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Jahreiß MC, Heemsbergen WD, Aben KKH, Incrocci L. Risk factors for secondary bladder cancer following prostate cancer radiotherapy. Transl Androl Urol 2024; 13:1288-1296. [PMID: 39100827 PMCID: PMC11291406 DOI: 10.21037/tau-23-667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/05/2024] [Indexed: 08/06/2024] Open
Abstract
This review investigates the complex landscape of secondary bladder cancer (SBC) after radiotherapy for prostate cancer (PCa). External beam radiotherapy (EBRT) poses an increased risk for SBC, while brachytherapy seems to be associated with smaller increased risks for SBC due to its targeted radiation delivery, sparing the surrounding bladder tissue. Secondary cancers in the bladder are the most frequently diagnosed secondary cancers in the PCa patient population treated with radiotherapy. Patient-related factors are pivotal, with age emerging as a dual-edged factor. While advanced age is a recognized risk for bladder cancer, younger PCa patients exhibit higher susceptibility to radiation-induced cancers. Smoking, a well-established bladder cancer risk factor, increases this vulnerability. Studies highlight the synergistic effect of smoking and radiation exposure, amplifying the likelihood of genetic mutations and SBC. The latency period of SBC, which spans years to decades, remains a critical aspect. There is a strong dose-response relationship between radiation exposure and SBC risk, with higher doses consistently being associated with a higher SBC risk. While specific models for therapeutic radiation-induced SBC are lacking, insights from related studies, like the Atomic Bomb survivor research, emphasize the bladder's sensitivity to radiation-induced cancer. Chemotherapy in combination with radiotherapy, although infrequently used in PCa, emerges as a potential risk for bladder cancer. Bladder cancer's complex epidemiology, encompassing risk factors, treatment modalities, and cancer types, provides a comprehensive backdrop. As research refines understanding, we hope that this review contributes to guide clinicians, inform patient care, and shape preventive strategies on SBC.
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Affiliation(s)
- Marie-Christina Jahreiß
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wilma D. Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katja K. H. Aben
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Deaprtment for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luca Incrocci
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kyei KA, Daniels J, Adom AK, Odonkor P, Nyantakyi AY, Adjabu DE. A dosimetric evaluation of intensity modulated radiotherapy and three-dimensional conformal radiotherapy for prostate cancer in Ghana. Ecancermedicalscience 2024; 18:1707. [PMID: 39021534 PMCID: PMC11254402 DOI: 10.3332/ecancer.2024.1707] [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: 01/08/2024] [Indexed: 07/20/2024] Open
Abstract
External beam radiotherapy incorporates treatment techniques such as three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), image-guided radiotherapy and volumetric modulated arc therapy to deliver high-energy radiation to cancer. The use of IMRT for cancer treatment is also associated with significant costs for patients in low-middle-income countries. The purpose of this study was to compare the dosimetric properties of 3DCRT and IMRT treatment plans for the external beam irradiation of patients with prostate cancer (Pca) to ascertain the superiority of IMRT in terms of dose homogeneity, conformity and dose limitation to organs at risk (OAR) in a resource-limited setting. One hundred and sixty treatment plans for 80 patients were created using 3DCRT and IMRT on the Eclipse treatment planning system (version 13.6). Data were collected and assessed from the dose-volume histogram of each plan. The conformity and homogeneity index (HI) for each of the plans were calculated. The doses to the OAR were also recorded and evaluated. The mean HIs for the IMRT and 3DCRT treatment techniques were 0.04 ± 0.02 (range: 0.01-0.011) and 0.09 ± 0.02 (range: 0.04-0.016), respectively. The mean conformity index (CI) for IMRT and 3DCRT techniques were 1.257 ± 0.112 (range: 0.99-1.58) and 1.302 ± 0.196 (range: 1.10-2.26). IMRT had a better significant mean HI and CI compared to 3DCRT. Generally, for this study, IMRT had better organ sparing compared to 3DCRT. The mean doses for the OARs ranged from 4.3-74.6 Gy for IMRT and 3.1-75.9 Gy for the 3DCRT technique. Overall, this study demonstrates that IMRT may offer an enhanced therapeutic profile, potentially reducing toxicity to the patient and ensuring more precise dose delivery to the target volume compared to 3DCRT in PCa external beam irradiation.
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Affiliation(s)
- Kofi Adesi Kyei
- Department of Radiography, University of Ghana, Legon, KB 143, Ghana
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, KB 369, Ghana
- https://orcid.org/0000-0003-3485-5368
| | - Joseph Daniels
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, KB 369, Ghana
- https://orcid.org/0000-0002-1466-150X
| | - Ameyaw Kwame Adom
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, KB 369, Ghana
- https://orcid.org/0009-0004-1999-3767
| | - Philip Odonkor
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, KB 369, Ghana
- https://orcid.org/0009-0003-8046-9078
| | - Andrew Yaw Nyantakyi
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, KB 369, Ghana
- https://orcid.org/0000-0003-0742-6007
| | - Dorothy Ekua Adjabu
- Department of Physiotherapy, School of Biomedical and Allied Health, University of Ghana, Accra, KB 143, Ghana
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Spohn SKB, Radicioni G, Eisfelder M, Zamboglou C, Baltas D, Grosu AL, Sachpazidis I. Predictors of radiation-induced late rectal toxicity in prostate cancer treatment: a volumetric and dosimetric analysis. Front Oncol 2024; 14:1371384. [PMID: 38737910 PMCID: PMC11082346 DOI: 10.3389/fonc.2024.1371384] [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: 01/16/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Prostate cancer (PCa) is a prevalent malignancy in European men, often treated with radiotherapy (RT) for localized disease. While modern RT achieves high success rates, concerns about late gastrointestinal (GI) toxicities persist. This retrospective study aims to identify predictors for late GI toxicities following definitive conventionally fractionated external beam RT (EBRT) for PCa, specifically exploring the dose to the rectal wall. Materials and methods A cohort of 96 intermediate- to high-risk PCa patients underwent EBRT between 2008 and 2016. Rectum and rectum wall contours were delineated, and 3D dose matrices were extracted. Volumetric and dosimetric indices were computed, and statistical analyses were performed to identify predictors using the Mann-Whitney U-rank test, logistic regression, and recursive feature elimination. Results In our cohort, 15 out of 96 patients experienced grade II late proctitis. Our analysis reveals distinct optimal predictors for rectum and rectum wall (RW) structures varying with α/β values (3.0 and 2.3 Gy) across prescribed doses of 68 to 76 Gy. Despite variability, RW predictors demonstrate greater consistency, notably V68Gy[%] to V74Gy[%] for α/β 3.0 Gy, and V68Gy[%] to V70Gy[%] for α/β 2.3 Gy. The model with α/β 2.3 Gy, featuring RW volume receiving 70 Gy (V70Gy[%]), stands out with a BIC value of 62.92, indicating its superior predictive effectiveness. Finally, focusing solely on the rectum structure, the V74Gy[%] emerges the best predictor for α/β 3.0 Gy, with a BIC value of 66.73. Conclusion This investigation highlights the critical role of V70Gy[%] in the rectum wall as a robust predictor for grade II late gastrointestinal (GI) toxicity following external beam radiation therapy (EBRT) for prostate cancer (PCa). Furthermore, our findings suggest that focusing on the rectum wall specifically, rather than the entire rectum, may offer improved accuracy in assessing proctitis development. A V70Gy (in EQD2 with α/β 2.3 Gy) of ≤5% and if possible ≤1% for the rectal wall should be achieved to minimize the risk of late grade II proctitis.
