1
|
Liu EY, Lin EY, Lee A, Venkat PS, Shiao JC, Wong A, Yu A, Hagio MA, Park SJ, Demanes J, Chang AJ. High-Dose Rate Brachytherapy Alone for Treatment of Unfavorable Intermediate Risk Prostate Cancer: A Propensity-Score Matched Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e408-e409. [PMID: 37785355 DOI: 10.1016/j.ijrobp.2023.06.1551] [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 demonstrate the feasibility of high-dose rate brachytherapy (HDR BT) as monotherapy for unfavorable intermediate risk (UIR) prostate cancer by comparing survival outcomes of HDR BT alone against external beam radiation therapy (EBRT) + HDR BT boost, +/- androgen deprivation therapy (ADT) using propensity-score matched (PSM) data. MATERIALS/METHODS This retrospective study queried two data registries collecting patient data from 1991 to present. 633 patients with UIR prostate cancer treated with HDR BT alone, HDR BT+EBRT or HDR+EBRT+ADT were included. HDR BT patients received 42-45Gy/6 fractions (fx) or 27 Gy/2 fx. For HDR BT+EBRT, the HDR dose was 20-24 Gy/2 fx, 24 Gy/4 fx, or 15 Gy/1 fx. EBRT patients received 45 Gy/25 fx to the prostate +/- pelvic nodes. GU/GI toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Time-to-event analyses were carried out to evaluate the relationship between treatments and five primary endpoints of interest: freedom from biochemical recurrence (FFBC), freedom from distant metastasis (FFDM), freedom from local failure (FFLF), cancer specific survival (CSS), and overall survival (OS) at 5 years. PSM was performed with one-to-n matching. Logistic regression was used to estimate the respective propensity scores. The five potential confounders identified were T-stage, Gleason score, pre-treatment PSA, age, and percent positive cores. Balance was checked using the standardized mean difference of covariates. Univariate and multivariate analyses were conducted on the matched data. Toxicity analysis was performed via association between a change in pre- and post-treatment GU/GI toxicity status and the treatment group, as well as incidence of post-treatment severe GI/GU toxicity (grade 3 or higher) and the treatment group. RESULTS Univariate analysis with Kaplan-Meier method and log rank test comparison between the three cohorts demonstrated no significant difference in all survival outcomes FFBC, FFDM, FFLF, CSS, OS (p = 0.15, 0.19, 0.29, 0.57, 0.28, respectively). Multivariate analysis with Cox proportional hazard regression showed no differences in HR for FFBC and OS (p = 0.95, 0.11) with addition of EBRT, or with EBRT+ADT (p = 0.17, 0.24); no fit was obtainable for FFDM, CSS, FFLF. Toxicities between the three cohorts were not significantly different when comparing post-treatment and baseline GI/GU symptoms (p = 0.53/1). No Grade 2 or 3 GI toxicities were identified, while 8%/1% HDR patients, 10%/1% HDR+EBRT patients, and 12%/2% HDR+EBRT+ADT patients experienced Grade 2/3 GU toxicities. The incidence of grade 3 or higher GU toxicities between the three groups was not significantly different (p = 0.91). CONCLUSION This propensity-score matched study demonstrates the feasibility of HDR BT alone for effective treatment of UIR prostate cancer when compared to HDR+EBRT or HDR+EBRT+ADT, while potentially minimizing the added toxicities of EBRT and the undesirable side effect profile of ADT.
