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Jang B, Chung MG, Lee DS. Association between gut microbial change and acute gastrointestinal toxicity in patients with prostate cancer receiving definitive radiation therapy. Cancer Med 2023; 12:20727-20735. [PMID: 37921267 PMCID: PMC10709749 DOI: 10.1002/cam4.6636] [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: 07/28/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This prospective study investigated the association between gut microbial changes and acute gastrointestinal toxicities in prostate cancer patients receiving definitive radiation therapy (RT). METHODS Seventy-nine fecal samples were analyzed. Stool samples were collected at the following timepoints: pre-RT (prRT), 2 weeks after the start of RT (RT-2w), 5 weeks after the start of RT (RT-5w), 1 month after completion of RT (poRT-1 m), and 3 months after completion of RT (poRT-3 m). We computed the microbial community polarization index (MCPI) as an indicator of RT-induced dysbiosis. RESULTS Patients experiencing toxicity had lower alpha diversity, especially at RT-2w (p = 0.037) and RT-5w (p = 0.003). Compared to patients without toxicity, the MCPI in those experiencing toxicities was significantly elevated (p = 0.019). In terms of predicted metabolic pathways, we found linearly decreasing pathways, including carbon fixation pathways in prokaryotes (p = 0.035) and the bacterial secretion system (p = 0.005), in patients who experienced toxicities. CONCLUSIONS We showed RT-induced dysbiosis among patients who experienced toxicities. Reduced diversity and elevated RT-related MCPI could be helpfully used for developing individualized RT approaches.
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Affiliation(s)
- Bum‐Sup Jang
- Department of Radiation OncologyCollege of MedicineSeoul National UniversitySeoulKorea
| | - Moon Gyu Chung
- Microbiome centerKorea Research Institute of Bio‐medical ScienceDaejeonKorea
| | - Dong Soo Lee
- Department of Radiation Oncology, College of MedicineThe Catholic University of KoreaSeoulKorea
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Martín-Núñez J, Heredia-Ciuró A, Valenza-Peña G, Granados-Santiago M, Hernández-Hernández S, Ortiz-Rubio A, Valenza MC. Systematic review of self-management programs for prostate cancer patients, a quality of life and self-efficacy meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107583. [PMID: 36459830 DOI: 10.1016/j.pec.2022.107583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the efficacy of self-management interventions on quality of life and/or self-efficacy in patients diagnosed with prostate cancer through a systematic review with meta-analysis. METHODS A search was conducted from database inception to March 2022 across three databases. Randomized controlled trials were included. Two reviewers performed independent data extraction and methodologic quality assessment of the studies. RESULTS A total of fifteen studies were included in the study. Self-management interventions were identified by the Practical Reviews in Self-Management Support. The meta-analysis showed that self-management interventions have a significant effect on self-efficacy CONCLUSION: Self-management programs could have positive effects on quality of life and improve self-efficacy in prostate cancer patients. PRACTICE IMPLICATIONS Self-management components may be heterogeneous but show positive results in improving self-efficacy in prostate cancer survivors. Including self-management components in the rehabilitation of prostate survivors can improve their quality of life.
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Affiliation(s)
- Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain.
| | | | | | | | | | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain.
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain.
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Singh J, Sohal SS, Ahuja K, Lim A, Duncan H, Thachil T, De Ieso P. Investigation of circulatory cytokines in patients undergoing intensity-modulated radiotherapy (IMRT) for adenocarcinoma of the prostate and association with acute RT-induced toxicity: A prospective clinical study. Cytokine 2020; 131:155108. [PMID: 32330791 DOI: 10.1016/j.cyto.2020.155108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/29/2020] [Accepted: 04/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Jagtar Singh
- College of Health and Human Sciences, Charles Darwin University, Northern Territory, Australia.
| | | | - Kiran Ahuja
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Aijye Lim
- Department of Anatomical Pathology, Royal Darwin Hospital, Northern Territory, Australia.
| | - Henry Duncan
- Darwin Private Hospital, Royal Darwin Hospital, Northern Territory, Australia.
| | - Thanuja Thachil
- Austin Radiation Oncology Centre, Ballarat, Victoria, Australia.
| | - Paolo De Ieso
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation. Radiol Med 2018; 124:65-78. [PMID: 30219945 DOI: 10.1007/s11547-018-0937-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the incidence and predictors for late toxicity and tumor outcome after hypofractionated radiotherapy using three different image-guided radiotherapy (IGRT) systems (hypo-IGRT) compared with conventional fractionation without image guidance (non-IGRT). METHODS AND MATERIALS We compared the late rectal and urinary toxicity and outcome in 179 prostate cancer patients treated with hypo-IGRT (70.2 Gy/26 fractions) and 174 non-IGRT patients (80 Gy/40 fractions). Multivariate analysis was performed to define predictors for late toxicity. 5- and 8-year recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS Mean follow-up was 81 months for hypo-IGRT and 90 months for non-IGRT group. Mainly mild late toxicity was observed: Hypo-IGRT group experienced 65 rectal (30.9% G1/G2; 6.3% G3/G4) and 105 urinary events (56% G1/G2; 4% G3/G4). 5- and 8-year RFS rates were 87.5% and 86.8% (hypo-IGRT) versus 80.4% and 66.8% (non-IGRT). 5- and 8-year OS rates were 91.3% and 82.7% in hypo-IGRT and 92.2% and 84% in non-IGRT group. Multivariate analysis showed that hypo-IGRT is a predictor for late genitourinary toxicity, whereas hypo-IGRT, acute urinary toxicity and androgen deprivation therapy are predictors for late rectal toxicity. Advanced T stage and higher Gleason score (GS) were correlated with worse RFS. CONCLUSIONS A small increase in mild late toxicity, but not statistically significant increase in severe late toxicity in the hypo-IGRT group when compared with conventional non-IGRT group was observed. Our study confirmed that IGRT allows for safe moderate hypofractionation, offering a shorter overall treatment time, a good impact in terms of RFS and providing potentially more economic health care.
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Vavassori A, Jereczek-Fossa BA, Beltramo G, De Cicco L, Fariselli L, Bianchi LC, Possanzini M, Bergantin A, DeCobelli O, Orecchia R. Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases. TUMORI JOURNAL 2018; 96:71-5. [DOI: 10.1177/030089161009600112] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Technological advances in treatment planning and execution are providing new potential opportunities in the treatment of recurrent prostate cancer. This study was conducted to evaluate the feasibility and safety of reirradiation with image-guided radiosurgery using CyberKnife, a robotic arm-driven compact linear accelerator, for intraprostatic recurrence after external beam radiotherapy (EBRT). Methods Between September 2007 and May 2008, 6 patients diagnosed with locally recurrent prostate cancer after EBRT were treated using the CyberKnife system. The total reirradiation dose was 30 Gy in five fractions. Prior to radiosurgery four patients were treated with androgen-deprivation therapy. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and the Houston-Phoenix definition (PSA nadir + 2 ng/mL) were used for toxicity and biochemical failure evaluation, respectively. Results After a median follow-up of 11.2 months (range, 9.6–18.6 months), all patients are alive with no evidence of severe urinary or rectal acute morbidity. Local control cannot be exactly determined due to the short follow-up and the bias of the use of androgen ablation. Four patients had biochemical failure, three of them with clinical failure evidence (lymph node, bone and lung metastasis, respectively): none of these patients had clinical evidence of tumor persistence in the prostate. Conclusions Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.
