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Sawayanagi S, Yamashita H, Ogita M, Kawai T, Sato Y, Kume H. In Curative Stereotactic Body Radiation Therapy for Prostate Cancer, There Is a High Possibility That 45 Gy in Five Fractions Will Not Be Tolerated without a Hydrogel Spacer. Cancers (Basel) 2024; 16:1472. [PMID: 38672553 PMCID: PMC11048095 DOI: 10.3390/cancers16081472] [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: 03/17/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to determine the maximum tolerated dose (MTD) for stereotactic body radiation therapy (SBRT) in the treatment of non-metastatic prostate cancer. This study was a phase 1 dose escalation trial conducted in Japan. Patients with histologically proven prostate cancer without lymph nodes or distant metastases were enrolled. The prescribed doses were 42.5, 45, or 47.5 Gy in five fractions. Dose-limiting toxicity (DLT) was defined as grade (G) 3+ gastrointestinal or genitourinary toxicity within 180 days after SBRT completion, and a 6 plus 6 design was used as the method of dose escalation. A total of 16 patients were enrolled, with 6 in the 42.5 Gy group and 10 in the 45 Gy group. No DLT was observed in the 42.5 Gy group. In the 45 Gy group, one patient experienced G3 rectal hemorrhage, and another had G4 rectal perforation, leading to the determination of 42.5 Gy as the MTD. None of the patients experienced biochemical recurrence or death during the follow-up period. We concluded that SBRT for non-metastatic prostate cancer at 42.5 Gy in five fractions could be safely performed, but a total dose of 45 Gy increased severe toxicity.
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Affiliation(s)
- Subaru Sawayanagi
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (S.S.); (M.O.)
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (S.S.); (M.O.)
| | - Mami Ogita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (S.S.); (M.O.)
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (T.K.); (Y.S.); (H.K.)
- Department of Urology, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8606, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (T.K.); (Y.S.); (H.K.)
- Department of Urology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu 183-8524, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (T.K.); (Y.S.); (H.K.)
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Jochems KFT, Menges D, Sanchez D, de Glas NA, Wildiers H, Eberli D, Puhan MA, Bastiaannet E. Outcomes in studies regarding older patients with prostate cancer: A systematic review. J Geriatr Oncol 2024:101763. [PMID: 38575500 DOI: 10.1016/j.jgo.2024.101763] [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: 10/23/2023] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Older patients are often deemed ineligible for clinical research, and many frequently-used endpoints and outcome measures are not as relevant for older patients for younger ones. This systematic review aimed to present an overview of outcomes used in clinical research regarding patients over the age of 65 years with prostate cancer. MATERIALS AND METHODS PubMed and Embase were systematically searched to identify studies on prostate cancer (treatment) in patients aged ≥65 between 2016 and 2023. Data on title, study design, number of participants and age, stage of disease, treatment, and investigated outcomes were synthesized and descriptively analyzed. RESULTS Sixty-eight studies were included. Of these most included patients over 65 years, while others used a higher age. Overall, 39 articles (57.3%) reported on survival-related outcomes, 22 (32.4%) reported on progression of disease and 38 (55.9%) used toxicity or adverse events as an outcome measure. Health-related quality of life and functional outcomes were investigated in 29.4%, and cognition in two studies. The most frequently investigated survival-related outcomes were overall and cancer-specific survival (51.3%); however, 38.5% only studied overall survival. DISCUSSION The main focus of studies included in this review remains survival and disease progression. There is limited attention for health-related quality of life and functional status, although older patients often prioritize the latter. Future research should incorporate outcome measures tailored to the aged population to improve care for older patients with prostate cancer.
