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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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Carpenter DJ, Natesan D, Floyd RW, Oyekunle T, Niedzwiecki D, Waters L, Godfrey D, Moravan MJ, Bitting RL, Gingrich JR, Lee WR, Salama JK. Impact of Race on Outcomes of High-Risk Patients With Prostate Cancer Treated With Moderately Hypofractionated Radiotherapy in an Equal Access Setting. Fed Pract 2022; 39:S35-S41. [PMID: 36426110 PMCID: PMC9662313 DOI: 10.12788/fp.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Moderately hypofractionated radiotherapy (MHRT) is an accepted treatment for localized prostate cancer; however, limited MHRT data address high-risk prostate cancer (HRPC) and/or African American patients. We report clinical outcomes and toxicity profiles for individuals with HRPC treated in an equal access system. METHODS We identified patients with HRPC treated with MHRT at a US Department of Veterans Affairs referral center. Exclusion criteria included < 12 months follow-up and elective nodal irradiation. MHRT included 70 Gy over 28 fractions or 60 Gy over 20 fractions. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicities were graded using Common Terminology Criteria for Adverse Events, version 5.0. Clinical endpoints, including biochemical recurrence-free survival (BRFS), distant metastases-free survival (DMFS), overall survival (OS), and prostate cancer-specific survival (PCSS) were estimated using Kaplan-Meier methods. Clinical outcomes, acute toxicity, and late toxicity-free survival were compared between African American and White patients with logistic regression and log-rank testing. RESULTS Between November 2008 and August 2018, 143 patients with HRPC were treated with MHRT and followed for a median of 38.5 months; 82 (57%) were African American and 61 were White patients. Concurrent androgen deprivation therapy (ADT) was provided for 138 (97%) patients for a median duration of 24 months. No significant differences between African American and White patients were observed for 5-year OS (73% [95% CI, 58%-83%] vs 77% [95% CI, 60%-97%]; P = .55), PCSS (90% [95% CI, 79%-95%] vs 87% [95 % CI, 70%-95%]; P = .57), DMFS (91% [95% CI, 80%-96%] vs 81% [95% CI, 62%-91%]; P = .55), or BRFS (83% [95% CI, 70%-91%] vs 71% [95% CI, 53%-82%]; P = .57), respectively. Rates of acute grade 3+ GU and GI were low overall (4% and 1%, respectively). Late toxicities were similarly favorable with no significant differences by race. CONCLUSIONS Individuals with HRPC treated with MHRT in an equal access setting demonstrated favorable clinical outcomes that did not differ by race, alongside acceptable rates of acute and late toxicities.
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Affiliation(s)
| | - Divya Natesan
- Duke University School of Medicine, Durham, North Carolina
| | - R Warren Floyd
- Duke University School of Medicine, Durham, North Carolina
| | - Taofik Oyekunle
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Health Care System, North Carolina
| | | | - Laura Waters
- Durham Veterans Affairs Health Care System, North Carolina
| | - Devon Godfrey
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Health Care System, North Carolina
| | | | - Rhonda L Bitting
- Durham Veterans Affairs Health Care System, North Carolina
- Duke Cancer Institute, Center for Prostate & Urologic Cancers, Duke University, Durham, North Carolina
| | - Jeffrey R Gingrich
- Durham Veterans Affairs Health Care System, North Carolina
- Duke Cancer Institute, Center for Prostate & Urologic Cancers, Duke University, Durham, North Carolina
| | - W Robert Lee
- Duke University School of Medicine, Durham, North Carolina
| | - Joseph K Salama
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Health Care System, North Carolina
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Dosimetric feasibility of moderately hypofractionated/dose escalated radiation therapy for localised prostate cancer with intensity-modulated proton beam therapy using simultaneous integrated boost (SIB-IMPT) and impact of hydrogel prostate-rectum spacer. Radiat Oncol 2022; 17:64. [PMID: 35365170 PMCID: PMC8973648 DOI: 10.1186/s13014-022-02025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To examine the dosimetric feasibility of hypofractionated/dose escalated radiation therapy in patients with localized prostate carcinoma using simultaneous integrated boost intensity-modulated proton beam therapy (SIB-IMPT) in absence or presence of prostate-rectum spacer.
Methods IMPT technique was implemented in 23 patients with intermediate- and high-risk prostate cancer treated at West German Proton Therapy Centre from March 2016 till June 2018, using SIB technique prescribing 60 GyRBE and 72 GyRBE in 30 fractions to PTV1 (prostate and seminal vesicle) and PTV2 boost (prostate and proximal seminal vesicle), respectively. In 15 patients, a transperineal injection of hydrogel was applied prior to radiotherapy to increase the distance between prostate and rectum. Planning and all treatments were performed with a 120 ml fluid-filled endorectal balloon customised daily for each patient. For each patient, 2 lateral IMPT beams were implemented taking a field-specific range uncertainty (RU) into account. Dose volume histograms (DVH) were analyzed for PTV2, PTV2 with range uncertainty margin (PTV2RU), rectum, bladder, right/left femoral heads, and penile bulb. For late rectal toxicities, the normal tissue complication probabilities (NTCP) were calculated using different biological models. A DVH- and NTCP-based dosimetric comparison was carried out between non-spacer and spacer groups. Results For the 23 patients, high-quality plans could be achieved for target volume and for other organs at risk (OARs). For PTV2, the V107% was 0% and the Dmax did not exceed 106.2% of the prescribed dose. The volume PTV2RU covered by 95% of the dose ranged from 96.16 to 99.95%. The conformality index for PTV2RU was 1.12 ± 0.057 and the homogeneity index (HI) was 1.04 ± 0.014. Rectum Dmax and rectal volume receiving 73–50 Gy could be further reduced for the spacer-group. Significant reductions in mean and median rectal NTCPs (stenosis/necrosis, late rectal bleeding ≥ 2, and late rectal toxicities ≥ 3) were predicted for the spacer group in comparison to the non-spacer group. Conclusion Hypofractionated/dose escalated radiotherapy with SIB-IMPT is dosimetrically feasible. Further reduction of the rectal volumes receiving high and medium dose levels (73–50 Gy) and rectal NTCP could be achieved through injection of spacers between rectum and prostate.
