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Canales JP, Barnafi E, Salazar C, Reyes P, Merino T, Calderón D, Cortés A. Moderate hypofractionated radiotherapy to the prostate bed with or without pelvic lymph nodes: a prospective trial. Rep Pract Oncol Radiother 2024; 29:187-196. [PMID: 39143977 PMCID: PMC11321776 DOI: 10.5603/rpor.99677] [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: 08/16/2023] [Accepted: 02/29/2024] [Indexed: 08/16/2024] Open
Abstract
Background Hypofractionated radiotherapy in the treatment of prostate cancer has been widely studied. However, in the postoperative setting it has been less explored. The objective of this prospective study is to evaluate the safety and efficacy of hypofractionated radiotherapy in postoperative prostate cancer. Materials and methods A prospective study was designed to include patients with prostate cancer with an indication of postoperative radiotherapy as adjuvant or salvage. A hypofractionated radiotherapy scheme of 51 Gy in 17 fractions was performed with the possibility of treating the pelvis at a dose of 36 Gy in 12 fractions sequentially. Safety was evaluated based on acute and late toxicity [according to the Radiation Therapy Oncology Group (RTOG) scale and Common Terminology Criteria Adverse Events (CTCAE) v4.03], International Prognostic Scoring System (IPSS) over time, and quality of life. Results From August 2020 to June 2022, 31 patients completed treatment and were included in this report. 35.5% of patients received elective treatment of the pelvic nodal areas. Most patients reported minimal or low acute toxicity, with an acute gastrointestinal (GI) and genitourinary (GU) grade 3 or greater toxicity of 3.2% and 0%, respectively. The evolution in time of the IPSS remained without significant differences (p = 0.42). With the exception of a significant improvement in the domains of hormonal and sexual symptoms of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire, the rest of the domains [EPIC, European Organization for Research and Treatment of Cancer (EORTC) Core quality of life questionnaire (C-30) and Prostate Cancer module (PR-25)] were maintained without significant differences over time. With a follow-up of 15.4 months, late GI and GU grade 2 toxicity was reported greater than 0% and 9.6%, respectively. Conclusions Hypofractionated radiotherapy in postoperative prostate cancer appears to be safe with low reports of relevant acute or late toxicity. Further follow-up is required to confirm these results. Trial registration The protocol was approved by the accredited Medical Ethical Committee of Pontificia Universidad Católica de Chile. All participants accepted and wrote informed consent.
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Affiliation(s)
- Juan P. Canales
- Department of Hemato-oncology, Radiotherapy, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Esteban Barnafi
- Medicine School, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Cristian Salazar
- Medicine School, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Paula Reyes
- Department of Hemato-oncology, Radiotherapy, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Tomas Merino
- Department of Hemato-oncology, Radiotherapy, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - David Calderón
- Department of Urology, Hospital del Salvador, Santiago de Chile, Chile
| | - Analía Cortés
- Department of Oncology, Hospital del Salvador, Santiago de Chile, Chile
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Latorzeff I, Le Guevelou J, Sargos P. Radiation therapy post radical prostatectomy: who, when and why? Curr Opin Support Palliat Care 2023; 17:47-54. [PMID: 36367534 DOI: 10.1097/spc.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW During decades, adjuvant radiotherapy (ART) has been the standard of care after surgery, based on four randomized clinical trials (RCTs). As early salvage radiotherapy (SRT) recently challenged the ART paradigm, the optimal timing to initiate radiotherapy remains a matter of debate. RECENT FINDINGS Three RCTs evaluated ART or SRT for postprostatectomy patients, with pathological risk factors (Gleason score > 8, pT3, positive margins). The ARTISTIC meta-analysis demonstrated similar 5-year biochemical recurrence-free survival for ART and SRT (89 vs. 88%). Lower rates of late genitourinary toxicity were demonstrated within the SRT arm, favouring early SRT in clinical practice.The addition of pelvic lymph node radiotherapy recently demonstrated an improvement in freedom from progression within the randomized RTOG 0534 trial, especially for patients with pretreatment prostate serum antigen (PSA) levels more than 0.35 ng/ml. The most appropriate androgen deprivation therapy duration remains a point of controversy. SUMMARY The SRT approach can be favoured for the vast majority of patients, provided close monitoring of PSA and early treatment in the event of biochemical recurrence. Radiotherapy dose and volumes and ADT use might be correlated to SRT timing (early vs. late). Results from trials including genomic tests and metabolic imaging will probably help to refine these criteria.
