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Large Prostate Volume Does Not Negatively Impact Health-Related Quality of Life in Patients with Prostate Cancer Treated with Ultrahypofractionated Stereotactic Body Radiotherapy. J Pers Med 2023; 13:jpm13020233. [PMID: 36836467 PMCID: PMC9967077 DOI: 10.3390/jpm13020233] [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: 11/18/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Survival outcomes after primary radiotherapy for localized prostate cancer (PCa) are excellent, regardless of the specific treatment modality. For this reason, health-related quality of life (HRQOL) has come to play an ever more important role in treatment selection. Stereotactic body radiation therapy (SBRT) is increasingly used to treat patients with PCa. However, the impact of prostate volume on HRQOL is not clear. In this study, we aimed to determine whether a large prostate volume negatively influences HRQOL outcomes in patients undergoing ultrahypofractionated SBRT. MATERIAL AND METHODS We conducted a prospective study of 530 men with low- and intermediate-risk localized PCa. All patients were treated from 2013 to 2017 with SBRT (Cyberknife system). HRQOL data were collected at baseline (pre-treatment), immediately after treatment, and at 12 and 24 months. QOL variables were assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 and PR-25 module. Differences in the QLQ-C30 scales were considered clinically relevant when the change was >10 points. For the analysis, patients were classified into two groups according to prostate volume (≤60 vs. >60 cm3). RESULTS The prostate volume was ≤60 cm3 in 415 patients (78.3%) and >60 cm3 in 115 (21.7%). No between-group differences were observed at baseline for any of the following variables: clinical stage; hormonal therapy; marital status; educational level; or employment status. No clinically-significant deterioration (functional and symptom scales) was observed in either group between the baseline and 24-month assessment. There were no clinically-relevant differences between the groups on any of the HRQOL variables, regardless of the prostate volume. CONCLUSIONS This study shows that a large prostate volume (>60 cm3) does not appear to negatively impact HRQOL outcomes at two years in patients with localized prostate cancer treated with ultrahypofractionated SBRT administered with the CyberKnife system.
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Alshak MN, Eidelberg A, Diaz SM, Stoddard MD, Formenti S, Nagar H, Kang J, Chughtai B. Natural history of lower urinary tract symptoms among men undergoing stereotactic body radiation therapy for prostate cancer with and without a Rectal Hydrogel Spacer. World J Urol 2022; 40:1143-1150. [PMID: 35182206 DOI: 10.1007/s00345-022-03953-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is increasingly used for prostate cancer, but has morbidity as both the bladder and rectum are radiated during treatment. Our goal was to document and compare lower urinary tract symptoms (LUTS) among men who underwent SBRT with and without SpaceOAR hydrogel (Augmenix, Inc., Bedford, MA). METHODS We performed a retrospective analysis of 87 men (50 SpaceOAR and 37 non-SpaceOAR) who underwent SBRT. Primary outcomes were patient reported symptoms during radiation therapy, pharmacotherapy usage, and urologic and bowel survey scores up to 6-months post-SBRT. RESULTS 78% of men were on α-inhibitors at the end of SBRT, an increase from 27.6% baseline usage (p < 0.001). Post-SBRT urinary frequency was more common in the non-SpaceOAR group versus the SpaceOAR group (68% versus 38%, p = 0.006), as was nocturia (35% vs. 8%, p = 0.002). Acute gastrointestinal symptoms did not differ. 58.8% of men were on α-inhibitors at 6-months of follow-up post-SBRT, an increase from 27.6% baseline usage (p < 0.001). Importantly, there was a difference of α-inhibitor use between non-SpaceOAR and SpaceOAR groups at the end of SBRT and at 1.5-, 3-, and 6-months follow up (86% vs. 53% [p = 0.002], 83% vs. 53% [p = 0.005], 72% vs. 49% [p = 0.038], respectively). CONCLUSION LUTS after SBRT remains a significant problem for men undergoing treatment for prostate cancer. LUTS affects men during and up to 6-months following SBRT. Owing to these increased LUTS, preemptive minimally invasive solutions and their mechanisms of protection, including the SpaceOAR, should be further investigated.
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Affiliation(s)
| | | | - Susana Martinez Diaz
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Michelina D Stoddard
- Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Josephine Kang
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA.
