1
|
Galienne M, Risbourg S, Lacornerie T, Taillez A, Lartigau E, Barthoulot M, Pasquier D. Extreme hypofractionated stereotactic radiotherapy for localized prostate Cancer: Efficacy and late urinary toxicity according to transurethral resection of the prostate history. Clin Transl Radiat Oncol 2024; 46:100779. [PMID: 38681137 PMCID: PMC11047194 DOI: 10.1016/j.ctro.2024.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background and purpose Extreme hypofractionated stereotactic body radiotherapy (SBRT) is a therapeutic alternative for localized low- or intermediate-risk prostate cancer. Despite the availability of several studies, the toxicity profile of SBRT has not been comprehensively described. This real-world evidence study assessed the efficacy and toxicities associated with this regimen, and potential prognosis factors for genitourinary toxicities. Materials and methods This retrospective study included 141 consecutive patients with localized prostatic adenocarcinoma treated with CyberKnife™ SBRT, as primary irradiation, at the Oscar Lambret Center between 2010 and 2020. The prescribed dose was 36.25 Gy in 5 fractions. Acute and late toxicities were graded according to the CTCAE (version 5.0). Biochemical recurrence-free survival (bRFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The cumulative incidence of biochemical recurrence (cBR) was estimated using the Kalbfleisch-Prentice method. Results Among the included patients, 13.5 % had a history of transurethral resection of the prostate (TURP). The median follow-up was 48 months. At 5 years, bRFS, cBR, and OS were 72 % (95 %CI: 61-81), 7 % (95 %CI: 3-14), and 82 % (95 %CI: 73-89), respectively. Twenty-nine patients experienced at least one late toxicity of grade ≥ 2; genitourinary (N = 29), including 3 cases of chronic hematuria, and/or gastrointestinal (N = 1). The cumulative incidence of late urinary toxicity of grade ≥ 2 was 20.6 % at 5 years (95 %CI: 13.9-28.1). Multivariate analysis revealed that a history of TURP was significantly associated with late urinary toxicity of grade ≥ 2, after adjusting for clinical target volume (Odds Ratio = 3.06; 95%CI: 1.05-8.86; P = 0.04). Conclusion Extreme hypofractionated SBRT is effective for localized prostate cancer with a low risk of late toxicity. A history of TURP is associated with a higher risk of late urinary toxicity. These findings may contribute to the optimal management of patients treated with this regimen, particularly those with a history of TURP.
Collapse
Affiliation(s)
- Maxime Galienne
- University of Picardie Jules Verne, Amiens, France
- Department of Radiotherapy, Amiens-Picardie University Hospital (South Site), Amiens, France
| | - Séverine Risbourg
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | | | | | - Eric Lartigau
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
| | - Maël Barthoulot
- Department of Methodology and Biostatistics, Oscar Lambret Center, Clinical Research and Innovation Directorate, Lille, France
| | - David Pasquier
- Department of Radiotherapy, Oscar Lambret Center, Lille, France
- University of Lille & CRIStAL (Research Center in Computer Science, Signal and Automatic Control of Lille ((UMR 9189), Lille, France
| |
Collapse
|
2
|
Ong WL, Davidson M, Cheung P, Chung H, Chu W, Detsky J, Liu S, Morton G, Szumacher E, Tseng CL, Vesprini D, Ravi A, McGuffin M, Zhang L, Mamedov A, Deabreu A, Kulasingham-Poon M, Loblaw A. Dosimetric correlates of toxicities and quality of life following two-fraction stereotactic ablative radiotherapy (SABR) for prostate cancer. Radiother Oncol 2023; 188:109864. [PMID: 37619656 DOI: 10.1016/j.radonc.2023.109864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE There is no evidence-based data to guide dose constraints in two-fraction prostate stereotactic ablative radiotherapy (SABR). Using individual patient-data from two prospective trials, we aimed to correlate dosimetric parameters with toxicities and quality of life (QoL) outcomes. MATERIALS AND METHODS We included 60 patients who had two-fraction prostate SABR in the 2STAR (NCT02031328) and 2SMART (NCT03588819) trials. The prescribed dose was 26 Gy to the prostate+/-32 Gy boost to the dominant intraprostatic lesions. Toxicities and QoL data were prospectively collected using CTCAEv4 and EPIC-26 questionnaire. The outcomes evaluated were acute and late grade ≥ 2 toxicities, and late minimal clinical important changes (MCIC) in QoL domains. Dosimetric parameters for bladder, urethra, rectum, and penile bulb were evaluated. RESULTS The median follow-up was 56 months (range: 39-78 months). The cumulative incidence of grade ≥ 2 genitourinary (GU), gastrointestinal (GI), and sexual toxicities were 62%, 3%, and 17% respectively in the acute setting (<3 months), and 57%, 15%, and 52% respectively in late setting (>6 months). There were 36%, 28%, and 29% patients who had late MCIC in urinary, bowel and sexual QoL outcomes respectively. Bladder 0.5 cc was significant predictor for late grade ≥ 2 GU toxicities, with optimal cut-off of 25.5 Gy. Penile bulb D5cc was associated of late grade ≥ 2 sexual toxicities (no optimal cut-off was identified). No dosimetric parameters were identified to be associated with other outcomes. CONCLUSION Using real-life patient data from prospective trials with medium-term follow-up, we identified additional dose constraints that may mitigate the risk of late treatment-related toxicities for two-fraction prostate SABR.
