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Moreno-Olmedo E, Suarez V, Chao MWT, Boike TP, Martinez AA, Kishan AU, López E, Low D, Guijarro M, Gejerman G, Engelman A, Schiffman Z, Shore N, Sylvester JE, Rivera D, Lederer J, Nurani R, Mariados NF, King MT. Hyaluronic Acid Rectal Spacer Stability during Radiation Therapy for Localized Prostate Cancer: An Intercontinental Study. Int J Radiat Oncol Biol Phys 2023; 117:e420. [PMID: 37785383 DOI: 10.1016/j.ijrobp.2023.06.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite IGRT and IMRT current techniques, rectal toxicity remains a significant problem after prostate cancer radiation therapy but implanted rectal spacers have successfully reduced toxicity rates. We are reporting the results of an intercontinental prospective rectal spacer trial performed at 13 centers in Spain, Australia, and USA. Our hypothesis was that the separation created between the prostate and anterior rectal wall was stable between the time of implant and a 3-month follow-up. MATERIALS/METHODS Our prospective multicenter study was approved by the corresponding IRBs and patients signed informed consent. It was performed between February - June 2021. Patients were imaged using T2 MRI immediately post-implant (MRI-1) and at 3 months (MRI-2). We analyzed the dimensions of hyaluronic acid (HA) rectal spacer inserted for low - intermediate risk prostate cancer treated with EBRT. The rectal displacement was determined by measuring the separation at 3 different levels: prostate midline, midgland +1cm (superior), and midgland -1 cm (inferior), from the posterior prostate capsule to the anterior rectal wall. The core laboratory performed the measurement for all sites. The confidence interval (CI) was computed using a Student's t-distribution. RESULTS A total of 136 patients randomized to the Barrigel arm underwent HA rectal spacing with 100% placement success rate. There were no device failures or surgical complications. Of these, 6 were lost to follow-up. The averages of the remaining 130 patients at the 3 perirectal distances were 13.04 mm +/- 3.1 mm and 12.79 mm +/- 3.5 mm for MRI-1 and MRI-2, respectively with an average difference of -0.17 mm +/- 3.48 mm. Additional parameters are listed on the table. CONCLUSION The results demonstrate the stability of the HA-created separation at the three different prostatic levels for up to 3 months. These findings show dimensional stability well within standard clinical margins. This indicates reliability for HA use in most clinics, as the results are relevant in the setting of dose escalation or ultra-hypofractionation schedules, as well as conventional fractionation.
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Affiliation(s)
| | - V Suarez
- GenesisCare Spain, Madrid, Spain
| | | | - T P Boike
- GenesisCare USA / Michigan Healthcare Professionals, Troy, MI
| | | | - A U Kishan
- University of California Los Angeles, Department of Radiation Oncology, Los Angeles, CA
| | - E López
- GenesisCare Spain, Madrid, Spain
| | - D Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | - N Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
| | - J E Sylvester
- 21st Century Oncology - Sarasota, Lakewood Ranch, FL
| | - D Rivera
- Austin Cancer Centers, Austin, TX
| | - J Lederer
- The Cancer Center of Hawaii, Honolulu, HI
| | - R Nurani
- MultiCare Regional Cancer Center, Tacoma, WA
| | - N F Mariados
- Associated Medical Professionals of NY PLLC, Syracuse, NY
| | - M T King
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Salari K, Ye H, Martinez AA, Sebastian E, Limbacher A, Krauss DJ. Long-Term Outcomes Associated with Different High-Dose-Rate Brachytherapy Dose Regimens for Favorable and Unfavorable Intermediate Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e433. [PMID: 37785411 DOI: 10.1016/j.ijrobp.2023.06.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To present long-term efficacy outcomes of prostate high-dose-rate (HDR) brachytherapy monotherapy using 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with favorable and unfavorable intermediate risk prostate cancer. MATERIALS/METHODS Patients treated with HDR brachytherapy monotherapy for NCCN favorable (FIR) or unfavorable (UIR) intermediate risk prostate cancer from 1999-2020 were identified in a prospectively maintained, single institution database. Patients with less than two years of follow-up and those treated with single fraction HDR brachytherapy were excluded. Biochemical failure was determined using Phoenix criteria. 10-year biochemical control (BC), local control (LC), and distant metastasis (DM) rates were estimated using the Kaplan-Meier method. RESULTS Two hundred sixty-seven patients were included. One hundred eighty-nine had FIR and 78 had UIR prostate cancer, with median follow-up of 9.6 years and 7.2 years, respectively. Of the 189 patients with FIR prostate cancer, 59 (31.2%) received 38 Gy in 4 fractions, 26 (13.7%) received 24 Gy in 2 fractions, and 104 (55.0%) received 27 Gy in 2 fractions. Of the 78 patients with UIR prostate cancer, 20 (25.6%) received 38 Gy in 4 fractions, 11 (14.1%) received 24 Gy in 2 fractions, and 47 (60.2%) received 27 Gy in 2 fractions. Date ranges of treatment for the respective fractionation schedules were 1999-2010, 2007-2016, and 2009-2020. Upfront androgen deprivation therapy (ADT) was given to 12 (6.3%) patients with FIR and 10 (12.8%) patients with UIR. 10-year rates of BC for FIR and UIR patients were 90.1% and 78.8% (p = 0.004), respectively. 10-year rates of LC were 92.4% and 85.0% (p = 0.06), respectively. 10-year rates of DM were 1.9% and 4.7% (p = 0.12), respectively. For FIR patients, 10-year BC rates were 96.2% for patients receiving 38 Gy in 4 fractions vs. 86.3% (p = 0.07) for those treated with the 2-fraction regimens, while 10-year LC rates were 97.9% and 89.0% (p = 0.049), respectively. Within the UIR subset, the 10-year BC rates for patients receiving 38 Gy in 4 fractions and patients receiving treatment in 2 fractions were 95.0% and 70.6% (p = 0.038). 10-year LC rates were 100% and 77.8% (p = 0.045), respectively. 10-year BC rates by treatment schedule are shown in the table below. CONCLUSION HDR brachytherapy monotherapy results in excellent long-term local control for intermediate risk prostate cancer. Improvements in biochemical and local disease control for patients treated with 38 Gy in 4 fractions warrants consideration of prospective study of optimal treatment dosing regimens.
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Affiliation(s)
- K Salari
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - H Ye
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | | | - E Sebastian
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - A Limbacher
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - D J Krauss
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
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Krauss DJ, Karrison T, Martinez AA, Morton G, Yan D, Bruner DW, Movsas B, Elshaikh M, Citrin D, Hershatter B, Michalski JM, Efstathiou JA, Currey A, Kavadi VS, Cury FL, Lock M, Raben A, Seaward SA, El-Gayed A, Rodgers JP, Sandler HM. Dose-Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer: Results of a Phase III Multi-Institutional Trial. J Clin Oncol 2023; 41:3203-3216. [PMID: 37104748 PMCID: PMC10489479 DOI: 10.1200/jco.22.02390] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE It remains unknown whether or not short-term androgen deprivation (STAD) improves survival among men with intermediate-risk prostate cancer (IRPC) treated with dose-escalated radiotherapy (RT). METHODS The NRG Oncology/Radiation Therapy Oncology Group 0815 study randomly assigned 1,492 patients with stage T2b-T2c, Gleason score 7, or prostate-specific antigen (PSA) value >10 and ≤20 ng/mL to dose-escalated RT alone (arm 1) or with STAD (arm 2). STAD was 6 months of luteinizing hormone-releasing hormone agonist/antagonist therapy plus antiandrogen. RT modalities were external-beam RT alone to 79.2 Gy or external beam (45 Gy) with brachytherapy boost. The primary end point was overall survival (OS). Secondary end points included prostate cancer-specific mortality (PCSM), non-PCSM, distant metastases (DMs), PSA failure, and rates of salvage therapy. RESULTS Median follow-up was 6.3 years. Two hundred nineteen deaths occurred, 119 in arm 1 and 100 in arm 2. Five-year OS estimates were 90% versus 91%, respectively (hazard ratio [HR], 0.85; 95% CI, 0.65 to 1.11]; P = .22). STAD resulted in reduced PSA failure (HR, 0.52; P <.001), DM (HR, 0.25; P <.001), PCSM (HR, 0.10; P = .007), and salvage therapy use (HR, 0.62; P = .025). Other-cause deaths were not significantly different (P = .56). Acute grade ≥3 adverse events (AEs) occurred in 2% of patients in arm 1 and in 12% for arm 2 (P <.001). Cumulative incidence of late grade ≥3 AEs was 14% in arm 1 and 15% in arm 2 (P = .29). CONCLUSION STAD did not improve OS rates for men with IRPC treated with dose-escalated RT. Improvements in metastases rates, prostate cancer deaths, and PSA failures should be weighed against the risk of adverse events and the impact of STAD on quality of life.