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4
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Onal C, Ozyigit G, Oymak E, Guler OC, Hurmuz P, Tilki B, Reyhan M, Tuncel M, Akyol F. Clinical parameters and nomograms for predicting lymph node metastasis detected with 68 Ga-PSMA-PET/CT in prostate cancer patients candidate to definitive radiotherapy. Prostate 2021; 81:648-656. [PMID: 33949694 DOI: 10.1002/pros.24142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Defining the extent of disease spread with imaging modalities is crucial for therapeutic decision-making and definition of treatment. This study aimed to investigate whether clinical parameters and nomograms predict prostate-specific membrane antigen (PSMA)-positive lymph nodes in treatment-naïve nonmetastatic prostate cancer (PC) patients. MATERIALS AND METHODS The clinical data of 443 PC patients (83.3% high-risk and 16.7% intermediate-risk) were retrospectively analyzed. Receiver operating characteristic (ROC) curves with areas under the curve (AUC) were generated to evaluate the accuracy of clinical parameters (prostate-specific antigen [PSA], T stage, Gleason score [GS], International Society of Urological Pathology [ISUP] grade) and nomograms (Roach formula [RF], Yale formula [YF], and a new formula [NF]) in predicting lymph node metastasis. The AUCs of the various parameters and clinical nomograms were compared using ROC and precision-recall (PR) curves. RESULTS A total of 288 lymph node metastases were identified in 121 patients (27.3%) using 68 Ga-PSMA-11-positron emission tomography (PET)/computed tomography (CT). Most PSMA-avid lymph node metastases occurred in external or internal iliac lymph nodes (142; 49.3%). Clinical T stage, PSA, GS, and ISUP grade were significantly associated with PSMA-positive lymph nodes according to univariate logistic regression analysis. The PSMA-positive lymph nodes were more frequently detected in patients with PSA >20 ng/ml, GS ≥7 or high risk disease compared to their counterparts. The clinical T stage, serum PSA level, GS, and ISUP grade showed similar accuracy in predicting PSMA-positive metastasis, with AUC values ranging from 0.675 to 0.704. The median risks for PSMA-positive lymph nodes according to the RF, YF, and NF were 31.3% (range: 12.3%-100%), 22.3% (range: 4.7%-100%), and 40.5% (range: 12.3%-100%), respectively. The AUC values generated from ROC and PR curve analyses were similar for all clinical nomograms, although the RF and YF had higher accuracy compared to NF. CONCLUSION The clinical T stage, PSA, GS, and ISUP grade are independent predictors of PSMA-positive lymph nodes. The RF and YF can be used to identify patients who can benefit from 68 Ga-PSMA-11 PET/CT for the detection of lymph node metastasis. Together with nomograms, 68 Ga-PSMA-11 PET/CT images help to localize PSMA-positive lymph node metastases and can thus assist in surgery and radiotherapy planning.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, İskenderun, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Reyhan
- Department of Nuclear Medicine, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Wang MH, Vos LJ, Yee D, Patel S, Pervez N, Parliament M, Usmani N, Danielson B, Amanie J, Pearcey R, Ghosh S, Field C, Fallone BG, Murtha AD. Clinical Outcomes of the CHIRP Trial: A Phase II Prospective Randomized Trial of Conventionally Fractionated Versus Moderately Hypofractionated Prostate and Pelvic Nodal Radiation Therapy in Patients With High-Risk Prostate Cancer. Pract Radiat Oncol 2021; 11:384-393. [PMID: 33705985 DOI: 10.1016/j.prro.2021.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE Hypofractionated radiation therapy (HFRT) may offer treatment advantages for patients with prostate cancer. However, HFRT may also increase the risk of gastrointestinal (GI) or genitourinary (GU) toxicity compared with conventionally fractionated radiation therapy (CFRT). Several large trials have found that HFRT is well tolerated in mixed risk population studies. Here, we report on a phase II, randomized controlled study conducted to evaluate these endpoints in exclusively high-risk patients with prostate cancer treated with prostate and pelvic nodal radiation. METHODS AND MATERIALS After giving informed consent, patients with high-risk prostate cancer were randomly assigned to prostate plus pelvic nodal radiation therapy with either HFRT (68 Gy in 25 fractions) or CFRT (78 Gy in 39 fractions) and 18 months of androgen suppression therapy. Toxicity was scored using the Common Terminology Criteria for Adverse Events (version 4.0). Biochemical failure was determined by the Phoenix definition. Patients were analyzed on an intention-to-treat basis. RESULTS From 2012 to 2018, 111 patients with high-risk prostate cancer were enrolled and 109 patients were treated. The cumulative incidence of grade 2 or higher acute GI toxicity was not significantly different between the arms (HFRT 18.9% vs CFRT 21.8%; P = .812). Similarly, acute GU (HFRT 30.2% vs CFRT 30.9%; P = 1.00), late GI (HFRT 16.0% vs CFRT 10.0%; P = .554), and late GU (HFRT 16.0% vs CFRT 6.0%; P = .200) were not significantly different between the arms. Median follow-up was 38.0 months (4.8-77.8 months). The 3-year biochemical recurrence-free survival was not significantly different between the 2 arms (97.3% for HFRT vs 91.0% for CFRT; P = .606). The 3-year overall survival was 94.8% in the HFRT arm and 100.0% in the CFRT arm (P = .116). CONCLUSIONS HFRT and CFRT using intensity modulated radiation therapy were both well tolerated for patients with high-risk prostate cancer and resulted in similar 3-year biochemical recurrence-free survival and overall survival.
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Affiliation(s)
- Michael H Wang
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Larissa J Vos
- Clinical Trials Unit, Cross Cancer Institute, Edmonton, AB, Canada
| | - Don Yee
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Samir Patel
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Nadeem Pervez
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Matthew Parliament
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Brita Danielson
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - John Amanie
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Robert Pearcey
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, AB, Canada; Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Colin Field
- Department of Oncology, University of Alberta, Edmonton, AB, Canada; Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - B Gino Fallone
- Department of Oncology, University of Alberta, Edmonton, AB, Canada; Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - Albert D Murtha
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, AB, Canada.
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Bresolin A, Faiella A, Garibaldi E, Munoz F, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Villa E, Magli A, Noris Chiorda B, Gatti M, Ferella L, Maggio A, Landoni V, Aimonetto S, Sini C, Rancati T, Sanguineti G, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. Acute patient-reported intestinal toxicity in whole pelvis IMRT for prostate cancer: Bowel dose-volume effect quantification in a multicentric cohort study. Radiother Oncol 2021; 158:74-82. [PMID: 33639190 DOI: 10.1016/j.radonc.2021.02.026] [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: 11/07/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. MATERIALS AND METHODS Complete data of 415 patients enrolled in a multi institute, prospective trial (#NCT02803086) treated with radical (31%), adjuvant (33%) and salvage (36%) intent at a median dose to pelvic nodes/lymph-nodal area of 53 Gy were available. The most severe changes between baseline and radiotherapy mid-point/end toxicity assessed by Inflammatory Bowel Disease Questionnaire (only Bowel Domain) were considered (ΔIBDQ). The 25th percentile values of these score variations were set as endpoints. DVHs of bowel loops for patients with/without toxicity were compared for each endpoint, having excluded patients with baseline scores <5 (rate ranging between 2% and 7% according to the endpoint): the resulting best dosimetric predictors were combined with selected clinical parameters through multivariate logistic regression (MVA) to derive predictive models. RESULTS ΔIBDQ ranged between 0.2-1.5 points considering separately each IBDQ symptom. Only four symptoms (IBDQ1 = frequency, IBDQ5 = diarrhea, IBDQ17 = gas passage, IBDQ24 = urgency) showed a median worsening ≥ 1; DVH predicted the risk of worse symptoms for IBDQ5, IBDQ24 and overall Bowel Domain. At multivariable analysis DVHs (best cut-off: V46Gy ≥80 cc) and baseline scores (Odd-Ratio:0.35-0.65) were independently associated to the three end-points. The resulting models were reliable (H&L test: 0.453-0.956), well calibrated (calibration plot: slope = 0.922-1.069, R2 = 0.725-0.875) and moderately discriminative (Area Under the Curve:0.628-0.669). A bootstrap-based validation confirmed their robustness. CONCLUSION Constraining the bowel loops (V46 < 80 cc) may reduce the risk of several moderate intestinal symptoms, with a much greater impact for patients with lower IBDQ baseline scores.
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Affiliation(s)
- Andrea Bresolin
- San Raffaele Scientific Institute, Milan, Italy; Fondazione Centro San Raffaele, Milan, Italy
| | - Adriana Faiella
- IRCCS Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | | | - Fernando Munoz
- Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | | | | | | | | | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, Bergamo, Italy
| | - Alessandro Magli
- Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | | | - Marco Gatti
- Istituto di Candiolo - FPO-IRCCS, Candiolo, Italy
| | | | | | - Valeria Landoni
- IRCCS Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | | | - Carla Sini
- San Raffaele Scientific Institute, Milan, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | | | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Prostate Cancer Program, Milan, Italy
| | - Nadia Di Muzio
- San Raffaele Scientific Institute, Milan, Italy; Dept. of Oncology and Hemato-Oncology, University Vita-Salute San Raffaele, Milan, Italy
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Herst PM, Aumata A, Sword V, Jones R, Purdie G, Costello S. Cranberry capsules are not superior to placebo capsules in managing acute non-haemorrhagic radiation cystitis in prostate cancer patients: A phase III double blinded randomised placebo controlled clinical trial. Radiother Oncol 2020; 149:117-123. [PMID: 32413530 DOI: 10.1016/j.radonc.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Acute radiation cystitis affects the quality of life of many prostate cancer patients. A previous pilot study suggested that cranberry capsules may decrease some of the symptoms of acute radiation cystitis. Here we further test their effectiveness in a multicentre double blinded placebo-controlled clinical trial. MATERIAL AND METHODS A total of 108 prostate cancer patients were recruited at three New Zealand hospitals between September 2016 and January 2019. Out of this cohort, 101 patients provided datasets for analysis (51 men on cranberry capsules and 50 men on beetroot-containing placebo capsules). Patients took two capsules each morning during RT and for 2 weeks after completion of RT. Three measures were used to assess cystitis severity: modified RTOG, O'Leary interstitial cystitis scale and a sensitive novel radiation induced cystitis assessment scale (RICAS). Cystitis severity was scored at baseline and weekly thereafter during RT and for two weeks after completion of RT. Radiation protocols were stratified to conventional fractionation or hypo-fractionated radiation therapy (CHHiP) to the prostate or radiation to the prostate bed. RESULTS Cranberry capsules performed significantly worse than placebo capsules with respect to day time frequency and bladder control, using the more sensitive RICAS scale. No significant difference in cystitis severity was seen between patients receiving hypofractionation and those receiving conventional fractionation to the prostate gland. CONCLUSION Cranberry capsules were not superior to beetroot-containing placebo capsules in managing radiation cystitis in our prostate patient cohort. RICAS may be a useful tool for measuring radiation cystitis in future studies.
