1
|
Ndjembidouma BCM, James LG, Meye PO, Loembamouandza SY, Belembaogo E, Ben-Bolie GH. Assessment of rectal toxicities after radiation therapy for localized prostate cancer: experience of the Akanda Cancer Institute in Gabon. Rep Pract Oncol Radiother 2023; 28:636-645. [PMID: 38179290 PMCID: PMC10764052 DOI: 10.5603/rpor.97507] [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: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
Background The purpose was to evaluate the incidence of acute and late rectal toxicities and their correlation with the clinical and dosimetric parameters of patients who underwent curative radiotherapy for localized prostate cancer at the Akanda Cancer Institute, Gabon. Materials and methods Between 2013 and 2021, a cohort of 46 patients with clinically localized stage cT1c-T4 prostate cancer was treated with three-dimensional conformal radiation therapy (3D-CRT) at the national cancer institute with doses ranging from 66 to 80 Gy. Post-radiation gastrointestinal (GI) toxicities were classified and graded according to the Common Terminology Criteria for Adverse Events CTCAE v4.0. Results In our study, 17.4% (8/46) developed acute GI. Grades 1 and 3 acute GI complications were seen in 13.0% (6/46) and 4.3% (2/46), respectively. No patient developed acute grade 2 or grade higher than 3 complications. Late GI side effects were limited. The median time to the development of late GI Grade ≥ 1 toxicities was 12 months (range: 9-19 months). 10.9% (5/46) had experience late GI. Among them, grade 1 and 2 were seen in 6.5% (3/46), and 4.3% (2/46), respectively. There was no grade 3 or higher complications. Statistically, we did not find any correlation between the presence of rectal toxicity and clinical factors or the presence of comorbidity. On the dosimetric level, the Mann-Whitney statistical test found a correlation between the presence of late GI toxicity and rectal volume irradiated at the prescribed dose (p = 0.02). Conclusion Despite the high radiation doses involved, our results showed an acceptable complication rate.
Collapse
Affiliation(s)
- Beaud Conrad Mabika Ndjembidouma
- Departement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
| | | | - Phillippe Ondo Meye
- General Directorate for Radiation Protection and Nuclear Safety, Ministery of Energy and Hydraulic Resources, Libreville Gabon
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
| | | | - Ernest Belembaogo
- Departement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon
| | - Germain Hubert Ben-Bolie
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
| |
Collapse
|
2
|
Singh B, Singh G, Oinam AS, Singh M, Kumar V, Vashistha R, Sidhu MS, Katake A. Radiobiological modeling of radiation-induced acute proctitis: A single-institutional study of prostate carcinoma. J Cancer Res Ther 2023; 19:664-670. [PMID: 37470591 DOI: 10.4103/jcrt.jcrt_1048_21] [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] [Indexed: 11/04/2022]
Abstract
Purpose To estimate the fitting parameters of the sigmoidal dose response (SDR) curve of radiation-induced acute proctitis in prostate cancer patients treated with intensity modulated radiation therapy (IMRT) for the calculation of normal tissue complication probability (NTCP). Materials and Methods Twenty-five prostate cancer patients were enrolled and evaluated weekly for acute radiation-induced (ARI) proctitis toxicity. Their scoring was performed as per common terminology criteria for adverse events version 5.0. The radiobiological parameters namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of prostate cancer patients. Results ARI toxicity for rectum in carcinoma of prostate patients was calculated for the endpoint of acute proctitis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 acute proctitis are found to be 0.13, 0.10, 30.48 ± 1.52 (confidence interval [CI] 95%), 3.18 and 0.08, 0.10, 44.37 ± 2.21 (CI 95%), 4.76 respectively. Conclusion This study presents the fitting parameters for NTCP calculation of Grade-1 and Grade-2 ARI rectum toxicity for the endpoint of acute proctitis. The provided nomograms of volume versus complication and dose versus complication for different grades of acute proctitis in the rectum help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
Collapse
Affiliation(s)
- Balbir Singh
- Centre for Medical Physics, Panjab University, Chandigarh; Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University; Department of Radiotherapy, PGIMER, Chandigarh, Punjab, India
| | | | - Maninder Singh
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, Punjab, India
| | - Rajesh Vashistha
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Manjinder Singh Sidhu
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Ajay Katake
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| |
