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Ingrosso G, Ponti E, Francolini G, Caini S, Fondelli S, Santini R, Valeriani M, Rago L, Duroni G, Bruni A, Augurio A, Tramacere F, Trippa F, Russo D, Bottero M, Tamburo M, Parisi S, Borghesi S, Lancia A, Gomellini S, Scoccianti S, Stefanacci M, Vullo G, Statuto T, Miranda G, Santo B, Di Marzo A, Bellavita R, Vinciguerra A, Livi L, Aristei C, Bertini N, Orsatti C, Detti B. Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE). LA RADIOLOGIA MEDICA 2024; 129:643-652. [PMID: 38369638 PMCID: PMC11021246 DOI: 10.1007/s11547-024-01782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series. MATERIALS AND METHODS We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan-Meier survival curves and fitted univariate and multivariable Cox's proportional hazards regression models to study the association between the clinical variables and each survival type. RESULTS At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3-99.6%) and 85.5% (95%CI 81.9-89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4-6%) and 6% (95%CI 4-8%), respectively. CONCLUSION Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials.
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Affiliation(s)
- Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Elisabetta Ponti
- Radiation Oncology Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy
| | - Simona Fondelli
- Radiation Oncology Unit, Department of Oncology, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Luciana Rago
- Radiation Oncology Unit, IRCCS -CROB, Rionero in Vulture, Potenza, Italy
| | - Giacomo Duroni
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139, Florence, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Francesco Tramacere
- Department of Radiation Oncology, Azienda Sanitaria Locale, 72100, Brindisi, Italy
| | - Fabio Trippa
- Department of Radiotherapy, Saint Maria Hospital, Terni, Italy
| | | | - Marta Bottero
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Tamburo
- Radiotherapy Unit, Cannizzaro Hospital, Catania, Italy
| | - Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Andrea Lancia
- Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | - Sara Gomellini
- Radiation Oncology Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Silvia Scoccianti
- Radiation Oncology Unit, Department of Oncology, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Marco Stefanacci
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Teodora Statuto
- Radiation Oncology Unit, IRCCS -CROB, Rionero in Vulture, Potenza, Italy
| | - Giulia Miranda
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Bianca Santo
- Radiotherapy Unit, Ospedale "Vito Fazzi", Lecce, Italy
| | | | - Rita Bellavita
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carolina Orsatti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Lischalk JW, Akerman M, Repka MC, Sanchez A, Mendez C, Santos VF, Carpenter T, Wise D, Corcoran A, Lepor H, Katz A, Haas JA. High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation. Front Oncol 2024; 14:1325200. [PMID: 38410097 PMCID: PMC10895712 DOI: 10.3389/fonc.2024.1325200] [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: 10/20/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose Modern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer. Methods and materials A large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan-Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes. Results A total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir. Conclusion Utilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.
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Affiliation(s)
- Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Meredith Akerman
- Division of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, Mineola, NY, United States
| | - Michael C. Repka
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Astrid Sanchez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Christopher Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Vianca F. Santos
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - David Wise
- Department of Medical Oncology, Perlmutter Cancer Center at New York University Langone Health - Manhattan, New York, NY, United States
| | - Anthony Corcoran
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Herbert Lepor
- Department of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, NY, United States
| | - Aaron Katz
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Jonathan A. Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
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Chauhan K, Ebner DK, Tzou K, Ryan K, May J, Kaleem T, Miller D, Stross W, Malouff TD, Landy R, Strong G, Herchko S, Serago C, Trifiletti DM, Miller RC, Buskirk S, Waddle MR. Assessment of bladder filling during prostate cancer radiation therapy with ultrasound and cone-beam CT. Front Oncol 2023; 13:1200270. [PMID: 37588094 PMCID: PMC10426376 DOI: 10.3389/fonc.2023.1200270] [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: 04/04/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Prostate cancer patients undergoing external beam radiation therapy (EBRT) benefit from a full bladder to decrease bowel and bladder toxicity. Ultrasound may offer a proxy metric for evaluation, sparing CBCT dosing. Patients were prospectively enrolled pre-simulation from January 2017 to February 2018. Bladder volume was evaluated prior to RT using US daily and CBCT for three daily treatments and then weekly unless otherwise indicated. 29 patients completed median 40 days of RT, resulting in 478 CBCT and 1,099 US bladder volumes. 21 patients were treated to intact glands and 8 to the post-prostatectomy bed. Median patient age was 70 years. Bladder volume on CBCT and US positively correlated (r = 0.85), with average bladder volume for all patients of 162 mL versus 149 mL, respectively. Bladder volume during treatment was consistently lower than the volume at CT simulation (153 mL vs 194 mL, p<0.01) and progressively declined during treatment. Patients older than 70 years presented with lower average bladder volumes than those < 70 years (122 mL vs 208 mL, respectively, p<0.01). Patients with the highest agreement between CBCT and US (<10% variability) had higher average bladder volumes (192 mL vs 120 mL, p=0.01). US was found to be an accurate measure of bladder volume and may be used to monitor daily bladder volumes in patients being treated with radiation for prostate cancer.
