1
|
Hurwitz JC, Haas J, Mendez C, Sanchez A, Santos VF, Akerman M, Carpenter T, Tam M, Katz A, Corcoran A, Mahadevan A, Taneja SS, Lepor H, Lischalk JW. Stereotactic Body Radiation Therapy for the Curative Treatment of Prostate Cancer in Ultralarge (≥100 cc) Glands. Pract Radiat Oncol 2024; 14:241-251. [PMID: 37984713 DOI: 10.1016/j.prro.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Historically, toxicity concerns have existed in patients with large prostate glands treated with radiation therapy, particularly brachytherapy. There are questions whether this risk extends to stereotactic body radiation therapy (SBRT). In this retrospective review, we examine clinical outcomes of patients with prostate glands ≥100 cc treated curatively with SBRT. METHODS AND MATERIALS We retrospectively analyzed a large institutional database to identify patients with histologically confirmed localized prostate cancer in glands ≥100 cc, who were treated with definitive-robotic SBRT. Prostate volume (PV) was determined by treatment planning magnetic resonance imaging. Toxicity was measured using Common Terminology Criteria for Adverse Events, version 5.0. Many patients received the Expanded Prostate Cancer Index Composite Quality of Life questionnaires. Minimum follow-up (FU) was 2 years. RESULTS Seventy-one patients were identified with PV ≥100 cc. Most had grade group (GG) 1 or 2 (41% and 37%, respectively) disease. All patients received a total dose of 3500 to 3625 cGy in 5 fractions. A minority (27%) received androgen deprivation therapy (ADT), which was used for gland size downsizing in only 10% of cases. Nearly half (45%) were taking GU medications for urinary dysfunction before RT. Median toxicity FU was 4.0 years. Two-year rates of grade 1+ genitourinary (GU), grade 1+ gastrointestinal (GI), and grade 2+ GU toxicity were 43.5%, 15.9%, and 30.4%, respectively. Total grade 3 GU toxicities were very limited (2.8%). There were no grade 3 GI toxicities. On logistic regression analysis, pretreatment use of GU medications was significantly associated with increased rate of grade 2+ GU toxicity (odds ratio, 3.19; P = .024). Furthermore, PV (analyzed as a continuous variable) did not have an effect on toxicity, quality of life, or oncologic outcomes. CONCLUSIONS With early FU, ultra large prostate glands do not portend increased risk of high-grade toxicity after SBRT but likely carry an elevated risk of low-grade GU toxicity.
Collapse
Affiliation(s)
- Joshua C Hurwitz
- Department of Radiation Oncology, New York University Long Island School of Medicine, Mineola, New York
| | - Jonathan Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Christopher Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Astrid Sanchez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Vianca F Santos
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Meredith Akerman
- Division of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, New York, New York
| | - Todd Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Moses Tam
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Aaron Katz
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Anthony Corcoran
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital-Long Island, New York, New York
| | - Anand Mahadevan
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, New York
| | - Samir S Taneja
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, New York
| | - Herbert Lepor
- Department of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, New York
| | - Jonathan W Lischalk
- Department of Radiation Oncology, New York University Long Island School of Medicine, Mineola, New York.
| |
Collapse
|
2
|
Galienne M, Risbourg S, Lacornerie T, Taillez A, Lartigau E, Barthoulot M, Pasquier D. Extreme hypofractionated stereotactic radiotherapy for localized prostate Cancer: Efficacy and late urinary toxicity according to transurethral resection of the prostate history. Clin Transl Radiat Oncol 2024; 46:100779. [PMID: 38681137 PMCID: PMC11047194 DOI: 10.1016/j.ctro.2024.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background and purpose Extreme hypofractionated stereotactic body radiotherapy (SBRT) is a therapeutic alternative for localized low- or intermediate-risk prostate cancer. Despite the availability of several studies, the toxicity profile of SBRT has not been comprehensively described. This real-world evidence study assessed the efficacy and toxicities associated with this regimen, and potential prognosis factors for genitourinary toxicities. Materials and methods This retrospective study included 141 consecutive patients with localized prostatic adenocarcinoma treated with CyberKnife™ SBRT, as primary irradiation, at the Oscar Lambret Center between 2010 and 2020. The prescribed dose was 36.25 Gy in 5 fractions. Acute and late toxicities were graded according to the CTCAE (version 5.0). Biochemical recurrence-free survival (bRFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The cumulative incidence of biochemical recurrence (cBR) was estimated using the Kalbfleisch-Prentice method. Results Among the included patients, 13.5 % had a history of transurethral resection of the prostate (TURP). The median follow-up was 48 months. At 5 years, bRFS, cBR, and OS were 72 % (95 %CI: 61-81), 7 % (95 %CI: 3-14), and 82 % (95 %CI: 73-89), respectively. Twenty-nine patients experienced at least one late toxicity of grade ≥ 2; genitourinary (N = 29), including 3 cases of chronic hematuria, and/or gastrointestinal (N = 1). The cumulative incidence of late urinary toxicity of grade ≥ 2 was 20.6 % at 5 years (95 %CI: 13.9-28.1). Multivariate analysis revealed that a history of TURP was significantly associated with late urinary toxicity of grade ≥ 2, after adjusting for clinical target volume (Odds Ratio = 3.06; 95%CI: 1.05-8.86; P = 0.04). Conclusion Extreme hypofractionated SBRT is effective for localized prostate cancer with a low risk of late toxicity. A history of TURP is associated with a higher risk of late urinary toxicity. These findings may contribute to the optimal management of patients treated with this regimen, particularly those with a history of TURP.
Collapse
Affiliation(s)
- Maxime Galienne
- University of Picardie Jules Verne, Amiens, France
- Department of Radiotherapy, Amiens-Picardie University Hospital (South Site), Amiens, France
| | - Séverine Risbourg
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | | | | | - Eric Lartigau
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
| | - Maël Barthoulot
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | - David Pasquier
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
| |
Collapse
|
3
|
Westerhoff JM, Daamen LA, Christodouleas JP, Blezer ELA, Choudhury A, Westley RL, Erickson BA, Fuller CD, Hafeez S, van der Heide UA, Intven MPW, Kirby AM, Lalondrelle S, Minsky BD, Mook S, Nowee ME, Marijnen CAM, Orrling KM, Sahgal A, Schultz CJ, Faivre-Finn C, Tersteeg RJHA, Tree AC, Tseng CL, Schytte T, Silk DM, Eggert D, Luzzara M, van der Voort van Zyp JRN, Verkooijen HM, Hall WA. Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance-Guided Radiotherapy. JAMA Netw Open 2024; 7:e2410819. [PMID: 38691356 PMCID: PMC11063805 DOI: 10.1001/jamanetworkopen.2024.10819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/06/2024] [Indexed: 05/03/2024] Open
Abstract
Importance In 2018, the first online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) system using a 1.5-T MR-equipped linear accelerator (1.5-T MR-Linac) was clinically introduced. This system enables online adaptive radiotherapy, in which the radiation plan is adapted to size and shape changes of targets at each treatment session based on daily MR-visualized anatomy. Objective To evaluate safety, tolerability, and technical feasibility of treatment with a 1.5-T MR-Linac, specifically focusing on the subset of patients treated with an online adaptive strategy (ie, the adapt-to-shape [ATS] approach). Design, Setting, and Participants This cohort study included adults with solid tumors treated with a 1.5-T MR-Linac enrolled in Multi Outcome Evaluation for Radiation Therapy Using the MR-Linac (MOMENTUM), a large prospective international study of MRgRT between February 2019 and October 2021. Included were adults with solid tumors treated with a 1.5-T MR-Linac. Data were collected in Canada, Denmark, The Netherlands, United Kingdom, and the US. Data were analyzed in August 2023. Exposure All patients underwent MRgRT using a 1.5-T MR-Linac. Radiation prescriptions were consistent with institutional standards of care. Main Outcomes and Measures Patterns of care, tolerability, and technical feasibility (ie, treatment completed as planned). Acute high-grade radiotherapy-related toxic effects (ie, grade 3 or higher toxic effects according to Common Terminology Criteria for Adverse Events version 5.0) occurring within the first 3 months after treatment delivery. Results In total, 1793 treatment courses (1772 patients) were included (median patient age, 69 years [range, 22-91 years]; 1384 male [77.2%]). Among 41 different treatment sites, common sites were prostate (745 [41.6%]), metastatic lymph nodes (233 [13.0%]), and brain (189 [10.5%]). ATS was used in 1050 courses (58.6%). MRgRT was completed as planned in 1720 treatment courses (95.9%). Patient withdrawal caused 5 patients (0.3%) to discontinue treatment. The incidence of radiotherapy-related grade 3 toxic effects was 1.4% (95% CI, 0.9%-2.0%) in the entire cohort and 0.4% (95% CI, 0.1%-1.0%) in the subset of patients treated with ATS. There were no radiotherapy-related grade 4 or 5 toxic effects. Conclusions and Relevance In this cohort study of patients treated on a 1.5-T MR-Linac, radiotherapy was safe and well tolerated. Online adaptation of the radiation plan at each treatment session to account for anatomic variations was associated with a low risk of acute grade 3 toxic effects.
Collapse
Affiliation(s)
- Jasmijn M. Westerhoff
- University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands
| | - Lois A. Daamen
- University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands
| | - John P. Christodouleas
- Elekta AB, Stockholm, Sweden
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia
| | - Erwin L. A. Blezer
- University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands
| | - Ananya Choudhury
- Department of Clinical Oncology, The University of Manchester, Manchester, United Kingdom
| | - Rosalyne L. Westley
- The Royal Marsden NHS Foundation Trust, Radiation Oncology, London, United Kingdom
| | - Beth A. Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee
| | - Clifton D. Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Shaista Hafeez
- The Royal Marsden NHS Foundation Trust, Radiation Oncology, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Uulke A. van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Martijn P. W. Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna M. Kirby
- The Royal Marsden NHS Foundation Trust, Radiation Oncology, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Susan Lalondrelle
- The Royal Marsden NHS Foundation Trust, Radiation Oncology, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Bruce D. Minsky
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlies E. Nowee
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Arjun Sahgal
- Sunnybrook Health Sciences Centre-Odette Cancer Centre, Department of Radiation Oncology, Toronto, Ontario, Canada
| | | | - Corinne Faivre-Finn
- Department of Clinical Oncology, The University of Manchester, Manchester, United Kingdom
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | | | - Alison C. Tree
- The Royal Marsden NHS Foundation Trust, Radiation Oncology, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Chia-Lin Tseng
- Sunnybrook Health Sciences Centre-Odette Cancer Centre, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dustin M. Silk
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Helena M. Verkooijen
- University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
4
|
Kedves A, Akay M, Akay Y, Kisiván K, Glavák C, Miovecz Á, Schiffer Á, Kisander Z, Lőrincz A, Szőke A, Sánta B, Freihat O, Sipos D, Kovács Á, Lakosi F. Predictive value of magnetic resonance imaging diffusion parameters using artificial intelligence in low-and intermediate-risk prostate cancer patients treated with stereotactic ablative radiotherapy: A pilot study. Radiography (Lond) 2024; 30:986-994. [PMID: 38678978 DOI: 10.1016/j.radi.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION To investigate the predictive value of the pre-treatment diffusion parameters of diffusion-weighted magnetic resonance imaging (DW-MRI) using artificial intelligence (AI) for prostate-specific antigen (PSA) response in patients with low- and intermediate-risk prostate cancer (PCa) treated with stereotactic ablative radiotherapy (SABR). METHODS Retrospective evaluation was performed for 30 patients using pre-treatment multi-parametric MR image datasets between 2017 and 2021. MR-based mean- and minimum apparent diffusion coefficients (ADCmean, ADCmin) were calculated for the intraprostatic dominant lesion. Therapeutic response was assessed using PSA levels. Predictive performance was assessed by the receiver operating characteristic (ROC) analysis. Statistics performed with a significance level of p ≤ 0.05. RESULTS No biochemical relapse was detected after a median follow-up of twenty-three months (range: 3-50), with a median PSA of 0.01 ng/ml (range: 0.006-2.8) at the last examination. Significant differences were observed between the pre-treatment ADCmean, ADCmin parameters, and the group averages of patients with low and high 1-year-PSA measurements (p < 0.0001, p < 0.0001). In prediction, the random forest (RF) model outperformed the decision tree (DT) and support vector machine (SVM) models by yielding area under the curves (AUC), with 0.722, 0.685, and 0.5, respectively. CONCLUSION Our findings suggest that pre-treatment MR diffusion data may predict therapeutic response using the novel approach of machine learning in PCa patients treated with SABR. IMPLICATIONS FOR PRACTICE Clinicians shall measure and implement the evaluation of the suggested parameters (ADCmin, ADCmean) to provide the most accurate therapy for the patient.