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Affiliation(s)
- Patries M Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand.
| | - Andre Aumata
- Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, New Zealand
| | | | - Rowan Jones
- Auckland Radiation Oncology, Epsom, New Zealand
| | - Gordon Purdie
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Shaun Costello
- Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, New Zealand
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Koerber SA, Winter E, Katayama S, Slynko A, Haefner MF, Uhl M, Sterzing F, Habl G, Schubert K, Debus J, Herfarth K. Elective Node Irradiation With Integrated Boost to the Prostate Using Helical IMRT-Clinical Outcome of the Prospective PLATIN-1 Trial. Front Oncol 2019; 9:751. [PMID: 31456941 PMCID: PMC6700274 DOI: 10.3389/fonc.2019.00751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/26/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: This prospective, non-randomized phase II trial aimed to investigate the role of additional irradiation of the pelvic nodes for patients with prostate cancer and a high risk for nodal metastases using helical intensity-modulated radiotherapy with daily image guidance (IMRT/IGRT). Methods and materials: Between 2009 and 2012, 40 men with treatment-naïve prostate cancer and a risk of lymph node involvement of more than 20% were enrolled in the PLATIN-1 trial. All patients received definitive, helical IMRT of the pelvic nodes (total dose of 51.0 Gy) with a simultaneous integrated boost (SIB) to the prostate (total dose of 76.5 Gy) in 34 fractions. Antihormonal therapy (AHT) was administered for a minimum of 2 months before radiotherapy continuing for at least 24 months. Results: After a median follow-up of 71 months (range: 5-95 months), pelvic irradiation was associated with a 5-year overall survival (OS) and biochemical progression-free survival (bPFS) of 94.3% and 83.6%, respectively. For our cohort, no grade 4 gastrointestinal (GI) and genitourinary (GU) toxicity was observed. Quality of life (QoL) assessed by EORTC QLQ-C30 questionnaire was comparable to EORTC reference values without significant changes. Conclusion: The current trial demonstrates that elective IMRT/IGRT of the pelvic nodes with SIB to the prostate for patients with a high-risk of lymphatic spread is safe and shows an excellent clinical outcome without compromising the quality of life. The PLATIN-1 trial delivers eminent baseline data for future studies using modern irradiation techniques.
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Affiliation(s)
- Stefan Alexander Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Erik Winter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Katayama
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Alla Slynko
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Matthias Felix Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Matthias Uhl
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Florian Sterzing
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Radiation Oncology Unit, Strahlentherapie Süd, Kempten, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Radiation Oncology Unit, Radiologie München, Munich, Germany
| | - Kai Schubert
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Ion-Therapy Center, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Ion-Therapy Center, Heidelberg, Germany
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Koerber SA, Stach G, Kratochwil C, Haefner MF, Rathke H, Herfarth K, Kopka K, Holland-Letz T, Choyke PL, Haberkorn U, Debus J, Giesel FL. Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management. J Nucl Med 2019; 61:46-50. [PMID: 31302638 DOI: 10.2967/jnumed.119.227637] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
The importance of prostate-specific membrane antigen (PSMA) PET/CT for primary staging of treatment-naïve prostate cancer patients is still under debate. Therefore, the present study aimed to evaluate the role of PSMA PET/CT in detecting nodal metastases in a large cohort of men and compare imaging results with the risk of lymph node involvement based on the Roach formula. Methods: In total, 280 men with newly diagnosed prostate carcinoma were included in the present study. For all patients, PSMA PET/CT was performed for primary staging. Median age was 67 y (range, 38-84 y), and 84% of all patients were classified as high-risk according to the d'Amico criteria. The risk of lymph node involvement was calculated using the Roach formula and compared with the PSMA PET/CT results. Results: PSMA-positive nodes were detected in 90 of 280 men (32.1%). Although most nodal metastases occurred within the pelvis, 36.0% were in extrapelvic sites. In 9 patients (3.2%), nodal metastases occurred in the Virchow node. After comparison of PSMA data with the results of the Roach formula, an area under the curve of 0.781 was obtained for the Roach predictions. Conclusion: For treatment-naïve prostate cancer patients, PSMA PET/CT is well suited for the detection of nodal metastases. However, the original Roach formula can still be used for a quick assessment of potential lymphatic spread in daily clinical routine.
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Affiliation(s)
- Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Gerald Stach
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Henrik Rathke
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
| | - Tim Holland-Letz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany .,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, Heidelberg, Germany
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10
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Ferella L, Limoncin E, Vittorini F, Chalaszczyk A, Sorce C, Grimaldi G, Franzese P, Ruggieri V, Varrassi E, Di Staso M, Gimenez De Lorenzo R, Marampon F, Tombolini V, Masciocchi C, Gravina GL. Are we ready for a paradigm shift from high-dose conventional to moderate hypofractionated radiotherapy in intermediate-high risk prostate cancer? A systematic review of randomized controlled trials with trial sequential analysis. Crit Rev Oncol Hematol 2019; 139:75-82. [DOI: 10.1016/j.critrevonc.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022] Open
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11
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Chuong MD, Hartsell W, Larson G, Tsai H, Laramore GE, Rossi CJ, Wilkinson JB, Kaiser A, Vargas C. Minimal toxicity after proton beam therapy for prostate and pelvic nodal irradiation: results from the proton collaborative group REG001-09 trial. Acta Oncol 2018; 57:368-374. [PMID: 29034790 DOI: 10.1080/0284186x.2017.1388539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Proton beam therapy (PBT) reduces normal organ dose compared to intensity modulated radiation therapy (IMXT) for prostate cancer patients who receive pelvic radiation therapy. It is not known whether this dosimetric advantage results in less gastrointestinal (GI) and genitourinary (GU) toxicity than would be expected from IMXT. MATERIAL AND METHODS We evaluated treatment parameters and toxicity outcomes for non-metastatic prostate cancer patients who received pelvic radiation therapy and enrolled on the PCG REG001-09 trial. Patients who received X-ray therapy and/or brachytherapy were excluded. Of 3210 total enrolled prostate cancer patients, 85 received prostate and pelvic radiation therapy exclusively with PBT. Most had clinically and radiographically negative lymph nodes although 6 had pelvic nodal disease and one also had para-aortic involvement. Pelvic radiation therapy was delivered using either 2 fields (opposed laterals) or 3 fields (opposed laterals and a posterior beam). Median pelvic dose was 46.9 GyE (range 39.7-56) in 25 fractions (range 24-30). Median boost dose to the prostate +/- seminal vesicles was 30 GyE (range 20-41.4) in 16 fractions (range 10-24). RESULTS Median follow-up was 14.5 months (range 2.8-49.2). Acute grade 1, 2, and 3 GI toxicity rates were 16.4, 2.4, 0%, respectively. Acute grade 1, 2, and 3 GU toxicity rates were 60, 34.1, 0%, respectively. CONCLUSIONS Prostate cancer patients who receive pelvic radiation therapy using PBT experience significantly less acute GI toxicity than is expected using IMXT. Further investigation is warranted to confirm whether this favorable acute GI toxicity profile is related to small bowel sparing from PBT.
