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Snyder M, Joiner MC, Konski A, Bossenberger T, Burmeister J. Dose escalation in prostate cancer using intensity modulated neutron radiotherapy. Radiother Oncol 2011; 99:201-6. [PMID: 21620496 DOI: 10.1016/j.radonc.2011.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Initial promising results of 3D conformal neutron radiotherapy (3D-CNRT) were subsequently limited by high normal tissue toxicities. It is now possible to deliver intensity modulated neutron radiotherapy (IMNRT). The present work compares photon IMRT, 3D-CNRT and IMNRT for three prostate patients to quantify the benefits of IMNRT. MATERIALS AND METHODS We compare updated 3D-CNRT plans, IMNRT plans, and conventional IMRT plans by translating neutron DVHs into effective photon DVHs using the dose dependent radiobiological effectiveness (RBE) for each structure. RBE curves are parameterized for a range of normal tissue and prostate tumor values. Generalized equivalent uniform dose (gEUD) and gEUD in 2Gy fractions (gEUD(2)) is calculated for each structure, plan, and parameterization. Rectal sparing and dose to prostate-GTV are compared for 3D-CNRT, IMNRT, and IMRT as a function of normal tissue and prostate RBE. RESULTS The closer the RBE values of prostate tumor and normal tissue, the greater the advantage of IMNRT over 3D-CNRT. The rectal sparing achieved using IMNRT ranged from ∼5% to 13% depending upon the choice of RBE for rectum and the α/β value of prostate tumor. IMNRT may provide a theoretical dose advantage over photon IMRT if the α/β value of prostate is 1.5 and the RBEs of prostate and rectum differ by more than 5%. For higher values of prostate α/β any advantages of IMNRT over IMRT could require that the RBEs of prostate and rectum differ by as much as 20%. CONCLUSIONS IMNRT provides a clear normal tissue sparing advantage over 3D-CNRT. The advantage increases when the RBEs of the target structure and the normal tissue are similar. This RBE translation method could help identify clinical sites where the dose sparing advantages of IMNRT would allow for the exploitation of the radiobiological advantages of high-LET neutron radiotherapy.
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Affiliation(s)
- Michael Snyder
- Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MI, USA.
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Santanam L, He T, Yudelev M, Forman JD, Orton CG, Heuvel FV, Maughan RL, Burmeister J. Intensity modulated neutron radiotherapy for the treatment of adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys 2007; 68:1546-56. [PMID: 17674984 DOI: 10.1016/j.ijrobp.2007.04.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 04/11/2007] [Accepted: 04/12/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE This study investigates the enhanced conformality of neutron dose distributions obtainable through the application of intensity modulated neutron radiotherapy (IMNRT) to the treatment of prostate adenocarcinoma. METHODS AND MATERIALS An in-house algorithm was used to optimize individual segments for IMNRT generated using an organ-at-risk (OAR) avoidance approach. A number of beam orientation schemes were investigated in an attempt to approach an optimum solution. The IMNRT plans were created retrospectively for 5 patients previously treated for prostate adenocarcinoma using fast neutron therapy (FNT), and a comparison of these plans is presented. Dose distributions and dose-volume histograms (DVHs) were analyzed and plans were evaluated based on percentage volumes of rectum and bladder receiving 95%, 80%, and 50% (V(95), V(80), V(50)) of the prescription dose, and on V(60) for both the femoral heads and GM(muscle) group. RESULTS Plans were normalized such that the IMNRT DVHs for prostate and seminal vesicles were nearly identical to those for conventional FNT plans. Use of IMNRT provided reductions in rectum V(95) and V(80) of 10% (2-27%) and 13% (5-28%), respectively, and reductions in bladder V(95) and V(80) of 12% (3-26%) and 4% (7-10%), respectively. The average decrease in V(60) for the femoral heads was 4.5% (1-18%), with no significant change in V(60) for the GM(muscle) group. CONCLUSIONS This study provides the first analysis of the application of intensity modulation to neutron radiotherapy. The IMNRT technique provides a substantial reduction in normal tissue dose in the treatment of prostate cancer. This reduction should result in a significant clinical advantage for this and other treatment sites.
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Affiliation(s)
- Lakshmi Santanam
- Department of Radiation Oncology, Washington University, St. Louis, MO 63110-1093, USA.
