1
|
Schröder C, Mose L, Mathier E, Zwahlen DR, Aebersold DM, Förster R, Shelan M. Five Fractions versus Seven Fractions SBRT for Intermediate- and High-Risk Prostate Cancer: A Propensity Score Matched Pair Analysis. Cancers (Basel) 2023; 15:5815. [PMID: 38136360 PMCID: PMC10741876 DOI: 10.3390/cancers15245815] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. METHODS/MATERIAL We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either 35-36.25 Gy in five fractions (group A) using Cyberknife robotic platform or 42.7 Gy in seven fractions (group B) using a C-arm LINAC (image-guided). Propensity score matching was done (2:1 nearest neighbor matching without replacement), resulting in 120 patients (80 patients for group A, 40 patients for group B). Toxicity, PSA nadir, biochemical failure and disease-free survival (DFS) were analyzed. RESULTS Median follow up of all patients was 13 months (range 1-91 months). Overall, 23.3% of patients had ≥G2 acute GU toxicity (21.1% group A versus 30% group B (p = 0.222)) and 6.6% of patients ≥G2 GI toxicity (2.5% versus 15% (p = 0.010)). There was one acute G3 GU toxicity in arm A and one acute G4 rectal bleeding in group B (anticoagulated patient). Regarding late toxicity, 14.1% of patients had ≥G2 late GU toxicity (17.4% versus 6.6% (p = 0.159)) and 5.0% of patients had ≥G2 late GI toxicity (1.4% versus 13.3% (p = 0.013)). There was one G3 late GU toxicity in arm B and two G3 late GI toxicities, one in each arm. Relative median PSA reduction was 92.4% (-53.9-99.9%) from baseline PSA (93.7% (-53.9-99.9%) in group A versus 87.7% (39.8-99.9%) in group B (p = 0.043). In total, 4.2% of patients had biochemical relapse, 5.0% in group A and 2.5% in group B (p = 0.518). One-year DFS in the overall cohort was 97.3%, 98.8% in group A and 94.3% in group B (p = 0.318). CONCLUSION Both SBRT regimens have acceptable acute and late toxicity and good efficacy. There are significantly more GI toxicities in the seven-fraction regimen. Longer follow-up is warranted for better comparison of long-term efficacy.
Collapse
Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Lucas Mose
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Daniel Matthias Aebersold
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| |
Collapse
|
2
|
Shah S, Pepin A, Forsthoefel M, Burlile J, Collins BT, Simeng S, Aghdam N, Collins S. Testosterone as a Biomarker for Quality of Life (QOL) Following Androgen Deprivation Therapy (ADT) and Stereotactic Body Radiotherapy (SBRT). Cureus 2023; 15:e44440. [PMID: 37791195 PMCID: PMC10544092 DOI: 10.7759/cureus.44440] [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] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) causes fatigue and sexual dysfunction. The time to testosterone recovery depends on patient and treatment-specific characteristics. The kinetics of testosterone recovery in men treated with neoadjuvant ADT and stereotactic body radiotherapy (SBRT) is not well established. This study seeks to characterize testosterone recovery and evaluate its relationship with the improvement in patient-reported hormonal and sexual function. METHODS Institutional review board (IRB) approval was obtained for retrospective review of prospectively collected data. All patients with localized prostate cancer treated with short-course ADT (3-6 months of Leuprolide) and robotic SBRT (35-36.25 Gy in five fractions) at a single institution were included in this analysis. Testosterone levels were measured at the start of radiation, every 3 months for the first year, and every 6 months thereafter. Total testosterone recovery was defined as a serum level of >230 ng/dL. Sexual and hormonal function was recorded using the Expanded Prostate Index Composite (EPIC)-26 prior to ADT initiation, the first day of SBRT, and at each follow-up. The EPIC-26 subdomain scores were transformed to a 0-100 scale with higher scores reflecting less bother. RESULTS Between January 2009 and May 2018, 122 men with a median age of 72 years (range: 55-89 years) received ADT followed by SBRT. Thirty-two percent (N=39) were black and 27% [N=39 were obese (BMI > 30)]. The median pre-SBRT testosterone level was 15 ng/dL (range: 3-89 ng/dL). Around 77% (N=94) of patients received 3 months of ADT. The median pre-ADT EPIC-26 Hormone and Sexual Domain Scores were 94 and 41, respectively. At 12 months, 71% (N=87) of patients recovered to a eugonadal state with a mean recovery time of 4 months post-SBRT. Hormonal and sexual subdomain scores declined significantly following ADT but recovered to within the minimally important difference (MID) for sexual and hormonal domain scores by 12 months post-SBRT. CONCLUSIONS Testosterone recovery following short-course ADT with leuprolide and SBRT occurs rapidly in the majority of patients within one year after treatment. Quality of life domain improvements followed the testosterone recovery trend closely. Testosterone testing at follow-up appointments would allow for anticipatory counseling that may limit the bother associated with temporary quality of life decrements.