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3
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Shah S, Sholklapper T, Creswell M, Pepin A, Cantalino J, Hankins RA, Suy S, Collins SP. Bothersome Hematospermia Following Stereotactic Body Radiation Therapy for Prostate Cancer. Front Oncol 2021; 11:765171. [PMID: 34900713 PMCID: PMC8654776 DOI: 10.3389/fonc.2021.765171] [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: 08/26/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Hematospermia following prostate radiation therapy is a benign and often self-limiting side effect. However, it may be bothersome to some men and their partners with a negative impact on sexual quality of life (QOL). This study sought to evaluate the incidence, duration, and resolution of hematospermia in patients following stereotactic body radiation therapy (SBRT) for prostate cancer. Methods 227 patients treated with SBRT from 2013 to 2019 at Georgetown University Hospital for localized prostate carcinoma with a minimum follow up of two years were included in this retrospective review of data that was prospectively collected. Patients who were greater than 70 years old and/or received hormonal therapy were excluded. Hematospermia was defined as bright red blood in the ejaculate. Time points for data collection included initial consultation, pre-treatment, 1-, 3-, 6-, 9-, 12-, 18-, 24-month. All patients were treated with the CyberKnife Radiosurgical System (Accuray). Data on hematospermia including duration, resolution and recurrence was collected. Utilization of 5-alpha reductase inhibitors was documented at each visit. Results 227 patients (45 low-, 177 intermediate-, and 5 high-risk according to the D’Amico classification) at a median age of 65 years (range 47-70) received SBRT for their localized prostate cancer. The 2-year cumulative incidence of hematospermia was 5.6%(14 patients). For these patients, all but one patient (93%) saw resolution of their hematospermia by two years post-SBRT. The median time for hematospermia was 9 months post-treatment. Of the 14 patients who reported hematospermia, 70% were managed with 5-alpha reductase inhibitors. Hematospermia was transient in most patients with 70% of the men reporting resolution by the next follow-up visit. Conclusion The incidence of bothersome hematospermia following SBRT was low. Hematospermia, as noted by other studies, often self-resolves. 5-alpha reductase inhibitors may lead to quicker resolution of bothersome hematospermia.
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Affiliation(s)
- Sarthak Shah
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Tamir Sholklapper
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Michael Creswell
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Abigail Pepin
- Department of Radiation Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Cantalino
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Ryan Andrew Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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4
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Juarez JE, Romero T, Mantz CA, Pepin A, Aghdam N, Suy S, Steinberg ML, Levin-Epstein RG, Nickols NG, Kaplan ID, Meier RM, Pham HT, Linson PW, Hong RL, Buyyounouski MK, Bagshaw HP, Fuller DB, Katz AJ, Loblaw A, Collins SP, Kishan AU. Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series. Adv Radiat Oncol 2021; 6:100759. [PMID: 34585025 PMCID: PMC8453194 DOI: 10.1016/j.adro.2021.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To evaluate the safety of stereotactic body radiation therapy (SBRT) for prostate cancer in men with inflammatory bowel disease (IBD). Methods and Materials We queried a consortium database for patients with IBD receiving SBRT for prostate cancer between 2006 and 2012. Identified patients were matched with patients without a history of IBD in a 3:1 fashion based on dose, fractionation, use of androgen deprivation therapy, and age distribution. Logistic regression was used to evaluate the association between having IBD and experiencing acute and late gastrointestinal (GI) and genitourinary (GU) toxicities as scored on the Common Terminology Criteria for Adverse Events scale. Time to late toxicity was evaluated using proportional hazard Cox models. Our study was limited by absence of data on prostate size, baseline International Prostate Symptom Score, and rectal dose-volume histogram parameters. Results Thirty-nine patients with flare-free IBD at time of treatment (median follow-up 83.9 months) and 117 matched controls (median follow-up 88.7 months) were identified. A diagnosis of IBD was associated with increased odds of developing any late grade GI toxicity (odds ratio [OR] 6.11, P <.001) and GU toxicity (odds ratio 6.14, P < .001), but not odds of developing late grade ≥2 GI (P = .08) or GU toxicity (P = .069). Acute GI and GU toxicity, both overall and for grade ≥2 toxicities, were more frequent in men with IBD (P < .05). Time to late GI and GU toxicity of any grade was significantly shorter in patients with IBD (P < .001). Time to late grade ≥2 GU, but not grade ≥2 GI toxicity, was also shorter in patients with IBD (P = .044 for GU and P = .144 for GI). Conclusions Patients with IBD who received SBRT for PCa had a higher likelihood of developing acute GI and GU toxicity, in addition to experiencing lower grade late toxicities that occurred earlier. However, patients with IBD did not have a higher likelihood for late grade ≥2 GI or GU toxicity after SBRT compared with the control cohort. Interpretation of this data are limited by the small sample size. Thus, men with IBD in remission should be properly counseled about these risks when considering SBRT.