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Tsuji H, Yanagi T, Ishikawa H, Kamada T, Mizoe JE, Kanai T, Morita S, Tsujii H. Hypofractionated radiotherapy with carbon ion beams for prostate cancer. Int J Radiat Oncol Biol Phys 2005; 63:1153-60. [PMID: 15990247 DOI: 10.1016/j.ijrobp.2005.04.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 04/12/2005] [Accepted: 04/13/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE Analysis of the results of hypofractionated conformal carbon ion radiotherapy for localized prostate cancer was performed, with special regard to normal tissue morbidity and biochemical relapse-free rate (bNED). METHODS AND MATERIALS Analysis was performed for 201 patients treated with the dose fractionation regimen established during three clinical trials performed between June 1995 and February 2004. Outcomes were measured in terms of toxicity, survival, freedom from local recurrence, and bNED. RESULTS No Grade 3 or higher toxicities were observed in either the rectum or genitourinary system, and the incidences of Grade 2 rectum or genitourinary morbidity were only 1.0% and 6.0%, respectively. The overall 5-year biochemical relapse-free survival was 83.2% without any local recurrence. Gleason score, initial PSA, and T stage were all significant prognostic factors for bNED, which was 97.1% in patients with Gleason score < or =7 and initial PSA <20 ng/mL. CONCLUSION Hypofractionated carbon ion radiotherapy with the established dose fractionation regimen yielded satisfactory bNED without local recurrence and with minimal morbidity. Long-term results are necessary to confirm the utility of carbon ion radiotherapy in the treatment of localized prostate cancer.
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Affiliation(s)
- Hiroshi Tsuji
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
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4
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Scalliet PGM, Remouchamps V, Curran D, Ledent G, Wambersie A, Richard F, van Cangh P. Retrospective analysis of results of p(65)+Be neutron therapy for treatment of prostate adenocarcinoma at the cyclotron of Louvain-la-Leuve. Part II: Side effects and their influence on quality of life measured with QLQ-C30 of EORTC. Int J Radiat Oncol Biol Phys 2004; 58:1549-61. [PMID: 15050336 DOI: 10.1016/j.ijrobp.2003.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2002] [Revised: 07/18/2003] [Accepted: 09/03/2003] [Indexed: 11/12/2022]
Abstract
PURPOSE Between 1978 and 1998, 533 prostate adenocarcinoma patients were treated with mixed photon-neutron radiotherapy. We report on a retrospective series of patients for whom the side effects of the treatment and their impact on quality of life were assessed by a mailed questionnaire. METHODS AND MATERIALS The European Organization for Research and Treatment of Cancer quality-of-life core questionnaire and a prostate-specific questionnaire were used. Between 1990 and 1996, 308 consecutive patients were treated. Two protocols were used: pelvic fields (50 Gy equivalent photons, 2 Gy/fraction) followed by a prostate boost (66 Gy) or prostate alone. The neutron/photon ratio varied. The questionnaire was mailed to 262 patients presumed to be alive. RESULTS Of the 262 patients, 230 replied. Of the 230 patients, 73% had no trouble doing strenuous activities and 4% had trouble with taking a short walk. The overall physical condition and quality-of-life questions received a mean score of 5.2 and 5.3 on a 7-point scale, respectively. Twenty-two percent had bowel movements at least four times daily, and 6% did so six times or more. Retaining stool was a problem in 26%, and only 38% reported full continence; 17% urinated four times or more nightly. Urinary incontinence was scored as "quite a bit" or "very much" in 11% and 5%, respectively. Hematuria and dysuria (pain) were reported by 7% and 16%, respectively, mainly as moderate. Only 28% reported easy erections, but 75% judged the sexual change acceptable. A greater neutron/photon ratio was significantly associated with more bowel problems (p = 0.003). CONCLUSION Mixed photon-neutron therapy for prostate cancer was associated with significant patient-reported side effects. Their significant effect on patients' quality of life is described.
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Affiliation(s)
- Pierre G M Scalliet
- Department of Radiation Oncology, Hospital St. Luc, Université Caholique de Louvain, Brussels, Belgium.