Collapse
Affiliation(s)
- Sarthak Shah
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Abigail Pepin
- Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, USA
| | - Matthew Forsthoefel
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Brian T Collins
- Radiation Medicine, Tampa General Hospital (TGH) Cancer Institute, Tampa, USA
| | - Suy Simeng
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nima Aghdam
- Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sean Collins
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
3
|
Fuller DB, Crabtree T, Kane BL, Medbery CA, Pfeffer R, Gray JR, Peddada A, Royce TJ, Chen RC. High Dose “HDR-Like” Prostate SBRT: PSA 10-Year Results From a Mature, Multi-Institutional Clinical Trial. Front Oncol 2022; 12:935310. [PMID: 35965547 PMCID: PMC9373838 DOI: 10.3389/fonc.2022.935310] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose/Objective(s) Although ample intermediate-term prostate stereotactic body radiotherapy (SBRT) outcomes have been reported, 10-year results remain relatively sparse. Materials/Methods Eighteen institutions enrolled 259 low- and intermediate-risk patients. Median follow-up is 5.5 years, with 66 patients followed ≥ 10 years. This SBRT regimen specifically emulated an existing HDR brachytherapy dose schedule and isodose morphology, prescribed to 38 Gy/4 fractions, delivered daily by robotic SBRT, mandating > 150% dose escalation in the peripheral zone. Androgen deprivation therapy was not allowed, and a hydrogel spacer was not available at that time. Results Median pre-SBRT PSA 5.12 ng/mL decreased to 0.1 ng/mL by 3.5 years, with further decrease to a nadir of < 0.1 ng/mL by 7 years, maintained through 10 years. Ten-year freedom from biochemical recurrence measured 100% for low-risk, 84.3% for favorable intermediate risk (FIR), and 68.4% for unfavorable intermediate (UIR) cases. Multivariable analysis revealed that the UIR group bifurcated into two distinct prognostic subgroups. Those so classified by having Gleason score 4 + 3 and/or clinical stage T2 (versus T1b/T1c) had a significantly poorer 10 year freedom from biochemical recurrence rate, 54.8% if either or both factors were present, while UIR patients without these specific factors had a 94.4% 10-year freedom from biochemical recurrence rate. The cumulative incidence of grade 2 GU toxicity modestly increased over time – 16.3% at 5 years increased to 19.2% at 10 years-- while the incidence of grade 3+ GU and GI toxicity remained low and stable to 10 years - 2.6% and 0%, respectively. The grade 2 GI toxicity incidence also remained low and stable to 10 years – 4.1% with no further events after year 5. Conclusion This HDR-like SBRT regimen prescribing 38 Gy/4 fractions but delivering much higher intraprostatic doses on a daily basis is safe and effective. This treatment achieves a median PSA nadir of <0.1 ng/mL and provides high long-term disease control rates without ADT except for a subgroup of unfavorable intermediate-risk patients.