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Affiliation(s)
| | - Theodore Karrison
- NRG Oncology Statistics and Data Management Center, University of Chicago, Chicago, IL
| | | | - Gerard Morton
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Di Yan
- Corewell Health Beaumont University Hospital, Royal Oak, MI
| | | | | | | | | | | | | | | | - Adam Currey
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | | | - Fabio L. Cury
- McGill University Health Center, Montreal, QC, Canada
| | - Michael Lock
- London Regional Cancer Program, London, ON, Canada
| | - Adam Raben
- Delaware/Christiana Care NCI Community Oncology Research Program, Newark, DE
- Milwaukee Veterans Administration Medical Center, Milwaukee, WI
| | | | | | - Joseph P. Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
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Movsas B, Rodgers JP, Elshaikh MA, Martinez AA, Morton GC, Krauss DJ, Yan D, Citrin DE, Hershatter BW, Michalski JM, Ellis RJ, Kavadi VS, Gore EM, Gustafson GS, Schulz CA, Velker VM, Olson AC, Cury FL, Papagikos MA, Karrison TG, Sandler HM, Bruner DW. Dose-Escalated Radiation Alone or in Combination With Short-Term Total Androgen Suppression for Intermediate-Risk Prostate Cancer: Patient-Reported Outcomes From NRG/Radiation Therapy Oncology Group 0815 Randomized Trial. J Clin Oncol 2023:JCO2202389. [PMID: 37104723 DOI: 10.1200/jco.22.02389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To report patient-reported outcomes (PROs) of a phase III trial evaluating total androgen suppression (TAS) combined with dose-escalated radiation therapy (RT) for patients with intermediate-risk prostate cancer. METHODS Patients with intermediate-risk prostate cancer were randomly assigned to dose-escalated RT alone (arm 1) or RT plus TAS (arm 2) consisting of luteinizing hormone-releasing hormone agonist/antagonist with oral antiandrogen for 6 months. The primary PRO was the validated Expanded Prostate Cancer Index Composite (EPIC-50). Secondary PROs included Patient-Reported Outcome Measurement Information System (PROMIS)-fatigue and EuroQOL five-dimensions scale questionnaire (EQ-5D). PRO change scores, calculated for each patient as the follow-up score minus baseline score (at the end of RT and at 6, 12, and 60 months), were compared between treatment arms using a two-sample t test. An effect size of 0.50 standard deviation was considered clinically meaningful. RESULTS For the primary PRO instrument (EPIC), the completion rates were ≥86% through the first year of follow-up and 70%-75% at 5 years. For the EPIC hormonal and sexual domains, there were clinically meaningful (P < .0001) deficits in the RT + TAS arm. However, there were no clinically meaningful differences by 1 year between arms. There were also no clinically meaningful differences at any time points between arms for PROMIS-fatigue, EQ-5D, and EPIC bowel/urinary scores. CONCLUSION Compared with dose-escalated RT alone, adding TAS demonstrated clinically meaningful declines only in EPIC hormonal and sexual domains. However, even these PRO differences were transient, and there were no clinically meaningful differences between arms by 1 year.
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Affiliation(s)
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | - Gerard C Morton
- Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Di Yan
- William Beaumont Hospital, Royal Oak, MI
| | - Deborah E Citrin
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | | | - Rodney J Ellis
- Penn State Milton Hershey Medical Center, Hershey, PA
- Case Western Reserve University, Cleveland, OH
| | | | - Elizabeth M Gore
- Froedtert and the Medical College of Wisconsin and Zablocki VAMC, Milwaukee, WI
| | | | - Craig A Schulz
- Columbia Saint Mary's Water Tower Medical Commons, Milwaukee, WI
| | | | - Adam C Olson
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Fabio L Cury
- The Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Michael A Papagikos
- Novant Health New Hanover Regional Medical Center-Zimmer Cancer Institute, Wilmington, NC
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Mariados NF, Orio PF, Schiffman Z, Van TJ, Engelman A, Nurani R, Kurtzman SM, Lopez E, Chao M, Boike TP, Martinez AA, Gejerman G, Lederer J, Sylvester JE, Bell G, Rivera D, Shore N, Miller K, Sinayuk B, Steinberg ML, Low DA, Kishan AU, King MT. Hyaluronic Acid Spacer for Hypofractionated Prostate Radiation Therapy: A Randomized Clinical Trial. JAMA Oncol 2023; 9:511-518. [PMID: 36757690 PMCID: PMC9912169 DOI: 10.1001/jamaoncol.2022.7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/15/2022] [Indexed: 02/10/2023]
Abstract
Importance Hypofractionated radiation therapy (RT) for prostate cancer has been associated with greater acute grade 2 gastrointestinal (GI) toxic effects compared with conventionally fractionated RT. Objective To evaluate whether a hyaluronic acid rectal spacer could (1) improve rectal dosimetry and (2) affect acute grade 2 or higher GI toxic effects for hypofractionated RT. Design, Setting, and Participants This randomized clinical trial was conducted from March 2020 to June 2021 among 12 centers within the US, Australia, and Spain, with a 6-month follow-up. Adult patients with biopsy-proven, T1 to T2 prostate cancer with a Gleason score 7 or less and prostate-specific antigen level of 20 ng/mL or less (to convert to μg/L, multiply by 1) were blinded to the treatment arms. Of the 260 consented patients, 201 patients (77.3%) were randomized (2:1) to the presence or absence of the spacer. Patients were stratified by intended 4-month androgen deprivation therapy use and erectile quality. Main Outcomes and Measures For the primary outcome, we hypothesized that more than 70% of patients in the spacer group would achieve a 25% or greater reduction in the rectal volume receiving 54 Gy (V54). For the secondary outcome, we hypothesized that the spacer group would have noninferior acute (within 3 months) grade 2 or higher GI toxic effects compared with the control group, with a margin of 10%. Results Of the 201 randomized patients, 8 (4.0%) were Asian, 26 (12.9%) Black, 42 (20.9%) Hispanic or Latino, and 153 (76.1%) White; the mean (SD) age for the spacer group was 68.6 (7.2) years and 68.4 (7.3) years for the control group. For the primary outcome, 131 of 133 (98.5%; 95% CI, 94.7%-99.8%) patients in the spacer group experienced a 25% or greater reduction in rectum V54, which was greater than the minimally acceptable 70% (P < .001). The mean (SD) reduction was 85.0% (20.9%). For the secondary outcome, 4 of 136 patients (2.9%) in the spacer group and 9 of 65 patients (13.8%) in the control group experienced acute grade 2 or higher GI toxic effects (difference, -10.9%; 95% 1-sided upper confidence limit, -3.5; P = .01). Conclusions and Relevance The trial results suggest that rectal spacing with hyaluronic acid improved rectal dosimetry and reduced acute grade 2 or higher GI toxic effects. Rectal spacing should potentially be considered for minimizing the risk of acute grade 2 or higher toxic effects for hypofractionated RT. Trial Registration ClinicalTrials.gov Identifier: NCT04189913.
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Affiliation(s)
| | - Peter F Orio
- Brigham and Women's Hospital, Boston, Massachusetts
- Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | - Rizwan Nurani
- Western Radiation Oncology, Campbell, California
- Interventional Radiation Oncology of California, Campbell
| | | | - Escarlata Lopez
- Vithas La Milagrosa Hospital, Calle de Modesto Lafuente, Madrid, Spain
| | - Michael Chao
- Ringwood Private Hospital, East Victoria, Australia
| | | | | | | | | | | | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina
| | | | | | | | | | | | - Martin T King
- Brigham and Women's Hospital, Boston, Massachusetts
- Dana Farber Cancer Institute, Boston, Massachusetts
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Wilson GD, Rogers CL, Mehta MP, Marples B, Michael DB, Welsh JS, Martinez AA, Fontanesi J. The Rationale for Radiation Therapy in Alzheimer's Disease. Radiat Res 2023; 199:506-516. [PMID: 36881804 DOI: 10.1667/rade-22-00179.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
Alzheimer's Disease (AD) represents a major health problem without effective treatments. As the incidence of the disease will continue to rise, it is imperative to find new treatment options to halt or slow disease progression. In recent years, several groups have begun to study the utility of low total dose radiation therapy (LTDRT) to inhibit some of the pathological features of AD and improve cognition in a variety of animal models. These preclinical studies have led to Phase 1 and 2 trials in different centers around the world. In this review, we present and interpret the pre-clinical evidence report some preliminary clinical data from a Phase 2 trial in early-stage AD patients.