Collapse
|
3
|
Rectal retractor in prostate radiotherapy: pros and cons. Radiat Oncol 2022; 17:204. [PMID: 36494732 PMCID: PMC9737745 DOI: 10.1186/s13014-022-02176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Dose escalation in prostate radiotherapy (RT) have led to improved biochemical controls and reduced the risk of distant metastases. Over the past three decades, despite technological advancements in RT planning and delivery, the rectum is a dose-limiting structure in prostate RT owing to the close anatomical proximity of the anterior rectal wall (ARW) to the prostate gland. RT-induced rectal toxicities remain a clinical challenge, limiting the prescribed dose during prostate RT. To address the spatial proximity challenge by physically increasing the distance between the posterior aspect of the prostate and the ARW, several physical devices such as endorectal balloons (ERBs), rectal hydrogel spacers, and rectal retractor (RR) have been developed. Previously, various aspects of ERBs and rectal hydrogel spacers have extensively been discussed. Over recent years, given the interest in the application of RR in prostate external beam radiotherapy (EBRT), this editorial will discuss opportunities and challenges of using RR during prostate EBRT and provide information regarding which aspects of this device need attention.
Collapse
|
4
|
Ali S, Esper P. Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers. Clin J Oncol Nurs 2021; 25:321-328. [PMID: 34019017 DOI: 10.1188/21.cjon.321-328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brachytherapy is a well-established and effective primary treatment modality for low- and favorable intermediate-risk prostate cancers. Although the benefits of brachytherapy in unfavorable intermediate- and high-risk prostate cancers have not been as clear, research suggests that brachytherapy boost may improve biochemical progression-free survival in these patients. OBJECTIVES This article aims to discuss evidence for the revival of brachytherapy use in unfavorable intermediate- and high-risk prostate cancers and specific nursing implications in the management of these patients. METHODS The literature on brachytherapy and its use to treat localized prostate cancers was reviewed. FINDINGS Nurses should be knowledgeable about the indications for brachytherapy, patient eligibility, anticipated side effects, and symptom management.
Collapse
Affiliation(s)
- Sanna Ali
- University of Maryland Medical Center
| | | |
Collapse
|
5
|
Seppenwoolde Y, Majercakova K, Buschmann M, Dörr E, Sturdza AE, Schmid MP, Pötter R, Georg D. Early morbidity and dose-volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques. Strahlenther Onkol 2021; 197:505-519. [PMID: 33929558 PMCID: PMC8154798 DOI: 10.1007/s00066-021-01781-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Predicting morbidity for patients with locally advanced cervix cancer after external beam radiotherapy (EBRT) based on dose-volume parameters remains an unresolved issue in definitive radiochemotherapy. The aim of this prospective study was to correlate patient characteristics and dose-volume parameters to various early morbidity endpoints for different EBRT techniques, including volumetric modulated arc therapy (VMAT) and adaptive radiotherapy (ART). METHODS AND MATERIALS The study population consisted of 48 patients diagnosed with locally advanced cervix cancer, treated with definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT). Multiple questionnaires (CTCAE 4.03, QLQ-C30 and EORTC QLQ-CX24) were assessed prospectively for patients treated with different EBRT techniques, including online adaptive VMAT. Contouring and treatment planning was based on the EMBRACE protocols. Acute toxicity, classified as general, gastrointestinal (GI) or genitourinary (GU) and their corresponding dose-volume histograms (DVHs) were first correlated by applying least absolute shrinkage and selection operator (LASSO) and subsequently evaluated by multiple logistic binomial regression. RESULTS The treated EBRT volumes varied for the different techniques with ~2500 cm3 for 3D conformal radiotherapy (3D-CRT), ~2000 cm3 for EMBRACE‑I VMAT, and ~1800 cm3 for EMBRACE-II VMAT and ART. In general, a worsening of symptoms during the first 5 treatment weeks and recovery afterwards was observed. Dose-volume parameters significantly correlating with stool urgency, rectal and urinary incontinence were as follows: bowel V40Gy < 250 cm3, rectum V40Gy < 80% and bladder V40Gy < 80-90%. CONCLUSION This prospective study demonstrated the impact of EBRT treatment techniques in combination with chemotherapy on early morbidity. Dose-volume effects for dysuria, urinary incontinence, stool urgency, diarrhea, rectal bleeding, rectal incontinence and weight loss were found.