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Affiliation(s)
- Andrea Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Giancarlo Beltramo
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Luigi De Cicco
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Laura Fariselli
- Radiotherapy Unit of the C Besta Neurological Institute Foundation, Milan, Italy
| | - Livia Corinna Bianchi
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Marco Possanzini
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Achille Bergantin
- Department of Medical Physics, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Ottavio DeCobelli
- University of Milan, Milan, Italy
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
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6
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Zschaeck S, Wust P, Beck M, Wlodarczyk W, Kaul D, Rogasch J, Budach V, Furth C, Ghadjar P. Intermediate-term outcome after PSMA-PET guided high-dose radiotherapy of recurrent high-risk prostate cancer patients. Radiat Oncol 2017; 12:140. [PMID: 28830532 PMCID: PMC5568206 DOI: 10.1186/s13014-017-0877-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By the use of PSMA positron emission tomography (PET) detection of prostate cancer lesions with a high sensitivity and specificity combined with a favorable lesion to background contrast is feasible. Therefore, PSMA-PET is increasingly used for planning of radiotherapy treatment; however, any data on intermediate-term outcome is missing so far. METHODS Patients with high-risk or very high risk prostate cancer, referred for salvage radiotherapy (SRT, n = 22) between 2013 and 2015, underwent PSMA-PET prior to therapy. Irradiation was planned on PET data with boost to macroscopic tumors/metastases. Treatment related toxicity was measured using Common Terminology Criteria for Adverse Events (CTCAE, v4.0). RESULT Findings in PSMA-PET led to treatment modifications in 77% of SRT patients compared to available CT information. One patient did not receive irradiation due to disseminated disease, the other patients received increased boost doses to macroscopic disease and/or inclusion of additional target volumes. Toxicity was low as only 2 patients reported toxicities > grade 1. With a Median follow-up time of 29 in patients that were not lost to follow-up, prolonged PSA responses below baseline were observed in the majority of patients (14 of 20). In hormone-naïve SRT patients (n = 11), radiotherapy led to prolonged PSA decrease in 8/11 patients, however with 3 of these 8 patients receiving repeated PSMA based irradiation of novel lesions during follow-up. CONCLUSION PSMA-PET guided planning of radiotherapy led to change of treatment in the majority of patients. Treatment related toxicity was well tolerated and promising results regarding intermediate-term PSA decrease were observed. TRIAL REGISTRATION No trial registration was performed due to retrospective evaluation.
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Affiliation(s)
- Sebastian Zschaeck
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peter Wust
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Waldemar Wlodarczyk
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julian Rogasch
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Sage EK, Schmid TE, Geinitz H, Gehrmann M, Sedelmayr M, Duma MN, Combs SE, Multhoff G. Effects of definitive and salvage radiotherapy on the distribution of lymphocyte subpopulations in prostate cancer patients. Strahlenther Onkol 2017; 193:648-655. [PMID: 28500490 DOI: 10.1007/s00066-017-1144-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/20/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Radiotherapy (RT) is an established treatment for patients with primary and recurrent prostate cancer. Herein, the effects of definitive and salvage RT on the composition of lymphocyte subpopulations were investigated in patients with prostate cancer to study potential immune effects. PATIENTS AND METHODS A total of 33 prostate cancer patients were treated with definitive (n = 10) or salvage RT (n = 23) after biochemical relapse. The absolute number of lymphocytes and the distribution of lymphocyte subpopulations were analyzed by multiparameter flow cytometry before RT, at the end of RT, and in the follow-up period. RESULTS Absolute lymphocyte counts decreased significantly after RT in both patient groups and a significant drop was observed in the percentage of B cells directly after RT from 10.1 ± 1.3 to 6.0 ± 0.7% in patients with definitive RT and from 9.2 ± 0.8 to 5.8 ± 0.7% in patients with salvage RT. In contrast, the percentages of T and natural killer (NK) cells remained unaltered directly after RT in both patient groups. However, 1 year after RT, the percentage of CD3+ T cells was significantly lower in patients with definitive and salvage RT. The percentage of regulatory T cells was slightly upregulated in primary prostate cancer patients after definitive RT, but not after salvage RT. CONCLUSION Definitive and salvage RT exert similar effects on the composition of lymphocyte subpopulations in prostate cancer patients. Total lymphocyte counts are lower in both patient groups compared to healthy controls and further decreased after RT. B cells are more sensitive to definitive and salvage RT than T and NK cells.
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Affiliation(s)
- Eva K Sage
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Thomas E Schmid
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Hans Geinitz
- Department of Radiation Oncology, Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern and Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Mathias Gehrmann
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Michael Sedelmayr
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Marciana N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.
- Department of Radiation Sciences (DRS), Institute of Innovate Radiotherapy (iRT), HelmholtzZentrum München, Munich, Germany.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany.
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Jereczek-Fossa BA, Fanetti G, Fodor C, Ciardo D, Santoro L, Francia CM, Muto M, Surgo A, Zerini D, Marvaso G, Timon G, Romanelli P, Rondi E, Comi S, Cattani F, Golino F, Mazza S, Matei DV, Ferro M, Musi G, Nolè F, de Cobelli O, Ost P, Orecchia R. Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes. Clin Genitourin Cancer 2017; 15:e623-e632. [PMID: 28185875 DOI: 10.1016/j.clgc.2017.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. PATIENTS AND METHODS Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. RESULTS Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. CONCLUSION SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
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Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Fanetti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
| | - Cristiana Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - Claudia Maria Francia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessia Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Giorgia Timon
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Paola Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Franco Nolè
- Division of Urogenital and Head and Neck Tumours, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Roberto Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
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Acute and Late Genitourinary Toxicity after 72 Gy of Conventionally Fractionated Conformal Radiotherapy for Localised Prostate Cancer: Impact of Individual and Clinical Parameters. Clin Oncol (R Coll Radiol) 2016; 28:577-86. [DOI: 10.1016/j.clon.2016.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 01/17/2023]
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10
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Primary focal prostate radiotherapy: Do all patients really need whole-prostate irradiation? Crit Rev Oncol Hematol 2016; 105:100-11. [DOI: 10.1016/j.critrevonc.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/09/2016] [Accepted: 06/16/2016] [Indexed: 12/27/2022] Open
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Rationale and protocol of AIRC IG-13218, short-term radiotherapy for early prostate cancer with concomitant boost to the dominant lesion. TUMORI JOURNAL 2016; 102:536-540. [PMID: 27514314 DOI: 10.5301/tj.5000547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Of the different treatments for early prostate cancer, hypofractionated external-beam radiotherapy is one of the most interesting and studied options. METHODS The main objective of this phase II clinical study is to evaluate the feasibility, in terms of the incidence of acute side effects, of a new ultra-hypofractionated scheme for low- or intermediate-risk prostate cancer patients treated with the latest imaging and radiotherapy technology, allowing dose escalation to the dominant intraprostatic lesion identified by multiparametric magnetic resonance imaging. Secondary endpoints of the study are the evaluation of the long-term tolerability of the treatment in terms of late side effects, quality of life, and efficacy (oncological outcome). RESULTS The study is ongoing, and we expect to complete recruitment by the end of 2016. CONCLUSIONS Like in previous studies, we expect ultra-hypofractionated radiation treatment for prostate cancer to be well tolerated and effective. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01913717.