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Affiliation(s)
- Kiran Chauhan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Daniel K. Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katherine Tzou
- Department of Radiation Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Karen Ryan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Jackson May
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Tasmeem Kaleem
- Department of Radiation Oncology, Trihealth System, Cincinnati, OH, United States
| | - Daniel Miller
- Department of Radiation Oncology, Gamma West Cancer Center, Idaho Falls, ID, United States
| | - William Stross
- Department of Radiation Oncology, United States Department of Veterans Affairs, Minneapolis, MN, United States
| | - Timothy Dean Malouff
- Department of Radiation Oncology, College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
| | - Robin Landy
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Gerald Strong
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Steve Herchko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Chris Serago
- Department of Therapeutic Radiology, School of Medicine, Yale University, New Haven, CT, United States
| | | | - Robert Clell Miller
- Department of Radiation Oncology, University of Tennessee Medical Center, Knoxville, TN, United States
| | - Steven Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Mark R. Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
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Lo Greco MC, Marletta G, Marano G, Fazio A, Buffettino E, Iudica A, Liardo RLE, Milazzotto R, Foti PV, Palmucci S, Basile A, Marletta F, Cuccia F, Ferrera G, Parisi S, Pontoriero A, Pergolizzi S, Spatola C. Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1144. [PMID: 37374348 DOI: 10.3390/medicina59061144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising.
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Affiliation(s)
- Maria Chiara Lo Greco
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giulia Marletta
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giorgia Marano
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Alessandro Fazio
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Emanuele Buffettino
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Arianna Iudica
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Rocco Luca Emanuele Liardo
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Roberto Milazzotto
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | | | | | | | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Corrado Spatola
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
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Nicosia L, Mazzola R, Rigo M, Giaj-Levra N, Pastorello E, Ricchetti F, Vitale C, Figlia V, Cuccia F, Ruggieri R, Alongi F. Linac-based versus MR-guided SBRT for localized prostate cancer: a comparative evaluation of acute tolerability. LA RADIOLOGIA MEDICA 2023; 128:612-618. [PMID: 37055672 DOI: 10.1007/s11547-023-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/16/2023] [Indexed: 04/15/2023]
Abstract
AIM This study aims to compare acute toxicity of prostate cancer (PCa) stereotactic body radiotherapy (SBRT) delivered by MR-guided radiotherapy (MRgRT) with 1.5-T MR-linac or by volumetric modulated arc (VMAT) with conventional linac. METHODS Patients with low-to-favorable intermediate risk class PCa were treated with exclusive SBRT (35 Gy in five fractions). Patients treated with MRgRT were enrolled in an Ethical Committee (EC) approved trial (Prot. n° 23,748), while patients treated with conventional linac were enrolled in an EC approved phase II trial (n° SBRT PROG112CESC). The primary end-point was the acute toxicity. Patients were included in the analysis if they had at least 6 months of follow-up for the primary end-point evaluation. Toxicity assessment was performed according to CTCAE v5.0 scale. International Prostatic Symptoms Score (IPSS) was also performed. RESULTS A total of 135 patients were included in the analysis. Seventy-two (53.3%) were treated with MR-linac and 63 (46.7%) with conventional linac. The median initial PSA before RT was 6.1 ng/ml (range 0.49-19). Globally, acute G1, G2, and G3 toxicity occurred in 39 (28.8%), 20 (14.5%), and 5 (3.7%) patients. At the univariate analysis, acute G1 toxicity did not differ between MR-linac and conventional linac (26.4% versus 31.8%), as well as G2 toxicity (12.5% versus 17.5%; p = 0.52). Acute G2 gastrointestinal (GI) toxicity occurred in 7% and 12.5% of cases in MR-linac and conventional linac group, respectively (p = 0.06), while acute G2 genitourinary toxicity occurred in 11% and 12.8% in MR-linac and conventional linac, respectively (p = 0.82). The median IPSS before and after SBRT was 3 (1-16) and 5 (1-18). Acute G3 toxicity occurred in two cases in the MR-linac and three cases in the conventional linac group (p = n.s.). CONCLUSION Prostate SBRT with 1.5-T MR-linac is feasible and safe. Compared to conventional linac, MRgRT might to potentially reduce the overall G1 acute toxicity at 6 months, and seems to show a trend toward a lower incidence of grade 2 GI toxicity. A longer follow-up is necessary to assess the late efficacy and toxicity.