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Affiliation(s)
- George D Wilson
- Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, Utah
| | - Minesh P Mehta
- Radiation Oncology, Baptist Health Miami Cancer Institute, Miami, Florida
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester, New York
| | - Daniel B Michael
- Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan
| | - James S Welsh
- Department of Radiation Oncology Loyola University Chicago, Maywood, Illinois
| | | | - James Fontanesi
- Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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Wilson GD, Wilson TG, Hanna A, Fontanesi G, Kulchycki J, Buelow K, Pruetz BL, Michael DB, Chinnaiyan P, Maddens ME, Martinez AA, Fontanesi J. Low Dose Brain Irradiation Reduces Amyloid-β and Tau in 3xTg-AD Mice. J Alzheimers Dis 2021; 75:15-21. [PMID: 32280098 DOI: 10.3233/jad-200030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have previously reported that low doses of external beam ionizing irradiation reduced amyloid-β (Aβ) plaques and improved cognition in APP/PS1 mice. In this study we investigated the effects of radiation in an age-matched series of 3xTg-AD mice. Mice were hemibrain-irradiated with 5 fractions of 2 Gy and sacrificed 8 weeks after the end of treatment. Aβ and tau were assessed using immunohistochemistry and quantified using image analysis with Definiens Tissue Studio. We observed a significant reduction in Aβ plaque burden and tau staining; these two parameters were significantly correlated. This preliminary data is further support that low doses of radiation may be beneficial in Alzheimer's disease.
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Affiliation(s)
- George D Wilson
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA
| | - Thomas G Wilson
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA
| | - Alaa Hanna
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA
| | | | - Justin Kulchycki
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA
| | - Katie Buelow
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA
| | | | - Daniel B Michael
- Michigan Head and Spine Institute, Southfield, MI, USA.,Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | - Michael E Maddens
- Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Alvaro A Martinez
- Radiation Oncology Institute, Division of Michigan Healthcare Professionals, Farmington Hills, MI, USA
| | - James Fontanesi
- Radiation Oncology Department, Beaumont Health, Royal Oak, MI, USA.,Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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8
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Siddiqui ZA, Gustafson GS, Ye H, Martinez AA, Mitchell B, Sebastian E, Limbacher A, Krauss DJ. Five-Year Outcomes of a Single-Institution Prospective Trial of 19-Gy Single-Fraction High-Dose-Rate Brachytherapy for Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2019; 104:1038-1044. [PMID: 30771408 DOI: 10.1016/j.ijrobp.2019.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To update outcome and toxicity results of a prospective trial of 19-Gy single-fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. METHODS AND MATERIALS Patients were treated on a prospective study of single-fraction HDR brachytherapy. All patients had low- or intermediate-risk prostate cancer. Patients with prostate volumes >50 cm3, taking alpha-blockers for urinary symptoms, or with baseline American Urologic Association symptom scores >12 were ineligible. Patients underwent transrectal ultrasound-guided interstitial implant of the prostate followed by single-fraction HDR brachytherapy to a prescription dose of 19 Gy. RESULTS Sixty-eight patients were enrolled with a median follow-up of 3.9 years. Median age was 62 years. Median gland volume at the time of treatment was 35 cm3, 92.6% of patients had T1 disease, 63.2% had a Gleason score of 6, and median pretreatment prostate-specific antigen was 5.0 ng/mL. Chronic grade 2 genitourinary toxicity was 14.7%. No grade 3 urinary toxicity occurred. A single patient experienced grade 2+ rectal toxicity (grade 3 diarrhea) that was transient and resolved with medical management. The 5-year estimated disease-free survival was 77.2% with no significant difference between low- and intermediate-risk patients. A single patient developed distant metastases during the follow-up period. Biopsy-proven local failure at 5 years was 18.8%, occurring at a median interval of 4.0 years posttreatment. No deaths occurred during follow-up. CONCLUSIONS With extended follow-up, toxicity rates after single-fraction 19-Gy HDR brachytherapy remain low. Higher-than-expected rates of biochemical and local failure, however, raise concerns regarding the adequacy of this dose. Additional investigation to define the optimal single-fraction HDR brachytherapy dose is warranted, and single-fraction treatment currently should not be offered outside the context of a clinical trial.
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Affiliation(s)
- Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Gary S Gustafson
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Hong Ye
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Alvaro A Martinez
- Michigan HealthCare Professionals/21st Century Oncology, Farmington Hills, Michigan
| | - Beth Mitchell
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Evelyn Sebastian
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Amy Limbacher
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
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9
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Krauss DJ, Ye H, Martinez AA, Mitchell B, Sebastian E, Limbacher A, Gustafson GS. Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2017; 97:98-106. [DOI: 10.1016/j.ijrobp.2016.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
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10
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Wilkinson JB, Shah C, Amin M, Nadeau L, Shaitelman SF, Chen PY, Grills IS, Martinez AA, Mitchell CK, Wallace MF, Vicini FA. Outcomes According to Breast Cancer Subtype in Patients Treated With Accelerated Partial Breast Irradiation. Clin Breast Cancer 2016; 17:55-60. [PMID: 27666436 DOI: 10.1016/j.clbc.2016.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/03/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the study was to determine outcomes for patients treated with accelerated partial breast irradiation (APBI) on the basis of breast cancer subtype (BCST). PATIENTS AND METHODS Our single-institution, institutional review board-approved APBI database was queried for patients who had complete testing results for the estrogen (ER), progesterone (PR), and HER2/neu receptors to determine outcomes for each BCST. Women were assigned as luminal A (LA), luminal B (LB), HER2, and basal BCST using their ER, PR, and HER2/neu receptor status. Degree of ER expression supplemented the receptor-based luminal BCST assignment. Two hundred seventy-eight patients had results for all 3 receptors (LA = 164 [59%], LB = 81 [29%], HER2 = 5 [2%], basal = 28 [10%]), which were submitted for analysis (ipsilateral breast tumor recurrence [IBTR], regional nodal failure, distant metastasis [DM], disease-free survival [DFS], cause-specific survival [CSS], and overall survival [OS]). RESULTS Median follow-up was 5.4 years (range, 0.1-12.4 years). Basal and HER2 subtype patients had higher histologic grades (Grade 3 = 75% vs. 10% LA/LB; P < .001), larger tumors (13.0 mm basal vs. 10.7 mm LA/LB; P = .059), and were more likely to receive chemotherapy (68% vs. 15% LA/LB; P < .001). Margin and nodal status were similar among BCSTs. At 5 years, IBTR rates were similar (1.8%, 2.9%, 0%, and 4.8%) for LA, LB, HER2, and basal subtypes, respectively (P = .62). DM was only seen in LA (2.9%) and LB (1.3%) (P = .83). DFS (95%-100%), CSS (97%-100%), and OS (80%-100%) were not statistically different (P = .97, .87, .46, respectively). CONCLUSION Five-year local control rates after breast-conserving surgery, APBI, and appropriate systemic therapy are excellent for luminal, HER2, and basal phenotypes of early-stage breast cancer; however, further study of receptor subtype effect on risk stratification in early-stage breast cancer is needed.