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Affiliation(s)
- Simon K. B. Spohn
- Department of Radiation Oncology, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
- Berta-Ottensein-Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gianluca Radicioni
- Department of Radiation Oncology, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Marcio Eisfelder
- Department of Radiation Oncology, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
- Department of Radiation Oncology, German Oncology Centre, European University Cyprus, Limassol, Cyprus
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Ilias Sachpazidis
- Division of Medical Physics, Department of Radiation Oncology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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Huynh MJ, Eng L, Ngo LH, Power NE, Kamran SC, Pierce TT, Lo AC. Incidence and survival of secondary malignancies after external beam radiotherapy for prostate cancer in the SEER database. Can Urol Assoc J 2024; 18:121-128. [PMID: 38381941 PMCID: PMC11034958 DOI: 10.5489/cuaj.8508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION We investigated the incidence of secondary bladder (BCa) and rectal cancers (RCa) after external beam radiotherapy (EBRT) for prostate cancer (PCa) compared to radical prostatectomy (RP) alone, and compared cancer-specific survival (CSS) of these secondary neoplasms to their primary counterparts. METHODS This retrospective cohort study included men in the SEER cancer registry with a diagnosis of non-metastatic, clinically node-negative PCa treated with either RP or EBRT from 1995-2011 and allowed a minimum five-year lag period for the development of secondary BCa or RCa. Patients were divided into two eras, 1995-2002 and 2003-2011, to examine differences in incidence of secondary malignancies over time. Univariable and multivariable competing risk analyses with Fine-Gray subdistribution hazard and cause-specific hazard models were used to examine the risk of developing a secondary BCa or RCa. Competing risks analyses were used to compare CSS of primary vs. secondary BCa and RCa. RESULTS A total of 198 184 men underwent RP and 190 536 underwent EBRT for PCa. The cumulative incidence of secondary BCa at 10 years was 1.71% for RP, and 3.7% for EBRT (p<0.001), while that of RCa was 0.52% for RP and 0.99% for EBRT (p<0.001). EBRT was associated with almost twice the risk of developing a secondary BCa and RCa compared to RP. The hazard of secondary BCa following EBRT delivered during 2003-2011 was 20% less than from 1995-2002 (p<0.09, Fine-Gray model), while that of secondary RCa was 31% less (p<0.001) (hazard ratio 0.78, p<0.001) for Fine-Gray and cause-specific hazard models. In the Fine-Gray model, the risk of death from BCa was 27% lower for secondary BCa after RP compared to primary BCa, while the risk of death was 9% lower for secondary BCa after EBRT compared to primary BCa. There was no difference in RCa-specific survival between primary or secondary RCa after RP or EBRT. CONCLUSIONS The risk of BCa and RCa is almost twice as high for men undergoing EBRT for localized PCa vs. RP, but that risk is declining, likely reflecting advances in radiation delivery. The development of secondary RCa or BCa does not confer elevated risk of death compared to their primary counterparts.
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Affiliation(s)
- Melissa J Huynh
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
- Division of Surgical Oncology, Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nicholas E Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
- Division of Surgical Oncology, Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Sophia C Kamran
- Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Theodore T Pierce
- Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Andrea C Lo
- Division of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC Canada
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Ghafour H, Ali JS, Taher Ali R, Sirelkhatim E. A Comparison of Field-in-Field and Intensity Modulated Radiation Therapy in Delivering Hypofractionated Radiation Therapy for Prostate Cancer. Adv Radiat Oncol 2024; 9:101356. [PMID: 38405309 PMCID: PMC10885577 DOI: 10.1016/j.adro.2023.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/07/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose This study compares the dosimetric performance of the field-in-field (FIF) technique with intensity modulated radiation therapy (IMRT) for delivering hypofractionated radiation therapy to prostate patients with cancer. The FIF technique uses 6 beams, whereas IMRT uses 9 beams. Methods and Materials This study was conducted on 15 patients with prostate cancer treated with step-and-shoot IMRT. The prescribed dose was 60 Gy in 20 fractions. The FIF plans contained 6 photon beams, and IMRT plans were designed using a 9-field step-and-shoot technique. Dose-volume histograms and dose distributions were evaluated to compare FIF and IMRT. Results The results of the planning target volume indices analysis showed a significant difference in the maximum dose, dose to 2% of volume, and homogeneity index in favor of FIF and in the mean dose, dose to 98% of volume, and D95 in favor of IMRT. The results of the organs-at-risk analysis showed significant differences in the volume of the rectum and bladder receiving 60 Gy in favor of FIF and the volume of the rectum and femoral heads receiving 30 Gy, as well as the mean dose to the rectum, in favor of IMRT. IMRT had a higher median number of monitor units (MUs) and segments (886 MU, 64 segments) compared to FIF (434 MUs, 6 segments). Conclusions The FIF technique and IMRT had comparable results in delivering hypofractionated radiation therapy for prostate cancer. The findings of this study may aid in decision-making for patients undergoing treatment.
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Lehtonen M, Kellokumpu-Lehtinen PL. The past and present of prostate cancer and its treatment and diagnostics: A historical review. SAGE Open Med 2023; 11:20503121231216837. [PMID: 38050625 PMCID: PMC10693792 DOI: 10.1177/20503121231216837] [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: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
The prognosis of local prostate cancer has improved drastically during the past 60 years. Similarly, the prognosis in metastatic stage is constantly improving due to a number of new pharmaceuticals introduced over the past 10 years. Previously, only palliative treatments were available for prostate cancer, but today, there are multiple options for treatment with curative intent: robotic-assisted radical prostatectomy, stereotactic radiotherapy and brachytherapy. Additionally, life-prolonging chemotherapeutic and androgen-suppressive treatments, as well as diagnostic imaging and staging, have improved considerably. This review summarizes the history of the treatment and diagnostics of prostate cancer, with a focus on the past 60 years. The aim was to provide a concise and easy-to-read introduction on the matter for all people that work with prostate cancer, as well as for patients. The literature was thoroughly examined covering the period from the earliest traceable records to the latest state-of-the-art studies.