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Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy.
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Edoardo Pastorello
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy
- University of Brescia, Brescia, Italy
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Acute and late toxicity patterns of moderate hypo-fractionated radiotherapy for prostate cancer: a systematic review and meta-analysis. Clin Transl Radiat Oncol 2023; 40:100612. [PMID: 36992969 PMCID: PMC10040508 DOI: 10.1016/j.ctro.2023.100612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Introduction Moderate hypofractionated (HF) radiotherapy is becoming the new standard in radiotherapy for prostate cancer patients. It is established as safe, but it might be associated with increased acute toxicity levels. We conducted a systematic review on moderate HF to establish acute toxicity levels and their required clinical management; late toxicity was reported as a secondary outcome. Material and methods Using PRISMA guidelines, we conducted a systematic review for studies published until June 2022. We identified 17 prospective studies, with 7796 localised prostate cancer patients, reporting acute toxicity of moderate hypofractionation (2.5-3.4 Gy/fraction). A meta-analysis was done for 10/17 studies with a control arm (standard fractionation (SF)), including evaluation of late toxicity rates. We used Cochrane bias assessment and Newcastle-Ottawa bias assessment tools for randomized controlled trials (RCTs) RCT and non-RCTs, respectively. Results Pooled results showed that acute grade ≥ 2 gastro-intestinal (GI) toxicity was increased by 6.3 % (95 % CI for risk difference = 2.0 %-10.6 %) for HF vs SF. Acute grade ≥ 2 Genito-urinary (GU) and late toxicity were not significantly increased. The overall risk of bias assessment revealed a low risk in the meta-analysis of included studies. Data on management of toxicity (medication, interventions) was only reported in 2/17 studies. Conclusion HF is associated with increased acute GI symptoms, needing adequate monitoring and management. Reports on toxicity management were very limited. Pooled late GI and GU toxicity showed similar levels for SF and HF.
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7
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Yu H, Wang C, Wu L, Zhou Z, Wang Y, Li W, Yuan H, Lu Z, Yan D, Chen S, Wang X, Yan S. A novel hydrogel orthotopic injection model in moderately hypofractionated radiation therapy for prostate cancer: Adaptive degradation and durable imaging. Front Oncol 2023; 12:1077900. [PMID: 36713508 PMCID: PMC9880553 DOI: 10.3389/fonc.2022.1077900] [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: 10/23/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose Moderately hypofractionated radiotherapy (MHRT) holds an important position in prostate cancer management. Existing hydrogel spacers can protect the rectum from radiation damage, but need improvement. We explored the application of a novel hydrogel in MHRT with adaptive degradation and durable imaging functions. Methods and materials The hydrogels were irradiated with 6MV x-ray to detect the radio-resistance property. Male SD rats (n=45) underwent hydrogel injection between the prostate and rectum. CT was used for investigating the novel spacer's degradation and imaging functions over three months. The hydrogel's radiation-attenuation properties and biocompatibility were further assessed. Results Hydrogel weight and volume remained stable for six weeks post-injection. After MHRT ended, the hydrogel showed accelerated degradation characteristics and remained in the body for at most three months. CT values of hydrogels exceeded 300 Hounsfield units (HU) throughout treatment, significantly higher than in surrounding normal tissues. A significant dose drop behind the hydrogel was observed post-implantation. Biocompatibility tests of hydrogel found it safe enough for living organisms. Conclusions The novel hydrogel application was fully adaptable to prostate cancer MHRT modalities, largely stable during treatment, rapidly degraded after radiotherapy ended, and consistently maintained superior imaging performance and biocompatibility. This novel spacer will be an effective tool in the era of hypofractionated radiotherapy.