Collapse
Affiliation(s)
- Donald B. Fuller
- CyberKnife Centers of San Diego, San Diego, CA, United States
- *Correspondence: Donald B. Fuller, ; Ronald C. Chen,
| | - Tami Crabtree
- Advance Research Associates, Santa Clara, CA, United States
| | | | | | - Robert Pfeffer
- Benefis Sletten Cancer Institute, Great Falls, MT, United States
| | - James R. Gray
- Sarah Cannon Research Institute, Nashville, TN, United States
| | - Anuj Peddada
- Penrose-St. Francis Health Services, Colorado Springs, CO, United States
| | - Trevor J. Royce
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ronald C. Chen
- University of Kansas, Kansas City, KS, United States
- *Correspondence: Donald B. Fuller, ; Ronald C. Chen,
| |
Collapse
|
4
|
Greco C, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Marques J, Fuks Z. Early PSA density kinetics predicts biochemical and local failure following extreme hypofractionated radiotherapy in intermediate-risk prostate cancer. Radiother Oncol 2022; 169:35-42. [DOI: 10.1016/j.radonc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
|
5
|
Pirlamarla AK, Hansen CC, Deng M, Handorf E, Paly J, Wong JK, Hallman MA, Chen DYT, Geynisman DM, Kutikov A, Horwitz EM. Early PSA kinetics for low- and intermediate-risk prostate cancer treated with definitive radiation therapy. Pract Radiat Oncol 2021; 12:60-67. [PMID: 34303033 DOI: 10.1016/j.prro.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study uses a patient-specific model to characterize and compare ideal PSA kinetics for low- and intermediate-risk prostate cancer following definitive radiation treatment with conventionally fractionated (CFRT), hypofractionated (HFRT), stereotactic body radiation therapy (SbRT), or brachytherapy, both high-dose-rate (HDR) and low-dose-rate (LDR). METHODS AND MATERIALS This retrospective analysis includes low- and intermediate-risk prostate cancer patients treated between 1998 and 2018 at an NCI-designated Comprehensive Cancer Center. Demographics and treatment characteristics were prospectively collected. Patients had at least two PSA measurements within 24-months of treatment and were free from biochemical recurrence. The incidence of, time to, and risk factors for PSA nadir (nPSA) and bounce (bPSA) were analyzed at 24-months following radiotherapy. Ideal PSA kinetics were characterized for each modality and compared. RESULTS Of 1,042 patients, 45% had low-risk cancer, 37% favorable intermediate-risk, and 19% unfavorable intermediate-risk. nPSA were higher for ablative modalities, both as absolute nPSA and relative to initial PSA (iPSA). Median time to nPSA ranged from 14.8 to 17.1 months. Over 50% treated with non-ablative therapy (CFRT, HFRT, and LDR) reached an nPSA threshold of ≤0.5 ng/mL compared to 23% of SbRT and 33% of HDR cohorts. The incidence of bPSA was 13.3% and not affected by treatment modality, Gleason Score, or prostate volume. PSA decay rate was faster for ablative therapies in the 6-24 month period. CONCLUSIONS Analysis of PSA within 24-months following radiation therapy revealed ablative therapies are associated with a latent PSA response and higher nPSA. Multivariable logistics modeling revealed younger age, iPSA above the median, presence of bPSA, and ablative therapy as predictors for not achieving nPSA ≤0.5 ng/mL. PSA decay rate appears to be faster in ablative therapies following a latent period. Understanding the different PSA kinetic profiles is necessary to assess treatment response and survey for disease recurrence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - David Y T Chen
- Departments of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | - Daniel M Geynisman
- Departments of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | - Alexander Kutikov
- Departments of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111
| | | |
Collapse
|
6
|
Darwis NDM, Oike T, Kubo N, Gondhowiardjo SA, Ohno T. Characteristics of PSA Bounce after Radiotherapy for Prostate Cancer: A Meta-Analysis. Cancers (Basel) 2020; 12:cancers12082180. [PMID: 32764448 PMCID: PMC7465291 DOI: 10.3390/cancers12082180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
The rate and characteristics of prostate-specific antigen (PSA) bounce post-radiotherapy remain unclear. To address this issue, we performed a meta-analysis. Reports of PSA bounce post-radiotherapy with a cutoff of 0.2 ng/mL were searched by using Medline and Web of Science. The primary endpoint was the occurrence rate, and the secondary endpoints were bounce characteristics such as amplitude, time to occurrence, nadir value, and time to nadir. Radiotherapy modality, age, risk classification, androgen deprivation therapy, and the follow-up period were extracted as clinical variables. Meta-analysis and univariate meta-regression were performed with random-effect modeling. Among 290 search-positive studies, 50 reports including 26,258 patients were identified. The rate of bounce was 31%; amplitude was 1.3 ng/mL; time to occurrence was 18 months; nadir value was 0.5 ng/mL; time to nadir was 33 months. Univariate meta-regression analysis showed that radiotherapy modality (29.7%), age (20.2%), and risk classification (12.2%) were the major causes of heterogeneity in the rate of bounce. This is the first meta-analysis of PSA bounce post-radiotherapy. The results are useful for post-radiotherapy surveillance of prostate cancer patients.
Collapse
Affiliation(s)
- Narisa Dewi Maulany Darwis
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, DKI Jakarta 10430, Indonesia;
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
- Correspondence:
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
| | - Soehartati A Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta Pusat, DKI Jakarta 10430, Indonesia;
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan; (N.D.M.D.); (N.K.); (T.O.)