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Affiliation(s)
- Kim F T Jochems
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dafne Sanchez
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nienke A de Glas
- Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Wildiers
- Oncology, University Hospital Leuven, Leuven, Belgium
| | - Daniel Eberli
- Urology, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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Slama Y, Baumont G, Arcambal A, Begue M, Maillot O, Sayah R, Castanet R, Caboche R, Liberati P, Slaoui H, Bouaziz M, Borson O, Nguyen NP, Dutheil F. Retrospective study on the toxicity induced by stereotactic body radiotherapy: overview of the reunion experience on prostate cancer in elderly patients. Front Oncol 2024; 14:1302001. [PMID: 38361775 PMCID: PMC10867626 DOI: 10.3389/fonc.2024.1302001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Prostate cancer is the fourth most commonly diagnosed cancer among men worldwide. Various tools are used to manage disease such as conventional radiotherapy. However, it has been demonstrated that large prostate volumes were often associated with higher rates of genitourinary and gastrointestinal toxicities. Currently, the improvements in radiotherapy technology have led to the development of stereotactic body radiotherapy, which delivers higher and much more accurate radiation doses. In order to complete literature data about short-term outcome and short-term toxic effects of stereotactic body radiotherapy, we aimed to share our experience about gastrointestinal and genitourinary toxicities associated with stereotactic body radiotherapy in prostate cancer in patients over 70 years old. Methods We retrospectively reviewed the medical records of elderly patients with prostate cancer treated between 2021 and 2022. The elderly patients were treated with a non-coplanar robotic stereotactic body radiotherapy platform using real-time tracking of implanted fiducials. The prostate, with or without part of the seminal vesicles, was treated with a total dose of 36.25 Gy delivered in five fractions, each fraction being administered every other day. Results We analyzed a total of 80 elderly patients, comprising 38 low-, 37 intermediate- and 5 high-risk patients. The median follow-up duration was 12 months. We did not observe biochemical/clinical recurrence, distant metastasis, or death. Grade 2 acute genitourinary toxicity was observed in 9 patients (11.25%) and Grade 2 acute gastrointestinal toxicity in 4 patients (5.0%). We did not observe any grade 3 or more acute or late toxicities. Conclusion Over the follow-up period, we noted a low frequency of gastrointestinal and genitourinary toxicities induced by stereotactic body radiotherapy in the context of prostate cancer in elderly patients. Therefore, stereotactic body radiotherapy seems to represent a promising treatment option for elderly patients, with acceptable acute toxicity.
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Affiliation(s)
- Youssef Slama
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Gilles Baumont
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Angelique Arcambal
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Mickael Begue
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Olivier Maillot
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Rima Sayah
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Romain Castanet
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Raoul Caboche
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Pedro Liberati
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Hakim Slaoui
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Medi Bouaziz
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Olivier Borson
- Cabinet de Radiologie Les Alizés, Saint-Denis, La Réunion, France
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, College of Medicine, Washington, DC, United States
| | - Fabien Dutheil
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
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Borzillo V, Scipilliti E, Pezzulla D, Serra M, Ametrano G, Quarto G, Perdonà S, Rossetti S, Pignata S, Crispo A, Di Gennaro P, D’Alesio V, Arrichiello C, Buonanno F, Mercogliano S, Russo A, Tufano A, Di Franco R, Muto P. Stereotactic body radiotherapy with CyberKnife ® System for low- and intermediate-risk prostate cancer: clinical outcomes and toxicities of CyPro Trial. Front Oncol 2023; 13:1270498. [PMID: 38023175 PMCID: PMC10660677 DOI: 10.3389/fonc.2023.1270498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Simple summary Stereotactic body radiotherapy (SBRT) of 35-36.25 Gy in five fractions with the CyberKnife System yields excellent control with low toxicity in low-intermediate-risk prostate cancer patients. We found no differences in biochemical control and overall survival in relation to dose. There were no significant differences in toxicity or quality of life between the two groups. Aims Stereotactic body radiotherapy (SBRT) is an emerging therapeutic approach for low- and intermediate-risk prostate cancer. We present retrospective data on biochemical control, toxicity, and quality of life of CyPro Trial. Materials