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Barth RF, Grecula JC, Yang W, Rotaru JH, Nawrocky M, Gupta N, Albertson BJ, Ferketich AK, Moeschberger ML, Coderre JA, Rofstad EK. Combination of boron neutron capture therapy and external beam radiotherapy for brain tumors. Int J Radiat Oncol Biol Phys 2004; 58:267-77. [PMID: 14697448 DOI: 10.1016/s0360-3016(03)01613-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Boron neutron capture therapy (BNCT) has been used clinically as a single modality treatment for high-grade gliomas and melanomas metastatic to the brain. The purpose of the present study was to determine whether its efficacy could be enhanced by an X-ray boost administered after BNCT. Two brain tumor models were used, the F98 glioma as a model for primary brain tumors and the MRA 27 human melanoma as a model for metastatic brain tumors. METHODS AND MATERIALS For biodistribution studies, either 10(5) F98 glioma cells were implanted stereotactically into the brains of syngeneic Fischer rats or 10(6) MRA 27 melanoma cells were implanted intracerebrally into National Institutes of Health (NIH)-rnu nude rats. Biodistribution studies were performed 11-13 days after implantation of the F98 glioma and 20-24 days after implantation of the MRA 27 melanoma. Animals bearing the F98 glioma received a combination of two boron-containing drugs, sodium borocaptate at a dose of 30 mg/kg and boron phenylalanine (BPA) at a dose of 250 mg/kg. MRA 27 melanoma-bearing rats received BPA (500 mg/kg) containing an equivalent amount of 10B (27 mg B/kg). The drugs were administered by either intracarotid or i.v. injection. RESULTS The tumor boron concentration after intracarotid injection was approximately 50% greater in the F98 glioma and MRA 27 melanoma after intracarotid injection (20.8 and 36.8 microg/g, respectively) compared with i.v. injection (11.2 and 19.5 microg/g, respectively). BNCT was carried out at the Brookhaven National Laboratory Medical Research Reactor approximately 14 days after tumor implantation of either the F98 glioma or the MRA 27 melanoma. Approximately 7-10 days after BNCT, subsets of animals were irradiated with 6-MV photons, produced by a linear accelerator at a total dose of 15 Gy, delivered in 5-Gy daily fractions. F98 glioma-bearing rats that received intracarotid or i.v. sodium borocaptate plus BPA, followed 2.5 h later by BNCT and 7-10 days later by X-rays, had similar mean survival times (61 days and 53 days, respectively, p = 0.25), and the non X-irradiated, BNCT-treated animals had a mean survival time of 52 and 40 days, respectively, for intracarotid vs. i.v. injection; the latter was equivalent to that of the irradiated animals. The corresponding survival time for MRA 27 melanoma-bearing rats that received intracarotid or i.v. BPA, followed by BNCT and then X-irradiation, was 75 and 82 days, respectively (p = 0.5), 54 days without X-irradiation (p = 0.0002), 37 days for X-irradiation alone, and 24 days for untreated controls. In contrast to the data obtained with the F98 glioma, MRA 27 melanoma-bearing rats that received i.v. BPA, followed by BNCT, had a highly significant difference in mean survival time compared with the irradiated controls (54 vs. 37 days, p = 0.008). CONCLUSION Our data are the first to suggest that a significant therapeutic gain may be obtained when BNCT is combined with an X-ray boost. Additional experimental studies are required to determine the optimal combination of X-radiation and neutron doses and whether it is more advantageous to administer the photon boost before or after BNCT.
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Affiliation(s)
- Rolf F Barth
- Department of Pathology, Ohio State University, Columbus, OH 43210, USA.
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Abstract
In an investigation by the Swedish Cancer Society, the present status, critical issues and future aspects and potentials were described by an expert group for each of nine major areas of radiation therapy research. The present report deals with the potential of proton and light ion beams in radiotherapy.
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Affiliation(s)
- Ingela Turesson
- Department of Oncology, Radiology and Clinical Immunology, University Hospital, Uppsala, Sweden
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Pirtskhalaishvili G, Hrebinko RL, Nelson JB. The treatment of prostate cancer: an overview of current options. CANCER PRACTICE 2001; 9:295-306. [PMID: 11879332 DOI: 10.1046/j.1523-5394.2001.96009.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this report is to discuss the current treatment options available to the patient with prostate cancer in all stages of the disease. OVERVIEW With the exception of skin cancer, prostate cancer is the most common cancer in men in the United States. Most patients in the current era will present with organ-confined disease, amenable to curative treatment. Treatment for organ-confined disease includes watchful waiting, radical prostatectomy, radiation therapy, and cryosurgery in selective cases. Hormone therapy is the cornerstone of treatment of patients with advanced prostate cancer. There is no curative treatment for hormone-refractory prostate cancer. CLINICAL IMPLICATIONS The availability of several therapeutic options for localized prostate cancer warrants careful consideration when planning treatment with curative intent. Patients need to be active participants in decision making, and they must be aware of the benefits and possible complications of the different types of treatment. Patients with advanced prostate cancer need to be aware that hormone treatment will provide temporization and palliation in the majority of cases. Hormone-resistant prostate cancer is refractory to most forms of conventional and experimental therapy.
