapet O, Crehange G, Guerif S, Duberge T, Allouache N, Clavere P, Gross E, Supiot S, Azria D, Bolla M, Sargos P. Patterns of practice of androgen deprivation therapy combined to radiotherapy in favorable and unfavorable intermediate risk prostate cancer. Results of The PROACT Survey from the French GETUG Radiation Oncology group. Cancer Radiother 2020; 24:892-897. [PMID: 33144063 DOI: 10.1016/j.canrad.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The intermediate-risk (IR) prostate cancer (PCa) group is heterogeneous in terms of prognosis. For unfavorable or favorable IR PCa treated by radiotherapy, the optimal strategy remains to be defined. In routine practice, the physician's decision to propose hormonal therapy (HT) is controversial. The PROACT survey aimed to evaluate pattern and preferences of daily practice in France in this IR population. MATERIALS AND METHODS A web questionnaire was distributed to French radiotherapy members of 91 centers of the Groupe d'Etude des Tumeurs Uro-Genitales (GETUG). The questionnaire included four sections concerning: (i) the specialists who prescribe treatments and multidisciplinary decisions (MTD) validation; (ii) the definition of IR subsets of patients; (iii) radiotherapy parameters; (iv) the pattern of practice regarding cardiovascular (CV) and (iv) metabolic evaluation. A descriptive presentation of the results was used. RESULTS Among the 82 responses (90% of the centers), HT schedules and irradiation techniques were validated by specific board meetings in 54% and 45% of the centers, respectively. Three-fourths (76%) of the centers identified a subset of IR patients for a dedicated strategy. The majority of centers consider PSA>15 (77%) and/or Gleason 7 (4+3) (87%) for an unfavorable IR definition. Overall, 41% of the centers performed systematically a CV evaluation before HT prescription while 61% consider only CV history/status in defining the type of HT. LHRH agonists are more frequently prescribed in both favorable (70%) and unfavorable (98%) IR patients. Finally, weight (80%), metabolic profile (70%) and CV status (77%) of patients are considered for follow-up under HT. CONCLUSION To the best of our knowledge, this is the first survey on HT practice in IR PCa. The PROACT survey indicates that three-quarters of the respondents identify subsets of IR-patients in tailoring therapy. The CV status of the patient is considered in guiding the HT decision, its duration and type of drug.
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Affiliation(s)
- Y Belkacemi
- AP-HP, hôpitaux universitaires Henri-Mondor, Inserm U955 (équipe 21), IMRB, université Paris-Est Créteil, CHU de Henri-Mondor, 51, avenue Mal-De-Lattre-de-Tassigny, 94000 Créteil, France.
| | | | | | - G Coraggio
- AP-HP, hôpitaux universitaires Henri-Mondor, Inserm U955 (équipe 21), IMRB, université Paris-Est Créteil, CHU de Henri-Mondor, 51, avenue Mal-De-Lattre-de-Tassigny, 94000 Créteil, France
| | - D Pasquier
- Centre OscarLambret, CHRU de Lille, Lille, France
| | - A Toledano
- Clinique Hartmann, Neuilly-sur-Seine, France
| | | | - A Bossi
- Institut Gustave-Roussy, Villejuif, France
| | | | - G Crehange
- Institut Curie/René Huguenin, Paris/Saint Cloud, France
| | - S Guerif
- CHU de Poitiers, Poitiers, France
| | - T Duberge
- Croix-Rouge française, Toulon, France
| | | | | | - E Gross
- Ramsay-Générale de santé, hôpital privé Clairval, Marseille, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, Saint-Heblain, France
| | | | - M Bolla
- CHU de Grenoble, Grenoble, France
| | - P Sargos
- Institut Bergonie, Bordeaux, France
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Yasui M, Sakaguchi M, Jikuya R, Tsutsumi S, Tatenuma T, Noguchi G, Umemoto S, Katayama K, Narimatsu H, Uemura H, Kishida T. Comparative effectiveness of surgery and radiotherapy for survival of patients with clinically localized prostate cancer: A population-based coarsened exact matching retrospective cohort study. Oncol Lett 2020; 20:150. [PMID: 32934718 PMCID: PMC7475640 DOI: 10.3892/ol.2020.12013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/31/2020] [Indexed: 11/05/2022] Open
Abstract
Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, no large cohort study comparing surgery and radiation has been performed in Japan or Asia. The objective of the current study was to compare the survival outcomes of patients with clinically localized prostate cancer and in elderly and young patients receiving surgery and radiotherapy. The survival outcomes of patients with localized prostate cancer (age at diagnosis ≤79 years, clinical T1-3) initially treated with surgery or radiotherapy were retrospectively analyzed. Data were collected from the population-based cancer registry of the Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage and cancer differentiation was performed between the two treatment groups. Patients were also categorized into two subgroups by age using a cutoff of 70 years for analysis. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in cancer-specific survival (CSS) was observed between the two groups (P=0.612). However, the surgery group had significantly better overall survival (OS; P=0.004). When stratified for age, similar tendencies were observed in the elderly group (aged 70-79 years; CSS, P=0.961 and OS, P=0.007). No significant difference in either CSS or OS was identified in the younger group (P=0.550 and P=0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than those undergoing surgery (69.3 vs. 78.2%; P=0.128). The results indicated that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, no significant difference was observed in CSS. These results should be interpreted with caution, given that some important factors were unavailable in the present study, such as prostate-specific antigen values and Gleason scores. Prospective trials evaluating these therapies are warranted.