Collapse
Affiliation(s)
- Yvette Seppenwoolde
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Katarina Majercakova
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Martin Buschmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Elke Dörr
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Alina E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Maximilian P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
6
|
Wang X, Zhang B, He Q, Kong Y, Dai Z, Meng H, Huang F, Zhang S, Zhu Y, Tan X, Zhen X. Rectum Protection by Rectal Gel Injection in Cervical Cancer Brachytherapy: A Dosimetric Study via Deformable Surface Dose Accumulation and Machine-Learning-Based Discriminative Modeling. Front Oncol 2021; 11:657208. [PMID: 33937068 PMCID: PMC8085420 DOI: 10.3389/fonc.2021.657208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose This retrospective study aimed to evaluate the dosimetric effects of a rectal insertion of Kushen Ningjiao on rectal protection using deformable dose accumulation and machine learning–based discriminative modelling. Materials and Methods Sixty-two patients with cervical cancer enrolled in a clinical trial, who received a Kushen Ningjiao injection of 20 g into their rectum for rectal protection via high–dose rate brachytherapy (HDR-BT, 6 Gy/f), were studied. The cumulative equivalent 2-Gy fractional rectal surface dose was deformably summed using an in-house-developed topography-preserved point-matching deformable image registration method. The cumulative three-dimensional (3D) dose was flattened and mapped to a two-dimensional (2D) plane to obtain the rectal surface dose map (RSDM). For analysis, the rectal dose (RD) was further subdivided as follows: whole, anterior, and posterior 3D-RD and 2D-RSDM. The dose–volume parameters (DVPs) were extracted from the 3D-RD, while the dose geometric parameters (DGPs) and textures were extracted from the 2D-RSDM. These features were fed into 192 classification models (built with 8 classifiers and 24 feature selection methods) for discriminating the dose distributions between pre-Kushen Ningjiao and pro-Kushen Ningjiao. Results The rectal insertion of Kushen Ningjiao dialated the rectum in the ambilateral direction, with the rectal column increased from pre-KN 15 cm3 to post-KN 18 cm3 (P < 0.001). The characteristics of DGPs accounted for the largest portions of the top-ranked features. The top-ranked dosimetric features extracted from the posterior rectum were more reliable indicators of the dosimetric effects/changes introduced by the rectal insertion of Kushen Ningjiao. A significant dosimetric impact was found on the dose–volume parameters D1.0cc–D2.5cc extracted on the posterior rectal wall. Conclusions The rectal insertion of Kushen Ningjiao incurs significant dosimetric changes on the posterior rectal wall. Whether this effect is eventually translated into clinical gains requires further long-term follow-up and more clinical data for confirmation.
