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Montero A, Hernando O, López M, Valero J, Ciérvide R, Sánchez E, Prado A, Zobec HB, Chen-Zhao X, Álvarez B, García-Aranda M, Alonso L, Alonso R, Fernández-Letón P, Rubio C. SABR tolerance after prostatectomy: pushing the boundaries of ultrahypofractionation. Clin Transl Oncol 2025:10.1007/s12094-025-03845-w. [PMID: 39862341 DOI: 10.1007/s12094-025-03845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 01/08/2025] [Indexed: 01/27/2025]
Abstract
OBJECTIVE To evaluate the feasibility and tolerance of ultra-hypofractionated SABR (stereotactic ablative radiation therapy) protocol following radical prostatectomy. PATIENTS AND METHODS We included patients undergoing adjuvant or salvage SABR between April 2019 and April 2023 targeting the surgical bed and pelvic lymph nodes up to a total dose of 36.25 Gy (7.25 Gy/fraction) and 26 Gy (5.2 Gy/fraction), respectively, in 5 fractions on alternate days with an urethra sparing protocol. Acute and late adverse effects were assessed using the CTCAE v5.0. Pearson's chi-square test for categorical variables was used to compare characteristics and possible associations among different subgroups. RESULTS Adjuvant radiation therapy (ART) was administered to 40 high-risk patients (detectable post-surgery PSA, Grade Group 4/5, nodal involvement, R1/R2 resection margin), while salvage radiotherapy (SRT) was delivered to 60 patients with rising PSA levels post-undetectable values. Elective nodal irradiation was performed in 57 patients, with 11 additional patients receiving a simultaneous integrated boost (total dose: 40 Gy in 5 fractions) for macroscopic nodal disease. Twenty-four high-risk patients underwent 24-months androgen deprivation therapy (ADT). Treatment was well-tolerated with minimal toxicity. The maximum grade of SABR-related toxicity observed was grade 3. Acute gastrointestinal (GI) toxicity included seven cases of grade 2 and one of grade 3, while acute genitourinary (GU) events were limited to grade 2 in eight patients. Early-late toxicity included two cases of grade 3 and seven of grade 2 for GI, and 11 cases of grade 2 for GU. No toxicity above grade 3 was reported. With a median follow-up of 24 months (6-60 months), 14 patients experienced disease recurrence. CONCLUSIONS Ultra-hypofractionated adjuvant/salvage SABR appears feasible and safe. Longer follow-up is needed to validate observed outcomes.
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Affiliation(s)
- Angel Montero
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain.
- Universidad Camilo José Cela of Madrid, Madrid, Spain.
| | - Ovidio Hernando
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | - Mercedes López
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | - Jeannette Valero
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | - Raquel Ciérvide
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | - Emilio Sánchez
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | | | - Helena B Zobec
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Xin Chen-Zhao
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | - Beatriz Álvarez
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | | | - Leyre Alonso
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - Rosa Alonso
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | | | - Carmen Rubio
- Department of Radiation Oncology, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
- Universidad Camilo José Cela of Madrid, Madrid, Spain
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Liang Y, Zhang W, Zhao X, Zhang H. Moderate Hypofractionated Post-Prostatectomy Radiotherapy (MYSTERY) Versus Conventionally Fractionated Post-Prostatectomy Radiotherapy (COPORT) for the Patients With Localized Prostate Cancer: The Protocol of a Prospective, Randomized Trial. Cancer Control 2025; 32:10732748251317682. [PMID: 39933701 PMCID: PMC11815805 DOI: 10.1177/10732748251317682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 12/10/2024] [Accepted: 01/06/2025] [Indexed: 02/13/2025] Open
Abstract
INTRODUCTION A few studies have examined whether the safety and efficacy of moderate hypofractionated post-prostatectomy radiotherapy (moderate HYPORT, also called MYSTERY) are equal to those of conventionally fractionated post-prostatectomy radiotherapy (COPORT) in patients with localized prostate cancer. Therefore, this study aims to compare the safety and efficacy of MYSTERY and COPORT in patients with postoperative prostate cancer. METHODS AND ANALYSIS This study is a prospective, single-center, open-label, randomized controlled clinical trial. Patients with localized prostate cancer will be randomly allocated to receive COPORT (66-74 Gy at 2 Gy per fraction) or MYSTERY (57.5-65 Gy at 2.5 Gy per fraction). The primary outcomes are radiotherapy-related gastrointestinal and genitourinary adverse events. Secondary outcomes include progression-free survival, quality of life, medical expenses, and overall survival.