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Affiliation(s)
- Masato Yasui
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Masahiko Sakaguchi
- Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa 241-8515, Japan
| | - Ryousuke Jikuya
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Sohgo Tsutsumi
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Go Noguchi
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Susumu Umemoto
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Kayako Katayama
- Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa 241-8515, Japan
| | - Hiroto Narimatsu
- Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa 241-8515, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
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Tsirkas K, Zygogianni A, Kougioumtzopoulou A, Kouloulias V, Liakouli Z, Papatsoris A, Georgakopoulos J, Antypas C, Armpillia C, Dellis A. A-blockers for the management of lower urinary tract symptoms in patients with prostate cancer treated with external beam radiotherapy: a randomized controlled study. World J Urol 2020; 39:1805-1813. [PMID: 32776244 DOI: 10.1007/s00345-020-03398-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This is a prospective study aiming to assess the efficacy of α-blockers in treating radiotherapy-induced symptoms of the lower urinary tract and its possible prophylactic role on acute urinary retention (AUR) in patients undergoing radical external beam radiotherapy (EBRT) for localized prostate cancer (PCa). METHODS Overall, 108 patients with localized PCa were recruited and randomly assigned in to two groups; 54 patients of Group 1 received tamsulosin 0.4 mg once daily with the initiation of EBRT and for 6 months and 54 patients of Group 2 served as the control group. All patients received radical EBRT and had post-void volume (Vres) assessment. The International Prostate Symptom Score (IPSS) questionnaire and evaluation of episodes of AUR were performed after the end of radiotherapy, at 3 and at 6 months. RESULTS The incidence of AUR was significantly (p = 0.027) lower in group 1 compared to group 2. No independent predictive factors for AUR were identified in regression analysis. The IPSS changes in univariate and multivariate analysis at 3 months showed significant correlation with α-blockers only, while at 6 months showed significant correlation with Vres assessments (at 3 and 6 months) and with α-blockers. Side effects due to medication were mild and none of the patients discontinued the treatment. CONCLUSIONS The selective use of α-blocker appears to prevent AUR in EBRT-treated patients. Although the administration of α-blockers might relieve patient-reported symptoms, there are no established independent predictive factors to distinguish patients who may benefit.
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Affiliation(s)
- Kimon Tsirkas
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Zygogianni
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Kougioumtzopoulou
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece.
| | - Vasileios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Zoi Liakouli
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Georgakopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Christos Antypas
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Armpillia
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Outaggarts Z, Wegener D, Berger B, Zips D, Paulsen F, Bleif M, Thorwarth D, Alber M, Dohm O, Müller AC. Target miss using PTV-based IMRT compared to robust optimization via coverage probability concept in prostate cancer. Acta Oncol 2020; 59:911-917. [PMID: 32436467 DOI: 10.1080/0284186x.2020.1760349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: Cure- and toxicity rates of prostate IGRT can both be affected by ill-chosen planning target volume (PTV) margins. For dose-escalated prostate radiotherapy, we studied the potential for organ at risk (OAR) sparing and compensation of prostate motion with robust plan optimization using the coverage probability (CovP) concept compared to conventional PTV-based IMRT.Material and methods: We evaluated plan quality of CovP-plans for 27 intermediate risk prostate cancer patients treated in a prospective study (78 Gy/39 fractions). Clinical target volume (CTV) and OARs were contoured on three separate CTs to capture movement and deformation. To define the internal target volume (ITV), the union of CTV1-3 was encompassed by an isotropic margin of 7 mm for the planning process. CovP-dose distribution is optimized considering weight factors for IMRT constraints derived from probabilities of systematic organ displacement in the three CTs. CovP-dose volume histograms (DVHs) were compared with additionally calculated conventional PTV-based IMRT plans. PTV-based IMRT was planned on one-single CT with an isotropically expanded CTV to generate the PTV (i.e., CTV1 + 7mm) and was evaluated on the two other CTs.Results: The CovP-concept showed higher robustness in target volume coverage. Target miss was frequently observed with PTV-based IMRT, resulting in cold spots until 70 Gy with the CovP-concept. The target dose at 74 Gy was comparable, while further the dose-escalation (75-78 Gy) was improved with PTV-based IMRT. However, dose-escalation with PTV-based IMRT was associated with increased OAR-doses, especially in high-dose areas.Conclusions: Probabilistic dose-escalated IMRT was feasible in this prospective study. Comparison of the CovP-concept with PTV-based IMRT revealed superiority with regard to target-coverage and sparing of OARs. The CovP-concept implements a robust plan optimization strategy for organ deformation and motions and could, therefore, serve as a less demanding compromise on the way to adaptive IGRT avoiding daily time-consuming re-planning. SUMMARYWe evaluated the robustness of coverage probability (CovP)-based IMRT plans within a prospective study for prostate cancer radiotherapy. The treatment plans were compared with newly calculated conventional PTV-based IMRT plans. We were able to show that CovP led to a clearly more robust target coverage by avoiding hot spots at OARs compared to conventional PTV-based IMRT. In addition, negative consequences of an inflated PTV can be ameliorated by a more relaxed CovP-based dose prescription.
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Affiliation(s)
- Zoulikha Outaggarts
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Berger
- Clinic for Radiation Oncology, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Bleif
- Clinic for Radiology and Radiation Oncology, ALB FILS Clinics Hospital on the Eichert, Goppingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section Medical Physics, University Hospital Tübingen, Tübingen, Germany
| | - Markus Alber
- Clinic for Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Dohm
- Department of Radiation Oncology, Section Medical Physics, University Hospital Tübingen, Tübingen, Germany
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Effectiveness of rectal displacement devices in managing prostate motion: a systematic review. Strahlenther Onkol 2020; 197:97-115. [DOI: 10.1007/s00066-020-01633-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
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31
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Radiotherapy of prostate cancer: impact of treatment characteristics on the incidence of second tumors. BMC Cancer 2020; 20:90. [PMID: 32013912 PMCID: PMC6998272 DOI: 10.1186/s12885-020-6581-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been hypothesized that radiotherapy (RT) techniques delivering radiations to larger volumes (IMRT, VMAT) are potentially associated with a higher risk of second primary tumors. The aim of this study was to analyse the impact of RT technique (3D-CRT vs IMRT/VMAT) on the incidence of second tumors in prostate cancer (PCa) patients. METHODS A retrospective study on 2526 previously irradiated PCa patients was performed. Patients were treated with 3D-CRT (21.3%), IMRT (68.1%), or VMAT (10.6%). Second tumors incidence was analysed in 3 categories: pelvic, pelvic and abdominal, and "any site". The correlation with RT technique was analysed using log-rank test and Cox's proportional hazard method. RESULTS With a median follow-up of 72 months (range: 9-185), 92 (3.6%) cases of second tumors were recorded with 48 months (range: 9-152) median interval from RT. Actuarial 10-year second tumor free survival (STFS) was 87.3%. Ten-year STFS in patients treated with 3D-CRT and IMRT/VMAT was 85.8 and 84.5%, respectively (p: .627). A significantly higher 10-year cumulative incidence of second tumors in the pelvis was registered in patients treated with IMRT/VMAT compared to 3D-CRT (10.7% vs 6.0%; p: .033). The lower incidence of second pelvic cancers in patients treated with 3D-CRT was confirmed at multivariable analysis (HR: 2.42, 95%CI: 1.07-5.47, p: .034). CONCLUSIONS The incidence of second pelvic tumors after RT of PCa showed a significant correlation with treatment technique. Further analyses in larger series with prolonged follow-up are needed to confirm these results.