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Affiliation(s)
- Miikka Lehtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
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Béasse A, Boisbouvier S. [Benefits and limitations of using a portable ultrasound scanner (bladderscan) in pelvic radiotherapy. Narrative review of the literature]. Cancer Radiother 2023; 27:259-265. [PMID: 37088573 DOI: 10.1016/j.canrad.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 04/25/2023]
Abstract
PURPOSE The reproducibility of bladder filling influences the target volume position for pelvis radiotherapy. The objective of this study was to summarize the current knowledge on the use of portable echograph systems named Bladderscan (BS) in this context. MATERIAL AND METHODS Review of the PubMed and Google Scholar publication databases was performed between September 2020 and April 2021. Results of this research were filtered in accordance to a set of eligibility criterias and are presented in this article. RESULTS Keyword search yielded a total of 2407 publications, which filtered down to 10 relevant articles in accordance to the eligibility criterias. These publications described the viability of the BS measures as well as their clinical and organizational repercussions. CONCLUSION According to multiple studies, BS allows to measure the bladder volume before each radiotherapy session. The use of BS decreases the amount of Cone Beam Computer Tomography potentially rejected due to non-conformed bladder filling, and improve the throughput of patients.
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Affiliation(s)
- A Béasse
- Fondation Cognacq-Jay, hôpital Forcilles, département de radiothérapie, Lieu-dit Forcilles, 77150 Férolles-Attilly, France.
| | - S Boisbouvier
- Centre de lutte contre le cancer, centre Léon-Bérard, département de radiothérapie, 28, Promenade Léa et Napoléon Bullukian, 69008 Lyon, France.
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Imaizumi H, Minami K, Hieda M, Narihiro N, Koizumi M. The linker of nucleoskeleton and cytoskeleton complex is required for X-ray-induced epithelial-mesenchymal transition. JOURNAL OF RADIATION RESEARCH 2023; 64:358-368. [PMID: 36694940 PMCID: PMC10036107 DOI: 10.1093/jrr/rrac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/13/2022] [Indexed: 06/17/2023]
Abstract
The linker of nucleoskeleton and cytoskeleton (LINC) complex has been implicated in various functions of the nuclear envelope, including nuclear migration, mechanotransduction and DNA repair. We previously revealed that the LINC complex component Sad1 and UNC84 domain containing 1 (SUN1) is required for sublethal-dose X-ray-enhanced cell migration and invasion. This study focused on epithelial-mesenchymal transition (EMT), which contributes to cell migration. Hence, the present study aimed to examine whether sublethal-dose X-irradiation induces EMT and whether LINC complex component SUN1 is involved in low-dose X-ray-induced EMT. This study showed that low-dose (0.5 Gy or 2 Gy) X-irradiation induced EMT in human breast cancer MDA-MB-231 cells. Additionally, X-irradiation increased the expression of SUN1. Therefore, SUN1 was depleted using siRNA. In SUN1-depleted cells, low-dose X-irradiation did not induce EMT. In addition, although the SUN1 splicing variant SUN1_916-depleted cells (containing 916 amino acids [AA] of SUN1) were induced EMT by low-dose X-irradiation like as non-transfected control cells, SUN1_888-depleted cells (which encodes 888 AA) were not induced EMT by low-dose X-irradiation. Moreover, since the Wnt/β-catenin signaling pathway regulates E-cadherin expression via the expression of the E-cadherin repressor Snail, the expression of β-catenin after X-irradiation was examined. After 24 hours of irradiation, β-catenin expression increased in non-transfected cells or SUN1_916-depleted cells, whereas β-catenin expression remained unchanged and did not increase in SUN1- or SUN1_888-depleted cells. Therefore, in this study, we found that low-dose X-irradiation induces EMT, and LINC complex component SUN1, especially SUN1_888, is required for X-ray-induced EMT via activation of the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Hiromasa Imaizumi
- Corresponding author. Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan. E-mail: ; Tel: +81-86-462-1111; Fax: +81-86-464-1109
| | - Kazumasa Minami
- Department of Medical Physics and Engineering, Graduate School of Medicine and Health Science, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Miki Hieda
- Graduate School of Health Sciences, Ehime Prefectural University of Health Sciences, 543 Takoda, Tobe-cho, Iyo-gun, Ehime 791-2101, Japan
| | - Naomasa Narihiro
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Graduate School of Medicine and Health Science, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
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Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database. Cancers (Basel) 2022; 14:cancers14225503. [PMID: 36428595 PMCID: PMC9688758 DOI: 10.3390/cancers14225503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background: In this study, the utilization rates and survival outcomes of different radiotherapy techniques are compared in prostate cancer (PCa) patients stratified by risk group. Methods: We analyzed an extensive data set of N0, M0, non-surgical PCa patients diagnosed between 2004 and 2015 from the National Cancer Database (NCDB). Patients were grouped into six categories based on RT modality: an intensity-modulated radiation therapy (IMRT) group with brachytherapy (BT) boost, IMRT with/without IMRT boost, proton therapy, stereotactic body radiation therapy (SBRT), low-dose-rate brachytherapy (BT LDR), and high-dose-rate brachytherapy (BT HDR). Patients were also stratified by the National Comprehensive Cancer Network (NCCN) guidelines: low-risk (clinical stage T1−T2a, Gleason Score (GS) ≤ 6, and Prostate-Specific Antigen (PSA) < 10), intermediate-risk (clinical stage T2b or T2c, GS of 7, or PSA of 10−20), and high-risk (clinical stage T3−T4, or GS of 8−10, or PSA > 20). Overall survival (OS) probability was determined using a Kaplan−Meier estimator. Univariate and multivariate analyses were performed by risk group for the six treatment modalities. Results: The most utilized treatment modality for all PCa patients was IMRT (53.1%). Over the years, a steady increase in SBRT utilization was observed, whereas BT HDR usage declined. IMRT-treated patient groups exhibited relatively lower survival probability in all risk categories. A slightly better survival probability was observed for the proton therapy group. Hormonal therapy was used for a large number of patients in all risk groups. Conclusion: This study revealed that IMRT was the most common treatment modality for PCa patients. Brachytherapy, SBRT, and IMRT+BT exhibited similar survival rates, whereas proton showed slightly better overall survival across the three risk groups. However, analysis of the demographics indicates that these differences are at least in part due to selection bias.
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Lee JW, Chung MJ. Prostate only radiotherapy using external beam radiotherapy: A clinician's perspective. World J Clin Cases 2022; 10:10428-10434. [PMID: 36312490 PMCID: PMC9602254 DOI: 10.12998/wjcc.v10.i29.10428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/12/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
Prostate-only radiotherapy (PORT) is widely used as the definitive treatment for localized prostate cancer. Prostate cancer has an α/β ratio; therefore, radiotherapy (RT) with a large fraction size is biologically effective for tumor control. The current external beam RT technique for PORT has been improved from three-dimensional conformal RT to intensity-modulated, stereotactic body, and image-guided RTs. These methods are associated with reduced radiation exposure to normal tissues, decreasing urinary and bowel toxicity. Several trials have shown improved local control with dose escalation through the aforementioned methods, and the efficacy and safety of intensity-modulated and stereotactic body RTs have been proven. However, the management of RT in patients with prostate cancer has not been fully elucidated. As a clinician, there are several concerns regarding the RT volume and dose considering the patient's age and comorbidities. Therefore, this review aimed to discuss the radiobiological basis and external beam technical advancements in PORT for localized prostate cancer from a clinician's perspective.