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Affiliation(s)
- Yiyin Liang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Weiwei Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
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Roukoz C, Lazrek A, Bardoscia L, Rubini G, Liu CM, Serre AA, Sardaro A, Rubini D, Houabes S, Laude C, Cozzi S. Evidences on the Use of Hypofractionation in Postoperative/Salvage Radiotherapy for Prostate Cancer: Systematic Review of the Literature and Recent Developments. Cancers (Basel) 2024; 16:4227. [PMID: 39766126 PMCID: PMC11727527 DOI: 10.3390/cancers16244227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 10/22/2024] [Accepted: 12/06/2024] [Indexed: 01/15/2025] Open
Abstract
BACKGROUND Radical prostatectomy (RP) is one possible curative treatment for localized prostate cancer. Despite that, up to 40% of patients will later relapse. Currently, post-operative radiotherapy (PORT) courses deliver 1.8-2 Gy daily to reach a total dose ranging between 64 and 74 Gy, completed in 7-8 weeks. Several articles reported encouraging data in terms of the effectiveness and the related toxicities using hypofractionation schedules. The objective of the present systematic review was to evaluate the clinical outcomes and toxicity of the use of hypofractionation in adjuvant/salvage prostate cancer treatments. METHODS Medline was searched via PubMed and Scopus from inception to July 2024 to retrieve studies on hypofractionation in adjuvant/salvage prostate cancer treatments. This study was conducted under PRISMA guidelines. RESULTS A total of 139 articles were identified from the initial search. Subsequently, the 139 studies were reviewed by title and abstract. Ninety-five studies were excluded due to being either abstracts or articles not available in English. In the second step, the full texts of 44 studies were reviewed. Eleven studies were excluded for being reviews, study protocols, or focused on SBRT treatments. Finally, 33 studies were included in our analysis, with a total number of 4269 patients. Of the 33 selected studies, 20 were retrospective trials and 11 were phase I/II prospective trials, while 2 studies were prospective phase III trials. The follow-up ranged from 18 to 217 months. Failure-free survival, for those with the longer follow-up, ranged between 85% and 91% at 3 years, 47 and 78.6% at 5 years and 51.5% at 10 years. Genitourinary (GU) and gastrointestinal acute toxicity was mild to moderate with similar rates across the normofractionated and hypofractionated groups. Acute grade-3 GU toxicity events were unusual, occurring in less than 4% of the cases overall. CONCLUSION The present study is the first systematic review of the literature that includes the first two randomized phase III studies published in the literature. Hypofractionated treatment has been shown to be safe, effective, with moderate toxicity and not inferior to conventional RT, with good biochemical control rates.
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Affiliation(s)
- Camille Roukoz
- Radiation Oncology Department, Centre Leon Berard, 69373 Lyon, France; (A.-A.S.); (C.L.)
| | - Amina Lazrek
- Radiation Oncology Unit, International University Hospital Cheikh Zaid, Rabat 10000, Morocco;
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy;
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari, 70124 Bari, Italy;
| | - Chieh-Min Liu
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83062, Taiwan;
| | - Anne-Agathe Serre
- Radiation Oncology Department, Centre Leon Berard, 69373 Lyon, France; (A.-A.S.); (C.L.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.S.); (D.R.)
| | - Dino Rubini
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.S.); (D.R.)
| | - Sarah Houabes
- Radiation Oncology Unit, Portes de Provence Hospital Groupe, 26200 Montélimar, France;
| | - Cecile Laude
- Radiation Oncology Department, Centre Leon Berard, 69373 Lyon, France; (A.-A.S.); (C.L.)
| | - Salvatore Cozzi
- Radiation Oncology Department, Centre Leon Berard, 69373 Lyon, France; (A.-A.S.); (C.L.)