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SBRT for Localized Prostate Cancer: Is it Ready for Take-Off? Int J Radiat Oncol Biol Phys 2020; 105:618-620. [PMID: 31540596 DOI: 10.1016/j.ijrobp.2019.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 11/23/2022]
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Hennequin C, Guillerm S, Quero L. Rationale for hypofractionation. Cancer Radiother 2019; 23:500-502. [PMID: 31444076 DOI: 10.1016/j.canrad.2019.07.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
Fractionation was established more than fifty years ago as the best way to obtain a differential effect between tumors and normal tissues. However, new technologies allowed today to spare critical organs from the radiation fields. And so protracted courses of irradiation are no longer required. Hypofractionation have clear practical advantages over classical fractionation: it saves the patient time; it saves money for public health system; it reduces pressure on radiotherapy units. In several localization, it has proved to be as efficient as classical fractionation without increasing late effects. In prostate cancer, some radiobiological considerations argue in favor of a better efficiency, but clinical trials did not demonstrated differences in biological control. In conclusion, for all diseases where hypofractionation was demonstrated efficient, it must be fully implemented. Invoice procedures must be adapted to maintain a sufficient level of reimbursement of radiotherapy centers.
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Affiliation(s)
- C Hennequin
- Radiation oncology department, hôpital Saint-Louis, AP-HP, Paris, France.
| | - S Guillerm
- Radiation oncology department, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Quero
- Radiation oncology department, hôpital Saint-Louis, AP-HP, Paris, France
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Pacelli R, Caroprese M, Palma G, Oliviero C, Clemente S, Cella L, Conson M. Technological evolution of radiation treatment: Implications for clinical applications. Semin Oncol 2019; 46:193-201. [PMID: 31395286 DOI: 10.1053/j.seminoncol.2019.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
The contemporary approach to the management of a cancer patient requires an "ab initio" involvement of different medical domains in order to correctly design an individual patient's pathway toward cure. With new therapeutic tools in every medical field developing faster than ever before the patient care outcomes can be achieved if all surgical, drug, and radiation options are considered in the design of the appropriate therapeutic strategy for a given patient. Radiation therapy (RT) is a clinical discipline in which experts from different fields continuously interact in order to manage the multistep process of the radiation treatment. RT is found to be an appropriate intervention for diverse indications in about 50% of cancer patients during the course of their disease. Technologies are essential in dealing with the complexity of RT treatments and for driving the increasingly sophisticated RT approaches becoming available for the treatment of Cancer. High conformal techniques, namely intensity modulated or volumetric modulated arc techniques, ablative techniques (Stereotactic Radiotherapy and Stereotactic Radiosurgery), particle therapy (proton or carbon ion therapy) allow for success in treating irregularly shaped or critically located targets and for the sharpness of the dose fall-off outside the target. The advanced on-board imaging, including real-time position management systems, makes possible image-guided radiation treatment that results in substantial margin reduction and, in select cases, implementation of an adaptive approach. The therapeutic gains of modern RT are also due in part to the enhanced anticancer activity obtained by coadministering RT with chemotherapy, targeted molecules, and currently immune checkpoints inhibitors. These main clinically relevant steps forward in Radiation Oncology represent a change of gear in the field that may have a profound impact on the management of cancer patients.
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Affiliation(s)
- Roberto Pacelli
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy.
| | - Mara Caroprese
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
| | - Giuseppe Palma
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | | | | | - Laura Cella
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
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Leufgens F, Berneking V, Vögeli TA, Kirschner-Hermanns R, Eble MJ, Pinkawa M. Quality of Life Changes >10 Years After Postoperative Radiation Therapy After Radical Prostatectomy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2019; 105:382-388. [PMID: 31201895 DOI: 10.1016/j.ijrobp.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/20/2019] [Accepted: 06/01/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To analyze long-term quality-of-life (QoL) changes related to postoperative radiation therapy (RT) after radical prostatectomy. METHODS AND MATERIALS Patients who received postoperative 3-dimensional conformal RT in the years 2003 to 2008 with 1.8 to 2.0 Gy fractions up to 66.0 to 66.6 Gy (n = 181) were surveyed using the Expanded Prostate Cancer Index Composite questionnaire before the beginning of RT (A); on the last day (B); and 2 months (C), 1 to 3 years (D), 6 to 9 years (E), and 10 to 13 years (F) after RT. RESULTS Mean urinary bother, urinary incontinence bother, and bowel bother score changes (in relation to baseline at time A) of 13, 14, and 7 and 14, 15, and 7 were found at times E and F, respectively (P < .01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (P < .01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time when comparing patients aged <68 versus ≥68 years: 0 versus 7 and 0 versus 7 points at time D and 8 versus 23 and 6 versus 35 points at time F, respectively. Patients who did not respond to RT with a decreasing prostate-specific antigen level had greater urinary and urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs 12; P = .04, 36 vs 10; P = .03, and 20 vs 5; P = .07, respectively). A higher rectal dose was associated with greater acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes. CONCLUSIONS In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel, and sexual domains was found >5 years after RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3-dimensional conformal RT was used in this study, intensity modulated concepts could result in improved outcomes.
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Affiliation(s)
| | - Vanessa Berneking
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | | | | | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany.