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Affiliation(s)
- Jeong Won Lee
- Department of Radiation Oncology, Daegu Catholic University School of Medicine, Daegu 42472, South Korea
| | - Mi Joo Chung
- Department of Radiation Oncology, Hanyang University Hanmaeum Changwon Hospital, Changwon 51139, South Korea
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Wong WW, Hillman DW, Daniels TB, Vargas CE, Rwigema JC, Corbin KS, Keole SR, Merrell KW, Stish BJ, Pisansky TM, Davis BJ, Mitchell CM, Choo R. A Phase II prospective study of hypofractionated proton therapy of prostate and pelvic lymph nodes: Acute effects on patient-reported quality of life. Prostate 2022; 82:1338-1345. [PMID: 35789497 DOI: 10.1002/pros.24408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to report acute changes in patient-reported quality of life (PRQOL) using the 26-item Expanded Prostate Index Composite (EPIC-26) questionnaire in a prospective study using hypofractionated intensity-modulated proton beam therapy (H-IMPT) targeting the prostate and the pelvic lymph nodes for high-risk or unfavorable intermediate-risk prostate cancer. METHODS Fifty-five patients were enrolled. H-IMPT consisted of 45 GyE to the pelvic lymph nodes and 67.5 GyE to the prostate and seminal vesicles in 25 fractions. PRQOL was assessed with the urinary incontinence (UI), urinary irritative/obstructive symptoms (UO), and bowel function (BF) domains of EPIC-26 questionnaire. Mean changes in domain scores were analyzed from pretreatment to the end of treatment and 3 months posttreatment. A clinically meaningful change (or minimum important change) was defined as a score change > 50% of the baseline standard deviation. RESULTS The mean scores of UO, UI, and BF at baseline were 84.6, 91.1, and 95.3, respectively. At the end of treatment, there were statistically significant and clinically meaningful declines in UO and BF scores (-13.5 and -2.3, respectively), while the decline in UI score was statistically significant but not clinically meaningful (-13.7). A clinically meaningful decline in UO, UI, and BF scores occurred in 53.5%, 22.7%, and 73.2% of the patients, respectively. At 3 months posttreatment, all three mean scores showed an improvement, with fewer patients having a clinically meaningful decline in UO, UI, and BF scores (18.4%, 20.5%, and 45.0%, respectively). There was no significant reduction in the mean UO and UI scores compared to baseline, although the mean BF score remained lower than baseline and the difference was clinically meaningful. CONCLUSIONS UO, UI, and BF scores of PRQOL declined at the end of H-IMPT. UO and UI scores showed improvement at 3 months posttreatment and were similar to the baseline scores. However, BF score remained lower at 3 months posttreatment with a clinically meaningful decline.
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Affiliation(s)
- William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - David W Hillman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas B Daniels
- Department of Radiation Oncology, New York University, New York, New York, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cecilia M Mitchell
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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12
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Mrčela I, Gregov M, Matanić A, Budanec M, Murgić J, Jakšić B, Prpić M, Prgomet Sečan A, Frobe A. DOSIMETRIC VERIFICATION OF INTENSITY MODULATED RADIOTHERAPY (IMRT) TREATMENT PLANS FOR PROSTATE CANCER PATIENTS. Acta Clin Croat 2022; 61:21-27. [PMID: 36938551 PMCID: PMC10022411 DOI: 10.20471/acc.2022.61.s3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Intensity modulated radiotherapy (IMRT) has become widely used as a standard radiation therapy technique for the treatment of localized prostate cancer. The transition from conformal radiotherapy (3D CRT) to a more complex IMRT technique triggered the need for more thorough verification of the accuracy in the dose delivery. In this work we present the clinical workflow and the results of patient specific quality assurance (PSQA) procedures for 40 prostate cancer patients who have been treated with step and shot IMRT ever since its implementation in our routine clinical practice. PSQA procedures include dosimetric verification of each treatment plan with dedicated rotational phantom and high-resolution matrix detector system Octavius 4D (PTW Freiburg) that allows three-dimensional comparison of the calculated and delivered radiation dose distribution. Our results proved the compliance with the universal tolerance limits recommended for those procedures (1), assuring the safety of the treatment and providing the possibility for the adoption of more stringent constraints in the future.
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Affiliation(s)
- Iva Mrčela
- Department of Medical Physics
- University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Marin Gregov
- Department of Medical Physics
- University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Ante Matanić
- Department of Medical Physics
- University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Mirjana Budanec
- Department of Medical Physics
- University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Jure Murgić
- Departement of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Vinogradska 29, Zagreb
- University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Blanka Jakšić
- Departement of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Vinogradska 29, Zagreb
| | - Marin Prpić
- Departement of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Vinogradska 29, Zagreb
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Angela Prgomet Sečan
- Departement of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Vinogradska 29, Zagreb
| | - Ana Frobe
- Departement of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Vinogradska 29, Zagreb
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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13
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Bromma K, Dos Santos N, Barta I, Alexander A, Beckham W, Krishnan S, Chithrani DB. Enhancing nanoparticle accumulation in two dimensional, three dimensional, and xenograft mouse cancer cell models in the presence of docetaxel. Sci Rep 2022; 12:13508. [PMID: 35931743 PMCID: PMC9356051 DOI: 10.1038/s41598-022-17752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Recent clinical trials show docetaxel (DTX), given in conjunction with radiation therapy (RT) and androgen suppression, improves survival in high-risk prostate cancer. Addition of gold nanoparticles (GNPs) to this current DTX/RT protocol is expected to further improve therapeutic benefits remarkably. However, the foundation for the triple combination of RT, DTX, and GNPs must be elucidated to ensure quicker facilitation to the clinic. In this study, we explored the use of low concentrations of DTX combined with GNPs in two prostate cancer cell lines in a two-dimensional monolayer, a three-dimensional spheroid, and a mouse xenograft model. When used together, DTX and GNPs induced a nearly identical relative increase in uptake of gold in both the spheroid model and the mouse xenograft, which saw a 130% and 126% increase respectively after 24 h, showcasing the benefit of using spheroids as an in vitro model to better optimize in vivo experiments. Further, the benefits of using low concentrations of DTX combined with GNPs extended for over 72 h, allowing for less frequency in dosing when translating to the clinic. Overall, these results highlight the benefits of using DTX combined with GNPs and lays the groundwork for the translation of the triple combination of RT, GNPs, and DTX to the clinic.