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Dubinsky P, Vojtek V, Belanova K, Janickova N, Balazova N, Tomkova Z. Hypofractionated Post-Prostatectomy Radiotherapy in 16 Fractions: A Single-Institution Outcome. Life (Basel) 2023; 13:1610. [PMID: 37511985 PMCID: PMC10381816 DOI: 10.3390/life13071610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The optimal hypofractionated schedule of post-prostatectomy radiotherapy remains to be established. We evaluated treatment outcomes and toxicity of moderately hypofractionated post-prostatectomy radiotherapy in 16 daily fractions delivered with intensity-modulated radiotherapy. The treatment schedule selection was motivated by limited technology resources and was radiobiologically dose-escalated. METHODS One hundred consecutive M0 patients with post-prostatectomy radiotherapy were evaluated. Radiotherapy indication was adjuvant (ART) in 19%, early-salvage (eSRT) in 46% and salvage (SRT) in 35%. The dose prescription for prostate bed planning target volume was 52.8 Gy in 16 fractions of 3.3 Gy. The Common Terminology Criteria v. 4 for Adverse Events scale was used for toxicity grading. RESULTS The median follow-up was 61 months. Five-year biochemical recurrence-free survival (bRFS) was 78.6%, distant metastases-free survival (DMFS) was 95.7% and overall survival was 98.8%. Treatment indication (ART or eSRT vs. SRT) was the only significant factor for bRFS (HR 0.15, 95% CI 0.05-0.47, p = 0.001) and DMFS (HR 0.16, 95% CI 0.03-0.90; p = 0.038). Acute gastrointestinal (GI) toxicity grade 2 was recorded in 24%, grade 3 in 2%, acute genitourinary (GU) toxicity grade 2 in 10% of patients, and no grade 3. A cumulative rate of late GI toxicity grade ≥ 2 was observed in 9% and late GU toxicity grade ≥ 2 in 16% of patients. CONCLUSIONS The observed results confirmed efficacy and showed a higher than anticipated rate of early GI, late GI, and GU toxicity of post-prostatectomy radiobiologically dose-escalated hypofractionated radiotherapy in 16 daily fractions.
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Affiliation(s)
- Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
- Faculty of Health, Catholic University in Ruzomberok, 034 01 Ruzomberok, Slovakia
| | - Vladimir Vojtek
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
| | - Katarina Belanova
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
| | - Natalia Janickova
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
| | - Noemi Balazova
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
| | - Zuzana Tomkova
- Department of Radiation Oncology, East Slovakia Institute of Oncology, 041 91 Kosice, Slovakia
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Wu SY, Effendi FF, Canales RE, Huang CC. The Latest Data Specifically Focused on Long-Term Oncologic Prognostication for Very Old Adults with Acute Vulnerable Localized Prostate Cancer: A Nationwide Cohort Study. J Clin Med 2022; 11:jcm11123451. [PMID: 35743522 PMCID: PMC9225393 DOI: 10.3390/jcm11123451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV-LPC). Clinicians have been deeply troubled by this near end-of-life medical choice for a very specific group of patients. We compared the oncological prognostication of very old patients with AV-LPC after they underwent either radical prostatectomy (RP) or massive-dose intensity-modulated radiotherapy (IMRT) coupled with long-term androgen deprivation therapy (ADT) over a long-term investigation. Methods: In this nationwide cohort study, we used the Taiwan Cancer Registry Database and retrieved information related to patients (aged ≥ 80 years) with AV-LPC who underwent standard RP (the RP group) or massive-dose IMRT + long-term ADT (at least 72 Gy and ADT use ≥18 months; the IMRT + ADT group). After potential confounders were controlled for using propensity score matching (PSM), we utilized the Cox proportional hazards regression to evaluate the oncologic prognostication. Results: The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all-cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41−2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36−2.11, p < 0.0001), 1.12 (95% CI: 1.04−1.33, p < 0.0001), and 1.15 (95% CI: 1.06−1.71, p = 0.0311), respectively. Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with AV-LPC.
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Affiliation(s)
- Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Fransisca Fortunata Effendi
- School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan; (F.F.E.); (R.E.C.)
- PT Inertia Utama, Dexa Group, Jl. Boulevard Bintaro Jaya, Pondok Jaya, Pondok Aren, South Tangerang 15117, Indonesia
| | - Ricardo E. Canales
- School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan; (F.F.E.); (R.E.C.)
- Collegiate of Doctors in Honduras, Colegio Médico de Honduras (CMH), CA 6 Boulevard Fuerzas Armadas, Tegucigalpa 11101, Honduras
| | - Chung-Chien Huang
- Biotech and Healthcare Management, School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Department of Medical Quality, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Department & School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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