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Affiliation(s)
- Igor Latorzeff
- Department of Radiation Oncology, Clinique Pasteur, Toulouse, France
| | - Jennifer Le Guevelou
- Department of Radiation Oncology, Geneva University Hospital, and Faculty of Medicine, Geneva, Switzerland
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
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Park G, Kim YJ, Ahn H, Park W, Lee JS, Kim YS. Salvage hypofractionated accelerated versus standard radiotherapy for the treatment of biochemical recurrence after radical prostatectomy (SHARE): the protocol of a prospective, randomized, open-label, superiority, multi-institutional trial. Trials 2021; 22:728. [PMID: 34674739 PMCID: PMC8532339 DOI: 10.1186/s13063-021-05708-5] [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: 04/01/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While several phase III trials have investigated the role of hypofractionated radiotherapy in the definitive treatment of localized prostate cancer, prospective data reporting the outcomes of hypofractionated radiotherapy in the postoperative treatment setting are sparse. Therefore, this study is designed to assess the efficacy and treatment-related toxicity of hypofractionated salvage radiotherapy for the treatment of biochemical recurrence in men who underwent radical prostatectomy. The primary objective of this trial is to investigate whether hypofractionated radiotherapy improves biochemical control compared with conventionally fractionated radiotherapy. In addition, treatment-related toxicity, quality of life, and survival will be evaluated as secondary endpoints. METHODS In this prospective, randomized, multi-institutional trial (the SHARE study), patients with intermediate- or high-risk prostate cancer will be randomized to receive either hypofractionated radiotherapy (65 Gy in 2.5-Gy fractions) or conventionally fractionated radiotherapy (66 Gy in 2-Gy fractions). Prostate bed irradiation or elective pelvic nodal irradiation including the prostate bed will be performed using intensity-modulated radiotherapy and daily image guidance. Treatment efficacy will be assessed using the serum tumor marker prostate-specific antigen, and toxicity will be evaluated through both physician- and patient-reported outcomes. Quality of life will also be investigated. DISCUSSION This study is designed to demonstrate whether hypofractionated radiotherapy is beneficial in terms of biochemical control and toxicity compared with standard salvage radiotherapy. If hypofractionated radiotherapy is shown to be superior to conventionally fractionated radiotherapy, it will mean that improved biochemical control can be achieved, accompanied by greater patient convenience and more efficient use of medical resources. TRIAL REGISTRATION ClinicalTrials.gov NCT03920033. Registered on 18 April 2019.
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Affiliation(s)
- Geumju Park
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Schick U, Latorzeff I, Sargos P. Postoperative radiotherapy in prostate cancer: Dose and volumes. Cancer Radiother 2021; 25:674-678. [PMID: 34400088 DOI: 10.1016/j.canrad.2021.07.003] [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: 06/14/2021] [Revised: 07/05/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Approximately thirty percent of patients experience biochemical recurrence after radical prostatectomy for prostate cancer. Early salvage radiotherapy has recently become a standard of care in this setting. The purpose of this review is first to summarize current knowledge in terms of dose to the prostate bed in light of the recent SAKK 09/10 randomized phase III trial results. The evidence on moderate hypofractionation will also be discussed whereas extreme hypofractionation remains highly investigational. Regarding target volumes, several different guidelines have been published to address the need for standardization of postoperative target delineation. The recent GFRU (Groupe Francophone de Radiothérapie Urologique) recommendations could represent an international consensus.
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Affiliation(s)
- U Schick
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, University Brest, Brest, France.