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Affiliation(s)
- Hao Yu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cheng Wang
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Lingyun Wu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ziyang Zhou
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiqi Wang
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenxiang Li
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huili Yuan
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Zeyi Lu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danfang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Si Chen
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
| | - Xu Wang
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
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Merten R, Fischer M, Christiansen H, Hellms S, von Klot CAJ, Thomas NH, Knöchelmann AC. Using a Further Planning MRI after Neoadjuvant Androgen Deprivation Therapy Significantly Reduces the Radiation Exposure of Organs at Risk in External Beam Radiotherapy of Prostate Cancer. J Clin Med 2023; 12:jcm12020574. [PMID: 36675503 PMCID: PMC9860985 DOI: 10.3390/jcm12020574] [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: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Radiotherapy for prostate cancer is often preceded by neoadjuvant androgen deprivation therapy (ADT), which leads to a reduction in the size of the prostate. This study examines whether it is relevant for treatment planning to acquire a second planning magnetic resonance imaging (MRI) after ADT (=MRI 2) or whether it can be planned without disadvantage based on an MRI acquired before starting ADT (=MRI 1). The imaging data for the radiotherapy treatment planning of 17 patients with prostate cancer who received two planning MRIs (before and after neoadjuvant ADT) were analyzed as follows: detailed comparable radiation plans were created separately, each based on the planning CT scan and either MRI 1 or MRI 2. After ADT for an average of 17.2 weeks, the prostate was reduced in size by an average of 24%. By using MRI 2 for treatment planning, the V60Gy of the rectum could be significantly relieved by an average of 15% with the same coverage of the target volume, and the V70Gy by as much as 33% (compared to using MRI 1 alone). Using a second MRI for treatment planning after neoadjuvant ADT in prostate cancer leads to a significant relief for the organs at risk, especially in the high dose range, with the same irradiation of the target volume, and should therefore be carried out regularly. Waiting for the prostate to shrink after a few months of ADT contributes to relief for the organs at risk and to lowering the toxicity. However, the use of reduced target volumes requires an image-guided application, and the oncological outcome needs to be verified in further studies.
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Affiliation(s)
- Roland Merten
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-2574
| | - Mirko Fischer
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Hans Christiansen
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Susanne Hellms
- Institute for Radiology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Nele Henrike Thomas
- Institute for Biostatistics, Hannover Medical School, 30625 Hannover, Germany
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The Usefulness of Adaptative Radiotherapy in Prostate Cancer: How, When, and Who? Biomedicines 2022; 10:biomedicines10061401. [PMID: 35740422 PMCID: PMC9220081 DOI: 10.3390/biomedicines10061401] [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: 05/01/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to develop a deformable image registration (DIR)-based offline ART protocol capable of identifying significant dosimetric changes in the first treatment fractions to determine when adaptive replanning is needed. A total of 240 images (24 planning CT (pCT) and 216 kilovoltage cone-beam CT (CBCT)) were prospectively acquired from 24 patients with prostate adenocarcinoma during the first three weeks of their treatment (76 Gy in 38 fractions). This set of images was used to plan a hypofractionated virtual treatment (57.3 Gy in 15 fractions); correlation with the DIR of pCT and each CBCT allowed to translate planned doses to each CBCT, and finally mapped back to the pCT to compare with those actually administered. In 37.5% of patients, doses administered in 50% of the rectum (D50) would have exceeded the dose limitation to 50% of the rectum (R50). We first observed a significant variation of the planned rectal volume in the CBCTs of fractions 1, 3, and 5. Then, we found a significant relationship between the D50 accumulated in fractions 1, 3, and 5 and the lack of compliance with the R50. Finally, we found that a D50 variation rate [100 × (administered D50 − planned D50/planned D50)] > 1% in fraction three can reliably identify variations in administered doses that will lead to exceeding rectal dose constraint.
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1.5T Magnetic Resonance-Guided Stereotactic Body Radiotherapy for Localized Prostate Cancer: Preliminary Clinical Results of Clinician- and Patient-Reported Outcomes. Cancers (Basel) 2021; 13:cancers13194866. [PMID: 34638348 PMCID: PMC8508440 DOI: 10.3390/cancers13194866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) offers the potential for achieving better prostate cancer (PC) treatment outcomes. This study reports the preliminary clinical results of 1.5T MRgSBRT in localized PC, based on both clinician-reported outcome measurement (CROM) and patient-reported outcome measurement (PROM). METHODS Fifty-one consecutive localized PC patients were prospectively enrolled with a median follow-up of 199 days. MRgSBRT was delivered in five fractions of 7.25-8 Gy with daily online adaptation. Clinician-reported gastrointestinal (GI) and genitourinary (GU) adverse events based on the Common Terminology Criteria for Adverse Events (CTCAE) Scale v. 5.0 were assessed. The Expanded Prostate Cancer Index Composite Questionnaire was collected at baseline, 1 month, and every 3 months thereafter. Serial prostate-specific antigen measurements were longitudinally recorded. RESULTS The maximum cumulative clinician-reported grade ≥ 2 acute GU and GI toxicities were 11.8% (6/51) and 2.0% (1/51), respectively, while grade ≥ 2 subacute GU and GI toxicities were 2.3% (1/43) each. Patient-reported urinary, bowel, and hormonal domain summary scores were reduced at 1 month, then gradually returned to baseline levels, with the exception of the sexual domain. Domain-specific subscale scores showed similar longitudinal changes. All patients had early post-MRgSBRT biochemical responses. CONCLUSIONS The finding of low toxicity supports the accumulation of clinical evidence for 1.5T MRgSBRT in localized PC.
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