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Qi WX, Zhang Q, Li P, Zhang XM, Zhang GY, Wu B, Lu JJ, Jiang GL, Fu S. The predictive role of ADC values in prostate cancer patients treated with carbon-ion radiotherapy: initial clinical experience at Shanghai Proton and Heavy Ion Center (SPHIC). J Cancer Res Clin Oncol 2016; 142:1361-7. [DOI: 10.1007/s00432-016-2142-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/03/2016] [Indexed: 12/13/2022]
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13
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Zerini D, Jereczek-Fossa BA, Fodor C, Bazzani F, Maucieri A, Ronchi S, Ferrario S, Colangione SP, Gerardi MA, Caputo M, Cecconi A, Gherardi F, Vavassori A, Comi S, Cambria R, Garibaldi C, Cattani F, De Cobelli O, Orecchia R. Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol 2015; 88:20150197. [PMID: 26055506 DOI: 10.1259/bjr.20150197] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.
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Affiliation(s)
- D Zerini
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - C Fodor
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Bazzani
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Maucieri
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ronchi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ferrario
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S P Colangione
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M A Gerardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M Caputo
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Cecconi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Gherardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- 2 Department of Health Sciences, University of Milan, Milan, Italy.,4 Department of Urology, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy.,5 Clinical Division of the National Center of Oncological Hadrontherapy, Pavia, Italy
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14
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Ricardi U, Franco P, Munoz F, Levis M, Fiandra C, Guarneri A, Moretto F, Bartoncini S, Arcadipane F, Badellino S, Piva C, Trino E, Ruggieri A, Filippi AR, Ragona R. Three-Dimensional Ultrasound-Based Image-Guided Hypofractionated Radiotherapy for Intermediate-Risk Prostate Cancer: Results of a Consecutive Case Series. Cancer Invest 2014; 33:23-8. [DOI: 10.3109/07357907.2014.988343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Yang X, Rossi P, Ogunleye T, Marcus DM, Jani AB, Mao H, Curran WJ, Liu T. Prostate CT segmentation method based on nonrigid registration in ultrasound-guided CT-based HDR prostate brachytherapy. Med Phys 2014; 41:111915. [PMID: 25370648 PMCID: PMC4241831 DOI: 10.1118/1.4897615] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The technological advances in real-time ultrasound image guidance for high-dose-rate (HDR) prostate brachytherapy have placed this treatment modality at the forefront of innovation in cancer radiotherapy. Prostate HDR treatment often involves placing the HDR catheters (needles) into the prostate gland under the transrectal ultrasound (TRUS) guidance, then generating a radiation treatment plan based on CT prostate images, and subsequently delivering high dose of radiation through these catheters. The main challenge for this HDR procedure is to accurately segment the prostate volume in the CT images for the radiation treatment planning. In this study, the authors propose a novel approach that integrates the prostate volume from 3D TRUS images into the treatment planning CT images to provide an accurate prostate delineation for prostate HDR treatment. METHODS The authors' approach requires acquisition of 3D TRUS prostate images in the operating room right after the HDR catheters are inserted, which takes 1-3 min. These TRUS images are used to create prostate contours. The HDR catheters are reconstructed from the intraoperative TRUS and postoperative CT images, and subsequently used as landmarks for the TRUS-CT image fusion. After TRUS-CT fusion, the TRUS-based prostate volume is deformed to the CT images for treatment planning. This method was first validated with a prostate-phantom study. In addition, a pilot study of ten patients undergoing HDR prostate brachytherapy was conducted to test its clinical feasibility. The accuracy of their approach was assessed through the locations of three implanted fiducial (gold) markers, as well as T2-weighted MR prostate images of patients. RESULTS For the phantom study, the target registration error (TRE) of gold-markers was 0.41 ± 0.11 mm. For the ten patients, the TRE of gold markers was 1.18 ± 0.26 mm; the prostate volume difference between the authors' approach and the MRI-based volume was 7.28% ± 0.86%, and the prostate volume Dice overlap coefficient was 91.89% ± 1.19%. CONCLUSIONS The authors have developed a novel approach to improve prostate contour utilizing intraoperative TRUS-based prostate volume in the CT-based prostate HDR treatment planning, demonstrated its clinical feasibility, and validated its accuracy with MRIs. The proposed segmentation method would improve prostate delineations, enable accurate dose planning and treatment delivery, and potentially enhance the treatment outcome of prostate HDR brachytherapy.
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Affiliation(s)
- Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Peter Rossi
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Tomi Ogunleye
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - David M Marcus
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Ashesh B Jani
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322
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16
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Luczynska E, Blecharz P, Dyczek S, Stelmach A, Petralia G, Bellomi M, Jereczek-Fossa BA, Jakubowicz J. Perfusion CT is a valuable diagnostic method for prostate cancer: a prospective study of 94 patients. Ecancermedicalscience 2014; 8:476. [PMID: 25435904 PMCID: PMC4239130 DOI: 10.3332/ecancer.2014.476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this study is to assess the usefulness of perfusion computer tomography (pCT) in prostate cancer (PCa) diagnostics. Materials and Methods 94 patients with biopsy-proven PCa were enrolled in the study. Dynamic pCT of the prostate gland was performed for 50 seconds after an intravenous injection of contrast medium. Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) were computed in the suspected PCa area and in normal prostatic tissue. Results PCa was visible in pCT in 90 of the 94 examined patients as a focal peripheral CT enhancement. When PCa was located in the peripheral zone (PZ), it was visible on perfusion maps, mostly showing an early peak followed by wash-out. The average values of all perfusion parameters were higher for tumour than for normal prostate tissue (p < 0.000). BV and BF were dependent on tumour grade expressed by the Gleason score (GS). All PCa cases were divided into groups, according to histological grade, as low (GS ≤ 6), medium (GS = 7), and high (GS > 7). In high-grade PCa, the mean BF value was significantly higher (p = 0.001) than the mean value of BF low- and medium-grade PCa (p = 0.011). Similar results were obtained regarding the mean values of BV; the more aggressive the cancer grade, the higher the mean BV value (p = 0.04). Conclusion CT quantitative perfusion imaging allows PCa to be distinguished from normal prostate tissue. The highest values for BF and BV were observed in the most aggressive PCa grade.
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Affiliation(s)
- Elzbieta Luczynska
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Pawel Blecharz
- Gynecologic Oncology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Sonia Dyczek
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Andrzej Stelmach
- Radiotherapy Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | | | - Massimo Bellomi
- Radiology Department, European Institute of Oncology, Milan, Italy ; Radiology Department, European Institute of Oncology, Milan, Italy
| | | | - Jerzy Jakubowicz
- Surgery Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
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17
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Chen C, Lin T, Zhou Y, Li D, Xu K, Li Z, Fan X, Zhong G, He W, Chen X, He X, Huang J. Adjuvant and salvage radiotherapy after prostatectomy: a systematic review and meta-analysis. PLoS One 2014; 9:e104918. [PMID: 25121769 PMCID: PMC4133270 DOI: 10.1371/journal.pone.0104918] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/11/2014] [Indexed: 12/31/2022] Open
Abstract
PURPOSE In men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). MATERIALS AND METHODS We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT. RESULTS Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30-0.46; p<0.00001, I(2) = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28-0.52; p<0.00001, I(2) = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41-0.68; p<0.00001, I(2) = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43-0.66; p<0.00001, I(2) = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis. CONCLUSION ART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.