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Affiliation(s)
- J Ben Wilkinson
- Department of Radiation Oncology, Willis-Knighton Health System, Louisiana State University Health Sciences Center, Shreveport, LA.
| | - Chirag Shah
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitual Amin
- Department of Pathology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laura Nadeau
- Department of Medical Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Simona F Shaitelman
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Peter Y Chen
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Alvaro A Martinez
- Department of Radiation Oncology, Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI
| | - Christina K Mitchell
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michelle F Wallace
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Frank A Vicini
- Department of Radiation Oncology, Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI
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Marples B, McGee M, Callan S, Bowen SE, Thibodeau BJ, Michael DB, Wilson GD, Maddens ME, Fontanesi J, Martinez AA. Cranial irradiation significantly reduces beta amyloid plaques in the brain and improves cognition in a murine model of Alzheimer's Disease (AD). Radiother Oncol 2016; 118:579-80. [PMID: 26838263 DOI: 10.1016/j.radonc.2016.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Brian Marples
- Department of Radiation Oncology, William Beaumont Hospital, 3811 W. Thirteen Mile Rd, 105-RI, Royal Oak, MI 48073, USA.
| | - Mackenzie McGee
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, USA
| | - Sean Callan
- Department of Psychology, Wayne State University, Detroit, USA
| | - Scott E Bowen
- Department of Psychology, Wayne State University, Detroit, USA
| | - Bryan J Thibodeau
- Beaumont BioBank and Erb Family Core Molecular Laboratories, William Beaumont Hospital, USA
| | - Daniel B Michael
- Beaumont Neurosurgery, William Beaumont Hospital and Michigan Head and Spine Institute, USA
| | - George D Wilson
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, USA
| | - Michael E Maddens
- Division of Geriatric Medicine, William Beaumont Hospital and Department of Internal Medicine, Oakland University-William Beaumont School of Medicine, Detroit, USA
| | - James Fontanesi
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, USA
| | - Alvaro A Martinez
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, USA
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Marples B, McGee M, Callan S, Bowen SE, Thibodeau BJ, Michael DB, Wilson GD, Maddens ME, Fontanesi J, Martinez AA. Cranial irradiation significantly reduces beta amyloid plaques in the brain and improves cognition in a murine model of Alzheimer’s Disease (AD). Radiother Oncol 2016; 118:43-51. [DOI: 10.1016/j.radonc.2015.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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13
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Martinez AA, Shah C, Mohammed N, Demanes DJ, Galalae R, Martinez-Monge R, Ghilezan M, Ye H. Ten-year outcomes for prostate cancer patients with Gleason 8 through 10 treated with external beam radiation and high-dose-rate brachytherapy boost in the PSA era. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0218-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fajardo LF, Meyer JL, Meshorer A, Prionas S, Martinez AA, Hahn GM. Thermal injury and thermotolerance in mesenchymal tissues. Front Radiat Ther Oncol 2015; 18:144-52. [PMID: 6706131 DOI: 10.1159/000429209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Martinez AA, Morgese MG, Pisanu A, Macheda T, Paquette MA, Seillier A, Cassano T, Carta AR, Giuffrida A. Activation of PPAR gamma receptors reduces levodopa-induced dyskinesias in 6-OHDA-lesioned rats. Neurobiol Dis 2014; 74:295-304. [PMID: 25486547 DOI: 10.1016/j.nbd.2014.11.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 01/31/2023] Open
Abstract
Long-term administration of l-3,4-dihydroxyphenylalanine (levodopa), the mainstay treatment for Parkinson's disease (PD), is accompanied by fluctuations in its duration of action and motor complications (dyskinesia) that dramatically affect the quality of life of patients. Levodopa-induced dyskinesias (LID) can be modeled in rats with unilateral 6-OHDA lesions via chronic administration of levodopa, which causes increasingly severe axial, limb, and orofacial abnormal involuntary movements (AIMs) over time. In previous studies, we showed that the direct activation of CB1 cannabinoid receptors alleviated rat AIMs. Interestingly, elevation of the endocannabinoid anandamide by URB597 (URB), an inhibitor of endocannabinoid catabolism, produced an anti-dyskinetic response that was only partially mediated via CB1 receptors and required the concomitant blockade of transient receptor potential vanilloid type-1 (TRPV1) channels by capsazepine (CPZ) (Morgese et al., 2007). In this study, we showed that the stimulation of peroxisome proliferator-activated receptors (PPAR), a family of transcription factors activated by anandamide, contributes to the anti-dyskinetic effects of URB+CPZ, and that the direct activation of the PPARγ subtype by rosiglitazone (RGZ) alleviates levodopa-induced AIMs in 6-OHDA rats. AIM reduction was associated with an attenuation of levodopa-induced increase of dynorphin, zif-268, and of ERK phosphorylation in the denervated striatum. RGZ treatment did not decrease striatal levodopa and dopamine bioavailability, nor did it affect levodopa anti-parkinsonian activity. Collectively, these data indicate that PPARγ may represent a new pharmacological target for the treatment of LID.
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Affiliation(s)
- A A Martinez
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - M G Morgese
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Clinical and Experimental Medicine, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - A Pisanu
- Institute of Neuroscience, National Research Council of Italy (CNR), Cagliari, Italy
| | - T Macheda
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - M A Paquette
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - A Seillier
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - T Cassano
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - A R Carta
- Department of Biomedical Sciences, University of Cagliari, Italy
| | - A Giuffrida
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Marina O, Gustafson GS, Kestin LL, Brabbins DS, Chen PY, Ye H, Martinez AA, Ghilezan MI, Wallace M, Krauss DJ. Comparison of dose-escalated, image-guided radiotherapy vs. dose-escalated, high-dose-rate brachytherapy boost in a modern cohort of intermediate-risk prostate cancer patients. Brachytherapy 2014; 13:59-67. [DOI: 10.1016/j.brachy.2013.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/06/2013] [Accepted: 05/17/2013] [Indexed: 11/26/2022]
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Marina O, Warner J, Ye H, Grills IS, Shah C, Wallace M, Gustafson GS, Brabbins DS, Martinez AA, Krauss DJ. An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer. Brachytherapy 2013; 13:163-8. [PMID: 24295963 DOI: 10.1016/j.brachy.2013.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 10/04/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare erectile dysfunction (ED) after adaptive dose-escalated image-guided intensity-modulated radiotherapy (IG-IMRT) and high-dose-rate interstitial brachytherapy (HDR) monotherapy. METHODS AND MATERIALS Low- and intermediate-risk prostate cancer patients treated with IG-IMRT or HDR were matched on pretreatment ED, age, Gleason score, T-stage, and prostate specific antigen. Patients who received androgen deprivation therapy were excluded. ED was graded by Common Terminology Criteria for Adverse Events v4. Actuarial rates of ED were computed by the Kaplan-Meier method. RESULTS There were 384 patients with median followup of 2.0 years (0.5-6.1) for IG-IMRT and 2.0 years (0.5-8.7) for HDR. The median IG-IMRT dose was 75.6 Gy and HDR dose 38 Gy in four fractions. For patients with no pretreatment ED, actuarial rates of requiring intervention (Grade ≥2 ED) at 3 years were 31% for IG-IMRT and 19% for HDR (p=0.23), and impotence despite medical intervention (Grade 3) were 0% for IG-IMRT and 6% for HDR (p=0.06). For patients with Grade 1 pretreatment ED, Grade ≥2 ED at 3 years were 47% for IG-IMRT and 34% for HDR (p=0.79), and Grade 3 ED were 15% in both groups (p=0.59). For patients with Grade 2 pretreatment ED, Grade 3 ED at 3 years were 22% for IG-IMRT and 37% for HDR (p=0.70). No variables were predictive of Grade ≥2 ED following treatment. CONCLUSIONS Rates of ED requiring medical intervention for both IG-IMRT and HDR are low and equivalent. Even patients with ED before treatment are likely to maintain potency with medication use at 3 years following treatment.
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Affiliation(s)
- Ovidiu Marina
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | | | - Hong Ye
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Chirag Shah
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Michelle Wallace
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Gary S Gustafson
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Donald S Brabbins
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Alvaro A Martinez
- Michigan HealthCare Professionals/21st Century Oncology, Farmington Hills, MI
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
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Shah C, Khan AJ, Arthur D, Fernandez E, Martinez AA, Vicini F. Intraoperative Radiation Therapy in Breast Cancer: Not Ready for Prime Time. Ann Surg Oncol 2013; 21:351-3. [DOI: 10.1245/s10434-013-3291-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Indexed: 11/18/2022]
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Lee DY, Chunta JL, Park SS, Huang J, Martinez AA, Grills IS, Krueger SA, Wilson GD, Marples B. Pulsed versus conventional radiation therapy in combination with temozolomide in a murine orthotopic model of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2013; 86:978-85. [PMID: 23845846 DOI: 10.1016/j.ijrobp.2013.04.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 03/29/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the efficacy of pulsed low-dose radiation therapy (PLRT) combined with temozolomide (TMZ) as a novel treatment approach for radioresistant glioblastoma multiforme (GBM) in a murine model. METHODS AND MATERIALS Orthotopic U87MG hGBM tumors were established in Nu-Foxn1(nu) mice and imaged weekly using a small-animal micropositron emission tomography (PET)/computed tomography (CT) system. Tumor volume was determined from contrast-enhanced microCT images and tumor metabolic activity (SUVmax) from the F18-FDG microPET scan. Tumors were irradiated 7 to 10 days after implantation with a total dose of 14 Gy in 7 consecutive days. The daily treatment was given as a single continuous 2-Gy dose (RT) or 10 pulses of 0.2 Gy using an interpulse interval of 3 minutes (PLRT). TMZ (10 mg/kg) was given daily by oral gavage 1 hour before RT. Tumor vascularity and normal brain damage were assessed by immunohistochemistry. RESULTS Radiation therapy with TMZ resulted in a significant 3- to 4-week tumor growth delay compared with controls, with PLRT+TMZ the most effective. PLRT+TMZ resulted in a larger decline in SUVmax than RT+TMZ. Significant differences in survival were evident. Treatment after PLRT+TMZ was associated with increased vascularization compared with RT+TMZ. Significantly fewer degenerating neurons were seen in normal brain after PLRT+TMZ compared with RT+TMZ. CONCLUSIONS PLRT+TMZ produced superior tumor growth delay and less normal brain damage when compared with RT+TMZ. The differential effect of PLRT on vascularization may confirm new treatment avenues for GBM.