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Affiliation(s)
- Jesus E Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | - Tahmineh Romero
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.,Department of Radiation Oncology, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Michael L Steinberg
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | | | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, California
| | - Irving D Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess, Boston, Massachusetts
| | | | - Huong T Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Patrick W Linson
- Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, California
| | - Robert L Hong
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia
| | | | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Donald B Fuller
- Division of Genesis Health care Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | - Alan J Katz
- Flushing Radiation Oncology Services, New York
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Urology, University of California, Los Angeles, California
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De Roover R, Crijns W, Poels K, Dewit B, Draulans C, Haustermans K, Depuydt T. Automated treatment planning of prostate stereotactic body radiotherapy with focal boosting on a fast-rotating O-ring linac: Plan quality comparison with C-arm linacs. J Appl Clin Med Phys 2021; 22:59-72. [PMID: 34318996 PMCID: PMC8425873 DOI: 10.1002/acm2.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The integration of auto-segmentation and automated treatment planning methods on a fast-rotating O-ring linac may improve the time efficiency of online adaptive radiotherapy workflows. This study investigates whether automated treatment planning of prostate SBRT with focal boosting on the O-ring linac could generate plans that are of similar quality as those obtained through manual planning on clinical C-arm linacs. METHODS For 20 men with prostate cancer, reference treatment plans were generated on a TrueBeam STx C-arm linac with HD120 MLC and a TrueBeam C-arm linac with Millennium 120 MLC using 6 MV flattened dual arc VMAT. Manual planning on the Halcyon fast-rotating O-ring linac was performed using 6 MV FFF dual arc VMAT (HA2-DL10) and triple arc VMAT (HA3-DL10) to investigate the performance of the dual-layer MLC system. Automated planning was performed for triple arc VMAT on the Halcyon linac (ET3-DL10) using the automated planning algorithms of Ethos Treatment Planning. The prescribed dose was 35 Gy to the prostate and 30 Gy to the seminal vesicles in five fractions. The iso-toxic focal boost to the intraprostatic tumor nodule(s) was aimed to receive up to 50 Gy. Plan deliverability was verified using portal image dosimetry measurements. RESULTS Compared to the C-arm linacs, ET3-DL10 shows increased seminal vesicles PTV coverage (D99% ) and reduced high-dose spillage to the bladder (V37Gy ) and urethra (D0.035cc ) but this came at the cost of increased high-dose spillage to the rectum (V38Gy ) and a higher intermediate dose spillage (D2cm). No statistically significant differences were found when benchmarking HA2-DL10 and HA3-DL10 with the C-arm linacs. All plans passed the patient-specific QA tolerance limit. CONCLUSIONS Automated planning of prostate SBRT with focal boosting on the fast-rotating O-ring linac is feasible and achieves similar plan quality as those obtained on clinical C-arm linacs using manual planning.
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Affiliation(s)
- Robin De Roover
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Wouter Crijns
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Kenneth Poels
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Bertrand Dewit
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Cédric Draulans
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Karin Haustermans
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Tom Depuydt
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
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6
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Aghdam N, Pepin A, Carrasquilla M, Johnson C, Danner M, Ayoob M, Yung T, Lei S, Collins BT, Kumar D, Suy S, Lynch J, Collins SP. Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT). Front Oncol 2020; 9:1528. [PMID: 32039015 PMCID: PMC6987387 DOI: 10.3389/fonc.2019.01528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on elderly patients is essential. The EORTC QLQ-ELD14 (ELD-14) is a validated questionnaire with a domain dedicated to burden of illness and treatment in the elderly. The Expanded Prostate Cancer Index Composite (EPIC)-26 is a validated questionnaire which measures urinary, bowel, sexual, and hormonal symptoms. This study reports trends in self-reported burden in patients with prostate cancer treated with SBRT and reveals convergence of self-reported burden with treatment related side effects obtained from the EPIC-26 questionnaire. Methods: All patients ≥70 years old, with localized prostate cancer treated with SBRT ± ADT at Medstar Georgetown University Hospital from 2013 to 2018 and had completed the ELD-14 were eligible for inclusion in this cross-sectional cohort study. Percentage of responses to questions related to disease and treatment burden were counted for each category (“not at all” and “a little” vs. “quite a bit” and “very much”). Additional demographic features were derived from available medical records. A total of 111 patients (median age of 74) responded to the ELD-14 questionnaire at onset of treatment and at the 2-year mark. Responses to EPIC questionnaires at matched follow-ups were scored and correlated with the self-reported burden domain of the ELD-14 using the Spearman correlation coefficient. Results: Number of patients reporting “quite a bit” or “very much” burden from prostate cancer was 6.3% prior to treatment. This was highest at 1-month (10.8%) and decreased to 9.0% at 24 months post-SBRT (X2 = 3.836, p = 0.6986). By comparison, 3.6 and 5.4% reported “quite a bit” or “very much” burden from treatment at start of treatment and 24 months, respectively (X2 = 1.046, p = 0.9838). Patient reported treatment burden was found to converge well with individual domains of EPIC-26. Patients undergoing ADT experienced more burden than their non-ADT counterparts. Conclusions: This cross-sectional study suggests a minority of patients reported high burden from their clinically localized prostate cancer or from their SBRT treatment. Self-reported burden converged well with lower EPIC scores in multiple domains.