and methods A total of 122 patients with low- and intermediate-risk prostate cancer were treated with the CyberKnife System at a dose of 35 Gy or 36.25 Gy in five fractions. Biochemical failure (BF)/biochemical disease-free survival (bDFS) was defined using the Phoenix method (nadir + 2 ng/ml). Acute/late rectal and urinary toxicities were assessed by the Radiation Therapy Oncology Group (RTOG) toxicity scale. Quality of life (QoL) was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and PR25. International Erectile Function Index-5 (IIEF5) and International Prostate Symptom Score (IPSS) questionnaires were administered at baseline, every 3 months after treatment during the first years, and then at 24 months and 36 months. Results The 1-, 2-, and 5-year DFS rates were 92.9%, 92.9%, and 92.3%, respectively, while the 1-, 2-, and 5-year bDFS rates were 100%, 100%, and 95.7%, respectively. With regard to risk groups or doses, no statistically significant differences were found in terms of DFS or bDFS. Grade 2 urinary toxicity was acute in 10% and delayed in 2% of patients. No Grade 3 acute and late urinary toxicity was observed. Grade 2 rectal toxicity was acute in 8% and late in 1% of patients. No Grade 3-4 acute and late rectal toxicity was observed. Grade 2 acute toxicity appeared higher in the high-dose group (20% in the 36.25-Gy group versus 3% in the 35-Gy group) but was not statistically significant. Conclusion Our study confirms that SBRT of 35-36.25 Gy in five fractions with the CyberKnife System produces excellent control with low toxicity in patients with low-intermediate-risk prostate cancer. We found no dose-related differences in biochemical control and overall survival. Further confirmation of these results is awaited through the prospective phase of this study, which is still ongoing.
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Affiliation(s)
- Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Giuseppe Quarto
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sisto Perdonà
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sandro Pignata
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Valentina D’Alesio
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Cecilia Arrichiello
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | | | - Simona Mercogliano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Antonio Russo
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Naples, Napoli, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
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Cuccia F, Tamburo M, Piras A, Mortellaro G, Iudica A, Daidone A, Federico M, Zagardo V, Ferini G, Marletta F, Spatola C, Fazio I, Filosto S, Pergolizzi S, Ferrera G. Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1442. [PMID: 37629732 PMCID: PMC10456704 DOI: 10.3390/medicina59081442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicenter study evaluates the outcomes of a cohort of patients treated with stereotactic body radiotherapy for lymph-nodal oligometastases. Methods: Inclusion criteria were up to five lymph-nodal oligometastases detected either with Choline-PET or PSMA-PET in patients naïve for ADT or already ongoing with systemic therapy and at least 6 Gy per fraction for SBRT. Only patients with exclusive lymph-nodal disease were included. The primary endpoint of the study was LC; a toxicity assessment was retrospectively performed following CTCAE v4.0. Results: A total of 100 lymph-nodal oligometastases in 69 patients have been treated with SBRT between April 2015 and November 2022. The median age was 73 years (range, 60-85). Oligometastatic disease was mainly detected with Choline-PET in 47 cases, while the remaining were diagnosed using PSMA-PET, with most of the patients treated to a single lymph-nodal metastasis (48/69 cases), two in 14 cases, and three in the remaining cases. The median PSA prior to SBRT was 1.35 ng/mL (range, 0.3-23.7 ng/mL). Patients received SBRT with a median total dose of 35 Gy (range, 30-40 Gy) in a median number of 5 (range, 3-6) fractions. With a median follow-up of 16 months (range, 7-59 months), our LC rates were 95.8% and 86.3% at 1 and 2 years. DPFS rates were 90.4% and 53.4%, respectively, at 1 and 2 years, with nine patients developing a sequential oligometastatic disease treated with a second course of SBRT. Polymetastatic disease-free survival (PMFS) at 1 and 2 years was 98% and 96%. Six patients needed ADT after SBRT for a median time of ADT-free survival of 15 months (range, 6-22 months). The median OS was 16 months (range, 7-59) with 1- and 2-year rates of both 98%. In multivariate analysis, higher LC rates and the use of PSMA-PET were related to improved DPFS rates, and OS was significantly related to a lower incidence of distant progression. No G3 or higher adverse events were reported. Conclusions: In our experience, lymph-nodal SBRT for oligometastatic prostate cancer is a safe and effective option for ADT delay with no severe toxicity.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy; (G.M.)
| | - Maria Tamburo
- Radiotherapy Unit, Cannizzaro Hospital, 95100 Catania, Italy; (M.T.)
| | - Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, 90100 Palermo, Italy; (A.P.); (A.D.)