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Affiliation(s)
- David Y Lee
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
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Vicini FA, Shaitelman S, Wilkinson JB, Shah C, Ye H, Kestin LL, Goldstein NS, Chen PY, Martinez AA. Long-Term Impact of Young Age at Diagnosis on Treatment Outcome and Patterns of Failure in Patients with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy. Breast J 2013; 19:365-73. [DOI: 10.1111/tbj.12127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Frank A. Vicini
- Michigan Healthcare Professionals / 21st Century Oncology; Farmington Hills; Michigan
| | - Simona Shaitelman
- Department of Radiation Oncology; University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - John Ben Wilkinson
- Department of Radiation Oncology; Willis-Knighton Health System; Shreveport; Louisiana
| | - Chirag Shah
- Department of Radiation Oncology; Summa Health System; Akron; Ohio
| | - Hong Ye
- Department of Radiation Oncology; Oakland University William Beaumont School of Medicine; Beaumont Health System; Royal Oak; Michigan
| | - Larry L. Kestin
- Michigan Healthcare Professionals / 21st Century Oncology; Farmington Hills; Michigan
| | | | - Peter Y. Chen
- Department of Radiation Oncology; Oakland University William Beaumont School of Medicine; Beaumont Health System; Royal Oak; Michigan
| | - Alvaro A. Martinez
- Michigan Healthcare Professionals / 21st Century Oncology; Farmington Hills; Michigan
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Mangona VS, Marina O, Krauss DJ, Brabbins DS, Wallace M, Martinez AA, Gustafson GS. Boost Versus Monotherapy: A Propensity-Score Matched-Pair Analysis of High-Dose-Rate Brachytherapy with or without External Beam Radiotherapy for Low- and Intermediate-Risk Prostate Cancer. Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marina O, Krauss DJ, Brabbins DS, Fowler AM, Wallace M, Martinez AA, Gustafson GS. PSA Bounce After High-Dose-Rate Brachytherapy for Prostate Cancer is a Frequent Confounder for Biochemical Failure in Patients under Age 60. Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marina O, Krauss DJ, Brabbins D, Wallace M, Martinez AA, Ye H, Gustafson GS. Dose-escalated adaptive image-guided radiotherapy versus high-dose-rate brachytherapy monotherapy for low-risk prostate cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
145 Background: Both IGRT and HDR are used for definitive treatment of low-risk prostate. No comparative study of these contemporary modalities exists. Methods: Charts for patients with low-risk prostate cancer by NCCN criteria treated 1999-2012 were reviewed. For IGRT, the clinical target volume (CTV) included the prostate and proximal seminal vesicles. A CT-based, off-line adaptive treatment plan was made with a patient-specific confidence-limited planning target volume (cl-PTV) based on the planning plus four additional daily CT scans. Overall survival (OS) was calculated by the Kaplan-Meier method (log-rank test), with Cox regression for uni- and multi-variate analysis. Cumulative incidence (Gray’s test), with competing risks analysis (Fine and Gray) were used for biochemical control (BC) and freedom from local recurrence (FFLR). Results: There were 598 IGRT and 399 HDR patients (see Table), with a median follow-up of 6.1 and 3.6 years, respectively (p<0.001). The median prescribed IGRT dose was 75.6 Gy (range 73.8-79.2). HDR doses were 24 Gy (n=126) or 27 Gy (n=151) in 2 fractions, or 36 Gy (n=3) or 38 Gy (n=335) in 4 fractions. Five- and 10-year BC was 99% and 94% for IGRT and 98% and 95% for HDR (p=0.77); FFLR was 100% and 99% for both (p=0.89); and OS was 95% and 75% for IGRT and 97% and 85% for HDR (p=0.04). On multivariate analysis, predictors (p<0.10) for OS were age (p<0.001) and PNI (p=0.04); for LR, PPC (p=0.01); and for BC, a trend for PSA (p=0.08). Treatment type was not a predictor of OS, BC or FFLR (p>0.5). Conclusions: Both dose- escalated IGRT and HDR monotherapy yield similarly excellent outcomes for low-risk prostate cancer. Our experience supports the continued use of brachytherapy as monotherapy in low-risk prostate cancer. [Table: see text]
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Affiliation(s)
| | | | | | | | - Alvaro A Martinez
- Michigan HealthCare Professionals/21st Century Oncology, Farmington Hills, MI
| | - Hong Ye
- William Beaumont Hospital, Royal Oak, MI
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Chen PY, Shah C, Wilkinson JB, Wallace M, Ye H, Fowler A, Dekhne N, Benitez P, Martinez AA, Vicini F. Clinical efficacy of 2-day versus 5-day accelerated partial breast irradiation delivered via balloon-based brachytherapy: Results of a matched pair analysis. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
148 Background: This analysis compares the efficacy of a 2-day vs. 5-day accelerated partial breast irradiation (APBI) schedule in treatment of early-stage breast cancer. Methods: Patients were treated between 6/2000 and 1/2011 with balloon-based brachytherapy using a 2-day (700 cGy x 4 BID) or a 5-day (340 cGy x 10 BID) fractionation. The CTV was a 1cm expansion from the balloon surface with a single-lumen device used in all cases. To compare efficacy between the two treatment groups, a matched-pair analysis was performed using a 1:2 ratio which paired 38 two-day with 76 five-day patients. Match criteria included minimal follow-up (FU) > 1.0 yr, clinical stage, age (+/- 3 yrs), and ER status. Clinical outcomes analyzed include local-regional recurrence [LR, RR] distant metastases (DM), disease-free, cause-specific and overall survival [DFS, CSS, and OS]. Results: No significant differences were noted for age (p=0.838), clinical stage (p=1.000), ER (p=1.000), tumor size (p=0.236), margin status (p=0.556), nodal stage (p=0.381), PR (p=0.749), use of chemotherapy (p=0.927) or endocrine therapy (p=0.129). Per the ASTRO Consensus Guidelines, no differences were noted in the clinical groups between the 2-and 5-day treatments with the majority categorized as suitable or cautionary (2-day: 92% vs. 5-day: 87% p=0.436). With a mean FU of 4.7 yrs (4.9 yrs for 2-day vs. 4.5 yrs for 5-day, p=0.279), no differences were seen in the 5-year actuarial rates of LR (0.0% vs. 2.6%, p=0.359), DFS (94.4% vs. 96.1%, p=0.618), CSS (100% vs. 94.9 %, p=0.207), or OS (97.3% vs. 92.5%, p=0.811) between the 2-and 5-day groups, respectively. There was no RR in either group. DM rates were similar for both (5.6% vs. 1.3 %, p=0.456). Conclusions: With near 5-year FU for the 2-day schedule, APBI with the 2-day regimen yielded outcomes equivalent to the 5-day schema. Reduced on-treatment days by such hypofractionation offers flexibility in clinical and patient scheduling. Further FU and more patients will be needed to substantiate equivalence of hypofractionated APBI. An HIC-approved protocol randomizing patients between the 2 vs. 5-day treatments is currently open for accrual at our institution.