Collapse
Affiliation(s)
- A Kedves
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - M Akay
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Y Akay
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - K Kisiván
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - C Glavák
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - Á Miovecz
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Á Schiffer
- Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - Z Kisander
- Department of Electrical Networks, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - A Lőrincz
- Institute of Information and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - A Szőke
- 3D Printing and Visualization Centre, Medical School, University of Pécs, Pécs, Hungary
| | - B Sánta
- Röntgenpraxis Dr. Thomas Trieb, Innsbruck, Austria
| | - O Freihat
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, UAE
| | - D Sipos
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Á Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Lakosi
- "Moritz Kaposi" Teaching Hospital, Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary; Institute of Diagnostics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
| |
Collapse
|
5
|
Zilli T, Franzese C, Guckenberger M, Giaj-Levra N, Mach N, Koutsouvelis N, Achard V, Mcdonald A, Alongi F, Scorsetti M, Constantin G, Bertaut A, Miralbell R. ONE SHOT - single shot radiotherapy for localized prostate cancer: 18-month results of a single arm, multicenter phase I/II trial. Radiother Oncol 2024; 194:110181. [PMID: 38403022 DOI: 10.1016/j.radonc.2024.110181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To assess in a prospective, multicenter, single-arm phase I/II study the early safety and efficacy profile of single fraction urethra-sparing stereotactic body radiotherapy (SBRT) for men with localized prostate cancer. MATERIAL AND METHODS Patients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone were recruited. A single-fraction of 19 Gy was delivered to the prostate, with 17 Gy dose-reduction to the urethra. Intrafraction motion was monitored using intraprostatic electromagnetic transponders with intra-fraction correction of displacements exceeding 3 mm. Genitourinary (GU), gastrointestinal (GI), and sexual toxicity during the first 18 months were evaluated using the CTCAE v4.0 grading scale. Quality of life was assessed using the International Prostate Symptom Score, the Expanded Prostate Cancer Index composite 26 score, and the International Index of Erectile Function score. RESULTS Among the 45 patients recruited in 5 centers between 2017 and 2022, 43 received the single fraction without protocol deviations, and 34 had a minimal follow-up of 18 months. The worst GU toxicity was observed at day-5 after SBRT (42.5 % and 20 % with grade 1 and 2, respectively), returning to baseline at week-12 and month-6 (<3% with grade 2), with a 12 % grade 2 flare at month 18. Gl toxicity was mild in the acute phase, with no grade ≥ 2 events (12 % grade 1 at month 6). Grade-3 proctitis was observed in one patient at month 12, with < 3 % grade 2 toxicity at month 18. Mean GU and GI bother scores showed a decline at day 5, a complete recovery at month 6, and a flare between month 12 and 18. Mean PSA dropped from 6.2 ng/ml to 1.2 ng/ml at month 18 and 0.7 ng/ml at month 24. After a median follow-up time of 26 months, 3 biochemical failures (7 %) were observed at month 17, 21 and 30. CONCLUSIONS In this multicenter phase I/II trial, we demonstrated that a 19 Gy single-fraction urethra-sparing SBRT is feasible and associated with an acceptable toxicity rate, mostly returning to the baseline at week-12 and with a symptoms flare between months 12 and 18. Longer follow-up is needed to assess the potential long-term adverse effects and the disease control efficacy.
Collapse
Affiliation(s)
- Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland; Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland; Facoltà Scienze Biomediche Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don-Calabria, Negrar, Italy
| | - Nicolas Mach
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Medical Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Verane Achard
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Andrew Mcdonald
- Radiation Oncology, University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don-Calabria, Negrar, Italy; University of Brescia, Faculty of Medicine, Brescia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Guillaume Constantin
- Methodology and biostatistics unit, Centre Georges François Leclerc, Dijon, France
| | - Aurelie Bertaut
- Methodology and biostatistics unit, Centre Georges François Leclerc, Dijon, France
| | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| |
Collapse
|
6
|
Fredman E, Icht O, Moore A, Bragilovski D, Kindler J, Golan S, Limon D. SABR-Dual: a phase II/III trial of two-fraction versus five-fraction stereotactic radiotherapy for localized low- and favorable intermediate-risk prostate cancer. BMC Cancer 2024; 24:431. [PMID: 38589860 PMCID: PMC11000374 DOI: 10.1186/s12885-024-12165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Dose-escalated radiotherapy is known to improve progression free survival in patients with localized prostate cancer, and recent advances have led to the standardization of ultrahypofractionated stereotactic ablative radiotherapy (SABR) delivered in just 5-fractions. Based on the known effectiveness of the accepted though invasive 2-fraction treatment method of high-dose-rate brachytherapy and given the ubiquity of prostate cancer, a further reduction in the number of treatments of external-beam SABR is possible. This study aims to evaluate the safety, efficacy, and non-inferiority of generalizable 2-fraction SABR compared to the current 5-fraction regimen. METHODS 502 patients will be enrolled on this phase II/III randomized control trial. Eligible patients will have previously untreated low- or favorable intermediate-risk adenocarcinoma of the prostate. Patients will be randomized between standard SABR of 40 Gy in 5 fractions given every-other-day and 27 Gy in 2 fractions at least two days apart but completing within seven days. MRI-based planning, radiopaque hydrogel spacer insertion, and fiducial marker placement are required, and SABR will be delivered on either a standard CT-guided linear accelerator or MR-LINAC. The primary endpoint will be freedom from disease progression, with additional secondary clinical, toxicity, and quality of life endpoints. DISCUSSION This study will be the largest prospective randomized trial, adequately powered to demonstrate non-inferiority, comparing 2-fraction SABR to standard 5-fraction SABR for localized prostate cancer. As the protocol does not obligate use of an MRI-LINAC or other adaptive technologies, results will be broadly generalizable to the wider community. TRIAL REGISTRATION This trial is registered on Clinicaltrials.gov: ClinicalTrials.gov Identifier: NCT06027892.
Collapse
Affiliation(s)
- Elisha Fredman
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel.
| | - Oded Icht
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| | - Assaf Moore
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| | - Dimitri Bragilovski
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| | - Jonathan Kindler
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| | - Shay Golan
- Department of Urology, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| | - Dror Limon
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, 39 Ze'ev Jabotinsky St, Petah Tikvah, Israel
| |
Collapse
|
7
|
Kolenbrander ID, Maspero M, Hendriksen AA, Pollitt R, van der Voort van Zyp JRN, van den Berg CAT, Pluim JPW, van Eijnatten MAJM. Deep-learning-based joint rigid and deformable contour propagation for magnetic resonance imaging-guided prostate radiotherapy. Med Phys 2024; 51:2367-2377. [PMID: 38408022 DOI: 10.1002/mp.17000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/05/2023] [Accepted: 02/04/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Deep learning-based unsupervised image registration has recently been proposed, promising fast registration. However, it has yet to be adopted in the online adaptive magnetic resonance imaging-guided radiotherapy (MRgRT) workflow. PURPOSE In this paper, we design an unsupervised, joint rigid, and deformable registration framework for contour propagation in MRgRT of prostate cancer. METHODS Three-dimensional pelvic T2-weighted MRIs of 143 prostate cancer patients undergoing radiotherapy were collected and divided into 110, 13, and 20 patients for training, validation, and testing. We designed a framework using convolutional neural networks (CNNs) for rigid and deformable registration. We selected the deformable registration network architecture among U-Net, MS-D Net, and LapIRN and optimized the training strategy (end-to-end vs. sequential). The framework was compared against an iterative baseline registration. We evaluated registration accuracy (the Dice and Hausdorff distance of the prostate and bladder contours), structural similarity index, and folding percentage to compare the methods. We also evaluated the framework's robustness to rigid and elastic deformations and bias field perturbations. RESULTS The end-to-end trained framework comprising LapIRN for the deformable component achieved the best median (interquartile range) prostate and bladder Dice of 0.89 (0.85-0.91) and 0.86 (0.80-0.91), respectively. This accuracy was comparable to the iterative baseline registration: prostate and bladder Dice of 0.91 (0.88-0.93) and 0.86 (0.80-0.92). The best models complete rigid and deformable registration in 0.002 (0.0005) and 0.74 (0.43) s (Nvidia Tesla V100-PCIe 32 GB GPU), respectively. We found that the models are robust to translations up to 52 mm, rotations up to 15∘ $^\circ$ , elastic deformations up to 40 mm, and bias fields. CONCLUSIONS Our proposed unsupervised, deep learning-based registration framework can perform rigid and deformable registration in less than a second with contour propagation accuracy comparable with iterative registration.
Collapse
Affiliation(s)
- Iris D Kolenbrander
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Matteo Maspero
- Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Allard A Hendriksen
- Computational Imaging, Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | - Ryan Pollitt
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Cornelis A T van den Berg
- Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josien P W Pluim
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maureen A J M van Eijnatten
- Medical Image Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
8
|
Kobayashi H, Eriguchi T, Tanaka T, Ogata T, Osaki N, Suzuki H, Kosugi M, Kumabe A, Sato K, Ishida M. An optimal method of hydrogel spacer insertion for stereotactic body radiation therapy of prostate cancer. Jpn J Radiol 2024; 42:406-414. [PMID: 37932639 DOI: 10.1007/s11604-023-01506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study aimed to explore an ideal method for hydrogel spacer insertion by analyzing the efficacy and safety of our originally developed apex expansion method. MATERIALS AND METHODS Overall, 100 patients with low- and intermediate-risk localized prostate cancer treated with stereotactic body radiation therapy were included. A hydrogel spacer was inserted in 64 and 36 patients using the conventional and apex expansion methods, respectively. For dosimetry, we trisected the rectum into the upper rectum, middle rectum, and lower rectum on the sagittal section of magnetic resonance imaging. We compared the dose to each part of the rectum between the two methods using dose-volume histograms. Genitourinary and gastrointestinal toxicity assessments were conducted until 3 months of follow-up. RESULTS The whole rectal dose in the apex expansion method group was lower than that in the conventional method group, which was significant in all dose regions (V5-V35). Similarly, in the apex expansion method group, the dose to the middle rectum was lower in the low- to high-dose region (V10-V35), and the dose to the lower rectum was lower in the middle- to high-dose region (V15-35). No Grade ≥ 3 toxicity or procedure-related complications were observed. Additionally, Grade 2 genitourinary and gastrointestinal toxicities during the treatment showed no significant differences between the two methods. CONCLUSION The apex expansion method may be safe and effective in achieving a more efficient rectal dose reduction by expanding the anterior perirectal space in the prostatic apex area.
Collapse
Affiliation(s)
- Hiroaki Kobayashi
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
- Department of Urology, National Defense Medical College Hospital, Tokorozawa, Japan.
| | - Takahisa Eriguchi
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
- Department of Radiation Oncology, Saitama Red Cross Hospital, Saitama, Japan
| | - Tomoki Tanaka
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takeru Ogata
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Noriko Osaki
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hideaki Suzuki
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Michio Kosugi
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Atsuhiro Kumabe
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kozo Sato
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Masaru Ishida
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| |
Collapse
|
9
|
Marvaso G, Corrao G, Repetti I, Lorubbio C, Bellerba F, Zaffaroni M, Vincini MG, Zerini D, Alessi S, Luzzago S, Mistretta FA, Fodor C, Cambria R, Cattani F, Ceci F, Musi G, De Cobelli O, Zilli T, Gandini S, Orecchia R, Petralia G, Jereczek-Fossa BA. Extreme-hypofractionated RT with concomitant boost to the DIL in PCa: a 5-year update on oncological and patient-reported outcomes for the phase II trial "GIVE ME FIVE". World J Urol 2024; 42:169. [PMID: 38492078 DOI: 10.1007/s00345-024-04876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/09/2024] [Indexed: 03/18/2024] Open
Abstract
AIM The present work reports updated oncological results and patients-reported outcomes at 5 years of phase II trial "Short-term high precision RT for early prostate cancer with SIB to the dominant intraprostatic lesion (DIL) for patients with early-stage PCa". METHODS Data from patients enrolled within AIRC IG-13218 (NCT01913717) trial were analyzed. Clinical and GU/GI toxicity assessment and PSA measurements were performed every 3 months for at least 2 years after RT end. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and IIEF-5. Patients' score changes were calculated at the end of RT and at 1, 12, and 60 months after RT. RESULTS A total of 65 patients were included. At a median follow-up of 5 years, OS resulted 86%. Biochemical and clinical progression-free survival at 5 years were 95%. The median PSA at baseline was 6.07 ng/ml, while at last follow-up resulted 0.25 ng/ml. IPSS showed a statistically significant variation in urinary function from baseline (p = 0.002), with the most relevant deterioration 1 month after RT, with a recovery toward baseline at 12 months (p ≤ 0.0001). A numerical improvement in QoL according to the EORTC QLQ-C30 has been reported although not statistically significant. No change in sexual activity was recorded after RT. CONCLUSIONS The study confirms that extreme hypofractionation with a DIL boost is safe and effective, with no severe effects on the QoL. The increasing dose to the DIL does not worsen the RT toxicity, thus opening the possibility of an even more escalated treatment.
Collapse
Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ilaria Repetti
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Raffaella Cambria
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Huck C, Achard V, Maitre P, Murthy V, Zilli T. Stereotactic body radiation therapy for prostate cancer after surgical treatment of prostatic obstruction: Impact on urinary morbidity and mitigation strategies. Clin Transl Radiat Oncol 2024; 45:100709. [PMID: 38179576 PMCID: PMC10765005 DOI: 10.1016/j.ctro.2023.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
In the past decade, stereotactic body radiation therapy (SBRT) has emerged as a valid treatment option for patients with localized prostate cancer. Despite the promising results of ultra-hypofractionation in terms of tolerance and disease control, the toxicity profile of SBRT for prostate cancer patients with a history of surgical treatment of benign prostate hyperplasia is still underreported. Here we present an overview of the available data on urinary morbidity for prostate cancer patients treated with SBRT after prior surgical treatments for benign prostate hyperplasia. Technical improvements useful to minimize toxicity and possible treatments for radiation-induced urethritis are discussed.
Collapse
Affiliation(s)
- Constance Huck
- Division of Radiation Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vérane Achard
- Division of Radiation Oncology, Fribourg Cantonal Hospital, Fribourg, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Priyamvada Maitre
- Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vedang Murthy
- Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Thomas Zilli
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| |
Collapse
|
11
|
Gomez-Iturriaga A, Büchser D, Lopez-Campos F, Maldonado X. Enhancing Androgen Deprivation Therapy (ADT) integration in prostate cancer: Insights for Stereotactic Body Radiotherapy (SBRT) and brachytherapy modalities. Clin Transl Radiat Oncol 2024; 45:100733. [PMID: 38322544 PMCID: PMC10844661 DOI: 10.1016/j.ctro.2024.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
The utilization of Androgen Deprivation Therapy (ADT) in conjunction with Stereotactic Body Radiotherapy (SBRT) and Brachytherapy (BT) boost in prostate cancer treatment is a subject of ongoing debate and evolving clinical practice. While contemporary trends lean towards underutilizing ADT with these modalities, existing evidence suggests that its omission may lead to potentially inferior oncologic outcomes. Recommendations for ADT use should be patient-centric, considering individual risk profiles and comorbidities, with a focus on achieving optimal oncologic outcomes while minimizing potential side effects. Ongoing clinical trials, such as PACE-C, SPA, SHIP 0804, and SHIP 36B, are anticipated to provide valuable insights into the optimal use and duration of ADT in both SBRT and BT settings. Until new evidence emerges, it is recommended to initiate ADT for unfavorable intermediate-risk and high-risk prostate cancer patients undergoing radiotherapy, with a minimum duration of 6 months for unfavorable intermediate-risk patients and at least 12 months for those with high-risk characteristics. The decision to incorporate ADT into these radiation therapy modalities should be individualized, acknowledging the unique needs of each patient and emphasizing a tailored approach to achieve the best possible oncologic outcomes.