Collapse
Affiliation(s)
- Xuetao Wang
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bailin Zhang
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang He
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yilin Kong
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenhui Dai
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoyu Meng
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Shengfeng Zhang
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanhu Zhu
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Tan
- Radiation Oncology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Zhen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| |
Collapse
|
7
|
Stanić J, Stanković V, Nikitović M. Radiation toxicity in prostate cancer patients. MEDICINSKI PODMLADAK 2021. [DOI: 10.5937/mp72-32377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Prostate cancer (PC) is the most frequent male tumor, accounting for about one-third of all cancers in men. Since survival is often favorable regardless of therapy, treatment decisions may depend on therapy-specific health outcomes. The majority of men initially diagnosed with localized PC ultimately die with, rather than of, their disease. As a result, men who are diagnosed will live many years with the treatment's sequelae. The major therapeutic strategies include radical prostatectomy or external beam radiotherapy. Radiotherapy is one of the curative treatment options. The tumor dose-response relationship has been studied and is widely accepted. The unsatisfactory local control with doses < 70 Gy led to dose escalation using highly precise radiotherapy techniques - three-dimensional conformal radiotherapy and intensity-modulated radiotherapy enabling the delivery of high radiation doses up to 74 - 78 Gy. Bowel, rectal and urinary toxicities are the principal limiting factors in delivering a high dose. Acute symptoms include a change in bowel habits, urgency, and fecal incontinence. The most commonly reported late toxicities were chronic diarrhea, proctitis, or rectal bleeding. Several factors have been associated with increased gastrointestinal toxicity such as larger bowel volume receiving high doses, the patient's age, diabetes, and concomitant use of androgen deprivation therapy. Bladder damage resulting from acute radiation toxicity is manifested as radiation cystitis (frequent urination and dysuric disorders). Smoking, previous abdominopelvic surgeries and the use of diuretics significantly affect the occurrence of acute genitourinary toxicity grade ≥ 2. Risk factors for the development of late genitourinary complications are higher radiation dose, previous urinary problems, transurethral interventions, and acute genitourinary complications. It is essential to strike a balance between the therapeutic benefits and radiotherapy side effects. Severe late complications significantly reduce the quality of life (QOL) of PC survivors. Early detection and proper evaluation of complications are especially important in increasing the patient's QOL.
Collapse
|
8
|
Nguyen TTT, Arimura H, Asamura R, Hirose TA, Ohga S, Fukunaga JI. Comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy prostate cancer plans accounting for cold spots. Radiol Phys Technol 2019; 12:137-148. [PMID: 30805779 DOI: 10.1007/s12194-019-00502-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/25/2022]
Abstract
This study compared dosimetric indices of volumetric-modulated arc therapy (VMAT) with intensity-modulated radiation therapy (IMRT) accounting for cold spots in prostate cancer plans. IMRT plans were retrospectively generated from 30 prostate cancer patients with ten cases for each risk group, who received VMAT plans. The mean, maximum, and minimum doses, and conformity and homogeneity indexes were evaluated for planning target volume (PTV) and the mean dose and V20-V70 for organs at risk (OAR) including the rectum, bladder, right and left femoral heads, and rectum overlapped with PTV (ROP) regions. The numbers and volume percentages of cold spots within PTVs and ROP regions were measured using in-house software. Three-dimensional probabilistic distributions of the probability and distributions of cold spots were generated using a centroid matching technique for visualization and analysis. There was a statistically better dose conformity in the PTV, rectum, and bladder dose-sparing in VMAT compared to that in the IMRT plans, whereas VMAT had statistically worse target dose homogeneity, and right and left femoral head dose-sparing than those of the IMRT plans. The average volume percentage of cold spots per PTV for the VMAT was 4.37 ± 2.68%, which was smaller than the 5.72 ± 1.84% observed for IMRT plans (P = 0.007). The volume percentage of cold spots per ROP for the VMAT did not significantly differ from those for the IMRT plans. Compared with IMRT, the VMAT plans achieved better PTV dose conformity, OAR dose-sparing, and smaller cold spots in the treatment of prostate cancer.