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Affiliation(s)
- Peter Y. Chen
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | - Chirag Shah
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | - John Ben Wilkinson
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | - Michelle Wallace
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | - Hong Ye
- William Beaumont Hospital, Royal Oak, MI
| | - Ashley Fowler
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | | | | | - Alvaro A. Martinez
- Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI
| | - Frank Vicini
- Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI
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Huang J, Vicini FA, Williams SG, Ye H, McGrath S, Ghilezan M, Krauss D, Martinez AA, Kestin LL. Percentage of Positive Biopsy Cores: A Better Risk Stratification Model for Prostate Cancer? Int J Radiat Oncol Biol Phys 2012; 83:1141-8. [DOI: 10.1016/j.ijrobp.2011.09.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/10/2011] [Accepted: 09/26/2011] [Indexed: 01/27/2023]
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Park SS, Yan D, McGrath S, Dilworth JT, Liang J, Ye H, Krauss DJ, Martinez AA, Kestin LL. Adaptive Image-Guided Radiotherapy (IGRT) Eliminates the Risk of Biochemical Failure Caused by the Bias of Rectal Distension in Prostate Cancer Treatment Planning: Clinical Evidence. Int J Radiat Oncol Biol Phys 2012; 83:947-52. [PMID: 22208964 DOI: 10.1016/j.ijrobp.2011.08.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 08/20/2011] [Accepted: 08/30/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Sean S Park
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Wilkinson JB, Vicini FA, Shah C, Shaitelman S, Jawad MS, Ye H, Kestin LL, Goldstein NS, Martinez AA, Benitez P, Chen PY. Twenty-year outcomes after breast-conserving surgery and definitive radiotherapy for mammographically detected ductal carcinoma in situ. Ann Surg Oncol 2012; 19:3785-91. [PMID: 22644510 DOI: 10.1245/s10434-012-2412-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Management of mammographically detected ductal carcinoma in situ (DCIS) at a single institution was reviewed to determine long-term clinical outcomes after treatment with breast-conserving therapy (BCT). METHODS Data from all patient-cases with DCIS who received BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for their effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival. BCT included breast-conserving surgery followed by external-beam radiotherapy to the whole breast, with 86 % of patients receiving a lumpectomy cavity boost. The median dose to the whole breast was 50 Gy and 60.4 Gy to the lumpectomy cavity. RESULTS A total of 129 cases were evaluated; the median follow-up was 19.3 years. Twenty-one patients developed an ipsilateral breast tumor recurrence (IBTR), 76.2 % of which were invasive (n = 16). Fourteen recurrences (66 %) were within the same breast quadrant (true recurrence), while an additional 7 cases developed an IBTR elsewhere in the breast. True recurrences were more prevalent in women <45 years of age (20 %/24 % vs. 5.1 %/8 %) at 10 and 20 years (p = 0.02). The 5-, 10-, 15-, and 20-year actuarial rates of IBTR for this cohort were 8.7, 10.4, 12.1, and 16.3 % (IBTR), while overall survival at 5, 10, and 20 years was 97.6, 96.8, and 96.8 %, respectively. CONCLUSIONS Mammographically detected DCIS remains a clinically distinct subset of noninvasive breast cancer. With 20 year follow-up, local control and overall survival are excellent after BCT.
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Affiliation(s)
- J Ben Wilkinson
- Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Wilkinson JB, Martinez AA, Chen PY, Ghilezan MI, Wallace MF, Grills IS, Shah CS, Mitchell CK, Sebastian E, Limbacher AS, Benitez PR, Brown EA, Vicini FA. Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule. Brachytherapy 2012; 11:97-104. [DOI: 10.1016/j.brachy.2011.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/24/2011] [Accepted: 05/26/2011] [Indexed: 11/25/2022]
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Huang J, Chunta JL, Amin M, Lee DY, Grills IS, Wong CYO, Yan D, Marples B, Martinez AA, Wilson GD. Detailed characterization of the early response of head-neck cancer xenografts to irradiation using (18)F-FDG-PET imaging. Int J Radiat Oncol Biol Phys 2012; 84:485-91. [PMID: 22331000 DOI: 10.1016/j.ijrobp.2011.11.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate the metabolic information provided by (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) during the early response of head-and-neck squamous cell carcinoma (HNSCC) xenografts to radiotherapy (RT). METHODS AND MATERIALS Low-passage HNSCC cells (UT14) were injected into the rear flanks of female nu/nu mice to generate xenografts. After tumors grew to 400-500 mm(3), they were treated with either 15 Gy in one fraction (n = 18) or sham RT (n = 12). At various time points after treatment, tumors were assessed with 2-h dynamic FDG-PET and immediately harvested for direct histological correlation. Different analytical parameters were used to process the dynamic PET data: kinetic index (Ki), standard uptake value (SUV), sensitivity factor (SF), and retention index (RI). Tumor growth was assessed using the specific growth rate (SGR) and correlated with PET parameters using the Pearson correlation coefficient (r). Receiver operating characteristic (ROC) and the area under the ROC curve (AUC) were used to test PET parameters for their ability to predict for radiation necrosis and radiation change. RESULTS Tumor growth was arrested for the first 20 days after RT and recovered thereafter. Histologically, radiation change was observed in the peripheral regions of tumors between days 7 and 23 after RT, and radiation necrosis were observed in the central regions of tumors between days 7 and 40. Ki provided the best correlation with SGR (r = 0.51) and was the optimal parameter to predict for early radiation necrosis (AUC = 0.804, p = 0.07). SUV(30 min) was the strongest predictor for late radiation necrosis (AUC = 0.959, p = 0.004). Both RI(30-60 min) and SF(12-70 min) were very accurate in predicting for radiation change (AUC = 0.891 and 0.875, p = 0.009 and 0.01, respectively). CONCLUSIONS Dynamic FDG-PET analysis (such as Ki or SF) may provide informative assessment of early radiation necrosis or radiation change of HNSCC xenografts after RT.
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Affiliation(s)
- Jiayi Huang
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Wilkinson JB, Baschnagel A, Shah C, Amin M, Nadeau L, Mitchell CK, Wallace MF, Chen PY, Grills IS, Martinez AA, Vicini FA. P3-13-09: Impact of Estrogen Receptor Negativity on Clinical Outcomes Following Accelerated Partial Breast Irradiation. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-13-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To determine the impact of estrogen receptor (ER) negativity on clinical outcomes for patients treated with Accelerated Partial Breast Irradiation (APBI).
Materials/Methods(s): We evaluated 506 consecutive patients treated with interstitial brachytherapy (n= 199), balloon-based brachytherapy (n=203), and 3D-CRT (n=104). ER negative (ERN) status was assigned using the traditional definition of an ER nuclear IHC stain < 10%, which corresponds to an Allred/NSABP staining score of < 2. 63 patients (12.5%) were ER negative and 443 (87.5%) were ER positive (ERP). Patient demographics and clinical outcomes (IBTR, RNF, DM, DFS, CSS, OS) were analyzed for each group.
Results: The two groups had similar patient characteristics. Tumor sizes were slightly larger for the ERN group at 11.9mm vs. 10.7mm, although this was not statistically significant (p=0.14). No differences were seen in median age (63 vs. 64 years, p=0.36), rate of HER-2/neu overexpression (83% vs. 91%, p=0.11), or lymph node positivity (6% vs. 9%, p=0.55) between the ERN vs. ERP groups, respectively. There were an equal distribution of invasive ductal carcinoma (ERN n=55, 87%; ERP n=387, 87%) and DCIS (ERN n=8, 13%; ERP n=56, 13%) patients within each group. The use of chemotherapy (55% vs. 15%, p<0.001) and nuclear grade (71% vs. 12%, p<0.001) were higher in the ERN vs. ERP cohort. With a mean follow up of 6.1 years, the 5-year actuarial rates of ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), and distant metastasis (DM) for the entire cohort were 1.8%, 0.6%, and 3.2%. Although this was not statistically significant, ERN patients appear to have an increased rate of local failure than patients with ERP histology (4.0% vs. 1.5%, p=0.13). Rates of RNF and DM were, however, significantly higher for the ERN group (RNF: 4.9% ERN vs. 0% ERP, p<0.001; DM: 12.1% ERN vs. 2.0% ERP, p<0.001). Although there was no difference in overall survival at six years (86% vs. 90%, p=0.67), we observed a shorter disease-free survival (86.4% vs. 96.5%, p= 0.01) and cause-specific survival (90% vs. 98%, p=0.01) for the ERN vs. ERP groups.
Conclusion: The ER negative phenotype of early-stage breast cancer may have a decreased rate of locoregional control. We observed a higher rate of DM with reduced disease-free and cause-specific survival in ER negative cases, emphasizing the importance of systemic therapy and careful, long-term follow up for these patients. Prospective study of this histologic subtype with a larger cohort of patients is needed to substantiate these findings.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-09.