| | - I Latorzeff
- Department of Oncology Radiotherapy, Bât Atrium, Clinique Pasteur, Toulouse, France
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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Murgic J, Jaksic B, Prpic M, Kust D, Bahl A, Budanec M, Prgomet Secan A, Franco P, Kruljac I, Spajic B, Babic N, Kruslin B, Zovak M, Zubizarreta E, Rosenblatt E, Fröbe A. Comparison of hypofractionation and standard fractionation for post-prostatectomy salvage radiotherapy in patients with persistent PSA: single institution experience. Radiat Oncol 2021; 16:88. [PMID: 33980277 PMCID: PMC8115388 DOI: 10.1186/s13014-021-01808-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypofractionated post-prostatectomy radiotherapy is emerging practice, however with no randomized evidence so far to support it's use. Additionally, patients with persistent PSA after prostatectomy may have aggressive disease and respond less well on standard salvage treatment. Herein we report outcomes for conventionally fractionated (CFR) and hypofractionated radiotherapy (HFR) in patients with persistent postprostatectomy PSA who received salvage radiotherapy to prostate bed. METHODS Single institution retrospective chart review was performed after Institutional Review Board approval. Between May 2012 and December 2016, 147 patients received salvage postprostatectomy radiotherapy. PSA failure-free and metastasis-free survival were calculated using Kaplan-Meier method. Cox regression analysis was performed to test association of fractionation regimen and other clinical factors with treatment outcomes. Early and late toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. RESULTS Sixty-nine patients who had persistent PSA (≥ 0.1 ng/mL) after prostatectomy were identified. Median follow-up was 67 months (95% CI 58-106 months, range, 8-106 months). Thirty-six patients (52.2%) received CFR, 66 Gy in 33 fractions, 2 Gy per fraction, and 33 patients (47.8%) received HFR, 52.5 Gy in 20 fractions, 2.63 Gy per fraction. Forty-seven (68%) patients received androgen deprivation therapy (ADT). 5-year PSA failure- and metastasis-free survival rate was 56.9% and 76.9%, respectively. Thirty patients (43%) experienced biochemical failure after salvage radiotherapy and 16 patients (23%) experienced metastatic relapse. Nine patients (13%) developed metastatic castration-resistant disease and died of advanced prostate cancer. Median PSA failure-free survival was 72 months (95% CI; 41-72 months), while median metastasis-free survival was not reached. Patients in HFR group were more likely to experience shorter PSA failure-free survival when compared to CFR group (HR 2.2; 95% CI 1.0-4.6, p = 0.04). On univariate analysis, factors significantly associated with PSA failure-free survival were radiotherapy schedule (CFR vs HFR, HR 2.2, 95% CI 1.0-4.6, p = 0.04), first postoperative PSA (HR 1.02, 95% CI 1.0-1.04, p = 0.03), and concomitant ADT (HR 3.3, 95% CI 1.2-8.6, p = 0.02). On multivariate analysis, factors significantly associated with PSA failure-free survival were radiotherapy schedule (HR 3.04, 95% CI 1.37-6.74, p = 0.006) and concomitant ADT (HR 4.41, 95% CI 1.6-12.12, p = 0.004). On univariate analysis, factors significantly associated with metastasis-free survival were the first postoperative PSA (HR 1.07, 95% CI 1.03-1.12, p = 0.002), seminal vesicle involvement (HR 3.48, 95% CI 1.26-9.6,p = 0.02), extracapsular extension (HR 7.02, 95% CI 1.96-25.07, p = 0.003), and surgical margin status (HR 2.86, 95% CI 1.03-7.97, p = 0.04). The first postoperative PSA (HR 1.04, 95% CI 1.00-1.08, p = 0.02) and extracapsular extension (HR 4.24, 95% CI 1.08-16.55, p = 0.04) remained significantly associated with metastasis-free survival on multivariate analysis. Three patients in CFR arm (8%) experienced late genitourinary grade 3 toxicity. CONCLUSIONS In our experience, commonly used hypofractionated radiotherapy regimen was associated with lower biochemical control compared to standard fractionation in patients with persistent PSA receiving salvage radiotherapy. Reason for this might be lower biological dose in HFR compared to CFR group. However, this observation is limited due to baseline imbalances in ADT use, ADT duration and Grade Group distribution between two radiotherapy cohorts. In patients with persistent PSA post-prostatectomy, the first postoperative PSA is an independent risk factor for treatment failure. Additional studies are needed to corroborate our observations.
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Affiliation(s)
- Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Blanka Jaksic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Marin Prpic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000, Zagreb, Croatia
| | - Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS13NU, UK
| | - Mirjana Budanec
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Angela Prgomet Secan
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, 28100, Novara, Italy
- Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, 28100, Novara, Italy
| | - Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center Sestre Milosrdnice, University of Zagreb School of Medicine, Vinogradska 29, 10000, Zagreb, Croatia
| | - Borislav Spajic
- Department of Urology, University Hospital Center Sestre Milosrdnice, 10000, Zagreb, Croatia
| | - Nenad Babic
- Department of Radiology, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Bozo Kruslin
- Ljudevit Jurak Department of Pathology and Cytology, Sestre Milosrdnice University Hospital Centre, Vinogradska 29, 10000, Zagreb, Croatia
| | - Mario Zovak
- Department of Surgery, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency (IAEA), Wagramer Str. 5, 1220, Vienna, Austria
| | - Eduardo Rosenblatt
- Division of Human Health, International Atomic Energy Agency (IAEA), Wagramer Str. 5, 1220, Vienna, Austria
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia.