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Affiliation(s)
- Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States.,George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Michael Carrasquilla
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Colin Johnson
- Department of Surgery, University of Southampton, Southampton, United Kingdom
| | - 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
| | - Deepak Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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7
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Pryor D, Sidhom M, Arumugam S, Bucci J, Gallagher S, Smart J, Grand M, Greer P, Keats S, Wilton L, Martin J. Phase 2 Multicenter Study of Gantry-Based Stereotactic Radiotherapy Boost for Intermediate and High Risk Prostate Cancer (PROMETHEUS). Front Oncol 2019; 9:217. [PMID: 31001481 PMCID: PMC6454110 DOI: 10.3389/fonc.2019.00217] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives: To report feasibility, early toxicity, and PSA kinetics following gantry-based, stereotactic radiotherapy (SBRT) boost within a prospective, phase 2, multicenter study (PROMETHEUS: ACTRN12615000223538). Methods: Patients were treated with gantry-based SBRT, 19–20 Gy in two fractions delivered 1 week apart, followed by conventionally fractionated IMRT (46 Gy in 23 fractions). The study mandated MRI fusion for RT planning, rectal displacement, and intrafraction image guidance. Toxicity was prospectively graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). Results: Between March 2014 and July 2018, 135 patients (76% intermediate, 24% high-risk) with a median age of 70 years (range 53–81) were treated across five centers. Short course (≤6 months) androgen deprivation therapy (ADT) was used in 36% and long course in 18%. Rectal displacement method was SpaceOAR in 59% and Rectafix in 41%. Forty-two and ninety-three patients were treated at the 19 Gy and 20 Gy dose levels, respectively. Median follow-up was 24 months. Acute grade 2 gastrointestinal (GI) and urinary toxicity occurred in 4.4 and 26.6% with no acute grade 3 toxicity. At 6, 12, 18, 24, and 36 months post-treatment the prevalence of late grade ≥2 gastrointestinal toxicity was 1.6, 3.7, 2.2, 0, and 0%, respectively, and the prevalence of late grade ≥2 urinary toxicity was 0.8, 11, 12, 7.1, and 6.3%, respectively. Three patients experienced grade 3 late toxicity at 12 to 18 months which subsequently resolved to grade 2 or less. For patients not receiving ADT the median PSA value pre-treatment was 7.6 ug/L (1.1–20) and at 12, 24, and 36 months post-treatment was 0.86, 0.36, and 0.20 ug/L. Conclusions: Delivery of a gantry-based SBRT boost is feasible in a multicenter setting, is well-tolerated with low rates of early toxicity and is associated with promising PSA responses. A second transient peak in urinary toxicity was observed at 18 months which subsequently resolved. Follow-up is ongoing to document late toxicity, long-term patient reported outcomes, and tumor control with this approach.
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Affiliation(s)
- David Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark Sidhom
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Ingham Institute, Sydney, NSW, Australia
| | - Joseph Bucci
- University of New South Wales, Sydney, NSW, Australia.,St George Hospital, Cancer Care Centre, Sydney, NSW, Australia
| | - Sarah Gallagher
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Joanne Smart
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Melissa Grand
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,Ingham Institute, Sydney, NSW, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | - Sarah Keats
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Lee Wilton
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
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8
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Discovery of Metabolic Biomarkers Predicting Radiation Therapy Late Effects in Prostate Cancer Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1164:141-150. [PMID: 31576546 DOI: 10.1007/978-3-030-22254-3_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients presenting with prostate cancers undergo clinical staging evaluations to determine the extent of disease to guide therapeutic recommendations. Management options may include watchful waiting, surgery, or radiation therapy. Thus, initial risk stratification of prostate cancer patients is important for achieving optimal therapeutic results or cancer cure and preservation of quality of life. Predictive biomarkers for risks of complications or late effects of treatment are needed to inform clinical decisions for treatment selection. Here, we analyzed pre-treatment plasma metabolites in a cohort of prostate cancer patients (N = 99) treated with Stereotactic Body Radiation Therapy (SBRT) at Medstar-Georgetown University Hospital in a longitudinal, quality-of-life study to determine if individuals experiencing radiation toxicities can be identified by a molecular profile in plasma prior to treatment. We used a multiple reaction mass spectrometry-based molecular phenotyping of clinically annotated plasma samples in a retrospective outcome analysis to identify candidate biomarker panels correlating with adverse clinical outcomes following radiation therapy. We describe the discovery of candidate biomarkers, based on small molecule metabolite panels, showing high correlations (AUCs ≥ 95%) with radiation toxicities, suitable for validation studies in an expanded cohort of patients.