Collapse
Affiliation(s)
- Tran Thi Thao Nguyen
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Japan Society for the Promotion of Science, 5-3-1, Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Hidetaka Arimura
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ryosuke Asamura
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taka-Aki Hirose
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Saiji Ohga
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun-Ichi Fukunaga
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
9
|
Saadipoor A, Razzaghdoust A, Simforoosh N, Mahdavi A, Bakhshandeh M, Moghadam M, Abdollahi H, Mofid B. Randomized, double-blind, placebo-controlled phase II trial of nanocurcumin in prostate cancer patients undergoing radiotherapy. Phytother Res 2018; 33:370-378. [PMID: 30427093 DOI: 10.1002/ptr.6230] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
Clinical potential of curcumin in radiotherapy (RT) setting is outstanding and of high interest. The main purpose of this randomized controlled trial (RCT) was to assess the beneficial role of nanocurcumin to prevent and/or mitigate radiation-induced proctitis in prostate cancer patients undergoing RT. In this parallel-group study, 64 eligible patients with prostate cancer were randomized to receive either oral nanocurcumin (120 mg/day) or placebo 3 days before and during the RT course. Acute toxicities including proctitis and cystitis were assessed weekly during the treatment and once thereafter using CTCAE v.4.03 grading criteria. Baseline-adjusted hematologic nadirs were also analyzed and compared between the two groups. The patients undergoing definitive RT were followed to evaluate the tumor response. Nanocurcumin was well tolerated. Radiation-induced proctitis was noted in 18/31 (58.1%) of the placebo-treated patients versus 15/33 (45.5%) of nanocurcumin-treated patients (p = 0.313). No significant difference was also found between the two groups with regard to radiation-induced cystitis, duration of radiation toxicities, hematologic nadirs, and tumor response. In conclusion, this RCT was underpowered to indicate the efficacy of nanocurcumin in this clinical setting but could provide a considerable new translational insight to bridge the gap between the laboratory and clinical practice.
Collapse
Affiliation(s)
- Afshin Saadipoor
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Razzaghdoust
- Urology and Nephrology Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Allied Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Moghadam
- Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Urology and Nephrology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Leiker AJ, Desai NB, Folkert MR. Rectal radiation dose-reduction techniques in prostate cancer: a focus on the rectal spacer. Future Oncol 2018; 14:2773-2788. [PMID: 29939069 DOI: 10.2217/fon-2018-0286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer is the most common cancer in men. External beam radiotherapy by a variety of methods is a standard treatment option with excellent disease control. However, acute and late rectal side effects remain a limiting concern in intensification of therapy in higher-risk patients and in efforts to reduce treatment burden in others. A number of techniques have emerged that allow for high-radiation dose delivery to the prostate with reduced risk of rectal toxicity, including image-guided intensity-modulated radiation therapy, endorectal balloons and various forms of rectal spacers. Image-guided radiation therapy, either intensity-modulated radiation therapy or stereotactic ablative radiation therapy, in conjunction with a rectal spacer, is an efficacious means to reduce acute and long-term rectal toxicity.
Collapse
Affiliation(s)
- Andrew J Leiker
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390-9303, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390-9303, USA
| | - Michael R Folkert
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390-9303, USA
| |
Collapse
|
11
|
Prone Positioning on a Belly Board Decreases Rectal and Bowel Doses in Pelvic Intensity-Modulated Radiation Therapy (IMRT) for Prostate Cancer. Pathol Oncol Res 2018; 25:995-1002. [PMID: 29882196 DOI: 10.1007/s12253-018-0436-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
The presence of normal tissues in the irradiated volume limits dose escalation during pelvic radiotherapy (RT) for prostate cancer. Supine and prone positions on a belly board were compared by analyzing the exposure of organs at risk (OARs) using intensity modulated RT (IMRT). The prospective trial included 55 high risk, localized or locally advanced prostate cancer patients, receiving definitive image-guided RT. Computed tomography scanning for irradiation planning was carried out in both positions. Gross tumor volume, clinical and planning target volumes (PTV) and OARs were delineated, defining subprostatic and periprostatic rectal subsegments. At the height of the largest antero-posterior (AP) diameter of the prostate, rectal diameters and distance from the posterior prostate wall were measured. IMRT plans were generated. Normal tissue exposure and structure volumes were compared between supine and prone plans using paired t-test. In the volumes of the prostate, PTV, colon and small bowel, no significant differences were found. In prone position, all rectal volumes, diameters, and rectum-prostate distance were significantly higher, the irradiated colon and small bowel volume was lower in dose ranges of 20-40 Gy, and the exposure to all rectal segments was more favorable in 40-75 Gy dose ranges. No significant difference was found in the exposure of other OARs. Prone positioning on a belly board is an appropriate positioning method aiming rectum and bowel protection during pelvic IMRT of prostate cancer. The relative reduction in rectal exposure might be a consequence of the slight departure between the prostate and rectal wall.
Collapse
|