Collapse
Affiliation(s)
- A. Gomez-Iturriaga
- Hospital Universitario Cruces/ Biobizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
- Department of Surgery and Radiology and Physical Medicine, University of the Basque Country UPV/EHU, Spain
| | - D. Büchser
- Hospital Universitario Cruces/ Biobizkaia Health Research Institute, Radiation Oncology, Barakaldo, Spain
- Department of Surgery and Radiology and Physical Medicine, University of the Basque Country UPV/EHU, Spain
| | - F. Lopez-Campos
- Hospital Universitario Ramon y Cajal, Radiation Oncology, Madrid, Spain
| | - X. Maldonado
- Hospital Vall d́Hebron, Radiation Oncology, Barcelona, Spain
| |
Collapse
|
12
|
Ehret F. [The MIRAGE Trial (MRI-guided stereotactic body radiotherapy for prostate cancer) - Precision at its best?]. Strahlenther Onkol 2024; 200:255-258. [PMID: 38182832 PMCID: PMC10876491 DOI: 10.1007/s00066-023-02194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
13
|
Patel TA, Jain B, Cho HL, Corti C, Vapiwala N, Chino F, Leeman JE, Dee EC. Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting. Clin Oncol (R Coll Radiol) 2024; 36:183-192. [PMID: 38184401 DOI: 10.1016/j.clon.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
AIMS For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT. MATERIALS AND METHODS Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted. RESULTS Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT. CONCLUSIONS In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.
Collapse
Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - B Jain
- Stanford School of Medicine, Stanford, CA, USA
| | - H L Cho
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C Corti
- Breast Oncology Program, Dana-Farber Cancer Centre, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - E C Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
14
|
Ma TM, Ladbury C, Tran M, Keiper TD, Andraos T, Gogineni E, Mohideen N, Siva S, Loblaw A, Tree AC, Cheung P, Kresl J, Collins S, Cao M, Kishan AU. Stereotactic Body Radiation Therapy: A Radiosurgery Society Guide to the Treatment of Localized Prostate Cancer Illustrated by Challenging Cases. Pract Radiat Oncol 2024; 14:e117-e131. [PMID: 37661040 DOI: 10.1016/j.prro.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
Traditionally, external beam radiotherapy (EBRT) for localized prostate cancer (PCa) involved lengthy courses with low daily doses. However, advancements in radiation delivery and a better understanding of prostate radiobiology have enabled the development of shorter courses of EBRT. Ultrahypofractionated radiotherapy, administering doses greater than 5 Gy per fraction, is now considered a standard of care regimen for localized PCa, particularly for intermediate-risk disease. Stereotactic body radiotherapy (SBRT), a specific type of ultrahypofractionated radiotherapy employing advanced planning, imaging, and treatment technology to deliver in five or fewer fractions, is gaining prominence as a cost-effective, convenient, and safe alternative to longer radiotherapy courses. It is crucial to address practical considerations related to patient selection, fractionation scheme, target delineation, and planning objectives. This is especially important in challenging clinical situations where clear evidence for guidance may be lacking. The Radiosurgery Society endorses this case-based guide with the aim of providing a practical framework for delivering SBRT to the intact prostate, exemplified by two case studies. The article will explore common SBRT dose/fractionation schemes and dose constraints for organs-at-risk. Additionally, it will review existing evidence and expert opinions on topics such as SBRT dose escalation, the use of rectal spacers, the role of androgen deprivation therapy in the context of SBRT, SBRT in special patient populations (e.g., high-risk disease, large prostate, high baseline urinary symptom burdens, and inflammatory bowel disease), as well as new imaging-guidance techniques like Magnetic Resonance Imaging for SBRT delivery.
Collapse
Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Maxwell Tran
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Timothy D Keiper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Therese Andraos
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Najeeb Mohideen
- Department of Radiation Oncology, Northwest Community Hospital, Arlington Heights, Illinois
| | - Shankar Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Patrick Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Kresl
- Phoenix CyberKnife and Radiation Oncology Center, Phoenix, Arizona
| | - Sean Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, D.C
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; Department of Urology, University of California Los Angeles, Los Angeles, California.
| |
Collapse
|
15
|
Berchtold J, Winkler C, Karner J, Groher M, Gaisberger C, Sedlmayer F, Wolf F. Noninvasive inter- and intrafractional motion control in ultrahypofractionated radiation therapy of prostate cancer using RayPilot HypoCath™-a substitute for gold fiducial-based IGRT? Strahlenther Onkol 2024; 200:195-201. [PMID: 37626226 PMCID: PMC10876743 DOI: 10.1007/s00066-023-02125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/11/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE In ultrahypofractionated radiation concepts, managing of intrafractional motion is mandatory because tighter margins are used and random errors resulting from prostate movement are not averaged out over a large number of fractions. Noninvasive live monitoring of prostate movement is a desirable asset for LINAC-based prostate stereotactic body radiation therapy (SBRT). METHODS We prospectively analyzed a novel live tracking device (RayPilot HypoCath™; Micropos Medical AB, Gothenburg, Sweden) where a transmitter is noninvasively positioned in the prostatic urethra using a Foley catheter in 12 patients undergoing ultrahypofractionated intensity-modulated radiation therapy (IMRT) of the prostate. Gold fiducials (Innovative Technology Völp, Innsbruck, Austria) were implanted to allow comparison of accuracy and positional stability of the HypoCath system and its ability to be used as a standalone IGRT method. Spatial stability of the transponder was assessed by analyzing transmitter movement in relation to gold markers (GM) in superimposed kV image pairs. Inter- and intrafractional prostate movement and the impact of its correction were analyzed. RESULTS A total of 64 fractions were analyzed. The average resulting deviation vector compared to the GM-based position was 1.2 mm and 0.7 mm for inter- and intrafractional motion, respectively. The mean intrafractional displacement vector of the prostate was 1.9 mm. Table readjustment due to exceeding the threshold of 3 mm was required in 18.8% of fractions. Repositioning reduced the time spent outside the 3‑mm margin from 7.9% to 3.8% of beam-on time. However, for individual patients, the time spent outside the 3‑mm margin was reduced from to 49% to 19%. CONCLUSION the HypoCath system allows highly accurate and robust intrafractional motion monitoring. In conjunction with cone beam CT (CBCT) for initial patient setup, it could be used as a standalone image-guided radiation therapy (IGRT) system.
Collapse
Affiliation(s)
- Johannes Berchtold
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Carmen Winkler
- Paracelsus Medical University of Salzburg, Stubergasse 21, 5020, Salzburg, Austria
| | - Josef Karner
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Groher
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Christoph Gaisberger
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Felix Sedlmayer
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Frank Wolf
- Dpt. of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| |
Collapse
|
16
|
Poon DMC, Yuan J, Wong OL, Yang B, Tse MY, Lau KK, Chiu ST, Chiu PKF, Ng CF, Chui KL, Kwong YM, Ma WK, Cheung KY, Chiu G, Yu SK. One-year clinical outcomes of MR-guided stereotactic body radiation therapy with rectal spacer for patients with localized prostate cancer. World J Urol 2024; 42:97. [PMID: 38393414 PMCID: PMC10891188 DOI: 10.1007/s00345-024-04784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND PURPOSE This prospective study aimed to investigate adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (MRgSBRT) with rectal spacer for localized prostate cancer (PC) and report 1-year clinical outcomes. MATERIALS AND METHODS Thirty-four consecutive patients with low- to high-risk localized PC that underwent 5-fraction adaptive MRgSBRT with rectal spacer were enrolled. The dosimetric comparison was performed on a risk- and age-matched cohort treated with MRgSBRT but without a spacer at a similar timepoint. Clinician-reported outcomes were based on Common Terminology Criteria for Adverse Events. Patient-reported outcomes were based on the Expanded Prostate Cancer Index Composite (EPIC) questionnaire at baseline, acute (1-3 months), subacute (4-12 months), and late (> 12 months) phases. RESULTS The median follow-up was 390 days (range 28-823) and the median age was 70 years (range 58-82). One patient experienced rectal bleeding soon after spacer insertion that subsided before MRgSBRT. The median distance between the midline of the prostate midgland and the rectum after spacer insertion measured 7.8 mm (range 2.6-15.3), and the median length of the spacer was 45.9 mm (range 16.8-62.9) based on T2-weighted MR imaging. The use of spacer resulted in significant improvements in target coverage (V100% > 95% = 98.6% [range 93.4-99.8] for spacer vs. 97.8% [range 69.6-99.7] for non-spacer) and rectal sparing (V95% < 3 cc = 0.7 cc [range 0-4.6] for spacer vs. 4.9 cc [range 0-12.5] for non-spacer). Nine patients (26.5%) experienced grade 1 gastrointestinal toxicities, and no grade ≥ 2 toxicities were observed. During the 1-year follow-up period, EPIC scores for the bowel domain remained stable and were the highest among all other domains. CONCLUSIONS MRgSBRT with rectal spacer for localized PC showed exceptional tolerability with minimal gastrointestinal toxicities and satisfactory patient-reported outcomes. Improvements in dosimetry, rectal sparing, and target coverage were achieved with a rectal spacer. Randomized trials are warranted for further validation.
Collapse
Affiliation(s)
- Darren M C Poon
- Comprehensive Oncology Centre, 11/F, HKSH Eastern Building, 3 Tung Wong Roade Road, Shau Kei Wan, Hong Kong SAR.
| | - Jing Yuan
- Research Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Oi Lei Wong
- Research Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Bin Yang
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Mei Yan Tse
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Ka Ki Lau
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Sin Ting Chiu
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Chi Fai Ng
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Ka Lun Chui
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Yiu Ming Kwong
- Urology Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Wai Kit Ma
- Hong Kong Urology Clinic, Hong Kong, Hong Kong SAR
| | - Kin Yin Cheung
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - George Chiu
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| | - Siu Ki Yu
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR
| |
Collapse
|
17
|
Naim A, Lahlou Z, Kaanouch O, Heddat A, Mansouri S. Revolutionizing localized prostate cancer treatment: Stereotactic radiotherapy "Moroccan experience". Arch Ital Urol Androl 2024; 96:12104. [PMID: 38363238 DOI: 10.4081/aiua.2024.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/23/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Prostate cancer is the most common urological cancer, and its incidence is increasing. Radical prostatectomy and radiotherapy are theprimary treatments for localized forms. Stereotactic Body RadioTherapy (SBRT), a new and innovative therapy, has been validated for some cancer localizations but not yet for localized prostate cancer. Our study aims to report the efficacy and tolerance results of SBRT for localized prostate cancer. MATERIALS AND METHODS This is a retrospective study of 27 patients with localized prostate cancer (CaP) who were treated with SBRT in our department from 2017 to 2021 using transponders for tumor tracking. The dose was 36.25 Gy delivered in five fractions of 7.25 Gy. The delineation and doses of organs at risk were determined based on the recommendations of the SFRO and the TG101 report of medical physics. All patients were treated using a latest-generation linear accelerator (True Beam STXÒ). RESULTS Acute toxicities were observed in 33.3% of cases, with 22.2% grade 1 or 2 genitourinary (GU) and no grade 3 while 11.1% gastrointestinal (GI) toxicities were reported as grade 1-2 (7.4%) and one case grade 3 (3.7%). Late grade 1 or 2 GU toxicity was observed in 14.84% of cases, with no reports of late GI toxicity. After a 26-month follow-up period, the biochemical failure-free survival rate was 92.6%. CONCLUSIONS The results of our study are consistent with the existing literature and support the safety and effectiveness of SBRT as a treatment option for localized prostate cancer (CaP). In the United States, both ASTRO and the NCCN recognize SBRT as a valid treatment option for localized CaP. Ongoing phase III trials are being conducted to further substantiate these long-term results and to establish SBRT as the future standard of care for localized CaP.
Collapse
Affiliation(s)
- Asmâa Naim
- Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca; Research Unit, Mohammed VI Center for Research and Innovation, Rabat; Radiotherapy Department of Casablanca Cancer Center, University International Hospital Cheikh Khalifa, Casablanca.
| | - Zineb Lahlou
- Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca; Research Unit, Mohammed VI Center for Research and Innovation, Rabat.
| | - Othmane Kaanouch
- Radiotherapy Department of Casablanca Cancer Center, University International Hospital Cheikh Khalifa, Casablanca; Hassan First University of Settat, High Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat.
| | - Abdelajalil Heddat
- Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca; Research Unit, Mohammed VI Center for Research and Innovation, Rabat; Urology Department, University International Hospital Cheikh Khalifa, Casablanca.
| | | |
Collapse
|
18
|
Wang Y, Butaney M, Wilder S, Ghani K, Rogers CG, Lane BR. The evolving management of small renal masses. Nat Rev Urol 2024:10.1038/s41585-023-00848-6. [PMID: 38365895 DOI: 10.1038/s41585-023-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
Collapse
Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI, USA.