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Affiliation(s)
- JB Wilkinson
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - A Baschnagel
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - C Shah
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - M Amin
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - L Nadeau
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - CK Mitchell
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - MF Wallace
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - PY Chen
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - IS Grills
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - AA Martinez
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - FA Vicini
- 1Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
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Vicini FA, Shah C, Kestin L, Ghilezan M, Krauss D, Ye H, Brabbins D, Martinez AA. Identifying Differences Between Biochemical Failure and Cure: Incidence Rates and Predictors. Int J Radiat Oncol Biol Phys 2011; 81:e369-75. [DOI: 10.1016/j.ijrobp.2011.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/14/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
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Krauss DJ, Hayek S, Amin M, Ye H, Kestin LL, Zadora S, Vicini FA, Cotant M, Brabbins DS, Ghilezan MI, Gustafson GS, Martinez AA. Prognostic Significance of Neuroendocrine Differentiation in Patients With Gleason Score 8–10 Prostate Cancer Treated With Primary Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:e119-25. [DOI: 10.1016/j.ijrobp.2010.12.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/13/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
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Swanson TA, Krueger SA, Galoforo S, Thibodeau BJ, Martinez AA, Wilson GD, Marples B. TMPRSS2/ERG fusion gene expression alters chemo- and radio-responsiveness in cell culture models of androgen independent prostate cancer. Prostate 2011; 71:1548-58. [PMID: 21394739 DOI: 10.1002/pros.21371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/03/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE/OBJECTIVES The androgen regulated transmembrane serine protease (TMPRSS2) and ETS transcription factor (ERG) gene fusion is a strong prognostic factor for disease recurrence following prostatectomy. Expression of TMPRSS2/ETS-related gene (ERG) fusion gene transcripts is linked with tumor proliferation, invasion, and an aggressive phenotype. The aim of this study was to define the effect of TMPRSS2/ERG fusion gene expression on chemo- and radiosensitivity in prostate tumor cell lines. MATERIALS/METHODS Clonogenic survival of PC3 and DU145 cells stably expressing TMPRSS2/ERG Types III and VI fusion genes was measured after X-irradiation (0-8 Gy) and Paclitaxel. Cell cycle changes and DNA double-strand break induction and repair were assessed. Differential gene expression was measured by microarray analysis. ERG signaling pathway interactions were studied using Ariadne Pathway Studio. RESULTS Expression of the TMPRSS2/ERG fusions in PC3 cells increased radiation sensitivity and decreased paclitaxel sensitivity. Increased radiosensitivity was associated with persistent DNA breaks 24 hr post-irradiation, down-regulation of genes involved in DNA repair and mitosis and up-regulation of ETV, an ETS transcription factor. However, DU145 Types III and VI demonstrated a different sensitivity phenotype and gene expression changes. Pathway analysis of ERG signaling further illustrated the variation between the PC3 and DU145 cell lines containing TMPRSS2/ERG fusions. CONCLUSIONS The effect of TMPRSS2/ERG gene fusions had differing effects on radiosensitivity and chemosensitivity depending on cell line and fusion type. Further work is needed with clinical samples to establish whether TMPRSS2/ERG gene fusions affect radio- and chemosensitivity in vivo.
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Affiliation(s)
- Todd A Swanson
- Department of Radiation Oncology, University of Texas, Medical Branch, Galveston, Texas; Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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Ghilezan MI, Gustafson G, Brabbins D, Chen P, Krauss D, Wallace M, Dillworth J, Fontanesi J, Martinez AA. Chronic Toxicity of Two Fractionation Schedules of High-Dose-Rate Brachytherapy as Monotherapy in Low/Intermediate Prostate Cancer. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wilkinson JB, Martinez AA, Wallace M, Mitchell CK, Sebastian E, Limbacher A, Chen PY, Ghilezan MI, Benitez P, Brown EA, Vicini FA. Intermediate-Term Outcomes and Toxicity for Phase I/II Study Evaluating Breast Cancer Patients Undergoing Accelerated Partial Breast Irradiation With the MammoSite Radiation Delivery System Using a Two-Day Dose Schedule. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marina O, Kestin LL, Ghilezan MI, Shah C, Gustafson G, Brabbins DS, Ye H, Wallace M, Krauss DJ, Vicini FA, Martinez AA. Dose-Escalated Adaptive Image-Guided Radiotherapy Versus Pelvic Irradiation With High-Dose-Rate Brachytherapy Boost for Intermediate-Risk Prostate Cancer. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ye H, Martinez AA, Wallace M, Marvin K, Kestin L, Ghilezan M, Gustafson G. Long-Term Outcome and Late Toxicity Analysis for Clinically Localized Prostate Cancer Treated With Permanent Interstitial Brachytherapy. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shah C, Antonucci JV, Wallace M, Mitchell C, Benitez P, Dekhne N, Ye H, Chen P, Martinez AA, Vicini FA. Clinical Outcomes in Patients Treated With Accelerated Partial Breast Irradiation Versus Whole-Breast Irradiation: Results of Two Matched Pair Analyses. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kestin LL, Marina O, Ghilezan MI, Shah C, Gustafson G, Brabbins DS, Ye H, Wallace M, Krauss DJ, Vicini FA, Martinez AA. Dose-Escalated Adaptive Image-Guided Radiotherapy Versus Pelvic Irradiation With High-Dose-Rate Brachytherapy Boost for High-Risk Prostate Cancer. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tyagi N, Qin A, Sebastian E, Liang J, Yan D, Ghilezan MI, Martinez AA. Deformable Registration and Dose Accumulation for Image-Guided HDR Interstitial Brachytherapy (IG-BT) Boost and External Beam Pelvic IMRT (EB-IMRT) for Prostate Cancer Patients. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Patrias LM, Klaver AC, Coffey MP, Finke JM, Digambaranath JL, Dang L, Martinez AA, Loeffler DA. Effects of External Beam Radiation onIn VitroFormation of Abeta1-42 Fibrils and Preformed Fibrils. Radiat Res 2011; 175:375-81. [DOI: 10.1667/rr2448.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Marples B, Downing L, Sawarynski KE, Finkelstein JN, Williams JP, Martinez AA, Wilson GD, Sims MD. Pulmonary injury after combined exposures to low-dose low-LET radiation and fungal spores. Radiat Res 2011; 175:501-9. [PMID: 21275606 DOI: 10.1667/rr2379.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Exposure to infectious microbes is a likely confounder after a nuclear terrorism event. In combination with radiation, morbidity and mortality from an infection may increase significantly. Pulmonary damage after low-dose low-LET irradiation is characterized by an initial diffuse alveolar inflammation. By contrast, inhaled fungal spores produce localized damage around pulmonary bronchioles. In the present study, we assessed lung injury in C57BL/6 mice after combined exposures to whole-body X radiation and inhaled fungal spores. Either animals were exposed to Aspergillus spores and immediately irradiated with 2 Gy, or the inoculation and irradiation were separated by 8 weeks. Pulmonary injury was assessed at 24 and 48 h and 1, 2, 4, 8, and 24 weeks later using standard H&E-stained sections and compared with sham-treated age-matched controls. Immunohistochemistry for invasive inflammatory cells (macrophages, neutrophils and B and T lymphocytes) was performed. A semi-quantitative assessment of pulmonary injury was made using three distinct parameters: local infiltration of inflammatory cells, diffuse inflammation, and thickening and distortion of alveolar architecture. Radiation-induced changes in lung architecture were most evident during the first 2 weeks postexposure. Fungal changes were seen over the first 4 weeks. Simultaneous combined exposures significantly increased the duration of acute pulmonary damage up to 24 weeks (P < 0.01). In contrast, administration of the fungus 8 weeks after irradiation did not produce enhanced levels of acute pulmonary damage. These data imply that the inhalation of fungal spores at the time of a radiation exposure alters the susceptibility of the lungs to radiation-induced injury.