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
7
|
Roy S, Loblaw A, Cheung P, Chu W, Chung HT, Vesprini D, Ong A, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Helou J, Zhang L, Mamedov A, Deabreu A, Quon HC. Prostate-specific Antigen Bounce After Stereotactic Body Radiotherapy for Prostate Cancer: A Pooled Analysis of Four Prospective Trials. Clin Oncol (R Coll Radiol) 2019; 31:621-629. [PMID: 31126725 DOI: 10.1016/j.clon.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
AIMS We conducted a pooled analysis of four prospective stereotactic body radiotherapy (SBRT) trials of low- and intermediate-risk prostate cancer to evaluate the incidence of prostate-specific antigen (PSA) bounce and its correlation with the time-dose-fraction schedule. The correlation between bounce with PSA response at 4 years (nadir PSA < 0.4 ng/ml) and biochemical failure-free survival (BFFS) was also explored. MATERIALS AND METHODS The study included four treatment groups: 35 Gy/five fractions once per week (QW) (TG-1; n = 84); 40 Gy/five fractions QW (TG-2; n = 100); 40 Gy/five fractions every other day (TG-3; n = 73); and 26 Gy/two fractions QW (TG-4; n = 30). PSA bounce was defined as a rise in PSA by 0.2 ng/ml (nadir + 0.2) or 2 ng/ml (nadir + 2.0) above nadir followed by a decrease back to nadir. Patients with fewer than three follow-up PSA tests were excluded from the pooled analysis. RESULTS In total, 287 patients were included, with a median follow-up of 5.0 years. The pooled 5-year cumulative incidence of bounce by nadir + 2.0 was 8%. The 2-year cumulative incidences of PSA bounce by nadir + 0.2 were 28.9, 21, 19.6 and 16.7% (P = 0.12) and by nadir + 2.0 were 7.2, 8, 2.7 and 6.7% (P = 0.32) for TG-1 to TG-4, respectively. Multivariable analysis revealed that for nadir + 2.0, pre-treatment PSA (odds ratio 0.49; 95% confidence interval 0.26-0.97) correlated with PSA bounce. Although PSA bounce by nadir + 0.2 (odds ratio 0.10; 95% confidence interval 0.04-0.24) and nadir + 2.0 (odds ratio 0.29; 95% confidence interval 0.09-0.93) was associated with a lower probability of PSA response at 4 years, there was no association between bounce by nadir + 0.2 (hazard ratio 0.36; 95% confidence interval 0.08-1.74) or nadir + 2 (hazard ratio 1.77; 95% confidence interval 0.28-11.07) with BFFS. CONCLUSION The incidence of PSA bounce was independent of time-dose-fraction schedule for prostate SBRT. One in 13 patients experienced a bounce high enough to be misinterpreted as biochemical failure, and clinicians should avoid early salvage interventions in these patients. There was no association between PSA bounce and BFFS.
Collapse
Affiliation(s)
- S Roy
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada
| | - A Loblaw
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - P Cheung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - W Chu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H T Chung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - D Vesprini
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ong
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - A Chowdhury
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | | | - G Pang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - R Korol
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - M Davidson
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ravi
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - B McCurdy
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - J Helou
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - L Zhang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Mamedov
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Deabreu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H C Quon
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada.
| |
Collapse
|
8
|
Park Y, Park HJ, Jang WI, Jeong BK, Kim HJ, Chang AR. Long-term results and PSA kinetics after robotic SBRT for prostate cancer: multicenter retrospective study in Korea (Korean radiation oncology group study 15-01). Radiat Oncol 2018; 13:230. [PMID: 30470253 PMCID: PMC6251151 DOI: 10.1186/s13014-018-1182-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the treatment outcome and prostate-specific antigen (PSA) change after stereotactic body radiotherapy (SBRT) for localized prostate cancer. METHODS Patients with localized prostate cancer treated with SBRT at three academic hospitals were enrolled. Treatment was delivered using Cyberknife with dose range from 35 to 37.5 Gy in 5 fractions. Biochemical failure (BCF) was assessed with Phoenix definition and toxicities were scored with Radiation Therapy Oncology Group (RTOG) toxicity criteria. The PSA kinetics were analyzed in patients who received no androgen deprivation therapy (ADT) and showed no recurrence. RESULTS Of the total 88 patients, 14 patients (15.9%) received ADT. After median follow-up of 63.8 months, the 5-year BCF free survival (BCFFS) was 94.7%. Two patients experienced late grade ≥ 3 GI toxicities (2.2%). The median nadir PSA was 0.12 ng/mL (range, 0.00-2.62 ng/mL) and the median time to nadir was 44.8 months (range, 0.40-85.7 months). Patients who reached nadir before 24 months showed poorer BCFFS than the others. The rate of PSA decline was maximum in the first year after treatment and gradually decreased with time. The pattern of PSA change was significantly different according to the risk groups (p = 0.011) with the slope of - 0.139, - 0.161 and - 0.253 ng/mL/month in low-, intermediate- and high-risk groups, respectively. CONCLUSION SBRT for localized prostate cancer showed favorable efficacy with minimal toxicities. The time to PSA nadir was significantly associated with treatment outcome. PSA revealed rapid initial decline and slower decrease with longer follow-up and the patterns of PSA changes were different according to the risk groups.