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Affiliation(s)
- Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute at Baptist Health South Florida, Miami, FL, USA
| | - William Hartsell
- Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
| | - Gary Larson
- ProCure Proton Therapy Center Oklahoma City, Oklahoma City, OK, USA
| | - Henry Tsai
- ProCure Proton Therapy Center New Jersey, Somerset, NJ, USA
| | - George E. Laramore
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | | | - J. Ben Wilkinson
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Willis-Knighton Cancer Center, Shreveport, LA, USA
| | - Carlos Vargas
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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12
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Valeriani M, Carnevale A, Osti MF, Minniti G, De Sanctis V, Agolli L, Bracci S, Enrici RM. Hypofractionated Intensity-Modulated Simultaneous Integrated Boost and Image-Guided Radiotherapy in the Treatment of High-Risk Prostate Cancer Patients: A Preliminary Report on Acute Toxicity. TUMORI JOURNAL 2018; 99:474-9. [DOI: 10.1177/030089161309900406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate acute toxicity of hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in the treatment of high-risk prostate cancer patients. Methods Between November 2009 and March 2012, 59 patients with high-risk prostate cancer were enrolled. The eclipse inverse planning system (Varian) was used to calculate an IMRT plan with simultaneous integrated boost, delivering 68.75 Gy (2.75 Gy per fraction) to the prostate, 55 Gy (2.2 Gy per fraction) to the seminal vesicles and positive nodes, and 45 Gy (1.8 Gy per fraction) to the pelvis, 4 fractions per week, 25 fractions. Prior to each treatment, patients underwent a kilo-voltage cone-beam CT performing an image-guided radiation therapy (IGRT). All patients were submitted to neoadjuvant, concomitant and adjuvant hormone therapy. Results The median follow-up for all patients was 13 months (range, 3–28). At the last follow-up, no grade 3 or 4 side effect was observed. Toxicity occurred as follows during the treatment: grade 1 and 2 gastrointestinal toxicity 5.2% and 6.9%, respectively; grade 1 and 2 genitourinary toxicity 24.1% and 1.7%, respectively. Only 1.7% of the patients developed grade 3 genitourinary toxicity. No grade 3 gastrointestinal toxicity was observed. Conclusions The present study demonstrated that 4/w hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in patients with high-risk prostate cancer is feasible and safe. Low acute toxicity rates were verified. Longer follow-up is needed to evaluate the outcomes in terms of late toxicity and survival.
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Affiliation(s)
- Maurizio Valeriani
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Alessia Carnevale
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Giuseppe Minniti
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Linda Agolli
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Stefano Bracci
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
| | - Riccardo Maurizi Enrici
- Department of Radiation Oncology, “Sapienza” University, Sant'Andrea Hospital of Rome, Italy
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13
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Faria S, Ruo R, Cury F, Duclos M, Souhami L. Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiation therapy. Pract Radiat Oncol 2017; 7:264-269. [DOI: 10.1016/j.prro.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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14
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Pervez N, Boychak A, Drodge CS, Yee D, Le D, Murtha A, Parliament M, Amanie J, Mihai A, Field C, Mackenzie M, Ghosh S, Fallone G, Pearcey R. Late Toxicity and Outcomes in High-risk Prostate Cancer Patients Treated With Hypofractionated IMRT and Long-term Androgen Suppression Treatment. Am J Clin Oncol 2017; 40:200-206. [DOI: 10.1097/coc.0000000000000133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Moderate hypofractionated radiotherapy with volumetric modulated arc therapy and simultaneous integrated boost for pelvic irradiation in prostate cancer. J Cancer Res Clin Oncol 2017; 143:1301-1309. [DOI: 10.1007/s00432-017-2375-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
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16
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Acute toxicity and its dosimetric correlates for high-risk prostate cancer treated with moderately hypofractionated radiotherapy. Med Dosim 2017; 42:18-23. [PMID: 28129973 DOI: 10.1016/j.meddos.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/02/2016] [Accepted: 10/14/2016] [Indexed: 11/21/2022]
Abstract
AIMS To report the acute toxicity and the dosimetric correlates after moderately hypofractionated radiotherapy for localized prostate cancer. METHODS A total of 101 patients with localized prostate cancer were treated with image-guided intensity-modulated radiation therapy. Patients were treated to 65Gy/25Fr/5 weeks (n = 18), or 60Gy/20Fr/4 weeks (n = 83). Most (82.2%) had high-risk or pelvic node-positive disease. Acute toxicity was assessed using Radiation Therapy Oncology Group (RTOG) acute morbidity scoring criteria. Dose thresholds for acute rectal and bladder toxicity were identified. RESULTS The incidence of acute grade 2 GI toxicity was 20.8%, and grade 2 genitourinary (GU) toxicity was 6.9%. No Grade 3 to 4 toxicity occurred. Small bowel toxicity was uncommon (Gr 2 = 4%). The 2Gy equivalent doses (EQD2) to the rectum and bladder (α/β = 3) calculated showed that the absolute doses were more consistent predictors of acute toxicities than the relative volumes. Those with grade 2 or more GI symptoms had significantly higher VEQD2-60Gy (13.2 vs 9.9cc, p = 0.007) and VEQD2-50Gy (20.6 vs 15.4cc, p = 0.005). Those with grade 2 or more GU symptoms had significantly higher VEQD2-70Gy (30.4 vs 18.4cc, p = 0.001) and VEQD2-65Gy (44.0 vs 28.8cc, p = 0.001). The optimal cutoff value for predicting grade 2 acute proctitis, for VEQD2-60Gy was 9.7cc and for VEQD2-50Gy was 15.9cc. For grade 2 GU symptoms, the threshold values were 23.6cc for VEQD2-70Gy and 38.1cc for VEQD2-65Gy. CONCLUSIONS Hypofractionated radiotherapy for prostate cancer is well tolerated and associated with manageable acute side effects. The absolute dose-volume parameters of rectum and bladder predict for acute toxicities.
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17
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Ishii K, Ogino R, Hosokawa Y, Fujioka C, Okada W, Nakahara R, Kawamorita R, Tada T, Hayashi Y, Nakajima T. Comparison of dosimetric parameters and acute toxicity after whole-pelvic vs prostate-only volumetric-modulated arc therapy with daily image guidance for prostate cancer. Br J Radiol 2016; 89:20150930. [PMID: 26959612 DOI: 10.1259/bjr.20150930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare dosimetric parameters and acute toxicity rates between whole-pelvic (WP) and prostate-only (PO) volumetric-modulated arc therapy (VMAT) in patients with localized prostate cancer. METHODS A total of 224 consecutive patients treated with definitive VMAT to 78 Gy in 39 fractions were enrolled. Of these, 119 patients received initial WP VMAT at 46.8 Gy in 26 fractions using a simultaneous integrated boost technique, and 105 patients received PO VMAT. Image-guided radiotherapy was practised with daily cone beam CT. RESULTS The mean rectal dose, the rectal volume receiving ≥30 Gy (V30Gy), rectal V50Gy, the mean bladder dose, bladder V30Gy and bladder V50Gy were significantly increased in the WP group (p < 0.05 each); however, the rectal V70Gy did not differ between groups (p = 0.101), and the bladder V70Gy was significantly lower in the WP group (p = 0.029). The WP group experienced a significantly increased frequency of acute grade 2 diarrhoea relative to the PO group (5.9% vs 0%; p = 0.015). No differences were seen between the WP and PO groups in terms of acute grade 2 proctitis (10.1% vs 6.7%; p = 0.360) and genitourinary (GU) toxicity (12.6% vs 10.5%; p = 0.620). CONCLUSION Despite larger rectum and bladder volumes at low- and medium-dose levels, WP VMAT resulted in no significant increase in acute proctitis or GU toxicity when compared with PO VMAT. ADVANCES IN KNOWLEDGE This study demonstrates that whole-pelvic radiotherapy has comparable acute toxicity to those observed with prostate-only radiotherapy when VMAT with daily image guidance is used.