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Affiliation(s)
- Changhao Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yu Zhou
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Doudou Li
- Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Kewei Xu
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Zhihua Li
- Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Xinxiang Fan
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Guangzheng Zhong
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Wang He
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Xu Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Xianyin He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China
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18
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De Bari B, Fiorentino A, Arcangeli S, Franco P, D'Angelillo RM, Alongi F. From radiobiology to technology: what is changing in radiotherapy for prostate cancer. Expert Rev Anticancer Ther 2014; 14:553-64. [DOI: 10.1586/14737140.2014.883282] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Jereczek-Fossa BA, Zerini D, Fodor C, Santoro L, Maucieri A, Gerardi MA, Vischioni B, Cambria R, Garibaldi C, Cattani F, Vavassori A, Matei DV, Musi G, De Cobelli O, Orecchia R. Reporting combined outcomes with Trifecta and survival, continence, and potency (SCP) classification in 337 patients with prostate cancer treated with image-guided hypofractionated radiotherapy. BJU Int 2014; 114:E3-E10. [DOI: 10.1111/bju.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Barbara A. Jereczek-Fossa
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Dario Zerini
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Cristiana Fodor
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Luigi Santoro
- Department of Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Andrea Maucieri
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Marianna A. Gerardi
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | | | - Raffaella Cambria
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Cristina Garibaldi
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Federica Cattani
- Department of Medical Physics; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Andrea Vavassori
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Deliu V. Matei
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Gennaro Musi
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
| | - Ottavio De Cobelli
- Department of Urology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
| | - Roberto Orecchia
- Department of Radiation Oncology; the Epidemiology and Biostatistics of the European Institute of Oncology; Milan Italy
- University of Milan; Milan Italy
- Centro Nazionale di Adroterapia Oncologica (CNAO); Pavia Italy
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20
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Ikeda I, Mizowaki T, Norihisa Y, Takayama K, Kamba T, Inoue T, Nakamura E, Kamoto T, Ogawa O, Hiraoka M. Long-term outcomes of dynamic conformal arc irradiation combined with neoadjuvant hormonal therapy in Japanese patients with T1c-T2N0M0 prostate cancer: case series study. Jpn J Clin Oncol 2013; 44:180-5. [PMID: 24379210 DOI: 10.1093/jjco/hyt197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE There are few reports of the outcomes of external beam radiotherapy in Asian males with localized prostate cancer. The aim of this study is to evaluate the long-term outcomes of external beam irradiation using three-dimensional two-dynamic conformal arc therapy, combined with neoadjuvant hormonal therapy, in patients with T1c-T2N0M0 prostate cancer. METHODS Between March 2003 and August 2007, 150 Japanese patients with T1c-T2N0M0 prostate cancer were definitively treated with three-dimensional two-dynamic conformal arc therapy. The median age, pretreatment prostate-specific antigen values and neoadjuvant hormonal therapy period were 73 years, 9.4 ng/ml and 6 months, respectively. In principle, 74 Gy was delivered to the planning target volume, although the total dose was reduced to 70 Gy in patients with unfavorable risk factors, such as severe diabetes mellitus or anticoagulant therapy. No adjuvant hormonal therapy was given to any patient. Salvage hormonal therapy was started when the prostate-specific antigen value exceeded 4 ng/ml in a monotonically increasing manner. RESULTS The median follow-up period was 79 months. Salvage hormonal therapy was initiated in 10 patients and the median prostate-specific antigen value at the initiation was 4.7 ng/ml. The 5-year Kaplan-Meier estimates of the biochemical relapse-free survival rate, the salvage hormonal therapy -free rate and the overall survival rate were 83.3% (95% confidence interval = 77.1-89.6%), 94.3% (95% confidence interval = 90.4-98.1%) and 96.3% (95% confidence interval = 93.1-99.5%), respectively. The 5-year cumulative incidence rates of developing more than Grade 2 late rectal and urinary toxicities were 5.5 and 2.9%, respectively. CONCLUSIONS Three-dimensional two-dynamic conformal arc therapy, with up to 74 Gy, in patients with T1c-T2N0M0 prostate cancer with neoadjuvant hormonal therapy was well tolerated and achieved good biochemical control and survival outcomes.
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Affiliation(s)
- Itaru Ikeda
- *Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
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21
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Alongi F, De Bari B, Campostrini F, Arcangeli S, Matei DV, Lopci E, Petralia G, Bellomi M, Chiti A, Magrini SM, Scorsetti M, Orecchia R, Jereczek-Fossa BA. Salvage therapy of intraprostatic failure after radical external-beam radiotherapy for prostate cancer: A review. Crit Rev Oncol Hematol 2013; 88:550-63. [DOI: 10.1016/j.critrevonc.2013.07.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 05/20/2013] [Accepted: 07/17/2013] [Indexed: 01/29/2023] Open
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22
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De Bari B, Alongi F, Buglione M, Campostrini F, Briganti A, Berardi G, Petralia G, Bellomi M, Chiti A, Fodor A, Suardi N, Cozzarini C, Nadia DM, Scorsetti M, Orecchia R, Montorsi F, Bertoni F, Magrini SM, Jereczek-Fossa BA. Salvage therapy of small volume prostate cancer nodal failures: a review of the literature. Crit Rev Oncol Hematol 2013; 90:24-35. [PMID: 24315428 DOI: 10.1016/j.critrevonc.2013.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 10/02/2013] [Accepted: 11/13/2013] [Indexed: 11/30/2022] Open
Abstract
New imaging modalities may be useful to identify prostate cancer patients with small volume, limited nodal relapse ("oligo-recurrent") potentially amenable to local treatments (radiotherapy, surgery) with the aim of long-term control of the disease, even in a condition traditionally considered prognostically unfavorable. This report reviews the new diagnostic tools and the main published data about the role of surgery and radiation therapy in this particular subgroup of patients.
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Affiliation(s)
- Berardino De Bari
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
| | - Filippo Alongi
- Radiotherapy and Radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
| | - Michela Buglione
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | | | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Arturo Chiti
- Nuclear Medicine, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Andrei Fodor
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Nazareno Suardi
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Di Muzio Nadia
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan Italy and University of Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Filippo Bertoni
- Department of Radiation Therapy, Modena Hospital, Modena, Italy
| | - Stefano Maria Magrini
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
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23
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[11C]choline PET/CT impacts treatment decision making in patients with prostate cancer referred for radiotherapy. Clin Genitourin Cancer 2013; 12:155-9. [PMID: 24331577 DOI: 10.1016/j.clgc.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 10/08/2013] [Accepted: 11/08/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The purpose of our study was to analyze the role of [(11)C]choline-positron emission tomography/computed tomography (cho-PET/CT) in the management of patients with prostate cancer referred for radiotherapy. PATIENTS AND METHODS Inclusion criteria for this retrospective study were (1) presence of prostate cancer, (2) referral for first radiotherapy course (for primary or recurrent tumor) between February 2007 and July 2010, and (3) performance of cho-PET/CT. All cho-PET/CT scans were classified according to whether they were positive in the prostate/prostate bed (T), pelvic lymph nodes (N), and distant metastases (M) or negative. Therapeutic strategy based on the cho-PET/CT evaluation was compared with the strategy that would have been proposed had cho-PET/CT imaging not been available, following international and national prostate cancer guidelines. RESULTS Eighty-two cho-PET/CT scans performed in 74 patients were analyzed. Cho-PET/CT was positive in 49 studies (60%): T only in 22 (45% of all positive studies); N only in 4 (8%); T in combination with N in 3 (6%); and M in combination with T or N, or both, in 16 (33%). Treatment after positive cho-PET/CT examination included radiotherapy ± androgen deprivation (29 patients), surgery ± radiotherapy (6 patients), androgen deprivation only (8 patients), and other treatment (6 patients). In 22 cases, cho-PET/CT (27%) altered the treatment approach compared with the treatment that would have been adopted in the absence of cho-PET/CT analysis. CONCLUSION Cho-PET/CT is valuable in defining the extent of disease and supporting therapeutic decisions in the management of prostate cancer. The therapeutic strategy turned out to be influenced by cho-PET/CT imaging in about one third of the patients included in this study.