Collapse
Affiliation(s)
- Younghee Park
- Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hun-Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea.
| |
Collapse
|
9
|
Nakamura K, Ikeda I, Inokuchi H, Takayama K, Inoue T, Kamba T, Ogawa O, Hiraoka M, Mizowaki T. A pilot study of highly hypofractionated intensity-modulated radiation therapy over 3 weeks for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2018; 59:656-663. [PMID: 30085048 PMCID: PMC6151631 DOI: 10.1093/jrr/rry060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/15/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this pilot study was to evaluate the feasibility of highly hypofractionated intensity-modulated radiation therapy (IMRT) in 15 fractions over 3 weeks for treating localized prostate cancer based on prostate position-based image-guided radiation therapy. Twenty-five patients with National Comprehensive Cancer Network (NCCN) very low- to unfavorable intermediate-risk prostate cancer were enrolled in this study from April 2014 to September 2015 to receive highly hypofractionated IMRT (without intraprostatic fiducial markers) delivering 54 Gy in 15 fractions over 3 weeks. Patients with intermediate-risk disease underwent neoadjuvant androgen suppression for 4-8 months. Twenty-four patients were treated with highly hypofractionated IMRT, and one was treated with conventionally fractionated IMRT because the dose constraint of the small bowel seemed difficult to achieve during the simulation. Seventeen percent had very low- or low-risk, 42% had favorable intermediate-risk, and 42% had unfavorable intermediate-risk disease according to NCCN guidelines. The median follow-up period was 31 months (range, 24-42 months). No Grade ≥3 acute toxicity was observed, and the incidence rates of Grade 2 acute genitourinary and gastrointestinal toxicities were 21% and 4%, respectively. No Grade ≥2 late toxicity was observed. Biochemical relapse was observed in one patient at 15 months, and the biochemical relapse-free survival rate was 95.8% at 2 years. A prostate-specific antigen bounce of ≥0.4 ng/ml was observed in 11 patients (46%). The highly hypofractionated IMRT regimen is feasible in patients with localized prostate cancer and is more convenient than conventionally fractionated schedules for patients and health-care providers.
Collapse
Affiliation(s)
- Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Itaru Ikeda
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
- Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama City, Wakayama, Japan
| | - Kenji Takayama
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Takahiro Inoue
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Tomomi Kamba
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
- Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama City, Wakayama, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| |
Collapse
|
10
|
Phase II study of accelerated Linac-based SBRT in five consecutive fractions for localized prostate cancer. Strahlenther Onkol 2018; 195:113-120. [DOI: 10.1007/s00066-018-1338-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/04/2018] [Indexed: 12/26/2022]
|
11
|
Feng LR, Suy S, Collins SP, Lischalk JW, Yuan B, Saligan LN. Comparison of Late Urinary Symptoms Following SBRT and SBRT with IMRT Supplementation for Prostate Cancer. Curr Urol 2018; 11:218-224. [PMID: 29997466 DOI: 10.1159/000447222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Prostate cancer survivors commonly experience late-onset lower urinary tract symptoms following radiotherapy. We aimed to compare lower urinary tract symptoms in patients treated with stereotactic body radiotherapy (SBRT) to those treated with a combination of lower dose SBRT and supplemental intensity-modulated radiotherapy (SBRT + IMRT). Methods Subjects with localized prostate carcinoma scheduled to receive SBRT or a combination of SBRT and IMRT were enrolled and followed for up to 2 years after treatment completion. Participants treated with SBRT received 35-36.25 Gy in 5 fractions, while those treated with SBRT + IMRT received 19.5 Gy of SBRT in 3 fractions followed by 45-50.4 Gy of IMRT in 25-28 fractions. Urinary symptoms were measured using the American Urological Association (AUA) Symptom Score. Results Two hundred patients received SBRT (52% intermediate risk, 37.5% low risk according to D'Amico classification) and 145 patients received SBRT + IMRT (61.4% high risk, 35.2% intermediate risk). Both groups experienced a transient spike in urinary symptoms 1 month after treatment. More severe late urinary flare (increase in AUA scores ≥ 5 points from baseline to 1 year after treatment completion and an AUA score ≥ 15 at 1 year after treatment) was experienced by patients who received SBRT compared to those treated with SBRT + IMRT. Conclusion Participants who received SBRT and supplemental IMRT experienced less severe late urinary flare 1 year after treatment compared to those who received higher dose SBRT alone. This information can be used by clinicians to provide patients with anticipatory counseling to mitigate any psychological burden that comes with unanticipated late urinary toxicities.