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Affiliation(s)
- G Pirtskhalaishvili
- Department of Urology, Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Roach M, Pickett B, Akazawa PF, Weil M. Implementation of newer radiotherapeutic technology in the management of prostate cancer. Cancer Treat Res 2001; 93:247-68. [PMID: 9513784 DOI: 10.1007/978-1-4615-5769-2_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Roach
- Department of Radiation Oncology, University of California at San Francisco, Mt. Zion Cancer Center 94143-0226, USA
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Kestin LL, Martinez AA, Stromberg JS, Edmundson GK, Gustafson GS, Brabbins DS, Chen PY, Vicini FA. Matched-pair analysis of conformal high-dose-rate brachytherapy boost versus external-beam radiation therapy alone for locally advanced prostate cancer. J Clin Oncol 2000; 18:2869-80. [PMID: 10920135 DOI: 10.1200/jco.2000.18.15.2869] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We performed a matched-pair analysis to compare our institution's experience in treating locally advanced prostate cancer with external-beam radiation therapy (EBRT) alone to EBRT in combination with conformal interstitial high-dose-rate (HDR) brachytherapy boosts (EBRT + HDR). MATERIALS AND METHODS From 1991 to 1998, 161 patients with locally advanced prostate cancer were prospectively treated with EBRT + HDR at William Beaumont Hospital, Royal Oak, Michigan. Patients with any of the following characteristics were eligible for study entry: pretreatment prostate-specific antigen (PSA) level of >/= 10.0 ng/mL, Gleason score >/= 7, or clinical stage T2b to T3c. Pelvic EBRT (46.0 Gy) was supplemented with three (1991 through 1995) or two (1995 through 1998) ultrasound-guided transperineal interstitial iridium-192 HDR implants. The brachytherapy dose was escalated from 5.50 to 10.50 Gy per implant. Each of the 161 EBRT + HDR patients was randomly matched with a unique EBRT-alone patient. Patients were matched according to PSA level, Gleason score, T stage, and follow-up duration. The median PSA follow-up was 2.5 years for both EBRT + HDR and EBRT alone. RESULTS EBRT + HDR patients demonstrated significantly lower PSA nadir levels (median, 0.4 ng/mL) compared with those receiving EBRT alone (median, 1.1 ng/mL). The 5-year biochemical control rates for EBRT + HDR versus EBRT-alone patients were 67% versus 44%, respectively (P <.001). On multivariate analyses, pretreatment PSA, Gleason score, T stage, and the use of EBRT alone were significantly associated with biochemical failure. Those patients in both treatment groups who experienced biochemical failure had a lower 5-year cause-specific survival rate than patients who were biochemically controlled (84% v 100%; P <.001). CONCLUSION Locally advanced prostate cancer patients treated with EBRT + HDR demonstrate improved biochemical control compared with those who are treated with conventional doses of EBRT alone.