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9
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Seidman AD, Bordeleau L, Fehrenbacher L, Barlow WE, Perlmutter J, Rubinstein L, Wedam SB, Hershman DL, Hayes JF, Butler LP, Smith ML, Regan MM, Beaver JA, Amiri-Kordestani L, Rastogi P, Zujewski JA, Korde LA. National Cancer Institute Breast Cancer Steering Committee Working Group Report on Meaningful and Appropriate End Points for Clinical Trials in Metastatic Breast Cancer. J Clin Oncol 2018; 36:3259-3268. [PMID: 30212295 DOI: 10.1200/jco.18.00242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide evidence-based consensus recommendations on choice of end points for clinical trials in metastatic breast cancer, with a focus on biologic subtype and line of therapy. METHODS The National Cancer Institute Breast Cancer Steering Committee convened a working group of breast medical oncologists, patient advocates, biostatisticians, and liaisons from the Food and Drug Administration to conduct a detailed curated systematic review of the literature, including original reports, reviews, and meta-analyses, to determine the current landscape of therapeutic options, recent clinical trial data, and natural history of four biologic subtypes of breast cancer. Ongoing clinical trials for metastatic breast cancer in each subtype also were reviewed from ClinicalTrials.gov for planned primary end points. External input was obtained from the pharmaceutic/biotechnology industry, real-world clinical data specialists, experts in quality of life and patient-reported outcomes, and combined metrics for assessing magnitude of clinical benefit. RESULTS The literature search yielded 146 publications to inform the recommendations from the working group. CONCLUSION Recommendations for appropriate end points for metastatic breast cancer clinical trials focus on biologic subtype and line of therapy and the magnitude of absolute and relative gains that would represent meaningful clinical benefit.
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Affiliation(s)
- Andrew D Seidman
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Louise Bordeleau
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Louis Fehrenbacher
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - William E Barlow
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jane Perlmutter
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lawrence Rubinstein
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Suparna B Wedam
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dawn L Hershman
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer Fallas Hayes
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lynn Pearson Butler
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary Lou Smith
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Meredith M Regan
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Julia A Beaver
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Laleh Amiri-Kordestani
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Priya Rastogi
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jo Anne Zujewski
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Larissa A Korde
- Andrew D. Seidman, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University, New York, NY; Louise Bordeleau, Hamilton Health Sciences and Canadian Cancer Trials Group, Hamilton, Ontario, Canada; Louis Fehrenbacher, Kaiser Permanente, Vallejo, CA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Jane Perlmutter, Gemini Group, Ann Arbor, MI; Lawrence Rubinstein, Jennifer Fallas Hayes, and Larissa A. Korde, National Cancer Institute; Lynn Pearson Butler, The Emmes Corporation, Rockville; Suparna B. Wedam, Julia A. Beaver, and Laleh Amiri-Kordestani, US Food and Drug Administration, Silver Spring; Jo Anne Zujewski, JZ Oncology, Bethesda, MD; Mary Lou Smith, Research Advocacy Network, Plano, TX; Meredith M. Regan, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and Priya Rastogi, University of Pittsburgh Medical Center, Pittsburgh, PA
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10
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Bazire L, Darmon I, Calugaru V, Costa É, Dumas JL, Kirova YM. [Technical aspects and indications of extracranial stereotactic radiotherapy]. Cancer Radiother 2018; 22:447-458. [PMID: 30064828 DOI: 10.1016/j.canrad.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/16/2017] [Indexed: 12/25/2022]
Abstract
Extracranial stereotactic radiotherapy has developed considerably in recent years and is now an important part of the therapeutic alternatives to be offered to patients with cancer. It offers opportunities that have progressively led physicians to reconsider the therapeutic strategy, for example in the case of local recurrence in irradiated territory or oligometastatic disease. The literature on the subject is rich but, yet, there is no real consensus on therapeutic indications. This is largely due to the lack of prospective, randomized studies that have evaluated this technique with sufficient recoil. We propose a review of the literature on the technical aspects and indications of extracranial stereotactic radiotherapy.
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Affiliation(s)
- L Bazire
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France.
| | - I Darmon
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - V Calugaru
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - É Costa
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - J-L Dumas
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - Y M Kirova
- Département de radiothérapie oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
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11
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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.
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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
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12
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Syed YA, Patel-Yadav AK, Rivers C, Singh AK. Stereotactic radiotherapy for prostate cancer: A review and future directions. World J Clin Oncol 2017; 8:389-397. [PMID: 29067275 PMCID: PMC5638714 DOI: 10.5306/wjco.v8.i5.389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer affects over 200000 men annually in the United States alone. The role of conventionally fractionated external beam radiation therapy (RT) is well established as a treatment option for eligible prostate cancer patients; however, the use of stereotactic body radiotherapy (SBRT) in this setting is less well defined. Within the past decade, there have been a number of studies investigating the feasibility of SBRT as a potential treatment option for prostate cancer patients. SBRT has been well studied in other disease sites, and the shortened treatment course would allow for greater convenience for patients. There may also be implications for toxicity as well as disease control. In this review we present a number of prospective and retrospective trials of SBRT in the treatment of prostate cancer. We focus on factors such as biochemical progression-free survival, prostate specific antigen (PSA) response, and toxicity in order to compare SBRT to established treatment modalities. We also discuss future steps that the clinical community can take to further explore this new treatment approach. We conclude that initial studies examining the use of SBRT in the treatment of prostate cancer have demonstrated impressive rates of biochemical recurrence-free survival and PSA response, while maintaining a relatively favorable acute toxicity profile, though long-term follow-up is needed.