Collapse
Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Jonathan W Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Berwin Yuan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
12
|
Kataria S, Koneru H, Guleria S, Danner M, Ayoob M, Yung T, Lei S, Collins BT, Suy S, Lynch JH, Kole T, Collins SP. Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure? Front Oncol 2017; 7:157. [PMID: 28791252 PMCID: PMC5522851 DOI: 10.3389/fonc.2017.00157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background Our previous work on early PSA kinetics following prostate stereotactic body radiation therapy (SBRT) demonstrated that an initial rapid and then slow PSA decline may result in very low PSA nadirs. This retrospective study sought to evaluate the PSA nadir 5 years following SBRT for low- and intermediate-risk prostate cancer (PCa). Methods 65 low- and 80 intermediate-risk PCa patients were treated definitively with SBRT to 35–37.5 Gy in 5 fractions at Georgetown University Hospital between January 2008 and October 2011. Patients who received androgen deprivation therapy were excluded from this study. Biochemical relapse was defined as a PSA rise >2 ng/ml above the nadir and analyzed using the Kaplan–Meier method. The PSA nadir was defined as the lowest PSA value prior to biochemical relapse or as the lowest value recorded during follow-up. Prostate ablation was defined as a PSA nadir <0.2 ng/ml. Univariate logistic regression analysis was used to evaluate relevant variables on the likelihood of achieving a PSA nadir <0.2 ng/ml. Results The median age at the start of SBRT was 72 years. These patients had a median prostate volume of 36 cc with a median 25% of total cores involved. At a median follow-up of 5.6 years, 86 and 37% of patients achieved a PSA nadir ≤0.5 and <0.2 ng/ml, respectively. The median time to PSA nadir was 36 months. Two low and seven intermediate risk patients experienced a biochemical relapse. Regardless of the PSA outcome, the median PSA nadir for all patients was 0.2 ng/ml. The 5-year biochemical relapse free survival (bRFS) rate for low- and intermediate-risk patients was 98.5 and 95%, respectively. Initial PSA (p = 0.024) and a lower testosterone at the time of the PSA nadir (p = 0.049) were found to be significant predictors of achieving a PSA nadir <0.2 ng/ml. Conclusion SBRT for low- and intermediate-risk PCa is a convenient treatment option with low PSA nadirs and a high rate of early bRFS. Fewer than 40% of patients, however, achieved an ablative PSA nadir. Thus, the role of further dose escalation is an area of active investigation.