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Affiliation(s)
- L L Kestin
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA
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10
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Martinez AA, Kestin LL, Stromberg JS, Gonzalez JA, Wallace M, Gustafson GS, Edmundson GK, Spencer W, Vicini FA. Interim report of image-guided conformal high-dose-rate brachytherapy for patients with unfavorable prostate cancer: the William Beaumont phase II dose-escalating trial. Int J Radiat Oncol Biol Phys 2000; 47:343-52. [PMID: 10802358 DOI: 10.1016/s0360-3016(00)00436-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We analyzed our institution's experience treating patients with unfavorable prostate cancer in a prospective Phase II dose-escalating trial of external beam radiation therapy (EBRT) integrated with conformal high-dose-rate (HDR) brachytherapy boosts. This interim report discusses treatment outcome and prognostic factors using this treatment approach. METHODS AND MATERIALS From November 1991 through February 1998, 142 patients with unfavorable prostate cancer were prospectively treated in a dose-escalating trial with pelvic EBRT in combination with outpatient HDR brachytherapy at William Beaumont Hospital. Patients with any of the following characteristics were eligible: pretreatment prostate-specific antigen (PSA) >/= 10.0 ng/ml, Gleason score >/= 7, or clinical stage T2b or higher. All patients received pelvic EBRT to a median total dose of 46.0 Gy. Pelvic EBRT was integrated with ultrasound-guided transperineal conformal interstitial iridium-192 HDR implants. From 1991 to 1995, 58 patients underwent three conformal interstitial HDR implants during the first, second, and third weeks of pelvic EBRT. After October 1995, 84 patients received two interstitial implants during the first and third weeks of pelvic EBRT. The dose delivered via interstitial brachytherapy was escalated from 5.50 Gy to 6.50 Gy for each implant in those patients receiving three implants, and subsequently, from 8.25 Gy to 9.50 Gy per fraction in those patients receiving two implants. To improve implant quality and reduce operator dependency, an on-line, image-guided interactive dose optimization program was utilized during each HDR implant. No patient received hormonal therapy unless treatment failure was documented. The median follow-up was 2.1 years (range: 0.2-7.2 years). Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology Consensus Panel definition. RESULTS The pretreatment PSA level was >/= 10.0 ng/ml in 51% of patients. The biopsy Gleason score was >/= 7 in 58% of cases, and 75% of cases were clinical stage T2b or higher. Despite the high frequency of these poor prognostic factors, the actuarial biochemical control rate was 89% at 2 years and 63% at 5 years. On multivariate analysis, a higher pretreatment PSA level, higher Gleason score, higher PSA nadir level, and shorter time to nadir were associated with biochemical failure. In the entire population, 14 patients (10%) experienced clinical failure at a median interval of 1.7 years (range: 0.2-4.5 years) after completing RT. The 5-year actuarial clinical failure rate was 22%. The 5-year actuarial rates of local failure and distant metastasis were 16% and 14%, respectively. For all patients, the 5-year disease-free survival, overall survival, and cause-specific survival rates were 89%, 95%, and 96%, respectively. The 5-year actuarial rate of RTOG Grade 3 late complications was 9% with no patient experiencing Grade 4 or 5 acute or late toxicity. CONCLUSION Pelvic EBRT in combination with image-guided conformal HDR brachytherapy boosts appears to be an effective treatment for patients with unfavorable prostate cancer with minimal associated morbidity. Our dose-escalating trial will continue.
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Affiliation(s)
- A A Martinez
- Department ofRadiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Chuba PJ, Maughan R, Forman JD. Three dimensional conformal neutron radiotherapy for prostate cancer. Strahlenther Onkol 1999; 175 Suppl 2:79-81. [PMID: 10394405 DOI: 10.1007/bf03038896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The conditions for safe and effective conformal neutron radiotherapy have been established at Wayne State University.
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Affiliation(s)
- P J Chuba
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
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Pickles T, Goodman GB, Fryer CJ, Bowen J, Coldman AJ, Duncan GG, Graham P, McKenzie M, Morris WJ, Rheaume DE, Syndikus I. Pion conformal radiation of prostate cancer: results of a randomized study. Int J Radiat Oncol Biol Phys 1999; 43:47-55. [PMID: 9989513 DOI: 10.1016/s0360-3016(98)00371-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the efficacy of pion radiation therapy with conventional external beam photon therapy, for the treatment of locally advanced stage T3/4, N0, M0 adenocarcinoma of the prostate. METHODS AND MATERIALS Two hundred seventeen eligible patients were randomly allocated to either photon or pion therapy. No adjuvant hormone therapy was used. RESULTS Median follow-up was 42 months (range 2-90). Acute bladder toxicity was worse in the pion arm, p = 0.2, but other acute toxicity did not differ. Late grade 2 toxicity was significantly less in the pion arm (29% at 5 years versus 48%, p = 0.002), but late grade 3 or 4 toxicity did not differ. Clinical local control was not significantly different between treatment arms (64% after 5 years with photons, 56% with pions, p = 0.6). Cause-specific and overall survival also did not differ (p = 0.7). There was a significant delay in time to first failure in the photon arm, largely as a result of decreased biochemical relapse, p = 0.01. A multivariate analysis is presented. CONCLUSION Pion therapy was well tolerated, with increased acute toxicity and significantly decreased late tissue injury. This contrasts with the late toxicity observed with higher LET particle therapy such as neutron therapy. No improvement in local control with pion therapy was observed.