- RI.MED Foundation, 90100 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90100 Palermo, Italy
| | | | - Arianna Iudica
- Radiotherapy Unit, AOU Policlinico-VE, 95100 Catania, Italy; (A.I.); (C.S.)
| | - Antonino Daidone
- Radioterapia Oncologica, Villa Santa Teresa, 90100 Palermo, Italy; (A.P.); (A.D.)
| | - Manuela Federico
- Radiotherapy Unit, Casa di Cura Macchiarella, 90100 Palermo, Italy; (M.F.); (I.F.)
| | - Valentina Zagardo
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy
| | | | - Corrado Spatola
- Radiotherapy Unit, AOU Policlinico-VE, 95100 Catania, Italy; (A.I.); (C.S.)
| | - Ivan Fazio
- Radiotherapy Unit, Casa di Cura Macchiarella, 90100 Palermo, Italy; (M.F.); (I.F.)
| | - Sergio Filosto
- Radiation Oncology Unit, La Maddalena Dipartimento Oncologico di III Livello, 90100 Palermo, Italy;
| | - Stefano Pergolizzi
- Department of Radiological Science, University of Messina, 98121 Messina, Italy
| | - Giuseppe Ferrera
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy; (G.M.)
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Gregucci F, Carbonara R, Surgo A, Ciliberti MP, Curci D, Ciocia A, Branà L, Ludovico GM, Scarcia M, Portoghese F, Caliandro M, Ludovico E, Paulicelli E, Di Guglielmo FC, Bonaparte I, Fiorentino A. Extreme hypofractionated stereotactic radiotherapy for elderly prostate cancer patients: side effects preliminary analysis of a phase II trial. LA RADIOLOGIA MEDICA 2023; 128:501-508. [PMID: 36952115 DOI: 10.1007/s11547-023-01618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Aim of this study is to evaluate safety and efficacy of SBRT in elderly patients affected by localized prostate cancer (PC). MATERIAL AND METHODS Men aged 70 years or older were enrolled and analyzed. The SBRT schedule was 35 Gy in 5 fractions administered in 1-2 weeks. According to risk group, androgen deprivation therapy (ADT) was prescribed. Urinary symptoms were evaluated at baseline using the International Prostate Symptom Score (IPSS). Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed at the end of treatment, 2 weeks after SBRT and during follow-up using the Common Terminology Criteria for Adverse Events (CTCAE). PSA values were recorded before treatment and during follow-up as biochemical response criteria. RESULTS Between 07/2019 and 09/2021, 111 patients were enrolled. Median age was 77 years. At the end of treatment, no acute GU/GI toxicities ≥ G2 were observed. At 2-3 weeks after treatment, 3 patients reported G2 GU toxicity, while 14 patients referred G2 GI toxicity. During the last follow up, 26 and 2 patients reported, respectively, G1 and G2 GU toxicity, while 22 and 1 cases described, respectively, G1 and G2 GI toxicity. No late toxicities ≥ G3 were recorded. GU toxicity is related to absence of urethra sparing, increasing PTV volume, Dmax PTV and IPSS; GI toxicity is related to RT schedule (each other day is better than consecutive day), Dmax rectum and IPSS, At a median follow-up of 24 months, excellent biochemical disease control was achieved in all cases with median PSA of 0.5 ng/ml. CONCLUSION SBRT in elderly patients affected by PC is feasible and well tolerated with excellent biochemical disease control. Longer follow-up is needed to assess late toxicity profile and long-term clinical outcome.