Collapse
Affiliation(s)
- Shaan Kataria
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Harsha Koneru
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Shan Guleria
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - John H Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Kole
- Department of Radiation Oncology, Valley Hospital, Ridgewood, NJ, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| |
Collapse
|
13
|
Conventionally Fractionationed Volumetric Arc Therapy versus Hypofractionated Stereotactic Body Radiotherapy: Quality of Life, Side Effects, and Prostate-Specific Antigen Kinetics in Localized Prostate Cancer. Value Health Reg Issues 2016; 10:91-99. [PMID: 27881285 DOI: 10.1016/j.vhri.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare conventionally fractionationed volumetric arc therapy (VMAT) and hypofractionated stereotactic body radiotherapy (SBRT) modalities in terms of prostate-specific antigen (PSA) kinetics, toxicity, and quality of life (QOL) in patients with localized prostate cancer. METHODS Patients received radical radiotherapy as either 33.5 Gy/5 fr for SBRT or 75.6 Gy/35 fr for VMAT. International Prostate Symptom Score (IPSS) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer Module (QLQ-PR25) forms were used to assess QOL. RESULTS Of the 48 patients (28 in SBRT and 20 in VMAT) included in the study, 40 (20 in SBRT and 20 in VMAT) were evaluated for QOL status. PSA control rate was 100% and PSA nadir value was 0.5 ng/dl in both arms during the median follow-up period of 23 months. The magnitude of PSA bounce was higher in the SBRT arm than in the VMAT arm (P = 0.01). The PSA decline rate in the VMAT arm was higher than in the SBRT arm (P = 0.028). Three (10.7%) patients treated with SBRT who had a history of transurethral resection of the prostate (TURP) experienced grade 3 urinary toxicity. No significant difference was observed concerning sexual activity and sexual functioning scores, whereas scores at 10.5 and 13.5 months were decreased in both arms. The SBRT and VMAT arms had similar urinary incontinence, bowel symptoms, and IPSS obstruction scores. The magnitude of increase in IPSS scores at treatment completion was higher in the VMAT arm than in the SBRT arm (P = 0.046). The decrease in hormonal symptom scores at 4.5, 10.5, and 13.5 months was higher in the VMAT arm than in the SBRT arm (P = 0.007, 0.027, and 0.021, respectively). CONCLUSIONS Both treatment modalities had similar effectiveness and provided acceptable outcomes in terms of toxicity and QOL. Grade 3 urinary toxicities might be eliminated with careful patient selection for SBRT.
Collapse
|
14
|
Lee SH, Kim HJ, Kim WC. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy versus conventionally fractionated external beam radiotherapy for low- and intermediate-risk prostate cancer. Asia Pac J Clin Oncol 2016; 12:388-395. [DOI: 10.1111/ajco.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/23/2016] [Accepted: 04/17/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Seok Ho Lee
- Department of Radiation Oncology; Gachon University Gill Medical Center; Inchon South Korea
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital; Inha University of Medicine; Inchon South Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital; Inha University of Medicine; Inchon South Korea
| |
Collapse
|
15
|
Kishan AU, Wang PC, Upadhyaya SK, Hauswald H, Demanes DJ, Nickols NG, Kamrava M, Sadeghi A, Kupelian PA, Steinberg ML, Prionas ND, Buyyounouski MK, King CR. SBRT and HDR brachytherapy produce lower PSA nadirs and different PSA decay patterns than conventionally fractionated IMRT in patients with low- or intermediate-risk prostate cancer. Pract Radiat Oncol 2016; 6:268-275. [DOI: 10.1016/j.prro.2015.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 11/16/2022]
|
16
|
Kim HJ, Phak JH, Kim WC. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy boost and whole pelvic radiotherapy for intermediate- and high-risk prostate cancer. Asia Pac J Clin Oncol 2016; 13:21-27. [DOI: 10.1111/ajco.12472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Hun Jung Kim
- Department of Radiation Oncology; Inha University Hospital; Inha University of Medicine; Inchon Korea
| | - Jeong Hoon Phak
- Department of Radiation Oncology; Inha University Hospital; Inha University of Medicine; Inchon Korea
| | - Woo Chul Kim
- Department of Radiation Oncology; Inha University Hospital; Inha University of Medicine; Inchon Korea
| |
Collapse
|
17
|