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Affiliation(s)
- T Pickles
- Radiation Oncology Program, BC Cancer Agency, Vancouver, Canada
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Lindsley KL, Cho P, Stelzer KJ, Koh WJ, Austin-Seymour M, Russell KJ, Laramore GE, Griffin TW. Fast neutrons in prostatic adenocarcinomas: worldwide clinical experience. Recent Results Cancer Res 1998; 150:125-36. [PMID: 9670287 DOI: 10.1007/978-3-642-78774-4_7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Primary tumor control remains a major problem in the treatment of locally advanced prostate carcinoma. Clinical local failure rates approach 30-40% and may be significantly higher when results of prostatic biopsy or prostate-specific antigen (PSA) levels are considered. The low growth rate and cycling fraction of prostate adenocarcinoma suggest potential therapeutic advantage for the high linear energy transfer (LET) of neutrons. The Radiation Therapy Oncology Group (RTOG) performed a multi-institutional randomized trial (RTOG 77-04) comparing mixed beam (neutron plus photon) irradiation to conventional photon irradiation for the treatment of locally advanced prostate cancer. A subsequent trial by the Neutron Therapy Collaborative Working Group (NTCWG 85-23) compared pure neutron irradiation to standard photon irradiation. Both randomized trials demonstrate significant improvement in locoregional control with neutron irradiation compared to conventional photon irradiation in the treatment of locally advanced prostate carcinoma. To date, only the mixed beam trial has shown a significant survival benefit. Future analysis of the larger NTCWG trial at the 10-year point should confirm whether or not improved locoregional control translates into a survival advantage. These findings have significant implications for all local treatment strategies including dose-escalated conformal photon irradiation, prostate implantation, and neutron radiation. Given the large numbers of patients afflicted with this disease, a positive survival advantage for neutrons or mixed beam therapy would provide a strong incentive for the development of economically feasible clinical neutron facilities.
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Affiliation(s)
- K L Lindsley
- Department of Radiatioin Oncology, University of Washington Medical Center, Seattle 98195, USA
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15
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Vicini FA, Horwitz EM, Kini VR, Stromberg JS, Martinez AA. Radiotherapy options for localized prostate cancer based upon pretreatment serum prostate-specific antigen levels and biochemical control: a comprehensive review of the literature. Int J Radiat Oncol Biol Phys 1998; 40:1101-10. [PMID: 9539565 DOI: 10.1016/s0360-3016(97)00942-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To review all the available radiotherapy (RT) literature on localized prostate cancer treatment where serum prostate-specific antigen (PSA) levels were used to both stratify patients and evaluate outcome and determine if any conclusions can be reached regarding an optimal radiotherapeutic management for this disease. METHODS AND MATERIALS A MEDLINE search was conducted to obtain all articles in English on prostate cancer treatment employing RT from 1986-1997. Studies were considered eligible for review only if they met all the following criteria: 1) pretreatment PSA values were recorded and grouped for subsequent evaluation, 2) posttreatment PSA values were continuously monitored, 3) definitions of biochemical control were stated, and 4) the median follow-up was given. RESULTS Of the 246 articles identified, only 20 met the inclusion criteria; 4 using conformal external beam RT, 8 using conventional external beam RT, and 8 using interstitial brachytherapy (4 using a permanent implant alone, 3 combining external beam RT with a permanent implant, and 1 combining a conformal temporary interstitial implant boost with external beam RT). No studies using neutrons (with or without external beam RT) or androgen deprivation (combined with external beam RT) were identified where patients were stratified by pretreatment PSA levels. Results for all therapies were extremely variable with the 3-5-year rates of biochemical control for patients with pretreatment PSA levels < or = 4 ng/ml ranging from 48 to 100%, for PSA levels >4 and < or = 10 ng/ml ranging from 44 to 90%, for PSA levels >10 and < or = 20 ng/ml ranging from 27 to 89%, and for PSA levels >20 ranging from 14 to 89%. The median Gleason score, T-stage, definition of biochemical control, and follow-up were substantially different from series to series. No RT option consistently produced superior results. CONCLUSIONS When data are reviewed from studies using serum PSA levels to stratify patients and to evaluate treatment outcome, no consistently superior RT technique was identified. These data suggest that standard definitions of disease stage (combining clinical, pathologic, and biochemical criteria) and a common definition of biochemical cure (as developed by the American Society for Therapeutic Radiology and Oncology Consensus Panel) need to be adopted to evaluate treatment efficacy and advise patients on the most appropriate radiotherapeutic option for their disease.