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Affiliation(s)
- Kyle Bromma
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Nancy Dos Santos
- British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Ingrid Barta
- Animal Care Services, University of British Columbia, Vancouver, BC, Canada
| | - Abraham Alexander
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Beckham
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
- British Columbia Cancer, Victoria, BC, Canada
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Devika B Chithrani
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.
- British Columbia Cancer, Victoria, BC, Canada.
- Centre for Advanced Materials and Related Technologies (CAMTEC), University of Victoria, Victoria, BC, Canada.
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
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14
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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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15
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Does CyberKnife improve dose distribution versus IMRT and VMAT on a linear accelerator in low-risk prostate cancer? Radiol Oncol 2022; 56:259-266. [PMID: 35344646 PMCID: PMC9122296 DOI: 10.2478/raon-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypofractionated stereotactic body radiation therapy (SBRT) for prostate cancer (PCa) can be delivered with the robot-assisted CyberKnife (CK) system or on a linear accelerator using dynamic intensity-modulated radiotherapy (IMRT) or volumetric arc radiotherapy (VMAT). This retrospective study was performed to determine whether CK offers better dose distribution than IMRT and/or VMAT. MATERIALS AND METHODS Treatment plans for three techniques were prepared using the same treatment parameters (36.35 Gy, 7.25 Gy/fr). We evaluated target coverage, conformity index (CI), homogeneity index (HI), gamma index (GI), and organs at risk (OAR) constraints. RESULTS The mean planning target volume (PTV) dose for CK (39.58 Gy) was significantly greater than VMAT or IMRT (both 36.25 Gy). However, CK resulted in a wider dose range (31.48 to 45.89 Gy) vs. VMAT and IMRT (34.6-38.76 Gy). The mean dose to the rectum (V36Gy, mm3) was significantly lower (p < 0.001) in the CK plans (219.78 vs. 519.59 and 422.62, respectively). The mean bladder dose (V37Gy, mm3) was significantly greater for CK (3256 vs. 1090.75 for VMAT and 4.5 for IMRT (p < 0.001). CK yielded significantly better CI (1.07 vs. 1.17 and 1.25 for VMAT and IMRT, respectively; p < 0.01) and HI values (1.27 vs. 1.07 and 1.04; p < 0.01). GI values for the δd = 3mm, δ% = 3% criteria were 99.86 (VMAT), 99.07 (IMRT) and 99.99 (CK). For δd = 2mm, δ% = 2%, the corresponding values were 98.3, 93.35, and 97.12, respectively. CONCLUSIONS For most variables, CK was superior to both VMAT and IMRT. However, dynamic IMRT techniques, especially VMAT, do not differ significantly from CK plans and are therefore acceptable alternatives to CyberKnife.
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16
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Khauli R, Ferrigno R, Guimarães G, Bulbulan M, Uson Junior PLS, Salvajoli B, Palhares DMF, Racy D, Gil E, de Arruda FF, Lemos GC, Carvalhal GF, de Carvalho IT, Martins IAF, Gimpel IFP, Salvajoli JV, Chambo JL, Pontes J, Filho LAR, Nogueira L, Freitas MRP, Wroclawski M, Arap MA, Sadi MV, Coelho R, Gadia R, Roja RAL, Hanriot RDM, Baroni R, Zequi S, Nahas WC, Alfer W, Maluf FC. Treatment of Localized and Locally Advanced, High-Risk Prostate Cancer: A Report From the First Prostate Cancer Consensus Conference for Developing Countries. JCO Glob Oncol 2021; 7:530-537. [PMID: 33856890 PMCID: PMC8162969 DOI: 10.1200/go.20.00421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To generate and present survey results on important issues relevant to treatment and follow-up of localized and locally advanced, high-risk prostate cancer (PCa) focusing on developing countries. METHODS A panel of 99 PCa experts developed more than 300 survey questions of which 67 questions concern the main areas of interest of this article: treatment and follow-up of localized and locally advanced, high-risk PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up of localized and locally advanced, high-risk PCa in areas of limited resources discussed in this article. RESULTS The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion and not on a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations considered cost-effectiveness as well as the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. Results were tabulated in real time. CONCLUSION The voting results and recommendations presented in this article can guide physicians managing localized and locally advanced, high-risk PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment of localized and locally advanced, high-risk PCa in developing countries have not been defined, this article will serve as a point of reference when confronted with this disease.
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Affiliation(s)
- Raja Khauli
- Naef K. Basile Cancer Institute, Beirut, Lebanon
| | | | | | | | | | - Bernardo Salvajoli
- Instituto do Câncer de São Paulo, São Paulo, Brazil.,Hospital do Coração, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - João Victor Salvajoli
- Instituto do Câncer de São Paulo, São Paulo, Brazil.,Hospital do Coração, São Paulo, Brazil
| | | | - José Pontes
- Instituto do Câncer de São Paulo, São Paulo, Brazil
| | | | - Lucas Nogueira
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | | | | | - Stenio Zequi
- Hospital do Câncer AC Camargo, São Paulo, Brazil
| | | | | | - Fernando Cotait Maluf
- Hospital BP, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
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17
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Lockney NA, Henderson RH, Swarts SG, Zhang Z, Zhang B, Li J, Zlotecki RA, Morris CG, Casey-Sawicki KA, Okunieff PG. Measuring Radiation Toxicity Using Circulating Cell-Free DNA in Prostate Cancer Patients. Int J Part Ther 2021; 8:28-35. [PMID: 35127973 PMCID: PMC8768895 DOI: 10.14338/ijpt-d-21-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022] Open
Abstract
Background After radiation therapy (RT), circulating plasma cell-free DNA (cfDNA) released in response to RT damage to tissue can be measured within hours. We examined for a correlation between cfDNA measured during the first week of therapy and early and late gastrointestinal (GI) and genitourinary (GU) toxicity. Material and Methods Patients were eligible for enrollment if they planned to receive proton or photon RT for nonmetastatic prostate cancer in the setting of an intact prostate or after prostatectomy. Blood was collected before treatment and on sequential treatment days for the first full week of therapy. Toxicity assessments were performed at baseline, weekly during RT, and 6 months and 12 months after RT. Data were analyzed to examine correlations among patient-reported GI and GU toxicities. Results Fifty-four patients were evaluable for this study. Four (7%) and 3 (6%) patients experienced acute and late grade 2 GI toxicity, respectively. Twenty-two (41%) and 18 (35%) patients experienced acute and late grade 2 GU toxicity, respectively. No patients developed grade 3 or higher toxicity. Grade 2 acute GI toxicity, but not grade 2 acute GU toxicity, was significantly correlated with pre-RT cfDNA levels and on all days 1, 2, 3, 4, and 5 of RT (P < .005). Grade 2 late GI toxicity, but not GU toxicity, was significantly correlated with pre-RT cfDNA levels (P = .021). Conclusions Based on this preliminary study, cfDNA levels can potentially predict the subset of patients destined to develop GI toxicity during prostate cancer treatment. Given that the toxicity profiles of the various fractionations and modalities are highly similar, the data support the expectation that cfDNA could provide a biological estimate to complement the dose-volume histogram. A test of this hypothesis is under evaluation in a National Cancer Institute–funded multi-institutional study.