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| |
Collapse
|
19
|
De Bari B, Guibert G, Slimani S, Bashar Y, Risse T, Guisolan N, Trouillot J, Abel J, Weber P. Electromagnetic Transmitter-Based Prostate Gating for Dose-Escalated Linac-Based Stereotactic Body Radiation Therapy: An Evaluation of Intrafraction Motion. Curr Oncol 2024; 31:962-974. [PMID: 38392066 PMCID: PMC10887766 DOI: 10.3390/curroncol31020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Stereotactic Body Radiotherapy (SBRT) is as a standard treatment for prostate cancer (PCa). Tight margins and high dose gradients are needed, and the precise localization of the target is mandatory. Our retrospective study reports our experience regarding the evaluation of intrafraction prostate motion during LINAC-based SBRT evaluated with a novel electromagnetic (EM) tracking device. This device consists of an integrated Foley catheter with a transmitter connected to a receiver placed on the treatment table. METHODS We analyzed 31 patients who received LINAC-based SBRT using flattening filter-free (FFF) volumetric modulated arc therapy (VMAT). The patients were scheduled to be treated for primary (n = 27) or an intraprostatic recurrent PCa (n = 4). A simulation CT scan was conducted while the patients had a filled bladder (100-150 cc) and an empty rectum, and an EM tracking device was used. The same rectal and bladder conditions were employed during the treatment. The patients received 36.25 Gy delivered over five consecutive fractions on the whole prostate and 40 Gy on the nodule(s) visible via MRI, both delivered with a Simultaneous Integrated Boost approach. The CTV-to-PTV margin was 2 mm for both the identified treatment volumes. Patient positioning was verified with XVI ConeBeam-CT (CBCT) matching before each fraction. When the signals exceeded a 2 mm threshold in any of the three spatial directions, the treatment was manually interrupted. A new XVI CBCT was performed if this offset lasted >20 s. RESULTS We analyzed data about 155 fractions. The median and mean treatment times, calculated per fraction, were 10 m31 s and 12 m44 s (range: 6 m36 s-65 m28 s), and 95% of the fractions were delivered with a maximum time of 27 m48 s. During treatment delivery, the mean and median number of XVI CBCT operations realized during the treatment were 2 and 1 (range: 0-11). During the treatment, the prostate was outside the CTV-to-PTV margin (2 mm), thus necessitating the stoppage of the delivery +/- a reacquisition of the XVI CBCT for 11.2%, 8.9%, and 3.9% of the delivery time in the vertical, longitudinal, and lateral direction, respectively. CONCLUSIONS We easily integrated an EM-transmitter-based gating for prostate LINAC-based SBRT into our normal daily workflow. Using this system, a 2 mm CTV-to-PTV margin could be safely applied. A small number of fractions showed a motion exceeding the predefined 2 mm threshold, which would have otherwise gone undetected without intrafraction motion management.
Collapse
Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Geoffroy Guibert
- Medical Physics Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland
| | - Sabrine Slimani
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Yanes Bashar
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Terence Risse
- Medical Physics Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland
| | - Nicole Guisolan
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Juliane Trouillot
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Jonathan Abel
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland (N.G.)
| | - Patrick Weber
- Medical Physics Department, Réseau Hospitalier Neuchâtelois, CH-2300 La Chaux-de-Fond, Switzerland
| |
Collapse
|
20
|
Lischalk JW, Akerman M, Repka MC, Sanchez A, Mendez C, Santos VF, Carpenter T, Wise D, Corcoran A, Lepor H, Katz A, Haas JA. High-risk prostate cancer treated with a stereotactic body radiation therapy boost following pelvic nodal irradiation. Front Oncol 2024; 14:1325200. [PMID: 38410097 PMCID: PMC10895712 DOI: 10.3389/fonc.2024.1325200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose Modern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer. Methods and materials A large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan-Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes. Results A total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir. Conclusion Utilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.
Collapse
Affiliation(s)
- Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Meredith Akerman
- Division of Health Services Research, New York University Long Island School of Medicine, New York University Langone Health, Mineola, NY, United States
| | - Michael C. Repka
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Astrid Sanchez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Christopher Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Vianca F. Santos
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - David Wise
- Department of Medical Oncology, Perlmutter Cancer Center at New York University Langone Health - Manhattan, New York, NY, United States
| | - Anthony Corcoran
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Herbert Lepor
- Department of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, NY, United States
| | - Aaron Katz
- Department of Urology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| | - Jonathan A. Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, New York, NY, United States
| |
Collapse
|
21
|
Hu HP, Anagnostopoulos G, Gouran-Savadkoohi M, Dayes I, Ishkanian A, Hallock A, Lukka H, Quan K, Schnarr K, Cuthbert D, Goldberg M, Chang YM, Tsakiridis T. Disease control outcomes of stereotactic body radiation therapy or moderate hypo-fractionation for prostate cancer: Real-world experience at two Canadian centers. Prostate 2024; 84:193-202. [PMID: 37880911 DOI: 10.1002/pros.24638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Advantages of using stereotactic body radiation therapy to treat prostate cancer include short treatment times, decreased costs, and limited toxicity. Randomized trial outcomes comparing 5-fraction stereotactic body radiation therapy to conventionally fractionated radiotherapy or hypo-fractionated radiation therapy are pending. OBJECTIVE We report the 10-year experience with 5-fraction stereotactic body radiation therapy and hypo-fractionated radiation therapy at two Canadian centers. MATERIAL AND METHODS Patients with low- or intermediate-risk prostate cancer treated with stereotactic body radiation therapy alone (35-40 Gy in 5 fractions) or hypo-fractionated radiation therapy alone (60-62 Gy in 20 fractions) in the period of July 2010 and June 2020. The biochemical relapse-free survival, PSA nadir, interval time to PSA nadir, time to biochemical recurrence (2 ng/ml above PSA nadir) and overall survival were reviewed. Outcomes between treatment groups were compared after propensity-matching by patient baseline characteristics. Kaplan-Meier curves were used to assess biochemical relapse-free survival and overall survival. RESULTS We identified 205 and 513 patients with low or intermediate-risk prostate cancer who were treated with stereotactic body radiation therapy or hypo-fractionation, respectively. Intermediate-risk category composed 81% and 95% of the stereotactic body radiation therapy and hypo-fractionated radiation therapy cohorts, respectively. After a median follow up of 58.6 months for the stereotactic body radiation therapy cohort and 45.0 months for the hypo-fractionated cohort, biochemical relapse-free survival and overall survival were not significantly different between treatment groups. The 5-year biochemical relapse-free survival rates were 92.1% and 93.6% and overall survival rates were 96.4% and 95.0% for the stereotactic body radiation therapy and hypo-fractionated cohorts, respectively, after propensity-matching. Stereotactic body radiation therapy resulted in a significantly lower PSA nadir (0.18 ng/ml) compared to hypo-fractionated radiation therapy (0.48 ng/ml) in patients with low-risk prostate cancer. Mean time to biochemical recurrence was not different between treatment groups. CONCLUSIONS Stereotactic body radiation therapy is an effective treatment option for low and intermediate-risk prostate cancer with encouraging biochemical relapse-free survival and overall survival rates comparable with hypo-fractionated radiation therapy.
Collapse
Affiliation(s)
- Hsin-Pei Hu
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | | | | | - Ian Dayes
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Adrian Ishkanian
- Department of Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| | - Abhirami Hallock
- Department of Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| | - Himanshu Lukka
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Kimmen Quan
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Kara Schnarr
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - David Cuthbert
- Department of Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| | - Mira Goldberg
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Yi Meng Chang
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Theodoros Tsakiridis
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
- Department of Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| |
Collapse
|
22
|
Slama Y, Baumont G, Arcambal A, Begue M, Maillot O, Sayah R, Castanet R, Caboche R, Liberati P, Slaoui H, Bouaziz M, Borson O, Nguyen NP, Dutheil F. Retrospective study on the toxicity induced by stereotactic body radiotherapy: overview of the reunion experience on prostate cancer in elderly patients. Front Oncol 2024; 14:1302001. [PMID: 38361775 PMCID: PMC10867626 DOI: 10.3389/fonc.2024.1302001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Prostate cancer is the fourth most commonly diagnosed cancer among men worldwide. Various tools are used to manage disease such as conventional radiotherapy. However, it has been demonstrated that large prostate volumes were often associated with higher rates of genitourinary and gastrointestinal toxicities. Currently, the improvements in radiotherapy technology have led to the development of stereotactic body radiotherapy, which delivers higher and much more accurate radiation doses. In order to complete literature data about short-term outcome and short-term toxic effects of stereotactic body radiotherapy, we aimed to share our experience about gastrointestinal and genitourinary toxicities associated with stereotactic body radiotherapy in prostate cancer in patients over 70 years old. Methods We retrospectively reviewed the medical records of elderly patients with prostate cancer treated between 2021 and 2022. The elderly patients were treated with a non-coplanar robotic stereotactic body radiotherapy platform using real-time tracking of implanted fiducials. The prostate, with or without part of the seminal vesicles, was treated with a total dose of 36.25 Gy delivered in five fractions, each fraction being administered every other day. Results We analyzed a total of 80 elderly patients, comprising 38 low-, 37 intermediate- and 5 high-risk patients. The median follow-up duration was 12 months. We did not observe biochemical/clinical recurrence, distant metastasis, or death. Grade 2 acute genitourinary toxicity was observed in 9 patients (11.25%) and Grade 2 acute gastrointestinal toxicity in 4 patients (5.0%). We did not observe any grade 3 or more acute or late toxicities. Conclusion Over the follow-up period, we noted a low frequency of gastrointestinal and genitourinary toxicities induced by stereotactic body radiotherapy in the context of prostate cancer in elderly patients. Therefore, stereotactic body radiotherapy seems to represent a promising treatment option for elderly patients, with acceptable acute toxicity.
Collapse
Affiliation(s)
- Youssef Slama
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Gilles Baumont
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Angelique Arcambal
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Mickael Begue
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Olivier Maillot
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Rima Sayah
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Romain Castanet
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Raoul Caboche
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Pedro Liberati
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Hakim Slaoui
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Medi Bouaziz
- Clinique Sainte-Clotilde, Department of Urology, Groupe Clinifutur, Saint-Denis, La Réunion, France
| | - Olivier Borson
- Cabinet de Radiologie Les Alizés, Saint-Denis, La Réunion, France
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, College of Medicine, Washington, DC, United States
| | - Fabien Dutheil
- Clinique Sainte-Clotilde, Department of Radiotherapy, Groupe Clinifutur, Saint-Denis, La Réunion, France
| |
Collapse
|
23
|
Mathier E, Althaus A, Zwahlen D, Lustenberger J, Zamboglou C, De Bari B, Aebersold DM, Guckenberger M, Zilli T, Shelan M. HypoFocal SRT Trial: Ultra-hypofractionated focal salvage radiotherapy for isolated prostate bed recurrence after radical prostatectomy; single-arm phase II study; clinical trial protocol. BMJ Open 2024; 14:e075846. [PMID: 38296279 PMCID: PMC10828884 DOI: 10.1136/bmjopen-2023-075846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Despite radical prostatectomy (RP) and radiotherapy (RT) being established treatments for localised prostate cancer, a significant number of patients experience recurrent disease. While conventionally fractionated RT is still being used as a standard treatment in the postoperative setting, ultra-hypofractionated RT has emerged as a viable option with encouraging results in patients with localised disease in the primary setting. In addition, recent technological advancements in RT delivery and precise definition of isolated macroscopic recurrence within the prostate bed using prostate-specific membrane antigen-positron emission tomography (PSMA-PET) and multiparametric MRI (mpMRI) allow the exploration of ultra-hypofractionated schedules in the salvage setting using five fractions. METHODS AND ANALYSIS In this single-arm prospective phase II multicentre trial, 36 patients with node-negative prostate adenocarcinoma treated with RP at least 6 months before trial registration, tumour stage pT2a-3b, R0-1, pN0 or cN0 according to the UICC TNM 2009 and evidence of measurable local recurrence within the prostate bed detected by PSMA PET/CT and mpMRI within the last 3 months, will be included. The patients will undergo focal ultra-hypofractionated salvage RT with 34 Gy in five fractions every other day to the site of local recurrence in combination with 6 months of androgen deprivation therapy. The primary outcome of this study is biochemical relapse-free survival at 2 years. Secondary outcomes include acute side effects (until 90 days after the end of RT) of grade 3 or higher based on Common Terminology Criteria for Adverse Events V.5, progression-free survival, metastasis-free survival, late side effects and the quality of life (based on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, QLQ-PR25). ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Commission of the Canton of Bern (KEK-BE 2022-01026). Academic dissemination will occur through publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05746806.
Collapse
Affiliation(s)
- Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Althaus
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Jens Lustenberger
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | - Berardino De Bari
- Department of Radiation Oncology, Réseau hospitalier neuchâtelois, Neuchatel, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Zilli
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
24
|
Starling MTM, Thibodeau S, de Sousa CFPM, Restini FCF, Viani GA, Gouveia AG, Mendez LC, Marta GN, Moraes FY. Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings. Cancers (Basel) 2024; 16:539. [PMID: 38339290 PMCID: PMC10854666 DOI: 10.3390/cancers16030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.
Collapse
Affiliation(s)
| | - Stephane Thibodeau
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | | | | - Gustavo A. Viani
- Department of Medical Imagings, Ribeirão Preto Medical School, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto 14049-900, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Andre G. Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
- Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Lucas C. Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sirio Libanês, Sao Paulo 01308-050, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| |
Collapse
|
25
|
Antony F, Dubey A, Skrabek P, Tsang LF, Lambert P, Bybel B, Ahmed N. Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond. Curr Oncol 2024; 31:383-393. [PMID: 38248110 PMCID: PMC10814841 DOI: 10.3390/curroncol31010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20 and 50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic. METHODS Patients (n = 36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS). RESULTS The median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and nine (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and fifteen (42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax and nine (25%) to the abdomen or pelvis. The total dose ranged from 18 to 42.5 Gy in 6-17 fractions/2.67-5 Gy per fraction. The median dose in 2 Gy fractions for an alpha/beta (α/β) ratio of 10 amounted to 39 Gy (SD ± 13.86) and 43.6 Gy (SD ± 12) for an α/β of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. The two-year FFLP was 76% (95% CI: 34-93%) for the entire cohort and 100, 87 (95% CI: 56.4-96.5%), and 42% (95% CI: 1.1-84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI: 59.9-90.5%) and 100, 66.1 (95% CI: 36.4-84.4%), and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity. CONCLUSIONS HFRT in HM provides excellent local control to be validated in a larger prospective study.
Collapse
Affiliation(s)
- Febin Antony
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (F.A.)
| | - Arbind Dubey
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (F.A.)
| | - Pamela Skrabek
- Section of Medical Oncology/Hematology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A TR9, Canada;
| | - Lung Fung Tsang
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (L.F.T.)
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (L.F.T.)
| | - Bohdan Bybel
- Section of Nuclear Medicine, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Naseer Ahmed
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (F.A.)