- School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000, Zagreb, Croatia.
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López Campos F, Sancho Pardo G, Maldonado Pijoan X, Zilli T, Couñago Lorenzo F, Hervás Morón A. Is hypofractionation acceptable for prostate bed radiotherapy? Urol Oncol 2021; 39:346-350. [PMID: 34049781 DOI: 10.1016/j.urolonc.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
Abstract
Approximately 30% of patients who undergo radical prostatectomy for prostate cancer develop disease progression. The only potentially curative treatment in these patients is postoperative radiotherapy with or without hormonotherapy. One of the standards of care in nonsurgical patients is hypofractionated radiotherapy. However, the current evidence based is insufficient to define the optimal dose and fractionation schedule for postoperative radiotherapy. In this context, the aim of this editorial is to assess the main efficacy and toxicity data for postoperative hypofractionated radiotherapy and discuss the potential to implement this fractionation in routine clinical practice.
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Affiliation(s)
| | - Gemma Sancho Pardo
- Radiation Oncology Department. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Thomas Zilli
- Radiation Oncology Department. Geneva University Hospital, Geneva, Switzerland
| | - Felipe Couñago Lorenzo
- Radiation Oncology Department. Hospital Universitario Quirónsalud Madrid, Madrid, Spain.
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Murthy V, Mallick I, Arunsingh M, Gupta P. Prostate Radiotherapy in India: Evolution, Practice and Challenges in the 21st Century. Clin Oncol (R Coll Radiol) 2019; 31:492-501. [DOI: 10.1016/j.clon.2019.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/07/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
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Martell K, Cheung P, Morton G, Chung H, Deabreu A, Zhang L, Pang G, Alayed Y, Mamedov A, Gladwish A, Loblaw A. 5-Year Outcomes of a Prospective Phase 1/2 Study of Accelerated Hypofractionated Radiation Therapy to the Prostate Bed. Pract Radiat Oncol 2019; 9:354-361. [PMID: 31103715 DOI: 10.1016/j.prro.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the 5-year outcomes from a single institution, prospective, phase 1/2 study on hypofractionated, accelerated radiation therapy to the prostate bed after radical prostatectomy. METHODS AND MATERIALS Patients enrolled in this study were all eligible for postoperative radiation therapy and received a prescribed dose of 51 Gy in 17 fractions to the prostate bed. On follow-up, gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0; prostate-specific antigen (PSA) was evaluated and quality of life was assessed using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. RESULTS A total of 30 patients were enrolled between 2008 and 2011. Median age was 65 (52-75) years. Median pretreatment PSA was 0.12 ng/mL (0.01-1.42). Twenty-six (93%) patients had Gleason ≤7 disease, 13 (43%) had pT3 disease, and 20 (67%) had positive margins. Twenty-six patients (87%) underwent radiation therapy as salvage treatment. After a median follow-up of 6.4 (2.1-8.1) years, no patient experienced Common Terminology Criteria for Adverse Events grade 3/4 toxicity. Eleven patients (37%) had grade 2 genitourinary and 2 (7%) had grade 2 gastrointestinal toxicity. At baseline and 5 years after radiation therapy, mean EPIC urinary domain score was 80% (standard deviation, 18%) and 82% (17%). Mean EPIC bowel domain score was 93% (13%) and 93% (15%). One patient (4%) had a minimally clinically important change in urinary domain score and 1 patient (4%) had a minimally clinically important change in bowel domain score. Nelson-Aalen estimated cumulative incidence of biochemical failure was 31% (nadir +0.2) and 18% (nadir +2.0) at 5 years. Four-year PSA ≥0.4 was predictive of subsequent androgen deprivation therapy use (Nelson-Aalen cumulative incidence: 1.45; P < .0001). Five patients (17%) received hormonal therapy for biochemical failure. Nelson-Aalen estimated cumulative incidence of hormone therapy use was 14% at 5 years. All patients who received hormone therapy had PSA >0.4 at 4 years. CONCLUSIONS In this phase 1/2 study, hypofractionated postoperative radiation therapy seems to have good clinical efficacy without significant late toxicity. Phase 3 studies are warranted.