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Affiliation(s)
- Yusef A Syed
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30342, United States
| | - Ami K Patel-Yadav
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Charlotte Rivers
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Anurag K Singh
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
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13
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Abstract
Stereotactic body radiation therapy (SBRT) has become a viable treatment option for the many patients who receive a diagnosis of localized prostate cancer each year. Technological advancements have led to tight target conformality, allowing for high-dose-per-fraction delivery without untoward normal tissue toxicity. Biochemical control, now reported up to 5 years, appears to compare favorably with dose-escalated conventionally fractionated radiotherapy. Moreover, toxicity and quality of life follow-up data indicate genitourinary and gastrointestinal toxicities are likewise comparable to conventional radiation therapy. Nevertheless, because of the long natural history of prostate cancer, extended follow-up will be necessary to confirm these impressive initial results. Within this prostate SBRT review, we explore the detailed rationale for SBRT treatment, the diverse SBRT techniques utilized and their unique technical considerations, and finally data for SBRT clinical efficacy and treatment-related toxicity.
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14
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Repka MC, Kole TP, Lee J, Wu B, Lei S, Yung T, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP. Predictors of acute urinary symptom flare following stereotactic body radiation therapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2017; 56:1136-1138. [PMID: 28270015 DOI: 10.1080/0284186x.2017.1299221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michael C. Repka
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Thomas P. Kole
- Department of Radiation Oncology, The Valley Health Hospital, Ridgewood, NJ, USA
| | - Jacqueline Lee
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Binbin Wu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - John H. Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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15
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Kishan AU, King CR. Stereotactic Body Radiotherapy for Low- and Intermediate-Risk Prostate Cancer. Semin Radiat Oncol 2017; 27:268-278. [PMID: 28577834 DOI: 10.1016/j.semradonc.2017.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With over a decade׳s worth of clinical experience to guide stereotactic body radiotherapy (SBRT) for the treatment of clinically localized prostate cancer (PCa), sufficient data exist for robust conclusions to be made regarding its efficacy and the toxicities associated with this treatment. We briefly review the fundamental radiobiological basis of SBRT for PCa and provide a comprehensive synthesis of the medical literature to date, focusing on clinical outcomes and toxicities. When possible, we draw comparisons to comparable data for conventionally fractionated radiotherapy. Finally, a brief overview of technical considerations is presented. Although randomized clinical trials comparing SBRT with conventionally fractionated radiotherapy are underway, the current body of evidence supports the efficacy and safety of SBRT for PCa.
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Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
| | - Christopher R King
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
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16
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Repka MC, Guleria S, Cyr RA, Yung TM, Koneru H, Chen LN, Lei S, Collins BT, Krishnan P, Suy S, Dritschilo A, Lynch J, Collins SP. Acute Urinary Morbidity Following Stereotactic Body Radiation Therapy for Prostate Cancer with Prophylactic Alpha-Adrenergic Antagonist and Urethral Dose Reduction. Front Oncol 2016; 6:122. [PMID: 27242962 PMCID: PMC4870496 DOI: 10.3389/fonc.2016.00122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to the adjacent critical organs. Large fraction sizes may increase urinary morbidity due to unavoidable treatment of the prostatic urethra. This study reports rates of acute urinary morbidity following SBRT for localized prostate cancer with prophylactic alpha-adrenergic antagonist utilization and urethral dose reduction (UDR). METHODS From April 2013 to September 2014, 102 patients with clinically localized prostate cancer were treated with robotic SBRT to a total dose of 35-36.25 Gy in five fractions. UDR was employed to limit the maximum point dose of the prostatic urethra to 40 Gy. Prophylactic alpha-adrenergic antagonists were initiated 5 days prior to SBRT and continued until resolution of urinary symptoms. Quality of life (QoL) was assessed before and after treatment using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite-26 (EPIC-26). Clinical significance was assessed using a minimally important difference (MID) of one half SD change from baseline. RESULTS One hundred two patients underwent definitive prostate SBRT with UDR and were followed for 3 months. No patient experienced acute urinary retention requiring catheterization. A mean baseline AUA symptom score of 9.06 significantly increased to 11.83 1-week post-SBRT (p = 0.0024) and 11.84 1-month post-SBRT (p = 0.0023) but returned to baseline by 3 months. A mean baseline EPIC-26 irritative/obstructive score of 87.7 decreased to 74.1 1-week post-SBRT (p < 0.0001) and 77.8 1-month post-SBRT (p < 0.0001) but returned to baseline at 3 months. EPIC-26 irritative/obstructive score changes were clinically significant, exceeding the MID of 6.0. At baseline, 8.9% of men described their urinary function as a moderate to big problem, and that proportion increased to 37.6% 1 week following completion of SBRT before returning to baseline by 3 months. CONCLUSION Stereotactic body radiation therapy for localized prostate cancer with utilization of prophylactic alpha-adrenergic antagonist and UDR was well tolerated as determined by acute urinary function and bother, and symptoms were comparable to those observed following conventionally fractionated external beam radiation therapy (EBRT). Longer follow-up is required to assess long-term toxicity and efficacy following SBRT with UDR.