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Affiliation(s)
- Kentaro Ishii
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryo Ogino
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | | | - Chiaki Fujioka
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Wataru Okada
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryota Nakahara
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryu Kawamorita
- 1 Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Takuhito Tada
- 3 Department of Radiology, Izumi Municipal Hospital, Osaka, Japan
| | - Yoshiki Hayashi
- 2 Department of Urology, Tane General Hospital, Osaka, Japan
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18
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Becker-Schiebe M, Abaci A, Ahmad T, Hoffmann W. Reducing radiation-associated toxicity using online image guidance (IGRT) in prostate cancer patients undergoing dose-escalated radiation therapy. Rep Pract Oncol Radiother 2016; 21:188-94. [PMID: 27601949 DOI: 10.1016/j.rpor.2016.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/29/2015] [Accepted: 01/22/2016] [Indexed: 11/26/2022] Open
Abstract
AIM To determine the influence of IGRT in terms of toxicities compared to non-IGRT patients undergoing definitive RT. BACKGROUND Image-guided radiotherapy (IGRT) enables immediate correction of target movement by online imaging. For prostate cancer patients undergoing radiation therapy (RT), a geographical miss of the prostate may result in increased dose-volume effects in the rectum and bladder. METHODS A total of 198 prostate cancer patients treated between 2003 and 2013 were recruited randomly for this evaluation. The rates of genitourinary (GU) and gastrointestinal (GI) toxicity for 96 non-IGRT patients (total dose: 72/73.8 Gy) were compared to those for 102 IGRT patients (total dose: 77.4 Gy) according to the Common Toxicity Criteria Version 3.0 (CTCAEv3.0). Follow-up information included treatment-related symptoms and PSA relapse. RESULTS After a median follow-up of 55.4 months, a statistically significant difference was noted for acute GI toxicities ≥1 in favour of IGRT. Significantly more patients treated by IGRT were free of acute GI symptoms (43% vs. 19%, p = 0.0012). In the non-IGRT group, more patients experienced acute GU side effects (89% vs. 80%, p = 0.07). Late toxicity scores were comparable for both cohorts. CONCLUSIONS Based on the data, we demonstrated that despite dose escalation, IGRT enabled us to reduce the GI side effects of radiation. IGRT can therefore be considered to be the standard of care for dose-escalated RT of localized prostate cancer.
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Affiliation(s)
- Martina Becker-Schiebe
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany; Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Ali Abaci
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany
| | - Tahera Ahmad
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany
| | - Wolfgang Hoffmann
- Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany
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Barbosa Neto O, Souhami L, Faria S. Hypofractionated radiation therapy for prostate cancer: The McGill University Health Center experience. Cancer Radiother 2015; 19:431-6. [DOI: 10.1016/j.canrad.2015.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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20
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Liu HX, Du L, Yu W, Cai BN, Xu SP, Xie CB, Ma L. Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer: Preliminary Results of a Phase I-II Trial. Technol Cancer Res Treat 2015; 15:546-54. [PMID: 26152749 DOI: 10.1177/1533034615593189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
In our center, the feasibility and related acute toxicities of hypofractionated helical tomotherapy have been evaluated in older aged patients with prostate cancer . Between February 2009 and February 2014, 67 patients (older than 65 years) were enrolled in a prospective phase I-II study (registered number, ChiCTR-ONC-13004037). Patients in cohort 1 (n = 33) and cohort 2 (n = 34) received 76 Gy in 34 fractions (2.25 Gy/F) and 71.6 Gy in 28 fractions (2.65 Gy/F), respectively, to the prostate and seminal vesicles, while 25 patients in cohort 2 also received integrated elective lymph node irradiation (50.4 Gy). All patients were treated with helical tomotherapy, and daily image guidance was performed before each treatment. Acute toxicities were assessed with Radiation Therapy Oncology Group (RTOG)/European Organization for Research on Treatment of Cancer (EORTC) criteria. No significant difference was detected between the 2 cohorts in the incidence of acute toxicities. In cohort 1, the incidences of grade 1 and 2 genitourinary and gastrointestinal toxicities were 45.5% and 45.4%, respectively, and without grade 3 and 4 toxicities. In cohort 2, the incidences of acute grade 1 and 2 genitourinary and gastrointestinal toxicities were 47.1% and 55.9%, respectively, and grade 3 genitourinary toxicity (hematuria) was noted only in 1 patient. No significant difference was detected in the incidence of acute toxicities between the patients receiving integrated elective lymph node irradiation and those receiving irradiation to prostate and seminal vesicle in cohort 2. Univariate and multivariate analyses were performed with clinical parameters. Only the baseline weight was found negatively correlated with genitourinary toxicities at a weak level (relative risk = 0.946, 95% confidence interval 0.896-0.998], P = .043). This study shows that 2 hypofractionation regimens (76 Gy/34F and 71.6 Gy/28F) delivered with HT are well tolerated in older aged patients having prostate cancer without significant difference for acute toxicities between the 2 cohorts. Late toxicities and treatment outcomes for these patients are under investigation.
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Affiliation(s)
- Hai-Xia Liu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Lei Du
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Wei Yu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Bo-Ning Cai
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Shou-Ping Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Chuan-Bin Xie
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Lin Ma
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
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21
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Lecavalier-Barsoum M, Souhami L, Cury F, Duclos M, Ruo R, Faria S. Pelvic lymph node displacement in high-risk prostate cancer patients treated with image guided intensity modulated radiation therapy with 2 independent target volumes. Pract Radiat Oncol 2015; 5:406-10. [PMID: 26127006 DOI: 10.1016/j.prro.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/07/2015] [Accepted: 05/10/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the displacement of the pelvic lymph node (PLN) target when using cone beam computed tomography (CBCT) for localization of the prostate in patients treated with simultaneous integrated boost. METHODS AND MATERIALS High-risk prostate cancer patients treated with image guided intensity modulated radiation therapy with simultaneous integrated boost receiving 60 Gy in 20 fractions to the prostate and proximal seminal vesicles (PTV60) and 44 Gy in the same 20 fractions to the PLN (PTV44) were studied. Two hundred weekly CBCTs of 50 patients were retrospectively reviewed to assess the displacement of the iliac vessels compared with the simulation computed tomography. For each CBCT, possible displacements were analyzed at 3 levels of PTV44: a superior, middle, and inferior slice, making a total of 600 slices reviewed. Geographical miss (GM) was defined when any part of the iliac vessels on the CBCT was outside of the PTV44 contour. RESULTS GM was found in 7 of the 600 CBCT slices, all in different patients. All GMs were of ≤5 mm. Four GMs occurred on the middle slice and 3 on the superior slice. In 3 cases, the GM was related to shifts ≥7 mm applied to the prostate. CONCLUSIONS Our review suggests that for high-risk prostate cancer, the chance of not appropriately covering the PLN target after adjusting the prostate is low. GM was uncommon and in the order of only a few millimeters when it occurred.