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Dutz A, Agolli L, Baumann M, Troost EGC, Krause M, Hölscher T, Löck S. Early and late side effects, dosimetric parameters and quality of life after proton beam therapy and IMRT for prostate cancer: a matched-pair analysis. Acta Oncol 2019; 58:916-925. [PMID: 30882264 DOI: 10.1080/0284186x.2019.1581373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To compare early and late toxicities, dosimetric parameters and quality of life (QoL) between conventionally fractionated proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT) in prostate cancer (PCA) patients. Methods: Eighty-eight patients with localized PCA treated between 2013 and 2017 with either definitive PBT (31) or IMRT (57) were matched using propensity score matching on PCA risk group, transurethral resection of the prostate, prostate volume, diabetes mellitus and administration of anticoagulants resulting in 29 matched pairs. Early and late genitourinary (GU) and gastrointestinal (GI) toxicities according to Common Terminology Criteria for Adverse Events (CTCAE) and QoL based on EORTC-QLQ-C30/PR25 questionnaires were collected prospectively until 12 months after radiotherapy (RT). Associations between toxicities and dose-volume parameters in corresponding organs at risk (OARs) were modeled by logistic regression. Results: There were no significant differences in GI and GU toxicities between both treatment groups except for late urinary urgency, which was significantly lower after PBT (IMRT: 25.0%, PBT: 0%, p = .047). Late GU toxicities and obstruction grade ≥2 were significantly associated with the relative volume of the anterior bladder wall receiving 70 Gy and the entire bladder receiving 60 Gy, respectively. The majority of patients in both groups reported high functioning and low symptom scores for the QoL questionnaires before and after RT. No or little changes were observed for most items between baseline and 3 or 12 months after RT, respectively. Global health status increased more at 12 months after IMRT (p = .040) compared to PBT, while the change of constipation was significantly better at 3 months after PBT compared to IMRT (p = .034). Conclusions: Overall, IMRT and PBT were well tolerated. Despite the superiority of PBT in early constipation and IMRT in late global health status compared to baseline, overall QoL and the risks of early and late GU and GI toxicities were similar for conventionally fractionated IMRT and PBT.
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Affiliation(s)
- Almut Dutz
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Agolli
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Baumann
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Esther G. C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Mechthild Krause
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Tobias Hölscher
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Steffen Löck
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Johnstone PA, Peneguy S, Showalter TN, Yu JB. The case for radiotherapy in a Value based environment. Rep Pract Oncol Radiother 2019; 24:200-203. [PMID: 30833828 PMCID: PMC6384322 DOI: 10.1016/j.rpor.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/30/2018] [Accepted: 01/27/2019] [Indexed: 12/25/2022] Open
Abstract
AIM Describe the Value proposition for radiotherapy (RT) in the United States. BACKGROUND In the United States since 2005, two forces have worked to decrease RT cost per patient: Federal changes in reimbursement and hypofractionation of treatment courses. We theorize that these have driven stable reimbursement in the context of increasing technology of intensity modulation (IMRT) and image guidance (IGRT). This phenomenon provides increasing Value of the discipline to patients and systems. MATERIALS AND METHODS We searched the Medicare Physician/Supplier data for Program Payments per Person with Utilization for 2000 through 2016. This involves two databases: Enrollment Database (EDB) for 2000-2012 and Common Medicare Enrollment (CME) since 2013. RT payments to individual patients accessing services were retrieved. RESULTS Taking into account the change of calculation algorithm used by CMS in 2013, costs per patient were similar in 2012 and 2003, and 2016 and 2013. CONCLUSIONS In the United States, stabilizing costs in the face of increasing work, better outcomes, and decreased toxicity contributes to increasing RT value over the past 10 years.
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Affiliation(s)
- Peter A.S. Johnstone
- Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, United States
- Department of Heath Outcomes & Behavior, Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Susan Peneguy
- Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | | | - James B. Yu
- Yale Cancer Center, New Haven, CT, United States
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38
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Matta R, Chapple CR, Fisch M, Heidenreich A, Herschorn S, Kodama RT, Koontz BF, Murphy DG, Nguyen PL, Nam RK. Pelvic Complications After Prostate Cancer Radiation Therapy and Their Management: An International Collaborative Narrative Review. Eur Urol 2018; 75:464-476. [PMID: 30573316 DOI: 10.1016/j.eururo.2018.12.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
CONTEXT Radiotherapy used for treating localized prostate cancer is effective at prolonging cancer-specific and overall survival. Still, acute and late pelvic toxicities are a concern, with gastrointestinal (GI) and genitourinary (GU) sequelae being most common as well as other pelvic complications. OBJECTIVE To present a critical review of the literature regarding the incidence and risk factors of pelvic toxicity following primary radiotherapy for prostate cancer and to provide a narrative review regarding its management. EVIDENCE ACQUISITION A collaborative narrative review of the literature from 2010 to present was conducted. EVIDENCE SYNTHESIS Regardless of the modality used, the incidence of acute high-grade pelvic toxicity is low following conventionally fractionated external beam radiotherapy (EBRT). After moderate hypofractionation, the crude cumulative incidences for late grade 3 or higher (G3+) GI and GU complications are as high as 6% and 7%, respectively. After extreme hypofractionation, the 5-yr incidences of G2+ GU and GI toxicities are 3-9% and 0-4%, respectively. Following brachytherapy monotherapy, crude rates of late G3+ GU toxicity range from 6% to 8%, while late GI toxicity is rare. With combination therapy (EBRT and brachytherapy), the cumulative incidence of late GU toxicity is high, between 18% and 31%; however, the prevalence is lower at 4-14%. Whole pelvic radiotherapy remains a controversial treatment option as there is increased G3+ GI toxicity compared with prostate-only treatment, with no overall survival benefit. Proton beam therapy appears to have similar toxicity to photon therapies currently in use. With respect to specific complications, urinary obstruction and urethral stricture are the most common severe urinary toxicities. Rectal and urinary bleeding can be recurrent long-term toxicities. The risk of hip fracture is also increased following prostate radiotherapy. The literature is mixed on the risk of in-field secondary pelvic malignancies following prostate radiotherapy. Urinary and GI fistulas are rare complications. Management of these toxicities may require invasive treatment and reconstructive surgery for refractory and severe symptoms. CONCLUSIONS There has been progress in the delivery of radiotherapy, enabling the administration of higher doses with minimal tradeoff in terms of slightly increased or equal toxicity. There is a need to focus future improvements in radiotherapy on sparing critical structures to reduce GU and GI morbidities. While complications such as fistulae, bone toxicity, and secondary malignancy are rare, there is a need for higher-quality studies assessing these outcomes and their management. PATIENT SUMMARY In this report, we review the literature regarding pelvic complications following modern primary prostate cancer radiotherapy and their management. Modern radiotherapy technologies have enabled the administration of higher doses with minimal increases in toxicity. Overall, high-grade long-term toxicity following prostate radiotherapy is uncommon. Management of late high-grade pelvic toxicities can be challenging, with patients often requiring invasive therapies for refractory cases.