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Affiliation(s)
- Natalie A. Lockney
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Steven G. Swarts
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Zhenhuan Zhang
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Bingrong Zhang
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Jennifer Li
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Robert A. Zlotecki
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
| | | | - Paul G. Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville and Jacksonville, FL, USA
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18
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Da Silva Mendes V, Nierer L, Li M, Corradini S, Reiner M, Kamp F, Niyazi M, Kurz C, Landry G, Belka C. Dosimetric comparison of MR-linac-based IMRT and conventional VMAT treatment plans for prostate cancer. Radiat Oncol 2021; 16:133. [PMID: 34289868 PMCID: PMC8296626 DOI: 10.1186/s13014-021-01858-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to evaluate and compare the performance of intensity modulated radiation therapy (IMRT) plans, planned for low-field strength magnetic resonance (MR) guided linear accelerator (linac) delivery (labelled IMRT MRL plans), and clinical conventional volumetric modulated arc therapy (VMAT) plans, for the treatment of prostate cancer (PCa). Both plans used the original planning target volume (PTV) margins. Additionally, the potential dosimetric benefits of MR-guidance were estimated, by creating IMRT MRL plans using smaller PTV margins. Materials and methods 20 PCa patients previously treated with conventional VMAT were considered. For each patient, two different IMRT MRL plans using the low-field MR-linac treatment planning system were created: one with original (orig.) PTV margins and the other with reduced (red.) PTV margins. Dose indices related to target coverage, as well as dose-volume histogram (DVH) parameters for the target and organs at risk (OAR) were compared. Additionally, the estimated treatment delivery times and the number of monitor units (MU) of each plan were evaluated. Results The dose distribution in the high dose region and the target volume DVH parameters (D98%, D50%, D2% and V95%) were similar for all three types of treatment plans, with deviations below 1% in most cases. Both IMRT MRL plans (orig. and red. PTV margins) showed similar homogeneity indices (HI), however worse values for the conformity index (CI) were also found when compared to VMAT. The IMRT MRL plans showed similar OAR sparing when the orig. PTV margins were used but a significantly better sparing was feasible when red. PTV margins were applied. Higher number of MU and longer predicted treatment delivery times were seen for both IMRT MRL plans. Conclusions A comparable plan quality between VMAT and IMRT MRL plans was achieved, when applying the same PTV margin. However, online MR-guided adaptive radiotherapy allows for a reduction of PTV margins. With a red. PTV margin, better sparing of the surrounding tissues can be achieved, while maintaining adequate target coverage. Nonetheless, longer treatment delivery times, characteristic for the IMRT technique, have to be expected.
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Affiliation(s)
- Vanessa Da Silva Mendes
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Department of Radiation Oncology, Cologne University Hospital, Cologne, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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19
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Viani GA, Arruda CV, Oliveira R. Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system. Rev Assoc Med Bras (1992) 2021; 67:724-730. [DOI: 10.1590/1806-9282.20210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/14/2021] [Indexed: 11/22/2022] Open
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20
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Molecular Hydrogen as a Potential Clinically Applicable Radioprotective Agent. Int J Mol Sci 2021; 22:ijms22094566. [PMID: 33925430 PMCID: PMC8123813 DOI: 10.3390/ijms22094566] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023] Open
Abstract
Although ionizing radiation (radiation) is commonly used for medical diagnosis and cancer treatment, radiation-induced damages cannot be avoided. Such damages can be classified into direct and indirect damages, caused by the direct absorption of radiation energy into DNA and by free radicals, such as hydroxyl radicals (•OH), generated in the process of water radiolysis. More specifically, radiation damage concerns not only direct damages to DNA, but also secondary damages to non-DNA targets, because low-dose radiation damage is mainly caused by these indirect effects. Molecular hydrogen (H2) has the potential to be a radioprotective agent because it can selectively scavenge •OH, a reactive oxygen species with strong oxidizing power. Animal experiments and clinical trials have reported that H2 exhibits a highly safe radioprotective effect. This paper reviews previously reported radioprotective effects of H2 and discusses the mechanisms of H2, not only as an antioxidant, but also in intracellular responses including anti-inflammation, anti-apoptosis, and the regulation of gene expression. In doing so, we demonstrate the prospects of H2 as a novel and clinically applicable radioprotective agent.
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21
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Cathcart P, Ribeiro L, Moore C, Ahmed HU, Leslie T, Arya M, Orczyk C, Hindley RG, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Tunna K, Sooriakumaran P, Emberton M. Outcomes of the RAFT trial: robotic surgery after focal therapy. BJU Int 2021; 128:504-510. [PMID: 33891378 DOI: 10.1111/bju.15432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report toxicity of treatment observed in men participating in the Robotic surgery After Focal Therapy (RAFT) clinical trial. PATIENTS AND METHODS Men were eligible for this prospective single group interventional study if they had histologically confirmed recurrent/residual prostate adenocarcinoma following primary FT. The short-form Expanded Prostate Cancer Index Composite (EPIC-26) measured prior to salvage robotic prostatectomy (S-RARP) and 3-monthly post-operatively together with Clavien-Dindo complications (I-IV). Secondary outcomes included biochemical recurrence-free survival (BCFS) following surgery and need for salvage treatment after surgery. This study is registered with ClinicalTrials.gov NCT03011606. RESULTS Twenty-four men were recruited between February 2016 and September 2018. 1 patient withdrew from the trial after consenting and before S-RARP. 23 men completed 12-month post S-RARP follow-up. Median EPIC-26 urinary continence scores initially deteriorated after 3 months (82.4 vs 100) but there was no statistically significant difference from baseline at 12 months (100 vs 100, P = 0.31). Median lower urinary tract symptom scores improved after 12 months compared to baseline (93.8 vs 87.5, P = 0.01). At 12 months, 19/23 (83%) were pad-free and 22/23 (96%) required 0/1 pads. Median sexual function subscale scores deteriorated and remained low at 12 months (22.2 vs 58.3, P < 0.001). Utilising a minimally important difference of nine points, at 12 months after surgery 17/23 (74%) reported urinary continence to be 'better' or 'not different' to pre-operative baseline. The corresponding figure for sexual function (utilising a minimally important difference of 12 points) was 7/23 (30%). There was no statistically significant difference on median bowel/hormonal subscale scores. Only a single patient had a post-operative complication (Clavien-Dindo Grade I). BCFS at 12 months after surgery was 82.6% (95% confidence interval [CI]: 60.1-93.1%) while 4/23 (17%) received salvage radiation. CONCLUSIONS The RAFT clinical trial suggests toxicity of surgery after FT is low, with good urinary function outcomes, albeit sexual function deteriorated overall. Oncological outcomes at 12 months appear acceptable.