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Affiliation(s)
- Magali Lecavalier-Barsoum
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Fabio Cury
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Marie Duclos
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Russel Ruo
- Department of Medical Physics, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Sergio Faria
- Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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22
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Drodge CS, Boychak O, Patel S, Usmani N, Amanie J, Parliament MB, Murtha A, Field C, Ghosh S, Pervez N. Acute toxicity of hypofractionated intensity-modulated radiotherapy for prostate cancer. ACTA ACUST UNITED AC 2015; 22:e76-84. [PMID: 25908924 DOI: 10.3747/co.22.2247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dose-escalated hypofractionated radiotherapy (hfrt) using intensity-modulated radiotherapy (imrt), with inclusion of the pelvic lymph nodes (plns), plus androgen suppression therapy (ast) in high-risk prostate cancer patients should improve patient outcomes, but acute toxicity could limit its feasibility. METHODS Our single-centre phase ii prospective study enrolled 40 high-risk prostate cancer patients. All patients received hfrt using imrt with daily mega-voltage computed tomography imaging guidance, with 95% of planning target volumes (ptv68 and ptv50) receiving 68 Gy and 50 Gy (respectively) in 25 daily fractions. The boost volume was targeted to the involved plns and the prostate (minus the urethra plus 3 mm and minus 3 mm from adjacent rectal wall) and totalled up to 75 Gy in 25 fractions. Acute toxicity scores were recorded weekly during and 3 months after radiotherapy (rt) administration. RESULTS For the 37 patients who completed rt and the 3-month follow-up, median age was 65.5 years (range: 50-76 years). Disease was organ-confined (T1c-T2c) in 23 patients (62.1%), and node-positive in 5 patients (13.5%). All patients received long-term ast. Maximum acute genitourinary (gu) and gastrointestinal (gi) toxicity peaked at grade 2 in 6 of 36 evaluated patients (16.6%) and in 4 of 31 evaluated patients (12.9%) respectively. Diarrhea and urinary frequency were the chief complaints. Dose-volume parameters demonstrated no correlation with toxicity. The ptv treatment objectives were met in 36 of the 37 patients. CONCLUSIONS This hfrt dose-escalation trial in high-risk prostate cancer has demonstrated the feasibility of administering 75 Gy in 25 fractions with minimal acute gi and gu toxicities. Further follow-up will report late toxicities and outcomes.
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Affiliation(s)
- C S Drodge
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB. ; Currently: Department of Radiation Oncology, Eastern Health, Dr. H. Bliss Murphy Cancer Centre, St. John's, NL
| | - O Boychak
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - S Patel
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - N Usmani
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - J Amanie
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - M B Parliament
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - A Murtha
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
| | - C Field
- Division of Medical Physics, Cross Cancer Institute, Edmonton, AB
| | - S Ghosh
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB
| | - N Pervez
- At the time of the study: Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB
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Ishii K, Ogino R, Hosokawa Y, Fujioka C, Okada W, Nakahara R, Kawamorita R, Tada T, Hayashi Y, Nakajima T. Whole-pelvic volumetric-modulated arc therapy for high-risk prostate cancer: treatment planning and acute toxicity. JOURNAL OF RADIATION RESEARCH 2015; 56:141-150. [PMID: 25304328 PMCID: PMC4572588 DOI: 10.1093/jrr/rru086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023]
Abstract
The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy (VMAT) and daily image guidance in high-risk prostate cancer patients. A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy (WPRT) were enrolled. All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume (PTV), while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions, followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions. Image-guided RT was performed with daily cone-beam computed tomography. Dose-volume parameters for the PTV and the organs at risk (OARs), total number of monitor units (MUs) and treatment time were evaluated. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events, version 4.0. All dosimetric parameters met the present plan acceptance criteria. Mean MU and treatment time were 471 and 146 s for double-arc VMAT, respectively, and were 520 and 76 s for single-arc VMAT, respectively. No Grade 3 or higher acute toxicity was reported. Acute Grade 2 proctitis, diarrhea, and genitourinary toxicity occurred in 12 patients (12%), 6 patients (6%) and 13 patients (13%), respectively. The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity. These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients.
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Affiliation(s)
- Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Yukinari Hosokawa
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Chiaki Fujioka
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Wataru Okada
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryota Nakahara
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, 4-10-10 Futyu-cho, Izumi, 594-0071, Japan
| | - Yoshiki Hayashi
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Toshifumi Nakajima
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
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Hegemann NS, Guckenberger M, Belka C, Ganswindt U, Manapov F, Li M. Hypofractionated radiotherapy for prostate cancer. Radiat Oncol 2014; 9:275. [PMID: 25480014 PMCID: PMC4273481 DOI: 10.1186/s13014-014-0275-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 12/01/2022] Open
Abstract
In the last few years, hypofractionated external beam radiotherapy has gained increasing popularity for prostate cancer treatment, since sufficient evidence exists that prostate cancer has a low α/β ratio, lower than the one of the surrounding organs at risk and thus there is a potential therapeutic benefit of using larger fractionated single doses. Apart from the therapeutic rationale there are advantages such as saving treatment time and medical resources and thereby improving patient’s convenience. While older trials showed unsatisfactory results in both standard and hypofractionated arm due to insufficient radiation doses and non-standard contouring of target volumes, contemporary randomized studies have reported on encouraging results of tumor control mostly without an increase of relevant side effects, especially late toxicity. Aim of this review is to give a detailed analysis of relevant, recently published clinical trials with special focus on rationale for hypofractionation and different therapy settings.
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Affiliation(s)
- Nina-Sophie Hegemann
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
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Yang ZX, Shen JT, Li YP, Zhao K, Shi CH, Xiao Y, Yu JJ, Guo WD, Li CC, Wang YQ, Li XL. Helical tomotherapy for cancer treatment: a rapid health technology assessment. J Evid Based Med 2014; 7:192-218. [PMID: 25156336 DOI: 10.1111/jebm.12109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 06/09/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Helical tomotherapy (HT) can be applied to treat complex malignant cancer with high-precise radiotherapy, and it can reduce the damage to normal tissues and improve treatment effects. But the procurement of HT must be approved by relevant departments of administration affairs. This study, appointed by the National Health and Family Planning Commission of China and undertook by the National Health Development Research Center and the Chinese Evidence-Based Medicine Centre, was aimed to rapidly assess the effectiveness, safety, costs, and applicability of HT, so as to provide currently available best evidence for decision-makers of health policies. METHODS We electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, CBM, and other professional websites. Two reviewer independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed quality, and then performed descriptive analysis. RESULTS (i) We finally included 150 studies, encompassing 5 HTAs, 18 CCTs, and 127 observational studies. (ii) The included HTAs were published during 2006-2009, providing fairly less evidence of low quality and the results of 145 primary studies showed that: HT had been used mainly in the treatments of 14 kinds of cancer, with low total toxicity and high survival rates. Although the quality of the included studies was poor, there was much evidence about prostate cancer, head and neck cancer, nasopharynx cancer, cervical cancer, lung cancer and liver cancer, with enough sample and fairly reliable results in HT efficacy and safety. And (iii) a total of 56 clinical trials were registered in Clinicaltrials.gov, most of which were registered by the occident. Among them, 9 were completed but the results had not been published yet. CONCLUSIONS The evidence of this study showed that, HT is safe and effective in clinic. But the abovementioned conclusion needs to be verified by conducting more high-quality studies with long-term follow-up. The costs of HT in procurement, maintenance, and application are high; and the skills, training, and qualification of operators are required. We suggest that the procurement of HT should be reduced; it should be allocated rationally and effectively used after comprehensive assessment in China's cancer epidemiology characteristics, health resource allocation, disease burden, medical service level, etc.; and also high-quality studies with long-term follow-up should be financially supported on the basis of establishing projects, so as to provide local evidence and consistently guide and improve scientific decision-making.