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Affiliation(s)
- Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ronald T Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke Prostate and Urologic Cancers Center, Duke University Medical Center, Durham, NC, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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39
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Jereczek-Fossa BA, Maucieri A, Marvaso G, Gandini S, Fodor C, Zerini D, Riva G, Alessandro O, Surgo A, Volpe S, Fanetti G, Arculeo S, Zerella MA, Parisi S, Maisonneuve P, Vavassori A, Cattani F, Cambria R, Garibaldi C, Starzyńska A, Musi G, De Cobelli O, Ferro M, Nolè F, Ciardo D, Orecchia R. Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer. Med Oncol 2018; 36:9. [PMID: 30483899 DOI: 10.1007/s12032-018-1233-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
Abstract
To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69-77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.
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Affiliation(s)
- B A Jereczek-Fossa
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Maucieri
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Marvaso
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - S Gandini
- Department of Experimental Oncology, European Institute of Oncology, Via Adamello 16, 20139, Milan, Italy
| | - C Fodor
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D Zerini
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Riva
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - O Alessandro
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Surgo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Volpe
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G Fanetti
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Arculeo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M A Zerella
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - S Parisi
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Vavassori
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Garibaldi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - G Musi
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - O De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Ferro
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Nolè
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D Ciardo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
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40
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Nakai Y, Tanaka N, Anai S, Miyake M, Asakawa I, Morizawa Y, Hori S, Torimoto K, Fujii T, Hasegawa M, Fujimoto K. Quality of life worsened the most severely in patients immediately after intensity-modulated radiotherapy for prostate cancer. Res Rep Urol 2018; 10:169-180. [PMID: 30425973 PMCID: PMC6203165 DOI: 10.2147/rru.s168651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study was to evaluate the chronological changes in lower urinary tract symptoms (LUTSs), disease-related quality of life (QOL), and health-related QOL (HR-QOL) of patients who received intensity-modulated radiotherapy (IMRT). Patients and methods In 121 patients who had received IMRT and were followed up for >2 years, the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Expanded Prostate Cancer Index Composite (EPIC), and 8-Item Short-Form Health Survey (SF-8) were used before IMRT, at the halfway point in IMRT, immediately after IMRT, and 1–24 months after the completion of IMRT. Results The IPSS and OABSS and the urinary and bowel domains of the EPIC indicated that QOL worsened at the halfway point in IMRT, further worsened more severely immediately after IMRT, and then improved. The sexual domain of the EPIC significantly decreased at the halfway point in IMRT, which significantly lowered until 24 months. The scores of physical functioning, role physical, bodily pain, vitality, social functioning, and role emotional domains in the SF-8 significantly decreased and reached their lowest points immediately after IMRT. Conclusion QOL worsened the most severely in patients immediately after IMRT for prostate cancer. This knowledge can influence treatment recommendations and enable patients to make better informed decisions.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Satoshi Anai
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Tomomi Fujii
- Department of Pathology, Nara Medical University, Nara, Japan
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41
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Lee HJ, Macomber MW, Spraker MB, Bowen SR, Hippe D, Fung A, Russell KJ, Laramore GE, Rengan R, Liao J, Apisarnthanarax S, Zeng J. Analysis of Gastrointestinal Toxicity in Patients Receiving Proton Beam Therapy for Prostate Cancer: A Single-Institution Experience. Adv Radiat Oncol 2018; 4:70-78. [PMID: 30706013 PMCID: PMC6349581 DOI: 10.1016/j.adro.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose We characterized both physician- and patient-reported rates of gastrointestinal (GI) toxicity in patients treated with proton beam therapy (PBT) at our institution for prostate adenocarcinoma and identified factors associated with toxicity. Methods and materials We treated 192 patients with PBT between July 2013 and July 2016. Included patients had ≥1 year of follow-up. Potential preexisting clinical and treatment-related risk factors for GI toxicity were recorded. Common Terminology Criteria for Adverse Events version 4.0 was used to score toxicity. Expanded Prostate Cancer Index Composite (EPIC) bowel domain questionnaires assessed patient-reported quality of life. Associations between grade (GR) 2+ toxicity and clinical, treatment, and dosimetric factors were assessed using Cox models and corresponding hazard ratios. Results The median follow-up was 1.7 years. Most of the observed GI toxicity (>90%) was in the form of rectal bleeding (RB). GR2+ GI toxicity and RB actuarial rates specifically at 2 years were 21.3% and 20.4%, respectively. GR3 toxicity was rare, with only 1 observed RB event. No GR4/5 toxicity was seen. The EPIC bowel domain median score was 96 (range, 61-100) pretreatment, 93 (range, 41-100) at 1 year, 89 (range, 57-100) at 1.5 years, and 89 (range, 50-100) at 2 years. Anticoagulation use was the only factor selected during multivariate analysis for predicting GR2+ RB, with a resulting concordance index of 0.59 (95% confidence interval, 0.48-0.68; P = .088). Type of proton technology (pencil beam scanning vs uniform scanning) and number of fields treated per day (1 vs 2) showed no significant difference in toxicity rate. Conclusions PBT was associated with acceptable rates of GR2+ transient GI toxicity, mostly in the form of RB, which correlated with anticoagulation use. High EPIC bowel domain quality of life was maintained in the 2 years after treatment.
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Affiliation(s)
- Howard J Lee
- Duke University School of Medicine, Durham, North Carolina
| | - Meghan W Macomber
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Matthew B Spraker
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Daniel Hippe
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Angela Fung
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Kenneth J Russell
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - George E Laramore
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jay Liao
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Smith Apisarnthanarax
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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Chhabra A, Schneider C, Chowdhary M, Diwanji TP, Mohindra P, Mishra MV. How Histopathologic Tumor Extent and Patterns of Recurrence Data Inform the Development of Radiation Therapy Treatment Volumes in Solid Malignancies. Semin Radiat Oncol 2018; 28:218-237. [PMID: 29933882 DOI: 10.1016/j.semradonc.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The ability to deliver highly conformal radiation therapy using intensity-modulated radiation therapy and particle therapy provides for new opportunities to improve patient outcomes by reducing treatment-related morbidities following radiation therapy. By reducing the volume of normal tissue exposed to radiation therapy (RT), while also allowing for the opportunity to escalate the dose of RT delivered to the tumor, use of conformal RT delivery should also provide the possibility of expanding the therapeutic index of radiotherapy. However, the ability to safely and confidently deliver conformal RT is largely dependent on our ability to clearly define the clinical target volume for radiation therapy, which requires an in-depth knowledge of histopathologic extent of different tumor types, as well as patterns of recurrence data. In this article, we provide a comprehensive review of the histopathologic and radiographic data that provide the basis for evidence-based guidelines for clinical tumor volume delineation.