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Affiliation(s)
- Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Domenico Curci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Annarita Ciocia
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Luciana Branà
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Marcello Scarcia
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Filippo Portoghese
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Eleonora Paulicelli
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
- Department of Medicine, LUM Giuseppe Degennaro University, Casamassima, Bari, Italy
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Moderate hypofractionated helical tomotherapy for older patients with localized prostate cancer: long-term outcomes of a phase I-II trial. Radiol Oncol 2022; 56:216-227. [PMID: 35344645 PMCID: PMC9122298 DOI: 10.2478/raon-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Our previous study showed that two different regimens of moderate hypofractionated radiotherapy (HFRT) delivered with helical tomotherapy (HT) are well tolerated in older prostate cancer patients. We provide a longterm efficacy and toxicity after > 7 years of follow-up. PATIENTS AND METHODS The study recruited 33 patients from February 2009 to July 2011 (76 Gy/34F; Group-1); and 34 from July 2011 to February 2014 (71.6 Gy/28F; 50.4 Gy/25F for the risk of pelvic lymph nodes involvement (LNI) >15%; Group-2). The primary outcomes were biochemical failure (BF), biochemical failure and clinical disease failure (BCDF), progression-free survival (PFS), overall survival (OS), late genitourinary (GU) and gastrointestinal (GI) toxicity. RESULTS The average ages of two groups were 80 and 77 years and the proportions of patients with LNI > 15% were 69.7% and 73.5%, respectively. At the final follow-up in February 2020, 27.3% and 20.6% cases experienced BF, with a median time until BF of 3.3 years. A total of 38.8% patients reached primary endpoints, in which 18 deaths were reported BCDF events (45.5% vs. 32.4%, p = 0.271). There was no significant difference in 7-year PFS (68.6% vs. 74.8%, p = 0.591), BCDF (45.5% vs. 32.4%, p = 0.271) and OS (71.9% vs. 87.5%, p = 0.376) for full set analysis and for subgroup analysis (all p > 0.05). The incidence of grade ≥ 2 late GU (6.2% vs. 6.3%, p = 0.127) and GI toxicities (9.4% vs. 15.6%, p = 0.554) was comparable. CONCLUSIONS In older patients with localized prostate cancer, two moderate hypofractionated regimens were all well tolerated with similar, mild late toxicities and satisfactory survival, without necessity of prophylactic pelvic node irradiation.
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SBRT for elderly oligometastatic patients as a feasible, safe and effective treatment opportunity. Clin Exp Metastasis 2021; 38:475-481. [PMID: 34487288 DOI: 10.1007/s10585-021-10122-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/30/2021] [Indexed: 01/04/2023]
Abstract
The constantly increasing life expectancy is raising the issue of treating oncological older patients, who were traditionally candidates to best supportive care or palliative treatments. Several literature data support SBRT in the treatment of the oligometastatic patient as a potentially curable therapeutic option. However, data on older patients are lacking. This study presents the outcomes of a cohort of 61 oligometastatic patients over the age of 80 years who received SBRT, that was proposed to all patients with a minimum Karnofsky Performance Status ≥ 70 and a life expectancy of at least 6 months, with up to five oligometastatic lesions. Radiotherapy was delivered in 3-10 fractions with VMAT-IGRT technique. Toxicity was retrospectively collected according to CTCAE v4.0. Data were retrospectively collected and analyzed. Univariate and multivariate analysis were performed for assessing any potential predictive factor for clinical outcomes. A total of 90 oligometastases were treated in 61 patients with median age 82 years (range, 80-90). The most frequent histology was colorectal cancer (27% of cases). Median follow-up was 20 months (range, 2-63). Local control rates at 1- and 2-years were 98.8% and 88.2%, with colorectal histology being associated with worse LC rates (p = 0.014) at univariate analysis. Progression-free survival rates at 1- and 2-years were 48.6% and 30.5%. Oligorecurrent lesions and single oligometastases were associated with better PFS rates (respectively, p = 0.04 and p = 0.011). Overall survival rates were 75% and 60.5%, polymetastatic spread being predictive of worse survival outcomes at multivariate analysis (p = 0.012). No G2 or higher adverse events were recorded. Our study supports the role of SBRT for the treatment of elderly oligometastatic patients, highlighting the possibility to further explore this therapeutic option in the management of older oncological patients.