- CancerCare Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada
| |
Collapse
|
26
|
Xiong Y, Rabe M, Rippke C, Kawula M, Nierer L, Klüter S, Belka C, Niyazi M, Hörner-Rieber J, Corradini S, Landry G, Kurz C. Impact of daily plan adaptation on accumulated doses in ultra-hypofractionated magnetic resonance-guided radiation therapy of prostate cancer. Phys Imaging Radiat Oncol 2024; 29:100562. [PMID: 38463219 PMCID: PMC10924058 DOI: 10.1016/j.phro.2024.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Background and purpose Ultra-hypofractionated online adaptive magnetic resonance-guided radiotherapy (MRgRT) is promising for prostate cancer. However, the impact of online adaptation on target coverage and organ-at-risk (OAR) sparing at the level of accumulated dose has not yet been reported. Using deformable image registration (DIR)-based accumulation, we compared the delivered adapted dose with the simulated non-adapted dose. Materials and methods Twenty-three prostate cancer patients treated at two clinics with 0.35 T magnetic resonance-guided linear accelerator (MR-linac) following the same treatment protocol (5 × 7.5 Gy with urethral sparing and daily adaptation) were included. The fraction MR images were deformably registered to the planning MR image. Both non-adapted and adapted fraction doses were accumulated with the corresponding vector fields. Two DIR approaches were implemented. PTV* (planning target volume minus urethra+2mm) D95%, CTV* (clinical target volume minus urethra) D98%, and OARs (urethra+2mm, bladder, and rectum) D0.2cc, were evaluated. Statistical significance was inferred from a two-tailed Wilcoxon signed-rank test (p < 0.05). Results Normalized to the baseline, the accumulated PTV* D95% increased significantly by 2.7 % ([1.5, 4.3]%) through adaptation, and the CTV* D98% by 1.2 % ([0.1, 1.7]%). For the OARs after adaptation, accumulated bladder D0.2cc decreased by 0.4 % ([-1.2, 0.4]%), urethra+2mmD0.2cc by 0.8 % ([-1.6, -0.1]%), while rectum D0.2cc increased by 2.6 % ([1.2, 4.9]%). For all patients, rectum D0.2cc was still below the clinical constraint. Results of both DIR approaches differed on average by less than 0.2 %. Conclusions Online adaptation in MRgRT improved target coverage and OARs sparing at the level of accumulated dose.
Collapse
Affiliation(s)
- Yuqing Xiong
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Kawula
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, National Center for Radiation Oncology, Heidelberg, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich, a Partnership between DKFZ and LMU University Hospital Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, National Center for Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
27
|
Menne Guricová K, Groen V, Pos F, Monninkhof E, Elias SG, Haustermans K, Smeenk RJ, van der Voort van Zyp J, Draulans C, Isebaert S, van Houdt PJ, Kerkmeijer LGW, van der Heide UA. Risk Modeling for Individualization of the FLAME Focal Boost Approach in External Beam Radiation Therapy for Patients With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2024; 118:66-73. [PMID: 37725026 DOI: 10.1016/j.ijrobp.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The FLAME trial (NCT01168479) showed that isotoxic focal boosting to the intraprostatic lesion(s) in patients with intermediate- and high-risk prostate cancer improves 5-year disease-free survival (DFS). Although the near-minimum dose to the gross tumor volume (D98%) was associated with improved outcomes, a closer look suggested that this might not be the same for all patients. Therefore, we investigated whether risk factors that are associated with a benefit of focal boosting can be identified. METHODS AND MATERIALS We described the distribution of clinical characteristics and the number of high-risk factors with respect to the D98% in 526 FLAME trial patients. We used penalized Cox regression to develop a prediction model. To investigate a potential benefit in patient subgroups, we compared the model-based predictions of 5-year DFS assuming standard whole-gland radiation therapy of 77 Gy to the predictions assuming an additional focal boost with D98% of 95 Gy. RESULTS Patients with high-risk factors were well represented in the group of 120 patients that received D98% > 85 Gy and showed fewer recurrences compared with the group that received 77 Gy. Applying the model simulating a standard dose of 77 Gy, we predicted a high DFS for grade group (GG) 1 patients, whereas patients with high-risk characteristics appeared to show a low DFS. All risk groups showed a high level of DFS when simulating D98% of 95 Gy. CONCLUSIONS Our results suggest that GG 1 patients already show a low level of failure at a standard dose of 77 Gy, limiting the additional benefit of focal boosting. In contrast, patients with high-risk characteristics, especially GG 4 or 5, show a low 5-year DFS, while focal boosting might improve this substantially. This suggests that reaching a high focal boost dose may be particularly beneficial for these patients.
Collapse
Affiliation(s)
- Karolína Menne Guricová
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Veerle Groen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Evelyn Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.
| |
Collapse
|
28
|
Pham J, Neilsen BK, Liu H, Cao M, Yang Y, Sheng K, Ma TM, Kishan AU, Ruan D. Dosimetric predictors for genitourinary toxicity in MR-guided stereotactic body radiation therapy (SBRT): Substructure with fraction-wise analysis. Med Phys 2024; 51:612-621. [PMID: 38055353 DOI: 10.1002/mp.16878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND MR-guided radiation therapy (MRgRT) systems provide superior soft tissue contrast than x-ray based systems and can acquire real-time cine for treatment gating. These features allow treatment planning margins to be reduced, allowing for improved critical structure sparing and reduced treatment toxicity. Despite this improvement, genitourinary (GU) toxicity continues to affect many patients. PURPOSE (1) To identify dosimetric predictors, potentially in combination with clinical parameters, of GU toxicity following SBRT by leveraging MRgRT to accurately monitor daily dose, beyond predicted dose calculated during planning. (2) Improve awareness of toxicity-sensitive bladder substructures, specifically the trigone and urethra. METHODS Sixty-nine prostate cancer patients (NCT04384770 clinical trial) were treated on a ViewRay MRIdian MRgRT system, with 40 Gy prescribed to 95% of the PTV in over five fractions. Overall, 17 (24.6%) prostate patients reported acute grade 2 GU toxicity. The CTV, PTV, bladder, bladder wall, trigone, urethra, rectum, and rectal wall were contoured on the planning and daily treatment MRIs. Planning and daily treatment DVHs (0.1 Gy increments), organ doses (min, max, mean), and organ volumes were recorded. Daily dose was estimated by transferring the planning dose distributions to the daily MRI based on the daily setup alignment. Patients were partitioned into a training (55) and testing set (14). Dose features were pre-filtered using a t-test followed by maximum relevance minimum redundancy (MRMR) algorithm. Logistic regression was investigated with regularization to select dosimetric predictors. Specifically, two approaches: time-group least absolute shrinkage and selection (LASSO), and interactive grouped greedy algorithm (IGA) were investigated. Shared features across the planning and five treatment fractions were grouped to encourage consistency and stability. The conventional flat non-temporally grouped LASSO was also evaluated to provide a solid benchmark. After feature selection, a final logistic regression model was trained. Dosimetric regression models were compared to a clinical regression model with only clinical parameters (age, baseline IPSS, prostate gland size, ADT usage, etc.) and a hybrid model, combining the best performing dosimetric features with the clinical parameters, was evaluated. Final model performance was evaluated on the testing set using accuracy, sensitivity, and specificity determined by the optimal threshold of the training set. RESULTS IGA had the best testing performance with an accuracy/sensitivity/specificity of 0.79/0.67/0.82, selecting 12 groups covering the bladder (V19.8 Gy, V20.5 Gy), bladder wall (19.7 Gy), trigone (15.9, 18.2, 43.3 Gy), urethra (V41.4 Gy, V41.7 Gy), CTV (V41.9 Gy), rectum (V8.5 Gy), and rectal wall (1.2, 44.1 Gy) dose features. Absolute bladder V19.8 Gy and V20.5 Gy were the most important features, followed by relative trigone 15.9 and 18.2 Gy. Inclusion of clinical parameters in the hybrid model with IGA did not significantly change regression performance. CONCLUSION Overall, IGA feature selection resulted in the best GU toxicity prediction performance. This exploratory study demonstrated the feasibility of identification and analysis of dosimetric toxicity predictors with awareness to sensitive substructures and daily dose to potentially provide consistent and stable dosimetric metrics to guide treatment planning. Further patient accruement is warranted to further assess dosimetric predictor and perform validation.
Collapse
Affiliation(s)
- Jonathan Pham
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Beth K Neilsen
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Hengjie Liu
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Minsong Cao
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ke Sheng
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, USA
| | - Dan Ruan
- Physics and Biology in Medicine Graduate Program, University of California, Los Angeles, USA
- Department of Radiation Oncology, University of California, Los Angeles, USA
| |
Collapse
|
29
|
Waters M, Price A, Laugeman E, Henke L, Hugo G, Stowe H, Andruska N, Brenneman R, Hao Y, Green O, Robinson C, Gay H, Michalski J, Baumann BC. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 2024; 44:100693. [PMID: 38021093 PMCID: PMC10663731 DOI: 10.1016/j.ctro.2023.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is an emerging treatment modality for clinically localized prostate cancer (PCa). Online daily adaptive radiotherapy (ART) could potentially improve the therapeutic ratio of prostate SBRT by accounting for inter-fraction variation in target and OAR volumes. To our knowledge, no group has evaluated the clinical utility of a novel AI-augmented CT-based ART system for prostate SBRT. In this study we hypothesized that adaptive prostate SBRT plans would result in improved target coverage and lower dose to OARs in comparison to unadapted treatment plans. Methods Seven patients with favorable intermediate to oligometastatic PCa treated with 5-fx prostate adaptive SBRT were retrospectively reviewed. Patients were treated with 3625 cGy to the prostate and seminal vesicles. 6 patients additionally received 2500 cGy to the pelvic nodes, 5 patients underwent a boost to 4000 cGy to the prostate. For each fraction, a CBCT was acquired and OARs (rectum, bladder, bowel, sigmoid, femurs) were segmented/deformed using AI. CTVs were rigidly registered. Volumes were adjusted manually and PTV expansions added. Adaptive treatment plans were developed based on the contoured targets and OARs and dose to these volumes for the adapted vs. initial plans were compared for each fraction. V100 and the D0.03 cc between scheduled and adapted treatment plans were compared using a Student's t-test, with significance threshold of P < 0.05. Results Seven patients completed 35 Fx's of adaptive RT. Daily adaptation resulted in a statistically significant mean improvement in PTV V100 for all targets: [21.4 % ± 4.3 % for PTV 4000 (p < 0.0001); 8.7 % ± 1.1 % for PTV 3625 (p < 0.0001); and 11.5 % ± 3.1 % for PTV 2500 (p = 0.0013)]. Mean rectal D0.03 was significantly reduced by 38.8 cGy ± 5.95 cGy (p < 0.0001) per fraction (194 cGy/5 fractions) compared to the initial plans. There was a modest increase in bladder dose of 10.9 cGy ± 4.93 cGy per fraction (p = 0.0424) for the adaptive plans. The adaptive plans met bladder constraints for every fraction. There were no statistically significant differences between sigmoid or bowel dose for adapted vs. initial plans. No patients experienced acute CTCAE grade ≥ 3 GI/GU adverse events (median F/U 9.5 months). All statistically significant differences were maintained in the presence and absence of rectal hydrogel spacer (p < 0.05). Conclusions CT-based online adaptive SBRT resulted in statistically significant and clinically meaningful improvements in PTV coverage and D0.03 cc dose to the rectum. A trial evaluating CT adaptive whole-pelvis prostate SBRT is underway.
Collapse
Affiliation(s)
- Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Geoff Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
30
|
Achard V, Zilli T, Lamanna G, Jorcano S, Bral S, Rubio C, Oliveira A, Bottero M, Bruynzeel AME, Ibrahimov R, Minn H, Symon Z, Constantin G, Miralbell R. Urethra-Sparing Prostate Cancer Stereotactic Body Radiation Therapy: Sexual Function and Radiation Dose to the Penile Bulb, the Crura, and the Internal Pudendal Arteries From a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)08307-4. [PMID: 38160915 DOI: 10.1016/j.ijrobp.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Erectile dysfunction (ED) is a common side effect after prostate cancer stereotactic body radiation therapy (SBRT). We aimed to assess the correlation between the dose to the penile bulb (PB), internal pudendal arteries (IPA), and crura with the development of ED after ultrahypofractionation as part of a phase 2 clinical trial of urethra-sparing prostate SBRT. METHODS AND MATERIALS Among the 170 patients with localized prostate cancer from 9 centers included in the trial, 90 men with Common Terminology Criteria for Adverse Events version 4.03 grade 0 to 1 ED (ED-) at baseline treated with 36.25 Gy in 5 fractions were selected for the present analysis. Doses delivered to the PB, crura, and IPA were analyzed and correlated with grade 2 to 3 ED (ED+) development. The effect on quality of life, assessed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-PR25) questionnaire, was reported. RESULTS After a median follow-up of 6.5 years, 43% (n = 39) of the patients developed ED+, and 57% (n = 51) remained ED-. The dose delivered to the crura was significantly higher in ED+ patients than in ED- patients (7.7 vs 3.6 Gy [P = .014] for the Dmean and 18.5 vs 7.2 Gy [P = .015] for the D2%, respectively). No statistically significant difference between ED+ and ED- patients was observed for the dose delivered to the PB and IPA. The median ED+-free survival was worse in patients receiving a crura Dmean ≥ 4.7 versus < 4.7 Gy (51.5% vs 71.7%, P = .005) and a crura D2% > 12 versus ≤ 12 Gy (54.9% vs 68.9%, P = .015). No ED+-free survival differences were observed for doses delivered to the PB and IPA. Decline in EORTC QLQ-PR25 sexual functioning was significantly more pronounced in patients with higher doses to the crura. CONCLUSIONS By keeping a Dmean and D2% to crura below 4.7 and 12 Gy, respectively, the risk of developing ED+ after prostate SBRT may be significantly reduced.