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Affiliation(s)
- Zong Xia Yang
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
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Hamilton K, Bennett NC, Purdie G, Herst PM. Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer 2014; 23:95-102. [PMID: 24993395 DOI: 10.1007/s00520-014-2335-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/22/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE Acute radiation cystitis, inflammation of the bladder, is a common side effect in men receiving external beam radiation for prostate cancer. Although several treatments provide symptomatic relief, there is no effective treatment to prevent or treat radiation cystitis. Cranberry products have been associated with urinary tract health. This study aimed to determine the effect of highly standardized cranberry capsules (containing 72 mg proanthocyanidins [PACS]) compared with that of placebo capsules on the incidence and severity of radiation cystitis. METHODS Forty-one men with prostate cancer participated in a double blinded randomized placebo controlled study. Men took one capsule a day at breakfast during treatment and for 2 weeks after treatment completion. Severity of urinary symptoms and the bother these caused were measured using the individual items of the urinary domain of the Modified Expanded Prostate Index Composite (EPIC). RESULTS The incidence of cystitis was lower in men taking cranberry capsules (65%) compared with those that took placebo capsules (90%) (p = 0.058); severe cystitis was seen in 30% of men in the cranberry arm and 45% in the placebo arm (p = 0.30). Overall, the incidence of pain/burning was significantly lower in the cranberry cohort (p = 0.045). Men on the low hydration regimen who took cranberry had less pain/burning (p = 0.038), stronger urine steam (p = 0.030) and used significantly fewer pads/liners (p = 0.042), which was significantly different from those on the high hydration regimen (p = 0.028). CONCLUSION Men receiving radiation therapy for prostate cancer may benefit from using cranberry capsules, particularly those on low hydration regimens or with baseline urinary symptoms.
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Affiliation(s)
- Katelin Hamilton
- Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, P.O. Box 1921, Dunedin, New Zealand
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27
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Zilli T, Jorcano S, Escudé L, Linero D, Rouzaud M, Dubouloz A, Miralbell R. Hypofractionated External Beam Radiotherapy to Boost the Prostate with ≥85 Gy/Equivalent Dose for Patients with Localised Disease at High Risk of Lymph Node Involvement: Feasibility, Tolerance and Outcome. Clin Oncol (R Coll Radiol) 2014; 26:316-22. [DOI: 10.1016/j.clon.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/16/2022]
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Yassa M, Vavassis P, Niazi T. In Regard to Kaidar-Person et al. Int J Radiat Oncol Biol Phys 2013; 87:634-5. [DOI: 10.1016/j.ijrobp.2013.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Norkus D, Karklelyte A, Engels B, Versmessen H, Griskevicius R, De Ridder M, Storme G, Aleknavicius E, Janulionis E, Valuckas KP. A randomized hypofractionation dose escalation trial for high risk prostate cancer patients: interim analysis of acute toxicity and quality of life in 124 patients. Radiat Oncol 2013; 8:206. [PMID: 24007322 PMCID: PMC3846611 DOI: 10.1186/1748-717x-8-206] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/03/2013] [Indexed: 12/01/2022] Open
Abstract
Background The α/β ratio for prostate cancer is postulated being in the range of 0.8 to 2.2 Gy, giving rise to the hypothesis that there may be a therapeutic advantage to hypofractionation. To do so, we carried out a randomized trial comparing hypofractionated and conventionally fractionated image-guided intensity modulated radiotherapy (IG-IMRT) in high-risk prostate cancer. Here, we report on acute toxicity and quality of life (QOL) for the first 124 randomized patients. Methods The trial compares 76 Gy in 38 fractions (5 fractions/week) (Arm 1) to 63 Gy in 20 fractions (4 fractions/week) (Arm 2) (IG-IMRT). Prophylactic pelvic lymph node irradiation with 46 Gy in 23 fractions sequentially (Arm 1) and 44 Gy in 20 fractions simultaneously (Arm 2) was applied. All patients had long term androgen deprivation therapy (ADT) started before RT. Both physician-rated acute toxicity and patient-reported QOL using EPIC questionnaire are described. Results There were no differences in overall maximum acute gastrointestinal (GI) or genitourinary (GU) toxicity. Compared to conventional fractionation (Arm 1), GI and GU toxicity both developed significantly earlier but also disappeared earlier in the Arm 2, reaching significant differences from Arm 1 at week 8 and 9. In multivariate analyses, only parameter shown to be related to increased acute Grade ≥1 GU toxicity was the study Arm 2 (p = 0.049). There were no statistically significant differences of mean EPIC scores in any domain and sub-scales. The clinically relevant decrease (CRD) in EPIC urinary domain was significantly higher in Arm 2 at month 1 with a faster recovery at month 3 as compared to Arm 1. Conclusions Hypofractionation at 3.15 Gy per fraction to 63 Gy within 5 weeks was well tolerated. The GI and GU physician-rated acute toxicity both developed earlier but recovered faster using hypofractionation. There was a correlation between acute toxicity and bowel and urinary QOL outcomes. Longer follow-up is needed to determine the significance of these associations with late toxicity.
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Affiliation(s)
- Darius Norkus
- Department of Radiotherapy, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
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30
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Supiot S, Créhange G, Latorzeff I, Pommier P, Paumier A, Rio E, Delaroche G, Guérif S, Catton C, Martin J, Lisbona A. [Hypofractionated radiotherapy in prostate cancer]. Cancer Radiother 2013; 17:349-54. [PMID: 23973460 DOI: 10.1016/j.canrad.2013.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 04/26/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022]
Abstract
Radiotherapy plays a central role in the management of localized prostate cancer, but the total duration of treatment of nearly 2 months poses not only problems of fatigue related to repetitive transports, especially for older patients, but also increases the overall cost of treatment including linear accelerators occupancy and patient transportation. To address this problem, various teams have developed hypofractionated radiotherapy protocols seeking to maintain the same efficacy and toxicity while reducing the total duration of treatment. These hypofractionated protocols require recent techniques such as image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Single centre series have validated the feasibility of "light" hypofractionation schemes at doses per fraction less than 6 Gy Similarly, different teams have shown the possibility of stereotactic irradiation for delivering "severe" hypofractionation schemes at doses greater than 6 Gy per fraction. Whatever the dose per fraction, the current clinical data support the conclusion that hypofractionated radiotherapy does not increase mid-term toxicity and could even improve biochemical control. Studies with the objective of demonstrating non-inferiority are expected to definitively validate the role of hypofractionated irradiation in the treatment of prostate cancer.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
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Kaidar-Person O, Roach M, Créhange G. Whole-pelvic nodal radiation therapy in the context of hypofractionation for high-risk prostate cancer patients: a step forward. Int J Radiat Oncol Biol Phys 2013; 86:600-5. [PMID: 23523182 DOI: 10.1016/j.ijrobp.2013.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer.