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Affiliation(s)
- Michael C. Repka
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shan Guleria
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Robyn A. Cyr
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Thomas M. Yung
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Harsha Koneru
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Leonard N. Chen
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Pranay Krishnan
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John Lynch
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sean P. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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17
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Kole TP, Tong M, Wu B, Lei S, Obayomi-Davies O, Chen LN, Suy S, Dritschilo A, Yorke E, Collins SP. Late urinary toxicity modeling after stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2015; 55:52-8. [PMID: 25972264 DOI: 10.3109/0284186x.2015.1037011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Late urinary symptom flare has been shown to occur in a small subset of men treated with ultra- hypofractionated stereotactic body radiotherapy (SBRT) for prostate cancer. The purpose of this study was to use normal tissue complication probability modeling in an effort to derive SBRT specific dosimetric predictor's of late urinary flare. MATERIAL AND METHODS Two hundred and sixteen men were treated for localized prostate cancer using ultra- hypofractionated SBRT. A dose of 35-36.25 Gy in 5 fractions was delivered to the prostate and proximal seminal vesicles. Functional surveys were conducted before and after treatment to assess late toxicity. Phenomenologic NTCP models were fit to bladder DVHs and late urinary flare outcomes using maximum likelihood estimation. RESULTS Twenty-nine patients experienced late urinary flare within two years of completion of treatment. Fitting of bladder DVH data to a Lyman NTCP model resulted in parameter estimates of m, TD50, and n of 0.19 (0-0.47), 38.7 Gy (31.1-46.4), and 0.13 (-0.14-0.41), respectively. Subsequent fit to a hottest volume probit model revealed a significant association of late urinary flare with dose to the hottest 12.7% of bladder volume. Multivariate analysis resulted in a final model that included patient age and hottest volume probit model predictions. Kaplan-Meier analysis demonstrated a two-year urinary flare free survival of 95.7% in patients 65 years or older with a bladder D12.7% of 33.5 Gy or less, compared to 74.5% in patients meeting none of these criteria. CONCLUSION NTCP modeling of late urinary flare after ultra-hypofractionated prostate SBRT demonstrates a relatively small volume effect for dose to the bladder, suggesting that reduction of volume receiving elevated dose will result in decreased incidence of late urinary toxicity. Future studies will be needed to examine the impact of dose to other potential sources of late genitourinary toxicity.
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Affiliation(s)
- Thomas P. Kole
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Tong
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Binbin Wu
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | | | - Leonard N. Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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18
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Low-temperature plasma treatment induces DNA damage leading to necrotic cell death in primary prostate epithelial cells. Br J Cancer 2015; 112:1536-45. [PMID: 25839988 PMCID: PMC4454887 DOI: 10.1038/bjc.2015.113] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 12/26/2022] Open
Abstract
Background: In recent years, the rapidly advancing field of low-temperature atmospheric pressure plasmas has shown considerable promise for future translational biomedical applications, including cancer therapy, through the generation of reactive oxygen and nitrogen species. Method: The cytopathic effect of low-temperature plasma was first verified in two commonly used prostate cell lines: BPH-1 and PC-3 cells. The study was then extended to analyse the effects in paired normal and tumour (Gleason grade 7) prostate epithelial cells cultured directly from patient tissue. Hydrogen peroxide (H2O2) and staurosporine were used as controls throughout. Results: Low-temperature plasma (LTP) exposure resulted in high levels of DNA damage, a reduction in cell viability, and colony-forming ability. H2O2 formed in the culture medium was a likely facilitator of these effects. Necrosis and autophagy were recorded in primary cells, whereas cell lines exhibited apoptosis and necrosis. Conclusions: This study demonstrates that LTP treatment causes cytotoxic insult in primary prostate cells, leading to rapid necrotic cell death. It also highlights the need to study primary cultures in order to gain more realistic insight into patient response.