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24
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Zaorsky NG, Trabulsi EJ, Lin J, Den RB. Multimodality therapy for patients with high-risk prostate cancer: current status and future directions. Semin Oncol 2013; 40:308-21. [PMID: 23806496 DOI: 10.1053/j.seminoncol.2013.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prostate cancer is the most commonly diagnosed cancer and second most common cause of cancer death in American men. Although high-risk disease accounts for less than 15% of diagnoses, high-risk prostate cancer patients have a cancer-specific mortality rate of 15% at 10 years. There is currently no consensus on the optimal management of high-risk disease because (1) there are different primary modalities available (ie, surgery, radiation), for which there are no randomized trials comparing efficacy; and (2) unstandardized timing of different therapies (ie, neoadjuvant v concurrent v adjuvant), which makes comparisons of efficacy problematic. Increased understanding into the mechanisms leading to the formation of advanced metastatic disease has spurred the development of agents to target these pathways. However, new questions regarding optimal management of disease arise with regard to the role of these therapies in combination with "conventional" primary modalities for earlier stage, high-risk prostate cancer patients. In this article, we review the transforming world of multimodality therapy in high-risk prostate cancer.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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25
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Liss MA, Osann K, Cho J, Chua WC, Dash A. Severity of hematuria effects resolution in patients treated with hyperbaric oxygen therapy for radiation-induced hematuria. Urol Int 2013; 91:451-5. [PMID: 23919985 DOI: 10.1159/000351331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/13/2013] [Indexed: 01/22/2023]
Abstract
INTRODUCTION We investigated the differences between prostate cancer patients with radiation-induced hematuria treated with hyperbaric oxygen (HBO) therapy that did or did not have a resolution of hematuria. MATERIALS AND METHODS We performed a retrospective review of prostate cancer patients with radiation-induced hematuria who underwent HBO from April 2000 to March 2010. We performed an analysis of demographic data and severity of hematuria in those who had resolution of or persistent hematuria. Additionally, prostate-specific antigen (PSA) data were also obtained during the study period. RESULTS Overall, 11/22 men had resolution of hematuria after HBO therapy with a median follow-up of 2.2 (0.35-13.6) years. The Radiation Therapy Oncology Group (RTOG) grade of hematuria is predictive of final hematuria outcome (resolution vs. persistent) after HBO (p = 0.026). No significant PSA changes were noted before and after HBO therapy. CONCLUSIONS The RTOG hematuria grade is associated with the resolution of hematuria after HBO therapy for radiation-induced hematuria in men treated for prostate cancer. This information may be helpful during shared medical decision-making regarding utility of HBO therapy in the context of severity of hematuria.
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Affiliation(s)
- Michael A Liss
- Departments of Urology and Medicine, University of California - Irvine, Orange, Calif., USA
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26
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Jereczek-Fossa BA, Santoro L, Zerini D, Fodor C, Vischioni B, Dispinzieri M, Bossi-Zanetti I, Gherardi F, Bonora M, Caputo M, Vavassori A, Cambria R, Garibaldi C, Cattani F, Matei DV, Musi G, De Cobelli O, Orecchia R. Image Guided Hypofractionated Radiotherapy and Quality of Life for Localized Prostate Cancer: Prospective Longitudinal Study in 337 Patients. J Urol 2013; 189:2099-103. [DOI: 10.1016/j.juro.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Barbara A. Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Michela Dispinzieri
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Isa Bossi-Zanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Federica Gherardi
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Maria Bonora
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Mariangela Caputo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Raffaella Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Cristina Garibaldi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Deliu V. Matei
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberto Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
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Late toxicity and biochemical control in 554 prostate cancer patients treated with and without dose escalated image guided radiotherapy. Radiother Oncol 2013; 107:140-6. [DOI: 10.1016/j.radonc.2013.04.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/18/2022]
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Melchert C, Gez E, Bohlen G, Scarzello G, Koziol I, Anscher M, Cytron S, Paz A, Torre T, Bassignani M, Dal Moro F, Jocham D, Yosef RB, Corn BW, Kovács G. Interstitial biodegradable balloon for reduced rectal dose during prostate radiotherapy: results of a virtual planning investigation based on the pre- and post-implant imaging data of an international multicenter study. Radiother Oncol 2013; 106:210-4. [PMID: 23484879 DOI: 10.1016/j.radonc.2013.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 12/27/2012] [Accepted: 01/27/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate dose reduction caused by the implantation of an interstitial inflatable and biodegradable balloon device aiming to achieve lower rectal doses with virtual 3D conformal external beam radiation treatment. MATERIALS AND METHODS An inflatable balloon device was placed, interstitially and under transrectal ultrasound guidance, into the rectal-prostate interspace prior treatment initiation of 26 patients with localized prostate cancer, who elected to be treated with radiotherapy (3D CRT or IMRT). The pre- and post-implant CT imaging data of twenty two patients were collected (44 images) for the purpose of the 3D conformal virtual planning presented herein. RESULTS The dorsal prostate-ventral rectal wall separation resulted in an average reduction of the rectal V70% by 55.3% (± 16.8%), V80% by 64.0% (± 17.7%), V90% by 72.0% (± 17.1%), and V100% by 82.3% (± 24.1%). In parallel, rectal D2 ml and D0.1 ml were reduced by 15.8% (± 11.4%) and 3.9% (± 6.4%), respectively. CONCLUSIONS Insertion of the biodegradable balloon into the prostate-rectum interspace is similar to other published invasive procedures. In this virtual dose distribution analysis, the balloon insertion resulted in a remarkable reduction of rectal volume exposed to high radiation doses. This effect has the potential to keep the rectal dose lower especially when higher than usual prostate dose escalation protocols or hypo-fractionated regimes are used. Further prospective clinical investigations on larger cohorts and more conformal radiation techniques will be necessary to define the clinical advantage of the biodegradable interstitial tissue separation device.