Collapse
Affiliation(s)
- Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Lamanna
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Sandra Jorcano
- Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
| | - Samuel Bral
- Radiation Oncology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Carmen Rubio
- Radiation Oncology, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Angelo Oliveira
- Radiation Oncology, Portuguese Institut of Oncology, Porto, Portugal
| | - Marta Bottero
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Anna M E Bruynzeel
- Radiation Oncology, Amsterdam UMC, Location Vrije Universteit, Amsterdam, The Netherlands
| | - Roman Ibrahimov
- Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Heikki Minn
- Radiation Oncology, University Hospital Turku, Turku, Finland
| | - Zvi Symon
- Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
| |
Collapse
|
31
|
Panizza D, Faccenda V, Arcangeli S, De Ponti E. Treatment Optimization in Linac-Based SBRT for Localized Prostate Cancer: A Single-Arc versus Dual-Arc Plan Comparison. Cancers (Basel) 2023; 16:13. [PMID: 38201441 PMCID: PMC10778084 DOI: 10.3390/cancers16010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to comprehensively present data on treatment optimization in linac-based SBRT for localized prostate cancer at a single institution. Moreover, the dosimetric quality and treatment efficiency of single-arc (SA) versus dual-arc (DA) VMAT planning and delivery approaches were compared. Re-optimization was performed on twenty low-to-intermediate-risk- (36.25 Gy in 5 fractions) and twenty high-risk (42.7 Gy in 7 fractions) prostate plans initially administered with the DA FFF-VMAT technique in 2021. An SA approach was adopted, incorporating new optimization parameters based on increased planning and clinical experience. Analysis included target coverage, organ-at-risk (OAR) sparing, treatment delivery time, and the pre-treatment verification's gamma analysis-passing ratio. The SA optimization technique has consistently produced superior plans. Rectum and bladder mean doses were significantly reduced, and comparable target coverage and homogeneity were achieved in order to maintain a urethra protection strategy. The mean SA treatment delivery time was reduced by 22%; the mean monitor units increased due to higher plan complexity; and dose measurements demonstrated optimal agreement with calculations. The substantial reduction in treatment delivery time decreased the probability of prostate motion beyond the applied margins, suggesting potential decrease in treatment-related toxicity and improved target coverage in prostate SBRT. Further investigations are warranted to assess the long-term clinical outcomes.
Collapse
Affiliation(s)
- Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (E.D.P.)
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| |
Collapse
|
32
|
Schröder C, Mose L, Mathier E, Zwahlen DR, Aebersold DM, Förster R, Shelan M. Five Fractions versus Seven Fractions SBRT for Intermediate- and High-Risk Prostate Cancer: A Propensity Score Matched Pair Analysis. Cancers (Basel) 2023; 15:5815. [PMID: 38136360 PMCID: PMC10741876 DOI: 10.3390/cancers15245815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. METHODS/MATERIAL We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either 35-36.25 Gy in five fractions (group A) using Cyberknife robotic platform or 42.7 Gy in seven fractions (group B) using a C-arm LINAC (image-guided). Propensity score matching was done (2:1 nearest neighbor matching without replacement), resulting in 120 patients (80 patients for group A, 40 patients for group B). Toxicity, PSA nadir, biochemical failure and disease-free survival (DFS) were analyzed. RESULTS Median follow up of all patients was 13 months (range 1-91 months). Overall, 23.3% of patients had ≥G2 acute GU toxicity (21.1% group A versus 30% group B (p = 0.222)) and 6.6% of patients ≥G2 GI toxicity (2.5% versus 15% (p = 0.010)). There was one acute G3 GU toxicity in arm A and one acute G4 rectal bleeding in group B (anticoagulated patient). Regarding late toxicity, 14.1% of patients had ≥G2 late GU toxicity (17.4% versus 6.6% (p = 0.159)) and 5.0% of patients had ≥G2 late GI toxicity (1.4% versus 13.3% (p = 0.013)). There was one G3 late GU toxicity in arm B and two G3 late GI toxicities, one in each arm. Relative median PSA reduction was 92.4% (-53.9-99.9%) from baseline PSA (93.7% (-53.9-99.9%) in group A versus 87.7% (39.8-99.9%) in group B (p = 0.043). In total, 4.2% of patients had biochemical relapse, 5.0% in group A and 2.5% in group B (p = 0.518). One-year DFS in the overall cohort was 97.3%, 98.8% in group A and 94.3% in group B (p = 0.318). CONCLUSION Both SBRT regimens have acceptable acute and late toxicity and good efficacy. There are significantly more GI toxicities in the seven-fraction regimen. Longer follow-up is warranted for better comparison of long-term efficacy.
Collapse
Affiliation(s)
- Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Lucas Mose
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Daniel Matthias Aebersold
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital/Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (L.M.); (M.S.)
| |
Collapse
|
33
|
Greenwood H, Hassan J, Fife K, Ajithkumar TV, Thippu Jayaprakash K. Single-Fraction Stereotactic Ablative Body Radiotherapy for Primary and Extracranial Oligometastatic Cancers. Clin Oncol (R Coll Radiol) 2023; 35:773-786. [PMID: 37852814 DOI: 10.1016/j.clon.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Stereotactic ablative body radiotherapy (SABR) consists of delivering high doses of ionising radiation, typically across three to eight fractions with high precision and conformity. SABR has become increasingly commonplace throughout the last quarter of a century and is offered for the treatment of various primary and metastatic tumour types. Delivering SABR in a single fraction has arisen as an appealing possibility for several reasons. These include fewer hospital visits, greater patient convenience, improved sustainability and lower costs. However, these factors must be balanced against considerations such as toxicity, side-effects and, most importantly, progression-free and overall survival. In this review we seek to analyse the results of studies looking at the efficacy of single-fraction SABR for lung, prostate, renal and pancreas primary tumours, as well as oligometastases. The tumour type to be most widely treated with single-fraction SABR is lung, but its remit continues to expand. We also look at the biological rationale underpinning SABR and how this can be extended to single-fraction regimens. Finally, we turn our attention towards the future directions of SABR and specifically single-fraction regimens. These include the possibility of combining SABR with immunotherapy and technological advances in the field, which could serve to expand the scope of SABR. We conclude by summarising the current clinical studies of single-fraction SABR.
Collapse
Affiliation(s)
- H Greenwood
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - J Hassan
- University College London Medical School, London, UK
| | - K Fife
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T V Ajithkumar
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK.
| |
Collapse
|
34
|
Laughlin BS, Anderson JD, Hobbis D, Armstrong M, Vargas CE, Rong Y, Yu NY. Energy use in moderate hypofractionation and stereotactic body radiotherapy for prostate cancer. BJU Int 2023; 132:648-650. [PMID: 37553875 DOI: 10.1111/bju.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
| | | | - Dean Hobbis
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
35
|
Zilli T, Jorcano S, Bral S, Symon Z, Rubio C, Bruynzeel AME, Ibrahimov R, Minn H, Oliveira A, Bertaut A, Constantin G, Miralbell R. Every-Other-Day Versus Once-a-Week Urethra-Sparing Prostate Stereotactic Body Radiation Therapy: 5-Year Results of a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2023; 117:791-798. [PMID: 37001763 DOI: 10.1016/j.ijrobp.2023.03.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE The objective of this study was to present the 5-year results from a prospective, multicenter, phase 2 randomized trial of every-other-day (EOD) versus once-a-week (QW) urethra-sparing stereotactic body radiation therapy for localized prostate cancer. METHODS AND MATERIALS Between 2012 and 2015, 170 patients with cT1c-3aN0M0 prostate cancer from 9 European institutions were randomized to 36.25 Gy in 5 fractions (6.5 Gy/fraction to the urethra) delivered either EOD (arm A, n = 84) or QW (arm B, n = 86). The median follow-up was 78 months (interquartile range, 66-89 months) and 77 months (interquartile range, 66-82 months) for arms A and B, respectively. RESULTS Among the 165 patients treated and retained for the final analysis (arm A, n = 82; arm B, n = 83), acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 scale) was mild or absent, with no differences between arms. The 5-year grade 2 or greater genitourinary toxicity-free survival was 75.9% and 76.1% for arms A and B, respectively (P = .945), whereas the 5-year grade 2 or greater gastrointestinal toxicity-free survival was 89% and 92% for arms A and B, respectively (P = .596). No changes in European Organisation for Research and Treatment of Cancer QLQ-PR25 scores were observed in both arms for genitourinary, gastrointestinal, and sexual domains at 5-year follow-up compared with baseline. At the last follow-up, biochemical failure was observed in 14 patients in the EOD arm and in 7 patients in the QW arm, with a 5-year biochemical relapse-free survival rate of 92.2% and 93% for arms A and B, respectively (P = .13). CONCLUSIONS Stereotactic body radiation therapy for prostate cancer with a 10% dose reduction to urethra was associated with a minimal effect on urinary function and quality of life regardless of an EOD or QW fractionation schedule. Biochemical control so far has been encouraging and much alike in both study arms, although longer follow-up is probably needed to assess the true value of overall treatment time on disease outcome.
Collapse
Affiliation(s)
- Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.
| | - Sandra Jorcano
- Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
| | - Samuel Bral
- Radiation Oncology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Zvi Symon
- Radiation Oncology, Sheba Medical Center, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmen Rubio
- Radiation Oncology, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Anna M E Bruynzeel
- Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Roman Ibrahimov
- Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Heikki Minn
- Radiation Oncology, University Hospital Turku, Turku, Finland
| | - Angelo Oliveira
- Radiation Oncology, Portuguese Institut of Oncology, Porto, Portugal
| | - Aurélie Bertaut
- Methodology and Biostatistics, Centre Georges-François-Leclerc, Dijon, France
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
| |
Collapse
|
36
|
Borzillo V, Scipilliti E, Pezzulla D, Serra M, Ametrano G, Quarto G, Perdonà S, Rossetti S, Pignata S, Crispo A, Di Gennaro P, D’Alesio V, Arrichiello C, Buonanno F, Mercogliano S, Russo A, Tufano A, Di Franco R, Muto P. Stereotactic body radiotherapy with CyberKnife ® System for low- and intermediate-risk prostate cancer: clinical outcomes and toxicities of CyPro Trial. Front Oncol 2023; 13:1270498. [PMID: 38023175 PMCID: PMC10660677 DOI: 10.3389/fonc.2023.1270498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Simple summary Stereotactic body radiotherapy (SBRT) of 35-36.25 Gy in five fractions with the CyberKnife System yields excellent control with low toxicity in low-intermediate-risk prostate cancer patients. We found no differences in biochemical control and overall survival in relation to dose. There were no significant differences in toxicity or quality of life between the two groups. Aims Stereotactic body radiotherapy (SBRT) is an emerging therapeutic approach for low- and intermediate-risk prostate cancer. We present retrospective data on biochemical control, toxicity, and quality of life of CyPro Trial. Materials and methods A total of 122 patients with low- and intermediate-risk prostate cancer were treated with the CyberKnife System at a dose of 35 Gy or 36.25 Gy in five fractions. Biochemical failure (BF)/biochemical disease-free survival (bDFS) was defined using the Phoenix method (nadir + 2 ng/ml). Acute/late rectal and urinary toxicities were assessed by the Radiation Therapy Oncology Group (RTOG) toxicity scale. Quality of life (QoL) was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and PR25. International Erectile Function Index-5 (IIEF5) and International Prostate Symptom Score (IPSS) questionnaires were administered at baseline, every 3 months after treatment during the first years, and then at 24 months and 36 months. Results The 1-, 2-, and 5-year DFS rates were 92.9%, 92.9%, and 92.3%, respectively, while the 1-, 2-, and 5-year bDFS rates were 100%, 100%, and 95.7%, respectively. With regard to risk groups or doses, no statistically significant differences were found in terms of DFS or bDFS. Grade 2 urinary toxicity was acute in 10% and delayed in 2% of patients. No Grade 3 acute and late urinary toxicity was observed. Grade 2 rectal toxicity was acute in 8% and late in 1% of patients. No Grade 3-4 acute and late rectal toxicity was observed. Grade 2 acute toxicity appeared higher in the high-dose group (20% in the 36.25-Gy group versus 3% in the 35-Gy group) but was not statistically significant. Conclusion Our study confirms that SBRT of 35-36.25 Gy in five fractions with the CyberKnife System produces excellent control with low toxicity in patients with low-intermediate-risk prostate cancer. We found no dose-related differences in biochemical control and overall survival. Further confirmation of these results is awaited through the prospective phase of this study, which is still ongoing.
Collapse
Affiliation(s)
- Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Giuseppe Quarto
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sisto Perdonà
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Sandro Pignata
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Valentina D’Alesio
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Cecilia Arrichiello
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | | | - Simona Mercogliano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Antonio Russo
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Naples, Napoli, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Napoli, Italy
| |
Collapse
|
37
|
Baty M, Pasquier D, Gnep K, Castelli J, Delaby N, Lacornerie T, de Crevoisier R. Achievable Dosimetric Constraints in Stereotactic Reirradiation for Recurrent Prostate Cancer. Pract Radiat Oncol 2023; 13:e515-e529. [PMID: 37295723 DOI: 10.1016/j.prro.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Stereotactic body radiation therapy has been proposed as a salvage treatment for recurrent prostate cancer after irradiation. One crucial issue is choosing appropriate dose-volume constraints (DVCs) during planning. The objectives of this study were to (1) quantify the proportion of patients respecting the DVCs according to the Urogenital Tumor Study Group GETUG-31 trial, testing 36 Gy in six fractions, (2) explain geometrically why the DVCs could not be respected, and (3) propose the most suitable DVCs. METHODS AND MATERIALS This retrospective dosimetric analysis included 141 patients treated for recurrent prostate cancer with Cyberknife (Accuray), according to GETUG-31 DVCs: V95% ≥ 95% for the planning target volume (PTV), V12Gy < 20% and V27Gy < 2 cc for the rectum, and V12Gy < 15% and V27Gy < 5 cc for the bladder. The percentage of patients not respecting the DVCs was quantified. Correlations between the DVCs and anatomic structures were examined. New DVCs were proposed. RESULTS Only 19% of patients respected all DVCs, with a mean PTV of 18.5 cc (range, 3-48 cc), although the mean PTV was 40.5 cc (range, 3-174 cc) in the whole series. A total of 98% of the patients with a clinical target volume (CTV)/prostate ratio >0.5 could not respect the DVCs in the organs at risk. The target coverage and organ-at-risk sparing decreased significantly with increase in the values of PTV, CTV, CTV/prostate ratio, the overlapping volume between the PTV and bladder wall and between the PTV and rectal wall. Threshold values of PTV, >20 cc and 40 cc, allowed for the PTV and bladder DVCs, respectively. To improve DVC respect in case of large target volume, we proposed the following new DVCs: V12Gy < 25% and 25% and V27Gy < 2 cc and 5 cc for the rectum and bladder, respectively. CONCLUSIONS GETUG-31 DVCs are achievable only for small target volumes (CTV more than half of the prostate). For a larger target volume, new DVCs have been proposed.