Collapse
Affiliation(s)
- E Y Liu
- Department of Radiation Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - E Y Lin
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A Lee
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - P S Venkat
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - J C Shiao
- The University of Kansas Cancer Center, Kansas City, KS
| | - A Wong
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A Yu
- University of California, Los Angeles, Los Angeles, CA
| | - M A Hagio
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - S J Park
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - J Demanes
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A J Chang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
2
|
Lin E, Lee A, Demanes J, Kamrava M, Venkat P, Hagio M, Zaide L, Park S, Zarate C, Chang A. Outcomes of High-Dose Rate Brachytherapy for Intermediate- to High-Risk Prostate Cancer at One Institution. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.580] [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: 10/23/2022]
|
3
|
Lin E, Lee A, Demanes J, Kamrava M, Venkat P, Hagio M, Zaide L, Park S, Zarate C, Chang A. Outcomes of High-Dose Rate (HDR) Brachytherapy in Intermediate- to High-Risk Prostate Cancer Patients with Prior Transurethral Resection of the Prostate (TURP). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.488] [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: 11/15/2022]
|
4
|
Shaverdian N, Demanes J, Veruttipong D, Wang J, Kishan A, McCloskey S, Kupelian P, Steinberg M, King C. Exploring Value From the Patient’s Perspective Between Stereotactic Body Radiation Therapy, Intensity Modulated Radiation Therapy, and High-Dose-Rate Brachytherapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1221] [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]
|
5
|
Kuske R, Demanes J, Anderson B, Chen P, Hayes J, Quiet C, Wang J, Veruttipong D, Kamrava M. Discrepancies in Accelerated Partial Breast Irradiation (APBI) Treatment Outcomes in Younger Women When Using Claims Versus a Database (PROMIS) With Actual Recurrence Rates. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Patel S, Park S, Zhang M, Ragab O, Lee T, Demanes J, Kamrava M. High-Dose-Rate Brachytherapy Via Custom Skin Molds: A New Dosimetric Method as Applied to Non-Melanomatous Skin Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2422] [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]
|
7
|
Park S, Ragab O, Patel S, Kim Y, Demanes J, Kamrava M. SU-G-201-14: Is Maximum Skin Dose a Reliable Metric for Accelerated Partial Breast Irradiation with Brachytherapy? Med Phys 2016. [DOI: 10.1118/1.4956887] [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: 11/07/2022] Open
|
8
|
Park S, Demanes J, Kamrava M. SU-E-T-232: Custom High-Dose-Rate Brachytherapy Surface Mold Applicators: The Importance Source to Skin Distance. Med Phys 2015. [DOI: 10.1118/1.4924593] [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: 11/07/2022] Open
|
9
|
Park S, Scanderbeg D, Demanes J, Kamrava M. SU-E-T-383: Can Stereotactic Body Radiotherapy Mimic the Dose Distribution of High-Dose-Rate Tandem and Ovoids/ring Brachytherapy? Med Phys 2014. [DOI: 10.1118/1.4888716] [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: 11/07/2022] Open
|
10
|
Lamb J, Chao E, Kamrava M, Demanes J, McCannel T, Low D. TU-E-BRA-07: Post-Operative Eye Plaque Imaging Using Tomotherapy MVCT. Med Phys 2012; 39:3912. [PMID: 28518681 DOI: 10.1118/1.4735967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/07/2022] Open
Abstract
PURPOSE Intra-operative ultrasound is used to verify the positioning of episcleral eye plaques used to treat ocular melanoma. Ultrasound can be ambiguous because of image artifacts, and plaques may shift position after surgery. Ultrasound verification is particularly challenging for anterior tumors. Post-operative imaging could be used to trigger interventions that would prevent local treatment failure. We investigated if, and under what conditions, the Tomotherapy megavoltage computed tomography (MVCT) system could be used to perform post-implantation verification of eye plaque positioning. METHODS Plaques were placed on a preserved cow's eye, and imaged with the megavoltage CT of a Tomotherapy linear accelerator (Accuray, Sunnyvale, CA). The images were visually and quantitatively assessed to determine if they were of sufficient quality to verify tumor coverage and plaque tilt with respect to the sclera. We used the visibility of the lens as a proxy for visibility of a tumor. To test the utility of hypothetical higher beam current Tomotherapy images, we averaged sequential images of the same setup. RESULTS The plaque, the lens of the eye, and the globe are visible in the images. The CNR of the lens with respect to the vitreous was 5.6 for a single image. For 10 images averaged, the CNR was 9.2. Estimated dose from a single image was 1.3 cGy (body CTDIvol); even 10 times this dose would be an acceptable image-guidance dose for radiotherapy patients. One limitation of the imaging procedure is the long scan time (up to 240 seconds), during which time any significant patient motion would lead to image artifacts. Human trials on eye plaque patients are planned. CONCLUSIONS Tomotherapy MVCT imaging could be used to verify tumor coverage and plaque tilt after episcleral plaque implantation. Tumors should be visible in standard Tomotherapy images but higher beam current images would be preferred if available.