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Affiliation(s)
- Arpit Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Craig Schneider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University, Chicago, IL
| | - Tejan P Diwanji
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
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43
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Dang A, Kupelian PA, Cao M, Agazaryan N, Kishan AU. Image-guided radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:308-320. [PMID: 30050792 PMCID: PMC6043755 DOI: 10.21037/tau.2017.12.37] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intensity-modulated radiotherapy (IMRT) has become the standard radiotherapy technology utilized for the treatment of prostate cancer, as it permits the delivery of highly conformal radiation dose distributions. Image-guided radiotherapy (IGRT) is an essential companion to IMRT that allows the treatment team to account for daily changes in target anatomy and positioning. In the present review, we will discuss the different sources of geometric uncertainty and review the rationale behind using IGRT in the treatment of prostate cancer. We will then describe commonly employed IGRT techniques and review their benefits and drawbacks. Additionally, we will review the evidence suggesting a potential clinical benefit to utilizing IGRT.
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Affiliation(s)
- Audrey Dang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Patrick A Kupelian
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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44
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Abstract
Radiation therapy (RT) is a curative treatment modality for localized prostate cancer. Over the past two decades, advances in technology and imaging have considerably changed RT in prostate cancer treatment. Treatment has evolved from 2-dimensional (2D) planning using X-ray fields based on pelvic bony landmarks to 3-dimensional (3D) conformal RT (CRT) which uses computed tomography (CT) based planning. Despite improvements with 3D-CRT, dose distributions often remained suboptimal with portions of the rectum and bladder receiving unacceptably high doses. In more recent years, intensity-modulated radiation therapy (IMRT) has become the standard of care to deliver external beam RT. IMRT uses multiple radiation beams of different shapes and intensities delivered from a wide range of angles to ‘paint’ the radiation dose onto the tumor. IMRT allows for a higher dose of radiation to be delivered to the prostate while reducing dose to surrounding organs. Multiple clinical trials have demonstrated improved cancer outcomes with dose escalation, but toxicities using 3D-CRT and escalated doses have been problematic. IMRT is a method to deliver dose escalated RT with more conformal dose distributions than 3D-CRT and has been associated with improved toxicity profiles. IMRT also appears to be the safest method to deliver hypofractionated RT and pelvic lymph node radiation. The purpose of this review is to summarize the technical aspects of IMRT planning and delivery, and to review the literature supporting the use of IMRT for prostate cancer.
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Affiliation(s)
- Ben W Fischer-Valuck
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
| | - Yuan James Rao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA
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45
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Sujenthiran A, Nossiter J, Parry M, Charman SC, Cathcart PJ, van der Meulen J, Clarke NW, Payne H, Aggarwal A. Treatment-related toxicity in men who received Intensity-modulated versus 3D-conformal radiotherapy after radical prostatectomy: A national population-based study. Radiother Oncol 2018; 128:357-363. [PMID: 29773442 DOI: 10.1016/j.radonc.2018.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE In the post-prostatectomy setting the value of Intensity-modulated (IMRT) relative to 3D-conformal radiotherapy (3D-CRT) in reducing toxicity remains unclear. We compared genitourinary (GU) and gastrointestinal (GI) toxicity after post-prostatectomy IMRT or 3D-CRT. MATERIALS AND METHODS A population-based study of all patients treated with post-prostatectomy 3D-CRT (n = 2422) and IMRT (n = 603) was conducted between January 1 2010 and December 31 2013 in the English National Health Service. We identified severe GI and GU toxicity using a validated coding-framework and compared IMRT and 3D-CRT using a competing-risks proportional hazards regression analysis. RESULTS There was no difference in GI toxicity between patients who received IMRT and 3D-CRT (3D-CRT: 5.8 events/100 person-years; IMRT: 5.5 events/100 person-years; adjusted HR: 0.85, 95%CI: 0.63-1.13; p = 0.26). The GU toxicity rate was lower with IMRT but this effect was not statistically significant (3D-CRT: 5.4 events/100 person-years; IMRT: 3.8 events/100 person-years; adjusted HR: 0.76, 95%CI: 0.55-1.03; p = 0.08). CONCLUSIONS The use of post-prostatectomy IMRT compared to 3D-CRT is not associated with a statistically significant reduction in rates of severe GU and GI toxicity, although there is some evidence that GU toxicity is lower with IMRT. We would caution against rapid transition to post-prostatectomy IMRT until further evidence is available supporting its superiority.
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Affiliation(s)
- Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom.