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Stereotactic body radiotherapy for oligometastatic castration sensitive prostate cancer using 1.5 T MRI-Linac: preliminary data on feasibility and acute patient-reported outcomes. Radiol Med 2021; 126:989-997. [PMID: 33835309 DOI: 10.1007/s11547-021-01352-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To report preliminary data on feasibility and patient-reported outcomes following PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac. METHODS AND MATERIALS Between October 2019 and April 2020, twenty consecutive castration sensitive oligorecurrent prostate cancer patients were enrolled in an ethical committee approved prospective observational study (Protocol n. XXXX) and treated with PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac (Unity, Elekta AB, Stockholm, Sweden). The mean delivered dose was 35 Gy in 5 fractions. Clinicians reported toxicity was prospectively collected according to Common Terminology Criteria for Adverse Events v5.0. Quality of life (QoL) assessment was performed using EORTC-QLQ C30 questionnaires administered at baseline, end of treatment and at first follow-up. RESULTS Twenty-five lesions in 20 castration sensitive oligorecurrent patients were treated: the most commonly treated anatomic sites were nodal (n = 16) and pelvic bone (n = 9). Median PSA-value preMRI guided SBRT was 1.16 ng/mL (range, 0.27-8.9), whereas median PSA value at first follow-up after SBRT was 0.44 ng/mL (range, 0.06-8.15). At first follow-up, for 16 patients showing detectable PSA, PSMA-PET/CT was performed detecting, respectively, in 6 cases partial response and in 10 cases complete response. In the remaining cases, PSA-value was undetectable after SBRT. Radiotherapy treatment was safe and well tolerated according to the PROMs. No acute G2 or higher toxicities were recorded. CONCLUSIONS The current series represent the largest one exploring the feasibility and patient-reported outcomes following PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac. The preliminary findings here reported are encouraging in terms of effectiveness and tolerability.
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Feasibility and safety of 1.5 T MR-guided and daily adapted abdominal-pelvic SBRT for elderly cancer patients: geriatric assessment tools and preliminary patient-reported outcomes. J Cancer Res Clin Oncol 2020; 146:2379-2397. [PMID: 32372146 DOI: 10.1007/s00432-020-03230-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND We present preliminary data of the first older cancer patients treated with Hybrid Linac for stereotactic body radiotherapy (SBRT) consisting of 1.5 T MRI-guided and daily-adapted treatment. The aim was to assess feasibility, safety and the role of G8 and Charlson Comorbidity Index (CCI) questionnaires in predicting patients' QoL, evaluated by patient-reported outcome measures (PROMs). METHODS Two groups of patients with localized prostate cancer or abdominal-pelvic oligometastases were analyzed. SBRT schedule consisted of 35 Gy delivered in 5 fractions. The primary endpoint was to measure the impact of G8 and CCI on PROMs. Both G8 and the CCI were performed at baseline, while the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for PROMs assessment was prospectively performed at baseline and after SBRT. RESULTS Forty older patients were analyzed. The median age was 73 years (range 65-85). For the entire population, the median G8 score was 15 (10-17) and the median CCI score was 6 (4-11). Concerning the PROMS, the EORTC-QLQ C30 questionnaire reported no difference between the pre- and post-SBRT evaluation in all patients, except for the fatigue item that declined after SBRT, especially in the group of patients with a G8 score < 15 and with age < 75 years (p = 0.049). No grade 3 or higher acute toxicity occurred. CONCLUSION This is the first report documenting for older cancer patients that 1.5 T MRI-guided daily-adapted SBRT is feasible, safe and does not impact on the QoL at the end of treatment. Longer follow-up is advocated to report long-term outcomes. TRIAL REGISTRATION Date of approval April 2019 and numbered MRI/LINAC no. 23748.
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