Collapse
Affiliation(s)
- Manon Baty
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France.
| | - David Pasquier
- Department of Radiation Oncology, Center Oscar Lambret, Lille University, France
| | - Khemara Gnep
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France
| | - Joel Castelli
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Rennes, France
| | - Nolwenn Delaby
- Department of Medical Physics, Center Eugène Marquis, Rennes, France
| | - Thomas Lacornerie
- Department of Radiation Oncology, Center Oscar Lambret, Lille, France
| | - Renaud de Crevoisier
- Department of Radiotherapy, Center Eugène Marquis, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Rennes, France; Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
| |
Collapse
|
38
|
Le Guevelou J, Bosetti DG, Castronovo F, Angrisani A, de Crevoisier R, Zilli T. State of the art and future challenges of urethra-sparing stereotactic body radiotherapy for prostate cancer: a systematic review of literature. World J Urol 2023; 41:3287-3299. [PMID: 37668718 PMCID: PMC10632210 DOI: 10.1007/s00345-023-04579-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Doses delivered to the urethra have been associated with an increased risk to develop long-term urinary toxicity in patients undergoing stereotactic body radiotherapy (SBRT) for prostate cancer (PCa). Aim of the present systematic review is to report on the role of urethra-sparing SBRT (US-SBRT) techniques for prostate cancer, with a focus on outcome and urinary toxicity. METHOD A systematic review of the literature was performed on the PubMed database on May 2023. Based on the urethra-sparing technique, 13 studies were selected for the analysis and classified in the two following categories: "urethra-steering" SBRT (restriction of hotspots to the urethra) and "urethra dose-reduction" SBRT (dose reduction to urethra below the prescribed dose). RESULTS By limiting the urethra Dmax to 90GyEQD2 (α/β = 3 Gy) with urethra-steering SBRT techniques, late genitourinary (GU) grade 2 toxicity remains mild, ranging between 12.1% and 14%. With dose-reduction strategies decreasing the urethral dose below 70 GyEQD2, the risk of late GU toxicity was further reduced (< 8% at 5 years), while maintaining biochemical relapse-free survival rates up to 93% at 5 years. CONCLUSION US-SBRT techniques limiting maximum doses to urethra below a 90GyEQD2 (α/β = 3 Gy) threshold result in a low rate of acute and late grade ≥ 2 GU toxicity. A better understanding of clinical factors and anatomical substructures involved in the development of GU toxicity, as well as the development and use of adapted dose constraints, is expected to further reduce the long-term GU toxicity of prostate cancer patients treated with SBRT.
Collapse
Affiliation(s)
| | - Davide Giovanni Bosetti
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Francesco Castronovo
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Antonio Angrisani
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | | | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland.
- Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
39
|
Malatesta T, Scaggion A, Giglioli FR, Belmonte G, Casale M, Colleoni P, Falco MD, Giuliano A, Linsalata S, Marino C, Moretti E, Richetto V, Sardo A, Russo S, Mancosu P. Patient specific quality assurance in SBRT: a systematic review of measurement-based methods. Phys Med Biol 2023; 68:21TR01. [PMID: 37625437 DOI: 10.1088/1361-6560/acf43a] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
This topical review focuses on Patient-Specific Quality Assurance (PSQA) approaches to stereotactic body radiation therapy (SBRT). SBRT requires stricter accuracy than standard radiation therapy due to the high dose per fraction and the limited number of fractions. The review considered various PSQA methods reported in 36 articles between 01/2010 and 07/2022 for SBRT treatment. In particular comparison among devices and devices designed for SBRT, sensitivity and resolution, verification methodology, gamma analysis were specifically considered. The review identified a list of essential data needed to reproduce the results in other clinics, highlighted the partial miss of data reported in scientific papers, and formulated recommendations for successful implementation of a PSQA protocol.
Collapse
Affiliation(s)
- Tiziana Malatesta
- Medical Physics Unit, Department of Radiotherapy and Medical Oncology and Radiology, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | | | - Gina Belmonte
- Medical Physics Department, San Luca Hospital, Lucca, Italy
| | - Michelina Casale
- Medical Physics Unit, Azienda Ospedaliera 'Santa Maria', Terni, Italy
| | - Paolo Colleoni
- UOC Medical Physics Unit-ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, 'SS. Annunziata' Hospital, 'G. D'Annunzio' University, Chieti, Italy
| | - Alessia Giuliano
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Stefania Linsalata
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Carmelo Marino
- Medical Physics and Radioprotection Unit, Humanitas Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Eugenia Moretti
- Division of Medical Physics, Department of Oncology, ASUFC Udine, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Anna Sardo
- UOSD Medical Physics, ASLCN2, Verduno, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Department, IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| |
Collapse
|
40
|
Leeman JE, Shin KY, Chen YH, Mak RH, Nguyen PL, D'Amico AV, Martin NE. Acute toxicity comparison of magnetic resonance-guided adaptive versus fiducial or computed tomography-guided non-adaptive prostate stereotactic body radiotherapy: A systematic review and meta-analysis. Cancer 2023; 129:3044-3052. [PMID: 37485697 DOI: 10.1002/cncr.34836] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is gaining wider adoption for prostate cancer management but there remain significant toxicity risks when delivering prostate SBRT with standard techniques. Magnetic resonance-guided daily adaptive SBRT (MRg-A-SBRT) offers technological advantages in precision of radiation dose delivery, but the toxicity profile associated with MRg-A-SBRT compared to more standardly used fiducial or computed tomography-guided non-adaptive prostate SBRT (CT-SBRT) remains unknown. METHODS A meta-analysis to compare acute toxicity rates associated with MRg-A-SBRT and CT-SBRT for prostate cancer was performed in compliance with PRISMA guidelines. MEDLINE (PubMed) and Google Scholar were searched for prospective studies of prostate SBRT that were published between January 1, 2018 and August 31, 2022. Random effects and fixed effects models were used to estimate pooled toxicity rates, and meta-regression was performed to compare toxicity between MRg-A-SBRT and CT-SBRT study groups. RESULTS Twenty-nine prospective studies were identified that met the inclusion criteria and included a total of 2547 patients. The pooled estimates for acute grade 2 or higher (G2+) genitourinary (GU) and gastrointestinal (GI) toxicity for MRg-A-SBRT were 16% (95% confidence interval [CI], 10%-24%) and 4% (95% CI, 2%-7%) and for CT-SBRT they were 28% (95% CI, 23%-33%) and 9% (95% CI, 6%-12%), respectively. On meta-regression, the odds ratios for acute G2+ GU and GI toxicities comparing MRg-A-SBRT and CT-SBRT were 0.56 (95% CI, 0.33-0.97, p = .04) and 0.40 (95% CI, 0.17-0.96, p = .04), respectively. CONCLUSION MRg-A-SBRT is associated with a significantly reduced risk of acute G2+ GU or GI toxicity compared to CT-SBRT. Longer follow-up will be needed to evaluate late toxicity and disease control outcomes. PLAIN LANGUAGE SUMMARY Magnetic resonance imaging-guided daily adaptive prostate stereotactic radiation (MRg-A-SBRT) is a treatment that may allow for delivery of prostate radiation more precisely than other radiotherapy techniques, but it is unknown whether this reduces side effects compared to standardly used computed tomography-guided SBRT (CT-SBRT). In this systematic review and meta-analysis combining data from 29 clinical trials including 2547 patients, it was found that the risk of short-term urinary side effects was reduced by 44% and the risk of short-term bowel side effects was reduced by 60% with MRg-A-SBRT compared to CT-SBRT.
Collapse
Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee-Young Shin
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Yu-Hui Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
41
|
Makita K, Hamamoto Y, Kanzaki H, Nagasaki K, Hashine K. Relationship between seminal vesicle displacement and distribution of hydrogel spacer within the perirectal space in prostate radiotherapy. Mol Clin Oncol 2023; 19:78. [PMID: 37719041 PMCID: PMC10502802 DOI: 10.3892/mco.2023.2674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
The influence of a hydrogel spacer (HS) on seminal vesicle (SV) displacement in prostate radiotherapy was examined in the present study. A total of 20 patients with prostate cancer, who received intensity-modulated radiation therapy (IMRT), were enrolled. Computed tomography and magnetic resonance imaging were performed before and after HS insertion within the peripheral space for IMRT planning. Before and after HS insertion, The SV was delineated, and the amount of SV displacement was evaluated. Large SV cranial displacements (≥0.50 cm) were observed in 25% of patients. A HS lateral distribution of ≥1.00 cm in the upper two slices (midgland + superior) influenced the SV cranial displacements (P<0.01) and was associated with large SV cranial displacements (≥0.5 cm) (P<0.01). The HS cranial distribution in the upper slices did not influence SV cranial displacements (P=0.16). In addition, any HS lateral distribution of ≥1.00 cm in all slices did not induce the SV lateral and anterior-posterior displacements (P=0.50 and 0.70, respectively). In conclusion, SV cranial displacement was influenced by HS lateral distribution of ≥1.00 cm in the upper two slices. Therefore, when the sigmoid colon or small bowel is depressed in rectovesical excavation and SV needs to be included in the target volume, HS insertion should be performed carefully.
Collapse
Affiliation(s)
- Kenji Makita
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime 790-0024, Japan
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Katsuyoshi Hashine
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| |
Collapse
|
42
|
Vaziri T, Rao YJ, Whalen M, Bethony J, Thakkar P, Lin J, Goyal S. Management of Localized Prostate Cancer in Men With Human Immunodeficiency Virus: Analysis of a Large Retrospective Cohort. Clin Genitourin Cancer 2023; 21:614.e1-614.e8. [PMID: 37208248 PMCID: PMC10543456 DOI: 10.1016/j.clgc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION We aimed to characterize the clinicopathological characteristics and outcomes of HIV-positive patients with clinically localized, prostate cancer (PCa). METHODS A retrospective study was conducted of HIV-positive patients from a single institution with elevated PSA and diagnosis of PCa by biopsy. PCa features, HIV characteristics, treatment type, toxicities, and outcomes were analyzed by descriptive statistics. Kaplan-Meier analysis was used to determine progression-free survival (PFS). RESULTS Seventy-nine HIV-positive patients were included with a median age at PCa diagnosis of 61 years-old and median duration from HIV infection to PCa diagnosis of 21 years. The median PSA level at diagnosis and Gleason Score was 6.85 ng/mL and 7, respectively. The 5-year PFS was 82.5% with the lowest survival observed in patients treated with radical prostatectomy (RP) + radiation therapy (RT), followed by cryosurgery (CS). There were no reports of PCa-specific deaths, and the 5-year overall survival was 97.5%. CD4 count declined post-treatment in pooled treatment groups that included RT (P = .02). CONCLUSION We present the characteristics and outcomes of the largest cohort of HIV-positive men with prostate cancer in published literature. RP and RT ± ADT is well-tolerated in HIV-positive patients with PCa as seen by the adequate biochemical control and mild toxicity. CS resulted in worse PFS compared to alternative treatments for patients within the same PCa risk group. A decline in CD4 counts was observed in patients treated RT, and further studies are needed to investigate this relationship. Our findings support the use of standard-of-care treatment for localized PCa in HIV-positive patients.
Collapse
Affiliation(s)
- Tina Vaziri
- Department of Radiation Oncology, George Washington University Medical Faculty Associates, Washington, DC
| | - Yuan J Rao
- Department of Radiation Oncology, George Washington University Medical Faculty Associates, Washington, DC
| | - Michael Whalen
- Department of Urology, George Washington University School of Medicine, Washington, DC
| | - Jeffrey Bethony
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University School of Medicine, Washington, DC
| | - Punam Thakkar
- Department of Otolaryngology/Head and Neck Surgery, George Washington University School of Medicine, Washington, DC
| | - Jianqing Lin
- Department of Medicine, GW Cancer Center, George Washington University School of Medicine, Washington, DC
| | - Sharad Goyal
- Department of Radiation Oncology, George Washington University Medical Faculty Associates, Washington, DC.
| |
Collapse
|
43
|
Numakura K, Kobayashi M, Muto Y, Sato H, Sekine Y, Sobu R, Aoyama Y, Takahashi Y, Okada S, Sasagawa H, Narita S, Kumagai S, Wada Y, Mori N, Habuchi T. The Current Trend of Radiation Therapy for Patients with Localized Prostate Cancer. Curr Oncol 2023; 30:8092-8110. [PMID: 37754502 PMCID: PMC10529045 DOI: 10.3390/curroncol30090587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
A recent approach to radiotherapy for prostate cancer is the administration of high doses of radiation to the prostate while minimizing the risk of side effects. Thus, image-guided radiotherapy utilizes advanced imaging techniques and is a feasible strategy for increasing the radiation dose. New radioactive particles are another approach to achieving high doses and safe procedures. Prostate brachytherapy is currently considered as a combination therapy. Spacers are useful to protect adjacent organs, specifically the rectum, from excessive radiation exposure.