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom
| | - Matthew Parry
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan C Charman
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul J Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, United Kingdom
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, United Kingdom
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Lawrie TA, Green JT, Beresford M, Wedlake L, Burden S, Davidson SE, Lal S, Henson CC, Andreyev HJN. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Cochrane Database Syst Rev 2018; 1:CD012529. [PMID: 29360138 PMCID: PMC6491191 DOI: 10.1002/14651858.cd012529.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND An increasing number of people survive cancer but a significant proportion have gastrointestinal side effects as a result of radiotherapy (RT), which impairs their quality of life (QoL). OBJECTIVES To determine which prophylactic interventions reduce the incidence, severity or both of adverse gastrointestinal effects among adults receiving radiotherapy to treat primary pelvic cancers. SEARCH METHODS We conducted searches of CENTRAL, MEDLINE, and Embase in September 2016 and updated them on 2 November 2017. We also searched clinical trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions to prevent adverse gastrointestinal effects of pelvic radiotherapy among adults receiving radiotherapy to treat primary pelvic cancers, including radiotherapy techniques, other aspects of radiotherapy delivery, pharmacological interventions and non-pharmacological interventions. Studies needed a sample size of 20 or more participants and needed to evaluate gastrointestinal toxicity outcomes. We excluded studies that evaluated dosimetric parameters only. We also excluded trials of interventions to treat acute gastrointestinal symptoms, trials of altered fractionation and dose escalation schedules, and trials of pre- versus postoperative radiotherapy regimens, to restrict the vast scope of the review. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. We used the random-effects statistical model for all meta-analyses, and the GRADE system to rate the certainty of the evidence. MAIN RESULTS We included 92 RCTs involving more than 10,000 men and women undergoing pelvic radiotherapy. Trials involved 44 different interventions, including radiotherapy techniques (11 trials, 4 interventions/comparisons), other aspects of radiotherapy delivery (14 trials, 10 interventions), pharmacological interventions (38 trials, 16 interventions), and non-pharmacological interventions (29 trials, 13 interventions). Most studies (79/92) had design limitations. Thirteen studies had a low risk of bias, 50 studies had an unclear risk of bias and 29 studies had a high risk of bias. Main findings include the following:Radiotherapy techniques: Intensity-modulated radiotherapy (IMRT) versus 3D conformal RT (3DCRT) may reduce acute (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.26 to 0.88; participants = 444; studies = 4; I2 = 77%; low-certainty evidence) and late gastrointestinal (GI) toxicity grade 2+ (RR 0.37, 95% CI 0.21 to 0.65; participants = 332; studies = 2; I2 = 0%; low-certainty evidence). Conformal RT (3DCRT or IMRT) versus conventional RT reduces acute GI toxicity grade 2+ (RR 0.57, 95% CI 0.40 to 0.82; participants = 307; studies = 2; I2 = 0%; high-certainty evidence) and probably leads to less late GI toxicity grade 2+ (RR 0.49, 95% CI 0.22 to 1.09; participants = 517; studies = 3; I2 = 44%; moderate-certainty evidence). When brachytherapy (BT) is used instead of external beam radiotherapy (EBRT) in early endometrial cancer, evidence indicates that it reduces acute GI toxicity (grade 2+) (RR 0.02, 95% CI 0.00 to 0.18; participants = 423; studies = 1; high-certainty evidence).Other aspects of radiotherapy delivery: There is probably little or no difference in acute GI toxicity grade 2+ with reduced radiation dose volume (RR 1.21, 95% CI 0.81 to 1.81; participants = 211; studies = 1; moderate-certainty evidence) and maybe no difference in late GI toxicity grade 2+ (RR 1.02, 95% CI 0.15 to 6.97; participants = 107; studies = 1; low-certainty evidence). Evening delivery of RT may reduce acute GI toxicity (diarrhoea) grade 2+ during RT compared with morning delivery of RT (RR 0.51, 95% CI 0.34 to 0.76; participants = 294; studies = 2; I2 = 0%; low-certainty evidence). There may be no difference in acute (RR 2.22, 95% CI 0.62 to 7.93, participants = 110; studies = 1) and late GI toxicity grade 2+ (RR 0.44, 95% CI 0.12 to 1.65; participants = 81; studies = 1) between a bladder volume preparation of 1080 mls and that of 540 mls (low-certainty evidence). Low-certainty evidence on balloon and hydrogel spacers suggests that these interventions for prostate cancer RT may make little or no difference to GI outcomes.Pharmacological interventions: Evidence for any beneficial effects of aminosalicylates, sucralfate, amifostine, corticosteroid enemas, bile acid sequestrants, famotidine and selenium is of a low or very low certainty. However, evidence on certain aminosalicylates (mesalazine, olsalazine), misoprostol suppositories, oral magnesium oxide and octreotide injections suggests that these agents may worsen GI symptoms, such as diarrhoea or rectal bleeding.Non-pharmacological interventions: Low-certainty evidence suggests that protein supplements (RR 0.23, 95% CI 0.07 to 0.74; participants = 74; studies = 1), dietary counselling (RR 0.04, 95% CI 0.00 to 0.60; participants = 74; studies = 1) and probiotics (RR 0.43, 95% CI 0.22 to 0.82; participants = 923; studies = 5; I2 = 91%) may reduce acute RT-related diarrhoea (grade 2+). Dietary counselling may also reduce diarrhoeal symptoms in the long term (at five years, RR 0.05, 95% CI 0.00 to 0.78; participants = 61; studies = 1). Low-certainty evidence from one study (108 participants) suggests that a high-fibre diet may have a beneficial effect on GI symptoms (mean difference (MD) 6.10, 95% CI 1.71 to 10.49) and quality of life (MD 20.50, 95% CI 9.97 to 31.03) at one year. High-certainty evidence indicates that glutamine supplements do not prevent RT-induced diarrhoea. Evidence on various other non-pharmacological interventions, such as green tea tablets, is lacking.Quality of life was rarely and inconsistently reported across included studies, and the available data were seldom adequate for meta-analysis. AUTHORS' CONCLUSIONS Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.
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Affiliation(s)
- Theresa A Lawrie
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, 1st Floor Education Centre, Royal United Hospital, Combe Park, Bath, UK, BA1 3NG
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Schroeck FR, Jacobs BL, Bhayani SB, Nguyen PL, Penson D, Hu J. Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy. Eur Urol 2017; 72:712-735. [PMID: 28366513 PMCID: PMC5623181 DOI: 10.1016/j.eururo.2017.03.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
CONTEXT Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. OBJECTIVE To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. EVIDENCE ACQUISITION We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. EVIDENCE SYNTHESIS RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer's perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the limited comparative data on outcomes. Using the Grades of Recommendation, Assessment, Development and Evaluation approach, the quality of evidence was low for RARP and IMRT, and very low for proton beam therapy. CONCLUSIONS Treatment with new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective. PATIENT SUMMARY We review the cost and cost effectiveness of robot-assisted radical prostatectomy, intensity-modulated radiotherapy, and proton beam therapy in prostate cancer treatment. These technologies are costlier than their traditional counterparts. It remains unclear whether their use is associated with improved cure and reduced morbidity, and whether the increased cost is worth the expense.