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Affiliation(s)
- Corinna Melchert
- Department of Interdisciplinary Brachytherapy, University of Lübeck, Germany
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May intra-operative radiotherapy have a role in the treatment of prostate cancer? Crit Rev Oncol Hematol 2012; 83:123-9. [DOI: 10.1016/j.critrevonc.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/15/2011] [Accepted: 08/18/2011] [Indexed: 11/24/2022] Open
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Analysis of inter-fraction setup errors and organ motion by daily kilovoltage cone beam computed tomography in intensity modulated radiotherapy of prostate cancer. Radiat Oncol 2012; 7:56. [PMID: 22472040 PMCID: PMC3359229 DOI: 10.1186/1748-717x-7-56] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/02/2012] [Indexed: 12/03/2022] Open
Abstract
Background Intensity-modulated radiotherapy (IMRT) enables a better conformality to the target while sparing the surrounding normal tissues and potentially allows to increase the dose to the target, if this is precisely and accurately determined. The goal of this work is to determine inter-fraction setup errors and prostate motion in IMRT for localized prostate cancer, guided by daily kilovoltage cone beam computed tomography (kVCBCT). Methods Systematic and random components of the shifts were retrospectively evaluated by comparing two matching modalities (automatic bone and manual soft-tissue) between each of the 641 daily kVCBCTs (18 patients) and the planning kVCT. A simulated Adaptive Radiation Therapy (ART) protocol using the average of the first 5 kVCBCTs was tested by non-parametric bootstrapping procedure. Results Shifts were < 1 mm in left-right (LR) and in supero-inferior (SI) direction. In antero-posterior (AP) direction systematic prostate motion (2.7 ± 0.7 mm) gave the major contribution to the variability of results; the averages of the absolute total shifts were significantly larger in anterior (6.3 ± 0.2 mm) than in posterior (3.9 mm ± 0.2 mm) direction. The ART protocol would reduce margins in LR, SI and anterior but not in posterior direction. Conclusions The online soft-tissue correction based on daily kVCBCT during IMRT of prostate cancer is fast and efficient. The large random movements of prostate respect to bony anatomy, especially in the AP direction, where anisotropic margins are needed, suggest that daily kVCBCT is at the present time preferable for high dose and high gradients IMRT prostate treatments.
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Radical Prostatectomy and Intraoperative Radiation Therapy in High-Risk Prostate Cancer. Adv Urol 2012; 2012:687230. [PMID: 22400019 PMCID: PMC3287028 DOI: 10.1155/2012/687230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/12/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022] Open
Abstract
Intraoperative electron beam radiotherapy (IOERT) for prostate cancer (PC) is a radiotherapeutic technique, giving high doses of radiation during radical prostatectomy (RP). This paper presents the published treatment approaches for intraoperative radiotherapy analyzing functional outcome, morbidity, and oncological outcome in patients with clinical intermediate-high-risk prostate cancer. A systematic review of the literature was performed, searching PubMed and Web of Science. A “free text” protocol using the term intraoperative radiotherapy and prostate cancer was applied. Ten records were retrieved and analyzed including more than 150 prostate cancer patients treated with IOERT. IOERT represents a feasible technique with acceptable surgical time and minimal toxicity. A greater number of cases and longer follow-up time are needed in order to assess the long-term side effects and oncological outcome.
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Abstract
In Chap. 6 the German S3 guideline on prostate cancer addresses the issue of tumour recurrence following primary local treatment with curative intent, i.e. after radical prostatectomy or a form of radiotherapy. PSA recurrence after radical surgery is defined as a rising PSA of 0.2 ng/ml and after radiotherapy as an increase of at least 2 ng/ml above the individual nadir. Factors for the clinical judgement that a local recurrence is likely are empirical indicators from the primary tumour diagnosis and the PSA course after primary treatment. Salvage external beam radiotherapy after radical surgery does not require the histological proof of a local recurrence and should be initiated early (PSA < 0.5 ng/ml). Before salvage radical prostatectomy, which carries a higher complication rate, the presence of a local recurrence should be histologically verified.
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Affiliation(s)
- O W Hakenberg
- Urologische Universitäts-Klinik und Poliklinik, Ernst-Heydemann-Strasse 6, 18055 Rostock.
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Pella A, Cambria R, Riboldi M, Jereczek-Fossa BA, Fodor C, Zerini D, Torshabi AE, Cattani F, Garibaldi C, Pedroli G, Baroni G, Orecchia R. Use of machine learning methods for prediction of acute toxicity in organs at risk following prostate radiotherapy. Med Phys 2011; 38:2859-67. [PMID: 21815361 DOI: 10.1118/1.3582947] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The goal of this study is to investigate the advantages of large scale optimization methods vs conventional classification techniques in predicting acute toxicity for urinary bladder and rectum due to prostate irradiation. METHODS Clinical and dosimetric data of 321 patients undergoing prostate conformal radiotherapy were recorded. Gastro-intestinal and genito-urinary acute toxicities were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale. Patients were classified in two categories to separate mild (Grade < 2) from severe toxicity levels (Grade > 2). Machine learning methods at different complexity were implemented to predict toxicity as a function of multiple variables. The first approach consisted of a large scale optimization method, based on genetic algorithms (GAs) and artificial neural networks (ANN). The second approach was a binary classifier based on support vector machines (SVM). RESULTS The ANN and SVM-based solutions showed comparable prediction accuracy, exhibiting an area under the receiver operating characteristic (ROC) curve of 0.7. Different sensitivity and specificity features were measured for the two approaches. The ANN algorithm showed enhanced sensitivity if combined with appropriate classification criteria. CONCLUSIONS The results demonstrate that high sensitivity in toxicity prediction can be achieved with optimized ANNs, that are put forward to represent a valuable support in medical decisions. Future studies will be focused on enlarging the available patient database to increase the reliability of toxicity prediction algorithms and to define optimal classification criteria.
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Affiliation(s)
- Andrea Pella
- TBMLab, Department of Bioengineering, Politecnico di Milano University, 20133 Milano, Italy.
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Milecki P, Antczak A, Martenka P, Kwias Z. What is the possible role of PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process to initiate salvage radiotherapy following radical prostatectomy in patients with prostate cancer? Cent European J Urol 2011; 64:67-70. [PMID: 24578866 PMCID: PMC3921716 DOI: 10.5173/ceju.2011.02.art3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/20/2011] [Accepted: 04/27/2011] [Indexed: 11/26/2022] Open
Abstract
This article is an attempt to present a contemporary view on the role of the kinetics of PSA levels as defined by PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process to initiate salvage radiotherapy in patients with prostate cancer after radical prostatectomy (RP). The dynamics of the rise of PSA levels may be an early endpoint parameter, preceding the diagnosis of distant metastasis or death due to prostate cancer based on a single PSA determination. Thus, it seems reasonable to include the kinetics of PSA levels, apart from single PSA determination, in the decision-making algorithm. In a group of patients after RP, PSADT might be an early endpoint that could replace cause-specific survival rate as a late endpoint. PSADT allows distinguishing subgroups of patients at high risk of distant metastases and death, which in turn may lead to a change in the further treatment strategy. Therefore, patients with short PSA doubling time should become a subgroup, in which hormonal therapy should be considered. To date, there is no unanimous consent to accept the criteria of assessment of the dynamics of PSA levels as determinants of treatment in case of recurrences following RP. However, a number of non-randomized clinical trials in patients after RP suggest it would be useful to include these parameters in the decision-making process. For instance, a relationship was found between increased PSA velocity (>2 ng/mL/year) before initiation of oncological treatment and increased (12-fold) risk of death. A number of well-documented retrospective analyses show that PSADT is one of the most important parameters to describe the disease aggressiveness. It has to be stressed that single determination of PSA levels is much less precise in terms of describing the biological aggressiveness of prostate cancer than PSADT. Of course, the question regarding the need to include the PSA levels kinetic parameters as crucial elements of patient management algorithms can be answered in a definitive manner only by randomized clinical trials.