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Affiliation(s)
- Kevin Martell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Hans Chung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Andrea Deabreu
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - Liying Zhang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Geordi Pang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Yasir Alayed
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Alexandre Mamedov
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - Adam Gladwish
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto; Institute for Health Policy, Measurement and Evaluation, University of Toronto.
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Saldi S, Bellavita R, Lancellotta V, Palumbo I, Lupattelli M, Chierchini S, Falcinelli L, Zucchetti C, Bini V, Aristei C. Acute Toxicity Profiles of Hypofractionated Adjuvant and Salvage Radiation Therapy After Radical Prostatectomy: Results of a Prospective Study. Int J Radiat Oncol Biol Phys 2018; 103:105-111. [PMID: 30121233 DOI: 10.1016/j.ijrobp.2018.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Hypofractionated radiation therapy (RT) is controversial after radical prostatectomy (RP). In this interim analysis, our prospective observational study assessed acute genitourinary (GU) and gastrointestinal (GI) toxicity after hypofractionated adjuvant and salvage RT, as delivered by helical tomotherapy (HT), in patients with prostate cancer. METHODS AND MATERIALS After undergoing RP with or without pelvic lymph node dissection, 112 patients were enrolled. Hypofractionated adjuvant RT (2.25 Gy daily for 29 fractions; total 65.25 Gy) was administered to 40 patients with high-risk features. Hypofractionated salvage RT (2.25 Gy daily for 32 or 33 fractions; total 72-74.25 Gy) was prescribed for 72 patients (24 with biochemical relapse, 48 with local relapse). Toxicity was graded according to the Common Terminology Criteria for Adverse Events version 4.02. The impact of RT on urinary flow was assessed by uroflowmetry. RESULTS Acute GU toxicity occurred in 41 of 112 patients (36%) (G1 31, G2 10). Acute GI toxicity was observed in 55 (49%) patients (G1 44, G2 11). Uroflowmetry showed that only salvage RT reduced maximum flow significantly (maximum, 68 vs 50 mL/s; P = .003), perhaps because a higher RT dose had been administered. CONCLUSIONS After RP, moderate hypofractionated adjuvant and salvage RT were associated with acceptable incidences of slight-to-moderate acute GU and GI toxicity and had little impact on urinary flow. Prospective trials are warranted with longer follow-up in larger cohorts to confirm these findings.
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Affiliation(s)
- Simonetta Saldi
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy.
| | - Rita Bellavita
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Lancellotta
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Isabella Palumbo
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Lupattelli
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Sara Chierchini
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenzo Falcinelli
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Section of Medical Physics, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, Section of Internal Medicine, Endocrinology & Metabolism, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Cynthia Aristei
- Section of Radiation Oncology, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
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10
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Barra S, Belgioia L, Marcenaro M, Callegari S, Pastorino A, Trapani L, Cavagnetto F, Garelli S, Corvò R. Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome. Cancer Manag Res 2018; 10:473-480. [PMID: 29559810 PMCID: PMC5856046 DOI: 10.2147/cmar.s146131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background After radical prostatectomy (RP) radiotherapy (RT) plays a role, both as adjuvant
or salvage treatment. If negative features are present such as extracapsular
extension, seminal vesicle invasion, lymph invasion, and positive surgical
margins, RT after RP reduces the risk of recurrence, although it is associated
with an increased risk of acute and late toxicities. An intensified RT delivered
in a shortened time could improve clinical outcome and be safely combined with
hormonal therapy (HT). The aim of this study was to determine the acute and late
toxicities associated with hypofractionated RT and to assess the impact of the
addition of HT to RT in high-risk prostate cancer (PC) patients on overall
response and toxicity. Materials and methods Sixty-four PC patients undergoing RP were included in this retrospective study.
All patients were recommended to receive adjuvant or salvage RT. Prescription
doses were 62.5 Gy in 25 fractions to prostate bed, 56.25 Gy in 25 fractions to
seminal vesicles bed, and 50 Gy in 25 fractions to pelvis if indicated. HT was
administered to patients with additional adverse pathologic features including
Gleason score >7, prostate-specific antigen >20 ng/mL before
surgery, or prostate-specific antigen with rapid doubling time after relapse or
nodal involvement. After completion of RT, patients were observed after 4 weeks,
and then followed-up every 3–6 months. Acute and late toxicities were
assessed using Common Terminology Criteria for Adverse Events v4 and Radiation
Therapy Oncology Group scale, respectively. Results For acute toxicity, only grade 1 gastrointestinal and genitourinary toxicities
were detected in 17% and 11% of patients, respectively. As regards late toxicity,
only 5% of the patients developed grade 1 gastrointestinal adverse event; grade 1,
grade 2, and grade 3 genitourinary toxicity was recorded in 5%, 3.3%, and 3.3% of
patients, respectively. Two and 5 years overall survival were 98% and 96%,
respectively. The curves stratified for treatment show a slight difference between
patients receiving RT or RT+HT, but the differences did not reach statistical
significance (p=0.133). Conclusion In patients with PC undergoing RP, hypofractionated RT may contribute to achieve a
high overall survival with an acceptable toxicity profile. Combination of RT and
HT is also well tolerated and efficacious.