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Affiliation(s)
- B Marples
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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Martinez AA, Gonzalez J, Ye H, Ghilezan M, Shetty S, Kernen K, Gustafson G, Krauss D, Vicini F, Kestin L. Dose escalation improves cancer-related events at 10 years for intermediate- and high-risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79:363-70. [PMID: 21195875 DOI: 10.1016/j.ijrobp.2009.10.035] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the 10-year outcomes of intermediate- and high-risk prostate cancer patients treated with a prospective dose escalation hypofractionated trial of pelvic external beam radiation therapy (P-EBRT) with a high-dose-rate (HDR) brachytherapy boost. METHODS AND MATERIALS From 1992 to 2007, 472 patients were treated with a HDR boost at William Beaumont Hospital. They had at least one of the following: a prostate-specific antigen (PSA) level of >10 ng/ml, a Gleason score of ≥7, or clinical stage ≥T2b. Patients received 46-Gy P-EBRT and an HDR boost. The HDR dose fractionation was divided into two dose levels. The prostate biologically equivalent dose (BED) low-dose-level group received <268 Gy, and the high-dose group received >268 Gy . Phoenix biochemical failure (BF) definition was used. RESULTS Median follow-up was 8.2 years (range, 0.4-17 years). The 10-year biochemical failure rate of 43.1% vs. 18.9%, (p < 0.001), the clinical failure rate of 23.4% vs. 7.7%, (p < 0.001), and the distant metastasis of 12.4% vs. 5.7%, (p = 0.028) were all significantly better for the high-dose level group. On Cox multivariate analysis, higher BED levels (p = 0.017; hazard ratio [HR] = 0.586), pretreatment PSA assays (p < 0.001, HR = 1.022), and Gleason scores (p = 0.004) were significant variables for reduced biochemical failure. Higher dose levels (p, 0.002; HR, 0.397) and Gleason scores (p < 0.001) were significant for clinical failure. Grade 3 genitourinary complications were 2% and 3%, respectively, and grade 3 gastrointestinal complication was <0.5%. CONCLUSIONS This prospective trial using P-EBRT with HDR boost and hypofractionated dose escalation demonstrates a strong dose-response relationship for intermediate- and high-risk prostate cancer patients. The improvement at 10 years for locoregional control with higher radiation doses (BED, > 268 Gy) has significantly decreased biochemical and clinical failures as well as distant metastasis.
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Affiliation(s)
- Alvaro A Martinez
- Radiation Oncology Department, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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Huang J, Kestin LL, Ye H, Wallace M, Martinez AA, Vicini FA. Analysis of second malignancies after modern radiotherapy versus prostatectomy for localized prostate cancer. Radiother Oncol 2010; 98:81-6. [PMID: 20951450 DOI: 10.1016/j.radonc.2010.09.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE To clarify the risk of developing second primary cancers (SPCs) after radiotherapy (RT) versus prostatectomy for localized prostate cancer (PCa) in the modern era. METHODS The RT cohort consisted of 2120 patients matched on a 1:1 basis with surgical patients according to age and follow-up time. RT techniques consisted of conventional or two-dimensional RT (2DRT, 36%), three-dimensional conformal RT and/or intensity modulated RT (3DCRT/IMRT, 29%), brachytherapy (BT, 16%), and a combination of 2DRT and BT (BT boost, 19%). RESULTS The overall SPC risk was not significantly different between the matched-pair (HR 1.14, 95% CI 0.94-1.39), but the risk became significant >5years or >10years after RT (HR 1.86, 95% CI 1.36-2.55; HR 4.94, 95% CI 2.18-11.2, respectively). The most significant sites of increased risk were bladder, lymphoproliferative, and sarcoma. Of the different RT techniques, only 2DRT was associated with a significantly higher risk (HR 1.76, 95% CI 1.32-2.35), but not BT boost (HR 0.83, 95% CI 0.50-1.38), 3DCRT/IMRT (HR 0.81, 95% CI 0.55-1.21), or BT (HR 0.53, 95% CI 0.28-1.01). CONCLUSIONS Radiation-related SPC risk varies depending on the RT technique and may be reduced by using BT, BT boost, or 3DCRT/IMRT.
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Affiliation(s)
- Jiayi Huang
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA
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Shaitelman SF, Kim LH, Yan D, Martinez AA, Vicini FA, Grills IS. Continuous arc rotation of the couch therapy for the delivery of accelerated partial breast irradiation: a treatment planning analysis. Int J Radiat Oncol Biol Phys 2010; 80:771-8. [PMID: 20584586 DOI: 10.1016/j.ijrobp.2010.03.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 02/10/2010] [Accepted: 03/17/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE We present a novel form of arc therapy: continuous arc rotation of the couch (C-ARC) and compare its dosimetry with three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) for accelerated partial breast irradiation (APBI). C-ARC, like VMAT, uses a modulated beam aperture and dose rate, but with the couch, not the gantry, rotating. METHODS AND MATERIALS Twelve patients previously treated with APBI using 3D-CRT were replanned with (1) C-ARC, (2) IMRT, and (3) VMAT. C-ARC plans were designed with one medial and one lateral arc through which the couch rotated while the gantry was held stationary at a tangent angle. Target dose coverage was normalized to the 3D-CRT plan. Comparative endpoints were dose to normal breast tissue, lungs, and heart and monitor units prescribed. RESULTS Compared with 3D-CRT, C-ARC, IMRT, and VMAT all significantly reduced the ipsilateral breast V50% by the same amount (mean, 7.8%). Only C-ARC and IMRT plans significantly reduced the contralateral breast maximum dose, the ipsilateral lung V5Gy, and the heart V5%. C-ARC used on average 40%, 30%, and 10% fewer monitor units compared with 3D-CRT, IMRT, and VMAT, respectively. CONCLUSIONS C-ARC provides improved dosimetry and treatment efficiency, which should reduce the risks of toxicity and secondary malignancy. Its tangent geometry avoids irradiation of critical structures that is unavoidable using the en face geometry of VMAT.
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Affiliation(s)
- Simona F Shaitelman
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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McGrath SD, Matuszak MM, Yan D, Kestin LL, Martinez AA, Grills IS. Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: A dosimetric and treatment efficiency analysis. Radiother Oncol 2010; 95:153-7. [DOI: 10.1016/j.radonc.2009.12.039] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 12/21/2009] [Accepted: 12/27/2009] [Indexed: 11/25/2022]
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Shaitelman SF, Kestin LL, Ye H, Ghilezan MI, Gustafson GS, Krauss DJ, Marvin K, Martinez AA. Chronic Toxicity Profile of Hypofractionated, High-Dose-Rate Brachytherapy Boost with Pelvic External Beam Radiation Therapy for Intermediate- and High-Risk Prostate Cancer. Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ghilezan MI, Park S, Gustafson G, Brabbins D, Chen P, Krauss D, Vicini FA, Martinez AA, Kestin L. Is the Phoenix Biochemical Failure Definition Accurate for Prostate Cancer Patients Treated with Brachytherapy Alone? Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park SS, Grills IS, Kestin LL, Ghilezan MI, Chen PY, Wallace M, Martinez AA, Vicini FA. Accelerated Partial Breast Irradiation for Pure Ductal Carcinoma In Situ. Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hasan Y, Schoenherr D, Martinez AA, Wilson GD, Marples B. Prostate-specific natural health products (dietary supplements) radiosensitize normal prostate cells. Int J Radiat Oncol Biol Phys 2010; 76:896-904. [PMID: 20159364 DOI: 10.1016/j.ijrobp.2009.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 09/17/2009] [Accepted: 09/21/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate-specific health products (dietary supplements) are taken by cancer patients to alleviate the symptoms linked with poor prostate health. However, the effect of these agents on evidence-based radiotherapy practice is poorly understood. The present study aimed to determine whether dietary supplements radiosensitized normal prostate or prostate cancer cell lines. METHODS AND MATERIALS Three well-known prostate-specific dietary supplements were purchased from commercial sources available to patients (Trinovin, Provelex, and Prostate Rx). The cells used in the study included normal prostate lines (RWPE-1 and PWR-1E), prostate tumor lines (PC3, DU145, and LNCaP), and a normal nonprostate line (HaCaT). Supplement toxicity was assessed using cell proliferation assays [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] and cellular radiosensitivity using conventional clonogenic assays (0.5-4Gy). Cell cycle kinetics were assessed using the bromodeoxyuridine/propidium iodide pulse-labeling technique, apoptosis by scoring caspase-3 activation, and DNA repair by assessing gammaH2AX. RESULTS The cell growth and radiosensitivity of the malignant PC3, DU145, and LNcaP cells were not affected by any of the dietary prostate supplements (Provelex [2 microg/mL], Trinovin [10 microg/mL], and Prostate Rx [50 microg/mL]). However, both Trinovin (10 microg/mL) and Prostate Rx (6 microg/mL) inhibited the growth rate of the normal prostate cell lines. Prostate Rx increased cellular radiosensitivity of RWPE-1 cells through the inhibition of DNA repair. CONCLUSION The use of prostate-specific dietary supplements should be discouraged during radiotherapy owing to the preferential radiosensitization of normal prostate cells.
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Affiliation(s)
- Yasmin Hasan
- William Beaumont Hospital, Royal Oak, MI 48073, USA
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