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Affiliation(s)
- Piotr Milecki
- Radiotherapy Department, Greater Poland Cancer Center, Poznań, Poland ; Department of Electroradiology, Medical University, Poznań, Poland
| | | | - Piotr Martenka
- Radiotherapy Department, Greater Poland Cancer Center, Poznań, Poland
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Patient-specific PTV margins in radiotherapy for bladder cancer – A feasibility study using cone beam CT. Radiother Oncol 2011; 99:131-6. [DOI: 10.1016/j.radonc.2011.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 03/24/2011] [Accepted: 04/19/2011] [Indexed: 11/20/2022]
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González-San Segundo C, Herranz-Amo F, Alvarez-González A, Cuesta-Álvaro P, Gómez-Espi M, Paños-Fagundo E, Santos-Miranda JA. Radical prostatectomy versus external-beam radiotherapy for localized prostate cancer: long-term effect on biochemical control-in search of the optimal treatment. Ann Surg Oncol 2011; 18:2980-7. [PMID: 21431406 DOI: 10.1245/s10434-011-1660-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, randomized trials. METHODS This retrospective study comprised 505 patients diagnosed with low- or intermediate- risk prostate cancer in 1998-2005 and treated at Hospital Gregorio Marañón (Spain) with radical prostatectomy (RP) or external-beam radiotherapy (EBRT). No adjuvant therapy was administered. Biochemical relapse was defined as a prostate-specific antigen (PSA) level ≥0.4 ng/ml for RP cases and nadir + 2 for EBRT cases. RP was performed in 271 patients (53.6%) and EBRT in 234 patients (46.4%). The median follow-up was 60 months. The analysis end point was to compare the biochemical recurrence-free survival (bRFS) between the two groups. RESULTS The 5-year bRFS rates for RP and EBRT were 79 ± 2% and 86 ± 2%, respectively (P = 0.48). Multivariate analysis indicated that initial PSA (P = 0.00), perineural invasion in the biopsy specimen (P = 0.00), Gleason score (P = 0.04), EBRT dose (P = 0.02), and positive margins (P = 0.00) were independent predictors of relapse. A decision tree model was constructed with these variables. In the EBRT cohort, a nadir PSA of <0.3 ng/ml was associated with the best 5-year bRFS (96.6 vs. 56.5% if nadir PSA > 1.3 ng/ml). Late biochemical failure (>5 years) was more frequent in the RT group and with low-dose EBRT (≤72 Gy). CONCLUSIONS The biochemical failure rates were similar between PR and EBRT in low- and intermediate-risk subgroups. Outcome was determined by classic pre-treatment features, perineural invasion, low-dose EBRT (≤72 Gy), and nadir PSA value in the RT cohort.
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Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer. Int J Radiat Oncol Biol Phys 2011; 82:889-97. [PMID: 21277113 DOI: 10.1016/j.ijrobp.2010.11.031] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 11/20/2010] [Accepted: 11/30/2010] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer. METHODS AND MATERIALS Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [(11)C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months). RESULTS The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease. CONCLUSIONS CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor control and a low toxicity profile. Further investigation is warranted to identify the patients who benefit most from this treatment modality. The optimal combination with androgen deprivation should also be defined.
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Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy: Feasibility and Initial Experiences Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy. Pathol Oncol Res 2011; 17:315-24. [DOI: 10.1007/s12253-010-9319-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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Correlation Between Acute and Late Toxicity in 973 Prostate Cancer Patients Treated With Three-Dimensional Conformal External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:26-34. [DOI: 10.1016/j.ijrobp.2009.07.1742] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 07/11/2009] [Accepted: 07/16/2009] [Indexed: 11/18/2022]
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Thames HD, Kuban D, Levy LB, Horwitz EM, Kupelian P, Martinez A, Michalski J, Pisansky T, Sandler H, Shipley W, Zelefsky M, Zietman A. The role of overall treatment time in the outcome of radiotherapy of prostate cancer: An analysis of biochemical failure in 4839 men treated between 1987 and 1995. Radiother Oncol 2010; 96:6-12. [DOI: 10.1016/j.radonc.2010.03.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/15/2010] [Accepted: 03/29/2010] [Indexed: 12/25/2022]
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Baumann M, Hölscher T, Denham J. Fractionation in prostate cancer – Is it time after all? Radiother Oncol 2010; 96:1-5. [DOI: 10.1016/j.radonc.2010.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/02/2010] [Indexed: 01/08/2023]
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Dillman RO, Hafer R, Cox C, McClure SE. Overall survival benefit from postoperative radiation therapy for organ-confined, margin-positive prostate cancer. Int J Radiat Oncol Biol Phys 2010; 79:719-23. [PMID: 20472365 DOI: 10.1016/j.ijrobp.2009.11.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 10/22/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Radical prostatectomy for invasive prostate cancer is associated with positive margin rates in 10% to 50% of resected specimens. Postoperative radiation therapy may benefit patients who have organ-confined prostate cancer with positive margins. METHODS AND MATERIALS We performed a retrospective analysis to examine whether adjunctive radiation therapy enhanced long-term survival for prostate cancer patients who underwent prostatectomy for localized prostate cancer but with positive margins. We used the Hoag Cancer Center database to identify patients diagnosed with invasive prostate cancer. Relative and overall survival rates were calculated. RESULTS Among 1,474 patients diagnosed with localized invasive prostate cancer during the years 1990 to 2006 and undergoing prostatectomy, 113 (7.7%) were identified who had positive margins and did not have local extension of disease, positive lymph nodes, or distant metastases. A total of 17 patients received adjunctive radiation therapy (Group A), whereas 96 did not (Group B; 3 received hormonal therapy). Both groups had a median age of 64 years and median follow-up of 7.5 years. In Group A, no patients have died as of last follow-up, but in Group B, 18 have died. Estimated 10-year and 15-year overall survival rates were both 100% for Group A compared with 85% and 57% respectively for Group B (p2=0.050, log rank). Relative 10- and 15 year survival rates were both 100% for Group A compared with 100% and 79% respectively for Group B. CONCLUSIONS This retrospective analysis suggests that prostate cancer patients with localized disease but positive margins do derive a survival benefit from adjuvant radiation therapy.
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Affiliation(s)
- Robert O Dillman
- Hoag Cancer Center, Department of Medical Oncology, Hoag Memorial Hospital Presbyterian, Newport Beach, CA 92658, USA.
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Technical feasibility of transperineal MR-guided prostate interventions in a low-field open MRI unit: canine study. Pathol Oncol Res 2010; 15:315-22. [PMID: 18946728 DOI: 10.1007/s12253-008-9111-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
Magnetic resonance imaging (MRI) provides superior visualization of the prostate, its substructure, surrounding tissues, and, most important, focal lesions or cancer. The purpose of our canine study was to demonstrate the feasibility of a low-field (0.35 T) transperineal system that enables precise MR image guidance of prostate interventions. The canines were placed in the right lateral decubitus position. Template reconstruction, trajectory planning, contouring were based on T2-weighted FSE images. For image guidance and target confirmation, fast gradient spoiled-echo (FSPGR) sequence was used. MR compatible coaxial needles were manually inserted through the perineum to the base of the prostate. After satisfactory position was confirmed, brachytherapy catheters were placed through the coaxial needles. The mean deviation of the needle displacements was 2.9 mm with a median value of 2.7 mm. 97% of the errors were less than 4.0 mm. The needle placement accuracy was modelled by the Rayleigh distribution with a sigma value of 2.3 mm. Visual confirmation of needle placements was demonstrated on pathology tissue slices. The time needed for each step was: anaesthesia - 15 min, setup and positioning - 15 min, initial imaging - 15 min, template registration, projection - 15 min, contouring, trajectory planning, insertion of 12 needles - 60 min Based on our canine experiences our method seems to be a promising approach for performing feasible, accurate, reliable and high-quality prostate MR guidance within a reasonable time span.
