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Jiang P, Krockenberger K, Vonthein R, Tereszczuk J, Schreiber A, Liebau S, Huttenlocher S, Imhoff D, Balermpas P, Keller C, Dellas K, Baumann R, Rödel C, Hildebrandt G, Jünemann KP, Merseburger AS, Katz A, Ziegler A, Blanck O, Dunst J. Hypo-fractionated SBRT for localized prostate cancer: a German bi-center single treatment group feasibility trial. Radiat Oncol 2017; 12:138. [PMID: 28821268 PMCID: PMC5562995 DOI: 10.1186/s13014-017-0872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For prostate cancer treatment, treatment options with minimal side effects are desired. External beam radiation therapy (EBRT) is non-invasive, standard of care and delivered in either conventional fractionation over 8 weeks or with moderate hypo-fractionation over about 5 weeks. Recent advances in radiotherapy technology have made extreme hypo-fractionated stereotactic body radiation therapy (SBRT) of prostate cancer feasible, which has not yet been introduced as a standard treatment method in Germany. Initial results from other countries are promising, but long-term results are not yet available. The aim of this study is to investigate feasibility and effectiveness of SBRT for prostate cancer in Germany. METHODS/DESIGN This German bi-center single group trial (HYPOSTAT) is designed to evaluate feasibility and effectiveness, as measured by toxicity and PSA-response, respectively, of an extreme hypo-fractionated SBRT regimen with five fractions of 7 Gy in treatment of localized low and intermediate risk prostate cancer. The target volume includes the prostate with or without the base of seminal vesicles depending on risk stratification and uncertainty margins that are kept at 3-5 mm. SBRT treatment is delivered with the robotic CyberKnife system, which was recently introduced in Germany. Acute and late toxicity after one year will be evaluated according to Common Terminology Criteria for Adverse Events (CTCAE v. 4.0), Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) Scores. The quality of life will be assessed before and after treatment with the EORTC QLQ C30 questionnaire. Hypothesizing that the proportion of patients with grade 2 side effects or higher is less or equal than 2.8%, thus markedly lower than the standard EBRT percentage (17.5%), the recruitment target is 85 patients. DISCUSSION The HYPOSTAT trial aims at demonstrating short term feasibility of extreme hypo-fractioned SBRT for the treatment of prostate cancer and might be used as the pilot study for a multi-center multi-platform or for randomized-controlled trials comparing conventional radiotherapy with SBRT for localized prostate cancer in the future. The study concept of patient enrollment, follow up and evaluation by multiple public university clinics and actual patient treatment in dedicated private radiosurgery practices with high-tech radiation equipment is unique for clinical trials. STUDY STATUS The study is ongoing and currently recruiting patients. TRIAL REGISTRATION Registration number: NCT02635256 ( clinicaltrials.gov ). Registered 8 December 2015.
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Affiliation(s)
- Ping Jiang
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Klinik für Strahlentherapie, Universitätsklinik für Medizinische Strahlenphysik, Pius Hospital, Oldenburg, Germany
| | | | - Reinhard Vonthein
- Universität zu Lübeck, ZKS, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | | | | | - Stefan Huttenlocher
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany
| | - Detlef Imhoff
- Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Keller
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Rene Baumann
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Claus Rödel
- Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Guido Hildebrandt
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | | | - Alex S Merseburger
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Alan Katz
- Flushing Radiation Oncology Services, New York, USA.,Long Island Radiation Therapy, New York, USA
| | - Andreas Ziegler
- Universität zu Lübeck, ZKS, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany. .,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa. .,Department for Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark. .,Department of Radiation Oncology, Karl Lennert Cancer Center, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, D-24105, Kiel, Germany.
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