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Gupta T, Narayan CA. Image-guided radiation therapy: Physician's perspectives. J Med Phys 2013; 37:174-82. [PMID: 23293448 PMCID: PMC3532745 DOI: 10.4103/0971-6203.103602] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 07/09/2012] [Accepted: 10/08/2012] [Indexed: 12/13/2022] Open
Abstract
The evolution of radiotherapy has been ontogenetically linked to medical imaging. Over the years, major technological innovations have resulted in substantial improvements in radiotherapy planning, delivery, and verification. The increasing use of computed tomography imaging for target volume delineation coupled with availability of computer-controlled treatment planning and delivery systems have progressively led to conformation of radiation dose to the target tissues while sparing surrounding normal tissues. Recent advances in imaging technology coupled with improved treatment delivery allow near-simultaneous soft-tissue localization of tumor and repositioning of patient. The integration of various imaging modalities within the treatment room for guiding radiation delivery has vastly improved the management of geometric uncertainties in contemporary radiotherapy practice ushering in the paradigm of image-guided radiation therapy (IGRT). Image-guidance should be considered a necessary and natural corollary to high-precision radiotherapy that was long overdue. Image-guided radiation therapy not only provides accurate information on patient and tumor position on a quantitative scale, it also gives an opportunity to verify consistency of planned and actual treatment geometry including adaptation to daily variations resulting in improved dose delivery. The two main concerns with IGRT are resource-intensive nature of delivery and increasing dose from additional imaging. However, increasing the precision and accuracy of radiation delivery through IGRT is likely to reduce toxicity with potential for dose escalation and improved tumor control resulting in favourable therapeutic index. The radiation oncology community needs to leverage this technology to generate high-quality evidence to support widespread adoption of IGRT in contemporary radiotherapy practice.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India
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Müller AC, Lütjens J, Alber M, Eckert F, Bamberg M, Schilling D, Belka C, Ganswindt U. Toxicity and outcome of pelvic IMRT for node-positive prostate cancer. Strahlenther Onkol 2012; 188:982-9. [DOI: 10.1007/s00066-012-0169-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
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Pervez N, Krauze AV, Yee D, Parliament M, Mihai A, Ghosh S, Joseph K, Murtha A, Amanie J, Kamal M, Pearcey R. Quality-of-life outcomes in high-risk prostate cancer patients treated with helical tomotherapy in a hypofractionated radiation schedule with long-term androgen suppression. ACTA ACUST UNITED AC 2012; 19:e201-10. [PMID: 22670110 DOI: 10.3747/co.19.915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We examined the impact of hypofractionated radiation therapy and androgen suppression therapy (AST) on quality of life (QOL) in high-risk prostate cancer patients. METHODS Between March 2005 and March 2007, 60 patients with high-risk prostate cancer were enrolled in a prospective phase ii study. All patients received 68 Gy (2.72 Gy per fraction) to the prostate gland and 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes in 25 fractions over 5 weeks. Of the 60 patients, 58 received ast. The University of California-Los Angeles Prostate Cancer Index questionnaire was used to prospectively measure QOL at baseline (month 0) and at 1, 6, 12, 18, 24, 30, and 36 months after radiation treatment. The generalized estimating equation approach was used to compare the QOL scores at 1, 6, 12, 18, 24, 30, and 36 months with those at baseline. RESULTS We observed a significant decrease in QOL items related to bowel and sexual function. Several QOL items related to bowel function were significantly adversely affected at both 1 and 6 months, with improvement toward 6 months. Although decreased QOL scores persisted beyond the 6-month mark, they began to re-approach baseline at the 18- to 24-month mark. Most sexual function items were significantly adversely affected at both 1 and 6 months, but the effects were not considered to be a problem by most patients. A complete return to baseline was not observed for either bowel or sexual function. Urinary function items remained largely unaffected, with overall urinary function being the only item adversely affected at 6 months, but not at 1 month. Urinary function returned to baseline and remained unimpaired from 18 months onwards. CONCLUSIONS In our study population, who received hypofractionated radiation delivered using dynamic intensity-modulated radiotherapy with inclusion of the pelvic lymph nodes, and 2-3 years of ast prescription, QOL with respect to bowel and sexual function was significantly affected; QOL with respect to urinary function was largely unaffected. Our results are comparable to those in other published studies.
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Affiliation(s)
- N Pervez
- Radiation Oncology, Cross Cancer Institute, Edmonton, AB.
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35
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Vavassis P, Nguyen DHA, Bahary JP, Yassa M. Hypofractionated radiotherapy in prostate cancer. Expert Rev Anticancer Ther 2012; 12:965-72. [PMID: 22845411 DOI: 10.1586/era.12.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In regards to prostate cancer, the classic radiotherapy dose ranges from 70-80 Gy, administered in daily 2-Gy fractions. However, when taking into account the particular radiobiological model of prostate cancer cells, one realizes that there is a potential theoretical advantage to delivering a greater biological effective dose per treatment in a lower number of fractions. Both recent and older publications have attempted to explore this treatment option. This critical review comprehensively examines the current state of knowledge concerning hypofractionated radiotherapy in prostate cancer.
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Affiliation(s)
- Peter Vavassis
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada
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Geier M, Astner ST, Duma MN, Jacob V, Nieder C, Putzhammer J, Winkler C, Molls M, Geinitz H. Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy. Strahlenther Onkol 2012; 188:410-6. [PMID: 22367410 DOI: 10.1007/s00066-012-0081-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 01/20/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose-volume histogram data (DVH data). METHODS Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. The boost volume containing the prostate and 3 mm safety margins (5 mm craniocaudal) was treated as SIB to a total dose of 76 Gy (2.17 Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76 Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score. RESULTS SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38 Gy in all patients and the median volumes receiving at least 65 Gy (V65), 70 Gy (V70), and 75 Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade 4 toxicity was observed. Acute grade 3 toxicity was observed in 20% of patients involving nocturia only. Grade 2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data. CONCLUSION This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity.
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Affiliation(s)
- M Geier
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
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Quon H, Cheung PC, Loblaw DA, Morton G, Pang G, Szumacher E, Danjoux C, Choo R, Thomas G, Kiss A, Mamedov A, Deabreu A. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity. Int J Radiat Oncol Biol Phys 2012; 82:898-905. [DOI: 10.1016/j.ijrobp.2010.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 11/25/2022]
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Lock M, Best L, Wong E, Bauman G, D'Souza D, Venkatesan V, Sexton T, Ahmad B, Izawa J, Rodrigues G. A Phase II Trial of Arc-Based Hypofractionated Intensity-Modulated Radiotherapy in Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2011; 80:1306-15. [DOI: 10.1016/j.ijrobp.2010.04.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/08/2010] [Accepted: 04/07/2010] [Indexed: 11/17/2022]
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Davidson MTM, Blake SJ, Batchelar DL, Cheung P, Mah K. Assessing the role of volumetric modulated arc therapy (VMAT) relative to IMRT and helical tomotherapy in the management of localized, locally advanced, and post-operative prostate cancer. Int J Radiat Oncol Biol Phys 2011; 80:1550-8. [PMID: 21543164 DOI: 10.1016/j.ijrobp.2010.10.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/14/2010] [Accepted: 10/19/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE To quantify differences in treatment delivery efficiency and dosimetry between step-and-shoot intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) for prostate treatment. METHODS AND MATERIALS Twenty-five prostate cancer patients were selected retrospectively for this planning study. Treatment plans were generated for: prostate alone (n = 5), prostate + seminal vesicles (n = 5), prostate + seminal vesicles + pelvic lymph nodes (n = 5), prostate bed (n = 5), and prostate bed + pelvic lymph nodes (n = 5). Target coverage, dose homogeneity, integral dose, monitor units (MU), and sparing of organs at risk (OAR) were compared across techniques. Time required to deliver each plan was measured. RESULTS The dosimetric quality of IMRT, VMAT, and HT plans were comparable for target coverage (planning target volume V95%, clinical target volume V100% all >98.7%) and sparing of organs at risk (OAR) for all treatment groups. Although HT resulted in a slightly higher integral dose and mean doses to the OAR, it yielded a lower maximum dose to all OAR examined. VMAT resulted in reductions in treatment times over IMRT (mean = 75%) and HT (mean = 70%). VMAT required 15-38% fewer monitor units than IMRT over all treatment volumes, with the reduction per fraction ranging from 100-423 MU from the smallest to largest volumes. CONCLUSIONS VMAT improves efficiency of delivery for equivalent dosimetric quality as IMRT and HT across various prostate cancer treatment volumes in the intact and postoperative settings.
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Affiliation(s)
- Melanie T M Davidson
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Erratum to: Strahlentherapie und Onkologie, Volume 186 (No. 10) Guckenberger M, Ok S, Polat B, Sweeney RA, Flentje M. Toxicity after Intensity-Modulated, Image-Guided Radiotherapy for Prostate Cancer. Strahlenther Onkol 2010;186:535–43 (DOI 10.1007/s00066-010-2144-z). Strahlenther Onkol 2010. [DOI: 10.1007/s00066-010-7144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Toxicity after Intensity-Modulated, Image-Guided Radiotherapy for Prostate Cancer. Strahlenther Onkol 2010; 186:535-43. [DOI: 10.1007/s00066-010-2144-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
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Marcu LG. Altered fractionation in radiotherapy: from radiobiological rationale to therapeutic gain. Cancer Treat Rev 2010; 36:606-14. [PMID: 20494524 DOI: 10.1016/j.ctrv.2010.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 04/15/2010] [Accepted: 04/19/2010] [Indexed: 11/28/2022]
Abstract
The implementation of altered fractionation schedules in clinical practice came as a need to improve loco-regional control and survival in those cancer patient groups which did not respond satisfactorily to conventionally fractionated radiotherapy. The current review aims to present the radiobiological rationale behind various non-conventional treatment schedules including the encountered challenges, through a compilation of clinical studies/trials and their contribution towards therapeutic gain.
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