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High-dose-rate brachytherapy in combination with conformal external beam radiotherapy in the treatment of prostate cancer. Brachytherapy 2010; 9:27-35. [DOI: 10.1016/j.brachy.2009.04.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 11/18/2022]
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Acute toxicity of image-guided hypofractionated radiotherapy for prostate cancer: nonrandomized comparison with conventional fractionation. Urol Oncol 2009; 29:523-32. [PMID: 20005749 DOI: 10.1016/j.urolonc.2009.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/03/2009] [Accepted: 10/06/2009] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To compare acute toxicity of prostate cancer image-guided hypofractionated radiotherapy (hypo-IGRT) with conventional fractionation without image-guidance (non-IGRT). To test the hypothesis that the potentially injurious effect of hypofractionation can be counterbalanced by the reduced irradiated normal tissue volume using IGRT approach. MATERIALS AND METHODS One hundred seventy-nine cT1-T2N0M0 prostate cancer patients were treated within the prospective study with 70.2 Gy/26 fractions (equivalent to 84 Gy/42 fractions, α/β 1.5 Gy) using IGRT (transabdominal ultrasound, ExacTrac X-Ray system, or cone-beam computer tomography). Their prospectively collected data were compared with data of 174 patients treated to 80 Gy/40 fractions with non-IGRT. The difference between hypo-IGRT and non-IGRT cohorts included fractionation (hypofractionation vs. conventional fractionation), margins (hypo-IGRT margins: 7 mm and 3 mm, for all but posterior margins; respectively; non-IGRT margins: 10 and 5 mm, for all but posterior margins, respectively), and use of image-guidance or not. Multivariate analysis was performed to define the tumor-, patient-, and treatment-related predictors for acute toxicity. RESULTS All patients completed the prescribed radiotherapy course. Acute toxicity in the hypo-IGRT cohort included rectal (G1: 29.1%; G2: 11.2%; G3: 1.1%) and urinary events (G1: 33.5%; G2: 39.1%; G3: 5%). Acute toxicity in the non-IGRT patients included rectal (G1: 16.1%; G2: 6.3%) and urinary events (G1: 36.2%; G2: 20.7%; G3: 0.6%). In 1 hypo-IGRT and 2 non-IGRT patients, radiotherapy was temporarily interrupted due to acute toxicity. The incidence of mild (G1-2) rectal and bladder complications was significantly higher for hypo-IGRT (P = 0.0014 and P < 0.0001, respectively). Multivariate analysis showed that hypo-IGRT (P = 0.001) and higher PSA (P = 0.046) are correlated with higher acute urinary toxicity. No independent factor was identified for acute rectal toxicity. No significant impact of IGRT system on acute toxicity was observed. CONCLUSIONS The acute toxicity rates were low and similar in both study groups with some increase in mild acute urinary injury in the hypo-IGRT patients (most probably due to the under-reporting in the retrospectively analyzed non-IGRT cohort). The higher incidence of acute bowel reactions observed in hypo-IGRT group was not significant in the multivariate analysis. Further investigation is warranted in order to exclude the bias due to the nonrandomized character of the study.
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Magnetic resonance spectroscopy as a decision tool in multimodality treatment design for localised prostate cancer. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nakamura K, Ogawa K, Sasaki T, Onishi H, Koizumi M, Araya M, Mukumoto N, Mitsumori M, Teshima T. Patterns of Radiation Treatment Planning for Localized Prostate Cancer in Japan: 2003-05 Patterns of Care Study Report. Jpn J Clin Oncol 2009; 39:820-4. [DOI: 10.1093/jjco/hyp115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cambria R, Jereczek-Fossa BA, Cattani F, Garibaldi C, Zerini D, Fodor C, Serafini F, Pedroli G, Orecchia R. Evaluation of late rectal toxicity after conformal radiotherapy for prostate cancer. Strahlenther Onkol 2009; 185:384-9. [DOI: 10.1007/s00066-009-1933-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 01/26/2009] [Indexed: 02/07/2023]
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Moreira DM, Jayachandran J, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Stephenson AJ, Freedland SJ. Validation of a nomogram to predict disease progression following salvage radiotherapy after radical prostatectomy: results from the SEARCH database. BJU Int 2009; 104:1452-6. [PMID: 19466946 DOI: 10.1111/j.1464-410x.2009.08623.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To externally validate the nomogram published by Stephenson et al. (termed the 'Stephenson nomogram') to predict disease progression after salvage radiotherapy (SRT) among patients with prostate cancer from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. PATIENTS AND METHODS We analysed data from 102 men treated with SRT for prostate-specific antigen (PSA) failure after prostatectomy, of whom 30 (29%) developed disease progression after SRT during a median follow-up of 50 months. The predicted 6-year progression-free survival (PFS) was compared to the actuarial PFS using calibration plots. The accuracy of the nomogram to risk-stratify men for progression was assessed by the concordance index. RESULTS The median PSA and PSA doubling time before SRT was 0.6 ng/mL and 10.3 months, respectively. The 6-year actuarial disease-free progression after SRT was 57% (95% confidence interval 42-69%). The overall concordance index of the Stephenson nomogram was 0.65. The nomogram predicted failure more accurately at the extremes of risk (lowest and highest) but in intermediate groups, the accuracy was less precise. Of the 11 variables used in the nomogram, only negative margins and high PSA level before SRT were significantly associated with increased disease progression. CONCLUSION The Stephenson nomogram is an important tool to predict disease progression after SRT following radical prostatectomy. It adequately predicted progression in SEARCH with reasonable accuracy. Also, in SEARCH, disease progression was predicted by similar disease characteristics. However, the overall modest performance of the model in our validation cohort indicates there is still room for improvement in predictive models for disease progression after SRT.
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Affiliation(s)
- Daniel M Moreira
- Division of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
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Linac-based or robotic image-guided stereotactic radiotherapy for isolated lymph node recurrent prostate cancer. Radiother Oncol 2009; 93:14-7. [PMID: 19409636 DOI: 10.1016/j.radonc.2009.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 03/26/2009] [Accepted: 04/04/2009] [Indexed: 12/13/2022]
Abstract
We report on 14 patients treated with linac- or robotic image-guided stereotactic radiotherapy for isolated lymph node recurrence from prostate cancer, up to the mean dose of 30Gy/3 fractions. At the mean follow-up of 18.6months, five patients experienced clinical out-field progression. Toxicity was minimal. Further investigation is warranted in order to identify the patients that benefit most from this treatment modality and to define the optimal association of such local approach with androgen deprivation. Hopefully, effective local therapy might reduce the burden of systemic therapies given to the recurrent/metastatic prostate cancer patients.
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