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Affiliation(s)
- Paul Cathcart
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Luis Ribeiro
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Caroline Moore
- Department of Urology, University College Hospital London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals, Oxford, UK
| | - Manit Arya
- Department of Urology, University College Hospital London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College Hospital London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Fidelma Cahill
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Aaron Prendergast
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Carike Coetzee
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yathushan Yogeswaran
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kirsty Tunna
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College Hospital London, London, UK
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22
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Yoshimura T, Nishioka K, Hashimoto T, Fujiwara T, Ishizaka K, Sugimori H, Kogame S, Seki K, Tamura H, Tanaka S, Matsuo Y, Dekura Y, Kato F, Aoyama H, Shimizu S. Visualizing the urethra by magnetic resonance imaging without usage of a catheter for radiotherapy of prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:1-4. [PMID: 34258400 PMCID: PMC8254197 DOI: 10.1016/j.phro.2021.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Post urination MRI is useful for urethra-sparing radiotherapy treatment planning. This prospective clinical trial included 11 prostate cancer patients. Post urination MRI is the identification method of prostatic urinary tract in non-invasive manner.
The urethra position may shift due to the presence/absence of the catheter. Our proposed post-urination-magnetic resonance imaging (PU-MRI) technique is possible to identify the urethra without catheter. We aimed to verify the inter-operator difference in contouring the urethra by PU-MRI. The mean values of the evaluation indices of dice similarity coefficient, mean slice-wise Hausdorff distance, and center coordinates were 0.93, 0.17 mm, and 0.36 mm for computed tomography, and 0.75, 0.44 mm, and 1.00 mm for PU-MRI. Therefore, PU-MRI might be useful for identifying the prostatic urinary tract without using a urethral catheter. Clinical trial registration: Hokkaido University Hospital for Clinical Research (018-0221).
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Taro Fujiwara
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Sugimori
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shoki Kogame
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuya Seki
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Tamura
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Yuto Matsuo
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Yasuhiro Dekura
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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23
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Polce S, Gogineni E, Antone J, Ghaly M, Keith Frank D, Segal JD, Parashar B. Dental radiation dosimetric maps from intensity-modulated radiation therapy planning for head and neck cancers. Head Neck 2021; 43:1428-1439. [PMID: 33452742 DOI: 10.1002/hed.26611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity-modulated radiation therapy (IMRT). METHODS Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. RESULTS All patients were treated with prescribed doses of 50-70 Gy in 1.66-2 Gy/fraction. Patients receiving mean doses >50 Gy to the teeth, mandible, and maxilla included those with advanced tumors of the oral cavity and gross lymphadenopathy of level 1b. CONCLUSION We believe this to be the first study generating dosimetric maps of estimated doses to each tooth and each third of the mandible and the maxilla for common examples of head and neck cancer faced by radiation oncologists. Adoption of these dental maps may help improve clinical workflow efficiency.
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Affiliation(s)
- Simran Polce
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Emile Gogineni
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeffrey Antone
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Douglas Keith Frank
- Department of Otolaryngology, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
| | - Joshua D Segal
- Department of Dental Medicine, Division of Oral and Maxillofacial surgery, Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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24
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Hirano SI, Aoki Y, Li XK, Ichimaru N, Takahara S, Takefuji Y. Protective effects of hydrogen gas inhalation on radiation-induced bone marrow damage in cancer patients: a retrospective observational study. Med Gas Res 2021; 11:104-109. [PMID: 33942780 PMCID: PMC8174412 DOI: 10.4103/2045-9912.314329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although intensity-modulated radiation therapy (IMRT) has been developed as an alternative to conventional radiotherapy, reducing bone marrow damage is limited. Thus, a novel technology is needed to further mitigate IMRT-induced bone marrow damage. Molecular hydrogen (H2) was recently reported as a preventive and therapeutic antioxidant that selectively scavenges hydroxyl radical (·OH) and peroxynitrite (ONOO-). This observational study aimed to examine whether H2 gas treatment improves IMRT-induced bone marrow damage in cancer patients. The study was performed at Clinic C4 in Tokyo, Japan between May 2015 and November 2016. During this period, all enrolled patients received IMRT once per day for 1 to 4 weeks. After each time of IMRT, the patients of control group (n = 7, 3 men and 4 women, age range: 26-70 years) received mild hyperbaric oxygen therapy in health care chamber for 30 minutes, and the patients of H2 group (n = 16, 8 men and 8 women, age range: 35-82 years) received 5% H2 gas in health care chamber for 30 minutes once per day. Radiation-induced bone marrow damage was evaluated by hematological examination of peripheral blood obtained before and after IMRT, and the data were expressed by the ratio after to before treatment. The total number of radiation times and total exposure doses of radiation were similar between the control and H2 groups. IMRT with health care chamber therapy significantly reduced white blood cells and platelets, but not red blood cells, hemoglobin and hematocrit. In contrast, H2 gas treatment significantly alleviates the reducing effects of white blood cells and platelets (P = 0.0011 and P = 0.0275, respectively). Tumor responses to IMRT were similar between the two groups. The results obtained demonstrated that H2 gas inhalation therapy alleviated IMRT-induced bone marrow damage without compromising the anti-tumor effects of IMRT. The present study suggests that this novel approach of H2 gas inhalation therapy may be applicable to IMRT-induced bone marrow damage in cancer patients. The study protocol was approved by an Ethics Committee Review of Tokyo Clinic and Research Institute ICVS Incorporated (Tokyo, Japan) on February 1, 2019, and was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN ID: UMIN000035864) on February 20, 2019.
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Affiliation(s)
| | | | - Xiao-Kang Li
- Division of Transplantation Immunology, National Institute for Child Health and Development, Tokyo, Japan
| | - Naotsugu Ichimaru
- Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiro Takahara
- Department of Renal Transplantation Center, Kansai Medical Hospital, Osaka, Japan
| | - Yoshiyasu Takefuji
- Faculty of Environment and Information Studies, Keio University, Fujisawa, Japan
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25
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Taylor JM, Chen VE, Miller RC, Greenberger BA. The Impact of Prostate Cancer Treatment on Quality of Life: A Narrative Review with a Focus on Randomized Data. Res Rep Urol 2020; 12:533-546. [PMID: 33150144 PMCID: PMC7605665 DOI: 10.2147/rru.s243088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023] Open
Abstract
Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best made in an informed and shared medical decision-making process between clinician and patient with respect to cancer control as well as adverse effects. We outline in this narrative review an understanding regarding implications of surgical and radiation treatment on quality of life after treatment, and how these data may be considered in the context of advising patients regarding the selection of therapy. This narrative review largely focuses on the quality of life data obtained from prospective randomized trials of men treated for prostate cancer. We believe this provides the best assessment of the quality of life and can be used to inform patients when making treatment decisions.