Collapse
Affiliation(s)
- Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yumina Muto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hiromi Sato
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Ryuta Sobu
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yu Aoyama
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yoshiko Takahashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Syuhei Okada
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hajime Sasagawa
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Satoshi Kumagai
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| |
Collapse
|
44
|
De Cock L, Draulans C, Pos FJ, Isebaert S, De Roover R, van der Heide UA, Smeenk RJ, Kunze-Busch M, van der Voort van Zyp J, de Boer H, Kerkmeijer LGW, Haustermans K. From once-weekly to semi-weekly whole prostate gland stereotactic radiotherapy with focal boosting: Primary endpoint analysis of the multicenter phase II hypo-FLAME 2.0 trial. Radiother Oncol 2023; 185:109713. [PMID: 37178932 DOI: 10.1016/j.radonc.2023.109713] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND PURPOSE The hypo-FLAME trial showed that once-weekly (QW) focal boosted prostate stereotactic body radiotherapy (SBRT) is associated with acceptable acute genitourinary (GU) and gastrointestinal (GI) toxicity. Currently, we investigated the safety of reducing the overall treatment time (OTT) of focal boosted prostate SBRT from 29 to 15 days. MATERIAL AND METHODS Patients with intermediate- and high-risk prostate cancer were treated with SBRT delivering 35 Gy in 5 fractions to the whole prostate gland with an iso-toxic boost up to 50 Gy to the intraprostatic lesion(s) in a semi-weekly (BIW) schedule. The primary endpoint was radiation-induced acute toxicity (CTCAE v5.0). Changes in quality of life (QoL) were examined in terms of proportions achieving a minimal clinically important change (MCIC). Finally, acute toxicity and QoL scores of the BIW schedule were compared with the results of the prior QW hypo-FLAME schedule (n = 100). RESULTS Between August 2020 and February 2022, 124 patients were enrolled and treated BIW. No grade ≥3 GU or GI toxicity was observed. The 90-days cumulative incidence of grade 2 GU and GI toxicity rates were 47.5% and 7.4%, respectively. Patients treated QW scored significant less grade 2 GU toxicity (34.0%, p = 0.01). No significant differences in acute GI toxicity were observed. Furthermore, patients treated QW had a superior acute bowel and urinary QoL. CONCLUSION Semi-weekly prostate SBRT with iso-toxic focal boosting is associated with acceptable acute GU and GI toxicity. Based on the comparison between the QW and BIW schedule, patients should be counselled regarding the short-term advantages of a more protracted schedule. Registration number ClinicalTrials.gov: NCT04045717.
Collapse
Affiliation(s)
- Lisa De Cock
- Department of Oncology, KU Leuven, Leuven, Belgium.
| | | | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Sofie Isebaert
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Hans de Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Karin Haustermans
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
45
|
Pasquier D, Nickers P, Peiffert D, Maingon P, Pommier P, Lacornerie T, Tresch E, Barthoulot M, Lartigau E. A Multicenter Phase 2 Study of Ultrahypofractionated Stereotactic Boost After External Beam Radiotherapy in Intermediate-risk Prostate Carcinoma: A Very Long-term Analysis of the CKNO-PRO Trial. EUR UROL SUPPL 2023; 54:80-87. [PMID: 37545850 PMCID: PMC10403693 DOI: 10.1016/j.euros.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 08/08/2023] Open
Abstract
Background Genitourinary (GU) or gastrointestinal (GI) complications and tumor relapse can occur in the long term after radiotherapy for prostate cancer. Objective To assess the late tolerance and relapse-free survival (RFS) in patients undergoing hypofractionated stereotactic boost therapy after external beam radiotherapy (EBRT) for intermediate-risk prostate cancer. Design setting and participants Seventy-six patients with intermediate-risk prostate carcinoma between August 2010 and April 2013 were included. The first course delivered a dose of 46 Gy by conventional fractionation; the second course was a boost of 18 Gy (3 × 6 Gy) within 10 d. Outcome measurements and statistical analysis GU and GI toxicities were evaluated as the primary outcomes. The secondary outcomes were overall survival and RFS. The cumulative incidence of toxicity was calculated using a competing-risk approach. Overall survival and RFS were estimated using the Kaplan-Meier method. Results and limitations The median follow-up period was 88 mo (range, 81-99 mo). Sixty (79%) patients were treated with the CyberKnife and 16 (21%) using a linear accelerator. The cumulative incidences of GU and GI grade ≥2 toxicities at 120 mo were 1.4% (95% confidence interval [CI]: 0.1-6.6%) and 11.0% (95% CI: 5.1-19.4%), respectively. The overall survival and RFS rates at 8 yr were 89.1% (95% CI: 77-95%) and 76.9% (95% CI: 63.1-86.1), respectively. Conclusions A very long follow-up showed low GU and GI toxicities after a hypofractionated stereotactic boost after EBRT for intermediate-risk prostate cancer. Dose escalation of the boost delivered by hypofractionated radiation therapy appears safe for use in future trials. Patient summary We found low toxicity and good survival rates after a short and high-precision boost after external beam radiotherapy for intermediate-risk prostate cancer, with a long-term follow-up of 88 mo. This long-term treatment is safe and should be considered in future trials.
Collapse
Affiliation(s)
- David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- Univ. Lille, &, CNRS, Centrale Lille, UMR 9189 - CRIStAL, Lille, France
| | - Philippe Nickers
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Didier Peiffert
- Institut de Cancérologie de Lorraine-Alexis Vautrin, Nancy, France
| | | | - Pascal Pommier
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | | | | | - Maël Barthoulot
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- Univ. Lille, &, CNRS, Centrale Lille, UMR 9189 - CRIStAL, Lille, France
| |
Collapse
|
46
|
Pasquier D, Lacornerie T, Supiot S, Pommier P, Quivrin M, Simon JM, Loos G, Meyer E, Calais G, Peiffert D, Vandendorpe B, Aymes E, Leguillette C, Brihoum M, Nenan S, Cormier L, Le Deley MC, Lartigau EF. The Safety and Efficacy of Salvage Stereotactic Radiation Therapy in Patients with Intraprostatic Tumor Recurrence After Previous External Radiation Therapy: Phase 1 Results from the GETUG-AFU 31 Study. Eur Urol Oncol 2023; 6:399-405. [PMID: 36754722 DOI: 10.1016/j.euo.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/11/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is no consensus on the best local salvage treatment for prostate cancer recurrence after primary external beam radiotherapy. Prospective data on stereotactic body radiation therapy (SBRT) are very scarce. OBJECTIVE To determine the optimal dose regimen for salvage SBRT. DESIGN, SETTING, AND PARTICIPANTS The present report concerns the phase 1 part of the GETUG-AFU 31 multicenter open-label study. The main inclusion criteria were histologically proven biochemical recurrence, clinical stage T1-T2 upon relapse, multiparametric magnetic resonance imaging data, prostate-specific antigen (PSA) level ≤10 ng/ml prior to salvage SBRT, PSA doubling time >10 mo, and an International Prostate Symptom Score of ≤12. INTERVENTION Five or six fractions of 6 Gy were delivered using focal SBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Dose-limiting toxicity (DLT) was defined as grade ≥3 gastrointestinal or genitourinary tract toxicity, or any grade 4 toxicity (according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03) occurring in the first 18 wk following treatment initiation. A time-to-event continual reassessment method was used to select the dose regimen. RESULTS AND LIMITATIONS Twenty-one patients were treated (median [interquartile range] age: 76.8 yr [72.2-80.8]), including 12 at 6 × 6 dose level. No DLT was observed. The acute grade 2 genitourinary tract toxicity rate was 19%. With a median follow-up of 12.3 mo, the estimated cumulative incidence of late grade 2 genitourinary toxicity was 41.2% (95% confidence interval: 18.1-63.1%). No grade >2 genitourinary toxicity and no grade ≥2 gastrointestinal toxicity were reported. All treated patients were alive and relapse free at the last follow-up. CONCLUSIONS A 6 × 6 Gy dose regimen was selected for our phase 2 study of salvage SBRT. With a short follow-up period, the level of toxicity appears to be acceptable. PATIENT SUMMARY There is no consensus on the best local treatment for patients with local relapse after radiotherapy for prostate cancer. Prospective data are very scarce. Our early phase trial allowed us to recommend six fractions of 6 Gy using high-precision radiotherapy for further studies.
Collapse
Affiliation(s)
- David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France.
| | - Thomas Lacornerie
- Département de Physique Médicale, Centre Oscar Lambret, Lille, France
| | - Stéphane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint-Herblain, France
| | - Pascal Pommier
- Département de Radiothérapie, Centre Léon Bérard, Lyon, France
| | - Magali Quivrin
- Département de Radiothérapie, Centre Georges François Leclerc, Dijon, France
| | - Jean-Marc Simon
- Service d'Oncologie Radiothérapie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Geneviève Loos
- Département de Radiothérapie, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emmanuel Meyer
- Département de Radiothérapie, Centre François Baclesse, Caen, France
| | - Gilles Calais
- Département d'Oncologie et de Radiothérapie, CHRU Tours, France
| | - Didier Peiffert
- Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Estelle Aymes
- Département de Biostatistiques, Centre Oscar Lambret, Lille, France
| | | | | | - Soazig Nenan
- Unicancer, Recherche et Développement, Paris, France
| | | | | | - Eric F Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France
| |
Collapse
|
47
|
Cruz-Lim EM, Cereno RE, Cañal JP, Vega G, Inocencio E, Mou B. Challenges to Improving Access to Stereotactic Body Radiation Therapy and Radiosurgery in the Philippines: A Case Study for Lower-Middle Income Countries. Int J Radiat Oncol Biol Phys 2023; 116:430-438. [PMID: 37179092 DOI: 10.1016/j.ijrobp.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Ella Mae Cruz-Lim
- Department of Radiation Oncology, Zamboanga City Medical Center, Zamboanga City, Philippines; Department of Radiation Oncology, BC Cancer Kelowna, Kelowna, Canada.
| | - Reno Eufemon Cereno
- Department of Radiation Oncology, BC Cancer Kelowna, Kelowna, Canada; Department of Radiation Oncology, Manila Doctors Hospital, Manila, Philippines
| | - Johanna Patricia Cañal
- Division of Radiation Oncology, Department of Radiology, Philippine General Hospital, Manila, Philippines
| | - Gaudencio Vega
- Department of Radiation Oncology, The Medical City, Manila, Philippines
| | - Elrick Inocencio
- Division of Radiation Oncology, Department of Radiology, Philippine General Hospital, Manila, Philippines
| | - Benjamin Mou
- Department of Radiation Oncology, BC Cancer Kelowna, Kelowna, Canada
| |
Collapse
|
48
|
Fujii K, Nakano M, Kawakami S, Tanaka Y, Kainuma T, Tsumura H, Tabata KI, Satoh T, Iwamura M, Ishiyama H. Dosimetric Predictors of Toxicity after Prostate Stereotactic Body Radiotherapy: A Single-Institutional Experience of 145 Patients. Curr Oncol 2023; 30:5062-5071. [PMID: 37232841 DOI: 10.3390/curroncol30050383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
The indications for stereotactic body radiotherapy (SBRT) for prostate cancer have increased. However, the relationships between adverse events and risk factors remain unclear. This study aimed to clarify associations between adverse events and dose index for prostate SBRT. Participants comprised 145 patients irradiated with 32-36 Gy in 4 fractions. Radiotherapy-related risk factors such as dose-volume histogram parameters and patient-related risk factors such as T stage and Gleason score were evaluated in a competing risk analysis. Median follow-up duration was 42.9 months. A total of 9.7% had acute Grade ≥ 2 GU toxicities and 4.8% had acute Grade ≥ 2 GI toxicities. A total of 11.1% had late Grade ≥ 2 GU toxicities and 7.6% had late Grade ≥ 2 GI toxicities. Two (1.4%) patients suffered from late Grade 3 GU toxicities. Similarly, two (1.4%) patients suffered from late Grade 3 GI toxicities. Acute GU and GI events correlated with prostate volume and dose to the hottest 10 cc volume (D10cc)/volumes receiving a minimum of 30 Gy (V30 Gy) of rectum, respectively. Late GI toxicity, frequency, and rectal hemorrhage correlated with rectal D0.1 cc/D1 cc, maximum dose to the bladder, and rectal D0.1 cc, respectively. Toxicities after prostate SBRT using 32-36 Gy/4 fractions were acceptable. Our analysis showed that acute toxicities correlated with volume receiving a medium dose level, and late toxicities correlated with highest point dose of organs at risk.
Collapse
Affiliation(s)
- Kyohei Fujii
- Division of Radiation Oncology, Kitasato University Hospital, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Masahiro Nakano
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Shogo Kawakami
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Yuichi Tanaka
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Takuro Kainuma
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| |
Collapse
|
49
|
Monticelli D, Castriconi R, Tudda A, Fodor A, Deantoni C, Gisella Di Muzio N, Mangili P, Del Vecchio A, Fiorino C, Broggi S. Knowledge-based plan optimization for prostate SBRT delivered with CyberKnife according to RTOG0938 protocol. Phys Med 2023; 110:102606. [PMID: 37196603 DOI: 10.1016/j.ejmp.2023.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To extend the knowledge-based (KB) automatic planning approach to CyberKnife in the case of Stereotactic Body Radiation Therapy (SBRT) for prostate cancer. METHODS Seventy-two clinical plans of patients treated according to the RTOG0938 protocol (36.25 Gy/5fr) with CyberKnife were exported from the CyberKnife system to Eclipse to train a KB-model using the Rapid Plan tool. The KB approach provided dose-volume objectives for specific OARs only and not PTV. Bladder, rectum and femoral heads were considered in the model. The KB-model was successfully trained on 51 plans and then validated on 20 new patients. A KB-based template was tuned in the Precision system for both sequential optimization (SO) and VOLO optimization algorithms. Plans of the validation group were re-optimized (KB-TP) using both algorithms without any operator intervention and compared against the original plans (TP) in terms of OARs/PTV dose-volume parameters. Paired Wilcoxon signed-rank tests were performed to assess statistically significant differences (p < 0.05). RESULTS Regarding SO, automatic KB-TP plans were generally better than or equivalent to TP plans. PTVs V95% was slightly worse while OARs sparing for KB-TP was significantly improved. Regarding VOLO optimization, the PTVs coverage was significantly better for KB-TP while there was a limited worsening in the rectum. A significant improvement was observed in the bladder in the range of low-intermediate doses. CONCLUSIONS An extension of the KB optimization approach to the CyberKnife system has been successfully developed and validated in the case of SBRT prostate cancer.
Collapse
Affiliation(s)
- Davide Monticelli
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Roberta Castriconi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Università degli Studi di Milano, Milano, Italy; Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Nadia Gisella Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
50
|
Gharzai LA, Jagsi R. Incorporating financial toxicity considerations into clinical trial design to facilitate patient-centered decision-making in oncology. Cancer 2023; 129:1143-1148. [PMID: 36775839 DOI: 10.1002/cncr.34677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PLAIN LANGUAGE SUMMARY Financial toxicity is increasingly being recognized as an important and devastating consequence of cancer treatment that receives little attention when clinical trials are being designed. There is a significant need to obtain this important information in an era of increasingly expensive anticancer treatments. Patients who are informed of all implications of therapy-efficacy, side effects, cost, and broader financial impact-are able to select the best cancer treatment for themselves.
Collapse
Affiliation(s)
| | - Reshma Jagsi
- University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|