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Affiliation(s)
- Salvina Barra
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Michela Marcenaro
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy
| | - Serena Callegari
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alice Pastorino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Trapani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Stefania Garelli
- Medical Physics Department, Ospedale Policlinico San Martino, Genoa, Italy
| | - Renzo Corvò
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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11
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Picardi C, Perret I, Miralbell R, Zilli T. Hypofractionated radiotherapy for prostate cancer in the postoperative setting: What is the evidence so far? Cancer Treat Rev 2018; 62:91-96. [DOI: 10.1016/j.ctrv.2017.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
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12
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Tan J, Jiang X, Yin G, He L, Liu J, Long Z, Jiang Z, Yao K. Anacardic acid induces cell apoptosis of prostatic cancer through autophagy by ER stress/DAPK3/Akt signaling pathway. Oncol Rep 2017; 38:1373-1382. [PMID: 28731173 PMCID: PMC5549027 DOI: 10.3892/or.2017.5841] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
Anacardic acid, which is commonly seen in plants of Anacardiaceae, is an important composition of cashew, ginkgo leaf and fruit, and it has been suggested in previous research to show antitumor activity. The main aim of the present study was to evaluate the anticancer effects of anacardic acid on cell apoptosis of prostatic cancer and molecular mechanisms of this phenomenon. In this study we found that anacardic acid inhibited cell proliferation, induced apoptosis and caspase-3/9 activities and Bax protein expression of prostatic cancer. Anacardic acid induced the ER stress inducing factors (BiP, CHOP, p-eIF2α), autophagy, LC3, Beclin-1, Atg 7 and DAPK3 protein expression, and suppressed p-Akt and p-mTOR protein expression of prostatic cancer. Si-CHOP was used to inhibit ER stress in prostatic cancer by anacardic acid, which showed that the cell proliferation was increased, apoptosis, and caspase-3/9 activities and Bax protein expression was suppressed, autophagy, LC3, Beclin-1, Atg 7 and DAPK3 protein expression was reduced, and p-Akt and p-mTOR protein expression was promoted. DAPK3 inhibited p-Akt and p-mTOR protein expression, enhanced the anticancer effects of anacardic acid on prostatic cancer through autophagy. For the first time, the present study showed that anacardic acid induces cell apoptosis of prostatic cancer through autophagy by ER stress/DAPK3/Akt signaling pathway.
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Affiliation(s)
- Jing Tan
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xianzhen Jiang
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Guangming Yin
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Leye He
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jianye Liu
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhi Long
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhiqiang Jiang
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital of Central South University; Institute of Prostate Disease, Central South University, Changsha, Hunan 410013, P.R. China
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13
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Stritch MA, Forde E, Leech M. The impact of intensity-modulated radiation therapy plan normalization in the postprostatectomy setting—does it matter? Med Dosim 2017; 42:368-374. [DOI: 10.1016/j.meddos.2017.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/24/2017] [Indexed: 12/25/2022]
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14
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Murray JR, McNair HA, Dearnaley DP. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care? Cancer Manag Res 2015; 7:331-44. [PMID: 26635484 PMCID: PMC4646477 DOI: 10.2147/cmar.s51955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.
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Affiliation(s)
- Julia R Murray
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Helen A McNair
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David P Dearnaley
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
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15
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Sundar S, Walker G, Pascoe A. Should Elderly Prostate Cancer Patients with Comorbidity be Spared from Prostate Radiation Dose Escalation? Clin Oncol (R Coll Radiol) 2015; 28:227-8. [PMID: 26482454 DOI: 10.1016/j.clon.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
Affiliation(s)
- S Sundar
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - G Walker
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Pascoe
- Nottingham University Hospital NHS Trust, Nottingham, UK
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