Phak JH, Kim HJ, Kim WC. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy boost as post-external beam radiotherapy versus conventionally fractionated external beam radiotherapy for localized prostate cancer. Prostate Int 2015; 4:25-9. [PMID: 27014661 PMCID: PMC4789329 DOI: 10.1016/j.prnil.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/12/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. The purpose of this study was to compare the prostate-specific antigen (PSA) kinetics between conventionally fractionated external beam radiotherapy (CF-EBRT) and SBRT boost after whole pelvis EBRT (WP-EBRT) in localized prostate cancer. METHODS A total of 77 patients with localized prostate cancer [T-stage, T1-T3; Gleason score (GS) 5-9; PSA < 20 ng/mL] were enrolled. A total of 35 patients were treated with SBRT boost (21 Gy in 3 fractions) after WP-EBRT and 42 patients were treated with CF-EBRT (45 Gy WP-EBRT and boost of 25.2-30.6 Gy in 1.8-Gy fractions). PSA nadir and rate of change in PSA (slope) were calculated and compared. RESULTS With a median follow-up of 52.4 months (range, 14-74 months), the median PSA nadir and slope for SBRT boost were 0.29 ng/mL and -0.506, -0.235, -0.129, and -0.092 ng/mL/mo, respectively, for durations of 1 year, 2 years, 3 years, and 4 years postradiotherapy. Similarly, for CF-EBRT, the median PSA nadir and slopes were 0.39 ng/mL and -0.720 ng/mL/mo, -0.204 ng/mL/mo, -0.121 ng/mL/mo, and -0.067 ng/mL/mo, respectively. The slope of CF-EBRT was significantly different with a greater median rate of change for 1 year postradiotherapy than that of SBRT boost (P = 0.018). Contrastively, the slopes of SBRT boost for durations of 2 years, 3 years, and 4 years tended to be continuously greater than that of CF-EBRT. The significantly lower PSA nadir was observed in SBRT boost (median nadir 0.29 ng/mL) compared with CF-EBRT (median nadir 0.35 ng/mL, P = 0.025). Five-year biochemical failure (BCF) free survival was 94.3% for SBRT boost and 78.6% for CF-EBRT (P = 0.012). CONCLUSION Patients treated with SBRT boost after WP-EBRT experienced a lower PSA nadir and there tended to be a continuously greater rate of decline of PSA for durations of 2 years, 3 years, and 4 years than with CF-EBRT. The improved PSA kinetics of SBRT boost over CF-EBRT led to favorable BCF free survival.
Collapse
Affiliation(s)
- Jeong Hoon Phak
- Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, South Korea
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, South Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, South Korea
| |
Collapse
|
18
|
Prostate-specific antigen kinetics after stereotactic body radiotherapy as monotherapy or boost after whole pelvic radiotherapy for localized prostate cancer. Prostate Int 2015; 3:118-22. [PMID: 26779457 PMCID: PMC4685203 DOI: 10.1016/j.prnil.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 01/17/2023] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. However, prostate-specific antigen (PSA) kinetics after SBRT has not been well characterized. The purpose of the current study is to assess the kinetics of PSA for low- and intermediate-risk prostate cancer patients treated with SBRT using Cyberknife as both monotherapy and boost after whole pelvic radiotherapy (WPRT) in the absence of androgen deprivation therapy. Methods A total of 61 patients with low- and intermediated-risk prostate cancer treated with SBRT as monotherapy (36.25 Gy in 5 fractions in 32 patients) and SBRT (21 Gy in 3 fractions in 29 patients) boost combined with WPRT (45 Gy in 25 fractions). Patients were excluded if they failed therapy by the Phoenix definition or had androgen deprivation therapy. PSA nadir and rate of change in PSA over time (slope) were calculated and compared. Results With a median follow-up of 52.4 months (range, 14–74 months), for SBRT monotherapy, the median PSA nadir was 0.31 ng/mL (range, 0.04–1.15 ng/mL) and slopes were –0.41 ng/mL/mo, –0.17 ng/mL/mo, –0.12 ng/mL/mo, and –0.09 ng/mL/mo, respectively, for durations of 1 year, 2 years, 3 years, and 4 years postradiotherapy. Similarly, for SBRT boost after WPRT, the median PSA nadir was 0.34 ng/mL (range, 0.04–1.44 ng/mL) and slopes were –0.53 ng/mL/mo, –0.25 ng/mL/mo, –0.14 ng/mL/mo, and –0.09 ng/mL/mo, respectively. The median nadir and slopes of SBRT monotherapy did not differ significantly from those of SBRT boost after WPRT. Benign PSA bounces were common in 30.4% of all cohorts, and the median time to PSA bounce was 12 months (range, 6–25 months). Conclusions In this report of low- and intermediate-risk prostate cancer patients, an initial period of rapid PSA decline was followed by a slow decline, which resulted in a lower PSA nadir. The PSA kinetics of SBRT monotherapy appears to be comparable to those achieved with SBRT boost with WPRT.
Collapse
|
19
|
Høyer M, Muren LP, Glimelius B. The evolution of radiotherapy techniques in the management of prostate cancer. Acta Oncol 2015; 54:821-4. [PMID: 25973556 DOI: 10.3109/0284186x.2015.1048555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Morten Høyer
- Dept of Oncology, Aarhus University/Aarhus University Hospital , Aarhus , Denmark
| | | | | |
Collapse
|