Collapse
Affiliation(s)
- J Lamb
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| | - E Chao
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| | - M Kamrava
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| | - J Demanes
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| | - T McCannel
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| | - D Low
- UCLA, Los Angeles, CA.,Accuray, Inc.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA.,UCLA, Los Angeles, CA
| |
Collapse
|
11
|
Park S, Kamrava M, Demanes J. SU-E-T-322: A Dosimetric Comparison of PBI Brachytherapy Techniques: SAVI, Contura, and Tube and Button Applicators. Med Phys 2012; 39:3778. [DOI: 10.1118/1.4735409] [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: 11/07/2022] Open
|
12
|
Park S, Demanes J, Kamrava M. SU-D-213AB-02: Optimal Design of Multichannel Vaginal Cylinder Applicators for High Dose Rate Brachytherapy. Med Phys 2012; 39:3611. [DOI: 10.1118/1.4734662] [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: 11/07/2022] Open
|
13
|
Martinez A, Shah C, Mohammed N, Demanes J, Martinez-Monge R, Ye H, Galalae R. OC-24 TEN-YEAR OUTCOMES FOR PATIENTS WITH GLEASON 8-10 TREATED WITH HIGH DOSE RATE BRACHYTHERAPY BOOST. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71992-8] [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: 10/28/2022]
|
14
|
Park S, Demanes J, Steinberg M, Kamrava M. PO-289 MULTICHANNEL VAGINAL BRACHYTHERAPY: OVERKILL OR NECESSITY? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72255-7] [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: 10/28/2022]
|
15
|
Williams S, Pickles T, Kestin L, Buyyounouski M, Martinez A, Demanes J, Taylor J, Duchesne G. Androgen Deprivation Therapy Plus Hypofractionated Prostate Radiotherapy—Are We Castrating the Radiobiological Advantage? Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
16
|
Ghilezan M, Galalae R, Demanes J, Schour L, Gustafson G, Nuernberg N, Wallace M, Martinez A. 10-year Results in 1577 Intermediate/High Risk Prostate Cancer Patients Treated With External Beam RT (EBRT) and Hypofractionated High Dose Rate (HDR) Brachytherapy Boost. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.151] [Citation(s) in RCA: 7] [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] [Indexed: 11/30/2022]
|
17
|
Williams S, Demanes J, Wilson G, Martinez A, Ghilezan M, Millar J, Duchesne G. Defining the Optimal Hypofractionation Schedule: An Outcomes Nomogram for Multi-Fraction High-Dose-Rate Brachytherapy Boost (HDRBB) for Prostate Cancer Based on 1,934 Cases. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.317] [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: 11/27/2022]
|
18
|
Swanson T, Martinez A, Kestin L, Antonucci J, Galalae R, Schour L, Nuernberg N, Korman H, Demanes J. Improved 10-year Outcomes for Prostate Cancer Patients With Gleason 8–10 Treated With Intensity Modulated High Dose Rate Brachytherapy Boost in the PSA Era. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Vargas C, Martínez A, Galalae R, Demanes J, Harsolia A, Schour L, Nuernberg N, Gonzalez J. High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features. Prostate Cancer Prostatic Dis 2006; 9:245-53. [PMID: 16786040 DOI: 10.1038/sj.pcan.4500882] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) > or =10, Gleason Score (GS) > or =7, or T stage > or =T2b), 560 received no NAD (n=308) or NAD for < or =6 months (n=252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was >100 Gy (alpha/beta=1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on chi(2) tables for all 560 patients treated with or without NAD including pretreatment PSA (P=0.11), GS (P=0.4), and clinical T stage (P=0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P=0.04); cause-specific survival (CSS), 93 vs 98% (P=0.005)). Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n=112 (P=0.03, P=0.02)), pretreatment PSA> or =15 (n=136 (P=0.03, P=0.008)), and palpable disease > or =T2a (n=434 (P=0.04, P=0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P=0.003, HR 2.8) and NAD (P=0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate- and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.
Collapse
Affiliation(s)
- C Vargas
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Boike T, Vargas C, Demanes J, Altieri G, Gustafson G, Barnaba M, Skoolisariyaporn P, Schour L, Martinez A. Match Pair Analysis of Prostate Cancer Patients at Risk of Positive Pelvic Lymph Nodes >15% Treated to High Radiation Doses With and Without Pelvic EBRT. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.508] [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]
|