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Affiliation(s)
- F A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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16
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Reddy SM, Ruby J, Wallace M, Forman JD. Patient self-assessment of complications and quality of life after conformal neutron and photon irradiation for localized prostate cancer. RADIATION ONCOLOGY INVESTIGATIONS 1997; 5:252-6. [PMID: 9372548 DOI: 10.1002/(sici)1520-6823(1997)5:5<252::aid-roi6>3.0.co;2-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although neutron irradiation for prostate cancer has been associated with significant morbidity, pilot data in patients with early stage disease suggested that conformal neutron and photon irradiation was well tolerated without severe complications. A self-assessment questionnaire was mailed to the first 83 patients treated with conformal neutron and photon irradiation to objectively evaluate the impact on quality of life of this regimen. In total, 75 patients (90%) returned the completed questionnaire. These patients had received either 9 neutron Gy (N Gy) plus 38 photon Gy (50 patients) or 10 N Gy plus 38 photon Gy (33 patients) for stage T1/T2 N0 M0 prostate cancer (Gleason score < or = 7). The irradiated volume included the prostate and seminal vesicles with a 1.5 cm margin. Neutrons were delivered as a boost to the prostate only with a non-axial four field beam arrangement. Approximately 50% of the dose to the prostate was from neutron irradiation. Follow-up ranged from 6 to 25 months (median 13 months). The questionnaire used was a validated quality of life instrument used previously in patients treated with surgery or radiation. Prior to irradiation, 29% of patients reported urinary symptoms and 11% had prostate surgery (TURP). At follow-up, 23% reported persistent urinary symptoms. Of these, 21% dripped a few drops of urine, 3% used pads but none leaked > 1 tablespoon/day. One patient underwent surgery to dilate a urethral stricture. Although 55% of patients had gastrointestinal symptoms during radiation therapy, only 26% had persistent symptoms at the time of questioning. These included minor rectal bleeding in 20% and significant hematochezia in 3%. Of the 85% of patients able to obtain full or partial erections prior to irradiation, 87% maintained their potency. Fifteen percent sought treatment for impotence. Overall, at last follow-up, 84% felt little or no physical discomfort, 91% were very satisfied with their treatment, and 97% would choose radiation therapy again. This patient self-assessment questionnaire confirmed that this regimen of conformal neutron and photon irradiation resulted in levels of chronic toxicity acceptable to the patient.
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Affiliation(s)
- S M Reddy
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
OBJECTIVES To summarize improvements in patient selection and the results of focal therapy for the management of localized prostate cancer. METHODS A contemporary series of patients managed with wide surgical excision, radiation therapy (three-dimensional conformal radiation, interstitial radiation, and charged-particle or proton therapy), and cryo-therapy were reviewed. RESULTS We used preoperative cancer grade, transrectal ultrasound, and serum prostate-specific antigen (PSA) in all patients, and cross-sectional imaging and bone scans in selected patients to allow for reasonably accurate cancer staging and selection of patients most likely to be cured by radical prostatectomy or radiation. In patients with extracapsular extension of prostate cancer, wide surgical excision and achievement of a clear surgical margin had therapeutic value. Newer radiation techniques resulted in a higher likelihood of prostate cancer control than previous techniques. Cryotherapy for patients with stages T1 through 3 prostate cancer was associated with a posttreatment undetectable PSA rate of 48% and a positive biopsy rate of 23%. CONCLUSIONS Patients with organ-confined and, therefore, curable prostate cancer can be identified. Well-performed radical prostatectomy, radiation, and cryotherapy are alternative treatments for the management of localized prostate cancer.
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Affiliation(s)
- P R Carroll
- Department of Urology, University of California School of Medicine, San Francisco, USA
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Hanks GE, Lee WR. Neutron-photon treatment: modern day Pyrrhic victory? Regarding Haraf et al. IJROBP 33(1): 3-14; 1995. Int J Radiat Oncol Biol Phys 1996; 34:757. [PMID: 8621304 DOI: 10.1016/0360-3016(96)84799-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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