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Affiliation(s)
- Florian Rudolf Schroeck
- White River Junction VA Medical Center, White River Junction, VT, USA; Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sam B Bhayani
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - David Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - Jim Hu
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
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National Population-Based Study Comparing Treatment-Related Toxicity in Men Who Received Intensity Modulated Versus 3-Dimensional Conformal Radical Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 99:1253-1260. [PMID: 28974414 DOI: 10.1016/j.ijrobp.2017.07.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare, in a national population-based study, severe genitourinary (GU) and gastrointestinal (GI) toxicity in patients with prostate cancer who were treated with radical intensity modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS Patients treated with IMRT (n=6933) or 3D-CRT (n=16,289) between January 1, 2010 and December 31, 2013 in the English National Health Service were identified using cancer registry data, the National Radiotherapy Dataset, and Hospital Episodes Statistics, the administrative database of care episodes in National Health Service hospitals. We developed a coding system that identifies severe toxicity (at least grade 3 according to the National Cancer Institute Common Terminology Criteria for Adverse Events scoring system) according to the presence of a procedure and a corresponding diagnostic code in patients' Hospital Episodes Statistics records after radiation therapy. A competing risks regression analysis was used to estimate hazard ratios (HRs), comparing the incidence of severe GI and GU complications after IMRT and 3D-CRT, adjusting for patient, disease, and treatment characteristics. RESULTS The use of IMRT, as opposed to 3D-CRT, increased from 3.1% in 2010 to 64.7% in 2013. Patients who received IMRT were less likely than those receiving 3D-CRT to experience severe GI toxicity (4.9 vs 6.5 per 100 person-years; adjusted HR 0.66; 95% confidence interval 0.61-0.72) but had similar levels of GU toxicity (2.3 vs 2.4 per 100 person-years; adjusted HR 0.94; 95% confidence interval 0.84-1.06). CONCLUSIONS Prostate cancer patients who received radical radiation therapy using IMRT were less likely to experience severe GI toxicity, and they had similar GU toxicity compared with those who received 3D-CRT. These findings in an unselected "real-world" population support the use of IMRT, but further cost-effectiveness studies are urgently required.
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Evaluation of the preimplantation worksheet in determining Calypso eligibility for men prescribed postprostatectomy radiotherapy with electromagnetic transponder guidance. Med Dosim 2017. [PMID: 28648818 DOI: 10.1016/j.meddos.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to assess the design and performance of the preimplant suitability worksheet in determining Calypso eligibility for prostate cancer patients prescribed postprostatectomy radiotherapy with electromagnetic transponder guidance. The medical records and radiotherapy planning datasets of 75 patients prospectively recruited between June 2015 and September 2016 to a Phase 2 trial evaluating electromagnetic transponder-guided postprostatectomy radiotherapy were retrospectively examined. Correlation and differences between computed tomography (CT)-defined greater trochanter and prostatic fossa landmarks were evaluated. Receiver operating characteristic curves were also generated to assess the expected and observed accuracy of the worksheet in determining Calypso eligibility. Strong correlation was demonstrated between anterior surface to planning CT-defined greater trochanter and prostate bed center distances (r = 0.95, p <0.001), with a mean difference between measurements of 1.1 cm (95% confidence interval [CI]: 0.9 to 1.3). A similar correlation coefficient was found for surface to greater trochanter location and posterior beacon location (r = 0.92, p <0.001) but with a reduced mean difference of 0.4 cm (95% CI: 0.1 to 0.6). Performance of the worksheet as assessed by planning CT data demonstrated excellent accuracy as a test to determine eligibility (area under the curve: 0.97; 95% CI: 0.92 to 1.00); however, this was not replicated using the same data captured clinically (area under the curve 0.83; 95% CI: 0.68 to 0.98). Although the greater trochanter is a good surrogate for the prostate bed center, it is better associated with the posterior beacon location. As a result, the worksheet will underestimate the truly eligible population if performed accurately and according to manufacturer guidelines. Theoretically, the worksheet could be improved if a cut off of 20 cm is used and the greater trochanter is accurately identified; however, the latter appears to be difficult to achieve in practice.
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Goff PH, Harrison LB, Furhang E, Ng E, Bhatia S, Trichter F, Ennis RD. 2D kV orthogonal imaging with fiducial markers is more precise for daily image guided alignments than soft-tissue cone beam computed tomography for prostate radiation therapy. Adv Radiat Oncol 2017; 2:420-428. [PMID: 29114611 PMCID: PMC5605315 DOI: 10.1016/j.adro.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose The hypothesis is that 2-dimensional kV orthogonal imaging with fiducial markers (kV-FM) and soft-tissue cone beam computed tomography (ST-CBCT) are equally reproducible for daily positional alignments for image guided (IG) intensity modulated radiation therapy (IMRT) for prostate cancer. Methods and materials Ten patients undergoing definitive treatment for prostate cancer with IG-IMRT were imaged daily with kV-FM and ST-CBCT. For each acquired kV and CBCT image, offline alignments to the digitally reconstructed radiograph or planning CT, respectively, were made twice by the same physician to assess intraobserver test-retest reproducibility. The 256 kV and 142 CBCT images were analyzed, and the test-retest analysis was performed again on a subset of images by another physician to verify the results. Results The results demonstrated that kV-FM had better intraobserver test-retest reproducibility in the anterior-posterior (AP; 95% confidence interval [CI] Pearson correlation coefficient [r], 0.987-0.991), left-right (LR; 95% CI r, 0.955-0.969), and superior-inferior (SI; 95% CI r, 0.971-0.980) directions for daily IG alignments compared with ST-CBCT (AP: 95% CI r, 0.804-0.877; LR: 95% CI r, 0.877-0.924; SI: 95% CI r, 0.791-0.869). Errors associated with intraobserver test-retest reproducibility were submillimeter with kV-FM (AP: 0.4 ± 0.7 mm; RL: 0.4 ± 1.0 mm; SI: 0.5 ± 0.7 mm) compared with ST-CBCT (AP: 2.1 ± 2.2 mm; LR: 1.3 ± 1.4 mm; SI: 1.2 ± 1.8 mm). The mean shift differences between kV-FM and ST-CBCT were 0.3 ± 3.8 mm for AP, −1.1 ± 8.5 mm for LR, and −2.0 ± 3.7 mm for SI. Dose-volume histograms were generated and showed that test-retest variability associated with ST-CBCT IG-alignments resulted in significantly increased dose to normal structures and a reduced planning target volume dose in many patients. Conclusions The kV-FM–based daily IG alignment for IMRT of prostate cancer is more precise than ST-CBCT, as assessed by a physician's ability to reproducibly align images. Given the magnitude of the error introduced by inconsistency in making ST-CBCT alignments, these data support a role for daily kV imaging of FM to enhance the precision of external beam dose delivery to the prostate.
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Affiliation(s)
- Peter H Goff
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Louis B Harrison
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eli Furhang
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai and Mount Sinai West Hospital, New York, New York
| | - Evan Ng
- Genesis Cancer Care, Western Australia, Wembley, Australia
| | - Stephen Bhatia
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai and Mount Sinai West Hospital, New York, New York
| | - Frieda Trichter
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai and Mount Sinai West Hospital, New York, New York
| | - Ronald D Ennis
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai and Mount Sinai West Hospital, New York, New York
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