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Affiliation(s)
- James M Taylor
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Victor E Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan C Miller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
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26
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Lawes R, Carter E, Hussein M, Murray J, McNair HA. Retrospective audit of inter-fraction motion for pelvic node radiotherapy in prostate cancer patients. Radiography (Lond) 2020; 27:266-271. [PMID: 32830012 DOI: 10.1016/j.radi.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic lymph nodes move independently to the prostate. When delivering radiotherapy to prostate and pelvic lymph nodes, daily inter- and intra-fraction anatomical changes need to be accounted for. Planning target volume (PTV) margins, grown from the pelvic lymph node clinical target volume need to be determined, to account for this variation in position. METHODS Twenty patients who had daily online image guided radiotherapy to prostate and pelvic lymph nodes between April and December 2018 were selected. Ten pre-treatment verification images using cone beam CT from each patient were registered to pelvic bone anatomy, prostate soft tissue or fiducial markers and pelvic lymph node soft tissue to assess the accuracy of treatment delivery. Population systematic and random errors and PTV margins were calculated. RESULTS PTV margins of 0.4 cm, 0.4 cm and 0.7 cm left-right (LR), superior-inferior (SI) and anterior-posterior (AP) respectively were derived for the pelvic lymph nodes when registering to prostate. PTV margins of 0.3 cm, 0.2 cm and 0.4 cm LR, SI and AP respectively were derived for the pelvic lymph nodes when registering to bone. There was a posterior systematic shift of the prostate during the treatment course. CONCLUSION There is differential motion of pelvic lymph nodes to prostate and in the era of prostate and pelvic radiotherapy for patients with node positive prostate cancer; there is increasing importance in the accuracy of dose delivery to the involved lymph node. Hence, this group of patients may benefit from personalised radiotherapy PTV margins, especially if the involved pelvic lymph node is within the anterior part of the clinical target volume. IMPLICATIONS FOR PRACTICE Optimisation of dose delivery to the pelvic lymph nodes when prioritising the prostate in prostate and pelvic lymph node image guided radiotherapy.
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Affiliation(s)
- R Lawes
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK.
| | - E Carter
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK
| | - M Hussein
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK
| | - J Murray
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK; Academic Urology Unit, Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
| | - H A McNair
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
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27
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Overall survival comparison between androgen deprivation therapy (ADT) plus external beam radiation therapy (EBRT) vs ADT plus EBRT with brachytherapy boost in clinically node-positive prostate cancer. Brachytherapy 2020; 19:557-566. [PMID: 32624405 DOI: 10.1016/j.brachy.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Optimal therapy for clinically node-positive, nonmetastatic (cN1) prostate cancer (PC) patients remains controversial, ranging from aggressive local therapy to palliative systematic therapy alone. Despite guideline support, it is unclear if a brachytherapy (BT) boost should be considered for cN1 patients as these patients were excluded from randomized trials establishing its benefit. Herein, we compare definitive radiation therapy (RT) with or without a BT boost in cN1 PC. METHODS AND MATERIALS The National Cancer Database was used to identify men with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy between 2004 and 2013. Overall survival (OS) was compared between those who received external beam RT (EBRT) or combination EBRT plus BT boost (EBRT + BT) using Kaplan-Meier with propensity score matching and Cox proportional hazards. RESULTS With a median followup of 48.5 months, 1,650 patients were eligible for this analysis, 103 (6.2%) of whom received EBRT + BT. Younger age, no medical comorbidities, and Gleason score of six were associated with higher likelihood of receiving EBRT + BT over EBRT alone. The mean (median) OS for EBRT and EBRT + BT was 99.0 (110.6) months vs 109.2 (not reached) months, respectively (p = 0.048). However, no significance difference in OS was observed between the groups after propensity score matching. On multivariable analysis, EBRT + BT was not significantly associated with improved OS (adjusted HR 0.67, 95% CI, 0.41-1.07, p = 0.098). CONCLUSIONS In this retrospective, observational study of patients with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy, EBRT + BT had an unadjusted improvement in OS compared with EBRT alone that lost statistical significance after multivariable adjustment and propensity score matching.
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28
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Viani G, Hamamura AC, Faustino AC. Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference? Int Braz J Urol 2020; 45:1105-1112. [PMID: 31808397 PMCID: PMC6909869 DOI: 10.1590/s1677-5538.ibju.2018.0842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. Materials and Methods: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modified RTOG criteria. The biochemical control was defined by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. Results: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for >=grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no significant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No significant differences for OS and DMFS were observed comparing treatment groups. Conclusion: IMRT reduces significantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.
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Affiliation(s)
- Gustavo Viani
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP, Ribeirão Preto, SP, Brasil
| | - Ana Carolina Hamamura
- Departamento de Radioterapia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Alexandre C Faustino
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP, Ribeirão Preto, SP, Brasil
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29
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Chen RC. Randomized Trials and the Goldilocks Problem. Eur Urol 2020; 77:11-13. [PMID: 31103392 DOI: 10.1016/j.eururo.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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Strauss L, Shaw W. Considerations for the verification of volumetric modulated arc therapy-planned dose distributions. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2019. [DOI: 10.4102/sajo.v3i0.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Volumetric modulated arc therapy (VMAT) is the standard of care for many clinical indications, but should only be considered with proper technical support and quality assurance (QA) in place. Despite the high accuracy of VMAT systems, errors can be present and adequate verification is required. Dosimetric VMAT verification systems have a broadly similar analysis philosophy. However, many factors influence the analyses and the subsequent QA outcome, based on which the plan will pass or fail.Aim: This study investigated various factors that influence the dosimetric impact and detectability of known linac component deviations on VMAT QA, including geometries, tissue densities, gamma criteria and dose–volume differences.Setting: Universitas Hospital (Annex), Bloemfontein, South Africa.Methods: Deliberate multi-leaf collimator (MLC)-bank offsets were introduced on four different VMAT plans of the prostate, nasopharynx and brain. Measured reference dose sets were compared to measured QA results, using the IBA Dolphin© detector and Compass© software for three dosimetric scenarios. Gamma pass rates over a range of criteria from 1%/2-mm to 4%/4-mm in the total volumes and per structure, as well as dose–volume differences were studied.Results: Gamma tests in the total patient/phantom did not sufficiently detect errors. The calculation media did not influence the QA outcome greatly. However, the detection geometry affected the results. Per structure gamma analyses provided superior error detection, although still missed some clinically relevant differences. The addition of dose–volume analyses highlighted several important errors.Conclusion: Volumetric modulated arc therapy using only total volume gamma analyses can easily overlook clinically relevant errors. The choice of gamma criterion is crucial. Verification with at least a per structure gamma test in combination with dose–volume checks is recommended, especially in small target volume cases.
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New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer. Nat Rev Urol 2019; 16:523-538. [DOI: 10.1038/s41585-019-0213-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
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32
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Added value of diffusion-weighted MRI for nodal radiotherapy planning in pelvic malignancies. Clin Transl Oncol 2019; 21:1383-1389. [DOI: 10.1007/s12094-019-02068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/15/2019] [Indexed: 02/08/2023]
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