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19
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Woo JAL, Chen LN, Wang H, Cyr RA, Bhattasali O, Kim JS, Moures R, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP. Stereotactic Body Radiation Therapy for Prostate Cancer: What is the Appropriate Patient-Reported Outcome for Clinical Trial Design? Front Oncol 2015; 5:77. [PMID: 25874188 PMCID: PMC4379875 DOI: 10.3389/fonc.2015.00077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/13/2015] [Indexed: 01/07/2023] Open
Abstract
Purpose: Stereotactic body radiation therapy (SBRT) is increasingly utilized as primary treatment for clinically localized prostate cancer. Consensus regarding the appropriate patient-reported outcome (PRO) endpoints for clinical trials evaluating radiation modalities for early stage prostate cancer is lacking. To aid in clinical trial design, this study presents PROs over a 36-month period following SBRT for clinically localized prostate cancer. Methods: Between February 2008 and September 2010, 174 hormone-naïve patients with clinically localized prostate cancer were treated with 35–36.25 Gy SBRT (CyberKnife, Accuray) delivered in 5 fractions. Patients completed the validated Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaire at baseline and all follow-ups. The proportion of patients developing a clinically significant decline in each EPIC domain score was determined. The minimally important difference (MID) was defined as a change of one-half the standard deviation from the baseline. Per Radiation Therapy Oncology Group (RTOG) 0938, we also examined the patients who experienced a decline in EPIC urinary domain summary score of >2 points (unacceptable toxicity defined as ≥60% of all patients reporting this degree of decline) and EPIC bowel domain summary score of >5 points (unacceptable toxicity defined as >55% of all patients reporting this degree of decline) from baseline to 1 year. Results: A total of 174 patients at a median age of 69 years received SBRT with a minimum follow-up of 36 months. The proportion of patients reporting a clinically significant decline (MID for urinary/bowel are 5.5/4.4) in EPIC urinary/bowel domain scores was 34%/30% at 6 months, 40%/32.2% at 12 months, and 32.8%/21.5% at 36 months. The patients reporting a decrease in the EPIC urinary domain summary score of >2 points was 43.2% (CI: 33.7%, 54.6%) at 6 months, 51.6% (CI: 43.4%, 59.7%) at 12 months, and 41.8% (CI: 33.3%, 50.6%) at 36 months. The patients reporting a decrease in the EPIC bowel domain summary score of >5 points was 29.6% (CI: 21.9%, 39.3%) at 6 months, 29% (CI: 22%, 36.8%) at 12 months, and 22.4% (CI: 15.7%, 30.4%) at 36 months. Conclusion: Following prostate SBRT, clinically significant urinary symptoms are more common than bowel symptoms. Our prostate SBRT treatment protocol meets the RTOG 0938 criteria for moving forward to a Phase III trial comparing it to conventionally fractionated radiation therapy. Notably, between 12 and 36 months, the proportion of patients reporting a significant decrease in both EPIC urinary and bowel domain scores declined, suggesting a late improvement in these symptom domains. Further investigation is needed to elucidate (1) which EPIC domains bear the greatest influence on post-treatment quality of life and (2) at what time point PRO endpoint(s) should be assessed.
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Affiliation(s)
- Jennifer Ai-Lian Woo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Hongkun Wang
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University , Washington, DC , USA
| | - Robyn A Cyr
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Onita Bhattasali
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian Timothy Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
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20
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Janowski E, Chen LN, Kim JS, Lei S, Suy S, Collins B, Lynch J, Dritschilo A, Collins S. Stereotactic body radiation therapy (SBRT) for prostate cancer in men with large prostates (≥50 cm(3)). Radiat Oncol 2014; 9:241. [PMID: 25398516 PMCID: PMC4239322 DOI: 10.1186/s13014-014-0241-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/18/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with large prostate volumes have been shown to have higher rates of genitourinary and gastrointestinal toxicities after conventional radiation therapy for prostate cancer. The efficacy and toxicity of stereotactic body radiation therapy (SBRT), which delivers fewer high-dose fractions of radiation treatment, is unknown for large prostate volume prostate cancer patients. We report our early experience using SBRT for localized prostate cancer in patients with large prostate volumes. METHODS 57 patients with prostate volumes ≥50 cm(3) prior to treatment with SBRT for localized prostate carcinoma and with a minimum follow up of two years were included in this retrospective review of prospectively collected data. Treatment was delivered using Cyberknife (Accuray) with doses of 35-36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were scored using the CTCAE v.4. Quality of life was assessed using the American Urological Association (AUA) Symptom Score and the Expanded Prostate Cancer Index Composite (EPIC)-26. RESULTS 57 patients (23 low-, 25 intermediate- and 9 high-risk according to the D'Amico classification) at a median age of 69 years (range, 54-83 years) received SBRT with a median follow-up of 2.9 years. The median prostate size was 62.9 cm(3) (range 50-138.7 cm(3)). 33.3% of patients received ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.5 ng/ml and decreased to a median PSA of 0.4 ng/ml by 2 years (p <0.0001). A mean baseline AUA symptom score of 7.5 significantly increased to 13 at 1 month (p = 0.001) and returned to baseline by 3 months (p = 0.21). 23% of patients experienced a late transient urinary symptom flare in the first two years following treatment. Mean baseline EPIC bowel scores of 95.8 decreased to 78.1 at 1 month (p <0.0001), but subsequently improved to 93.5 three months (p = 0.08). The 2-year actuarial incidence rates of GU and GI toxicity ≥ grade 2 were 49.1% and 1.8%, respectively. Two patients (3.5%) experienced grade 3 urinary toxicity, and no patient experienced grade 3 gastrointestinal toxicity. CONCLUSIONS SBRT for clinically localized prostate cancer was well tolerated in men with large prostate volumes.
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Affiliation(s)
- Einsley Janowski
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Brian Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Sean Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
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