Collapse
Affiliation(s)
- Wee Loon Ong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Alfred Health Radiation Oncology, Monash University, Melbourne, Australia
| | - Melanie Davidson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Hans Chung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Jay Detsky
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Stanley Liu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Gerard Morton
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Chia-Lin Tseng
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Canada; Molli Surgical, Toronto, Canada
| | - Merrylee McGuffin
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrea Deabreu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Department of Health Policy, Measurement and Evaluation, University of Toronto, Canada.
| |
Collapse
|
3
|
Fujii K, Nakano M, Kawakami S, Tanaka Y, Kainuma T, Tsumura H, Tabata KI, Satoh T, Iwamura M, Ishiyama H. Dosimetric Predictors of Toxicity after Prostate Stereotactic Body Radiotherapy: A Single-Institutional Experience of 145 Patients. Curr Oncol 2023; 30:5062-5071. [PMID: 37232841 DOI: 10.3390/curroncol30050383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
The indications for stereotactic body radiotherapy (SBRT) for prostate cancer have increased. However, the relationships between adverse events and risk factors remain unclear. This study aimed to clarify associations between adverse events and dose index for prostate SBRT. Participants comprised 145 patients irradiated with 32-36 Gy in 4 fractions. Radiotherapy-related risk factors such as dose-volume histogram parameters and patient-related risk factors such as T stage and Gleason score were evaluated in a competing risk analysis. Median follow-up duration was 42.9 months. A total of 9.7% had acute Grade ≥ 2 GU toxicities and 4.8% had acute Grade ≥ 2 GI toxicities. A total of 11.1% had late Grade ≥ 2 GU toxicities and 7.6% had late Grade ≥ 2 GI toxicities. Two (1.4%) patients suffered from late Grade 3 GU toxicities. Similarly, two (1.4%) patients suffered from late Grade 3 GI toxicities. Acute GU and GI events correlated with prostate volume and dose to the hottest 10 cc volume (D10cc)/volumes receiving a minimum of 30 Gy (V30 Gy) of rectum, respectively. Late GI toxicity, frequency, and rectal hemorrhage correlated with rectal D0.1 cc/D1 cc, maximum dose to the bladder, and rectal D0.1 cc, respectively. Toxicities after prostate SBRT using 32-36 Gy/4 fractions were acceptable. Our analysis showed that acute toxicities correlated with volume receiving a medium dose level, and late toxicities correlated with highest point dose of organs at risk.
Collapse
Affiliation(s)
- Kyohei Fujii
- Division of Radiation Oncology, Kitasato University Hospital, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Masahiro Nakano
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Shogo Kawakami
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Yuichi Tanaka
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Takuro Kainuma
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan
| |
Collapse
|
4
|
Lucchini R, Panizza D, Colciago RR, Vernier V, Daniotti MC, Faccenda V, Arcangeli S. Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking. Radiat Oncol 2021; 16:180. [PMID: 34535168 PMCID: PMC8447697 DOI: 10.1186/s13014-021-01908-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE/OBJECTIVES To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilotÒ System) to account for intra-fractional organ motion. MATERIAL/METHODS Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. RESULTS All patients completed the treatment in the expected time (10.2 +/- 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of the fractions, either during setup or beam delivery. CONCLUSIONS Our preliminary findings show that dose intensified SBRT for unfavorable prostate tumors does not come at the cost of an increased toxicity, provided that a reliable technique for real time prostate monitoring is ensured. Fast FFF beams contributed to reduce intra-fractional motion. These observations need to be confirmed on a larger scale and a longer follow up.
Collapse
Affiliation(s)
- Raffaella Lucchini
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Radiation Oncology Department, ASST Monza, Monza, Italy
| | - Denis Panizza
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Medical Physics Department, ASST Monza, Monza, Italy
| | - Riccardo Ray Colciago
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
- Radiation Oncology Department, ASST Monza, Monza, Italy.
| | - Veronica Vernier
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Valeria Faccenda
- Medical Physics Department, ASST Monza, Monza, Italy
- Department of Physics, University of Milan, Milan, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Radiation Oncology Department, ASST Monza, Monza, Italy
| |
Collapse
|
5
|
Ito M, Yoshioka Y, Takase Y, Suzuki J, Matsunaga T, Takahashi H, Takeuchi A, Adachi S, Abe S, Oshima Y, Ohtakara K, Suzuki K, Okuda T. Stereotactic body radiation therapy for Japanese patients with localized prostate cancer: 2-year results and predictive factors for acute genitourinary toxicities. Jpn J Clin Oncol 2021; 51:1253-1260. [PMID: 34128053 DOI: 10.1093/jjco/hyab094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aimed to report the 2-year results of stereotactic body radiation therapy for prostate cancer and identify the clinical and dosimetric factors that predict acute genitourinary toxicities. METHODS We retrospectively reviewed the medical records of patients with non-metastatic prostate cancer treated at Toyota Memorial Hospital between 2017 and 2020. The patients were treated with stereotactic body radiation therapy with a total dose of 36.25 Gy in five fractions on consecutive weekdays. While low-risk patients received radiotherapy alone, intermediate- to high-risk patients also received androgen deprivation therapy. RESULTS We analysed a total of 104 patients, including 10, 60 and 34 low-, intermediate- and high-risk patients, respectively. The median follow-up duration was 2 years. We did not observe biochemical/clinical recurrence, distant metastasis or death from prostate cancer. One patient died of another cause. Grade 2 acute genitourinary toxicity was observed in 40 (38%) patients. Age (P = 0.021), genitourinary toxicity of grade ≥1 at baseline (P = 0.023) and bladder mean dose (P = 0.047) were significantly associated with the incidence of grade 2 acute genitourinary toxicity. The cut-off value of 65 years for age and 10.3 Gy for the bladder mean dose were considered the most appropriate. Grade 2 acute gastrointestinal toxicity was observed in five (5%) patients. None of the patients experienced grade ≥3 acute or late toxicity. CONCLUSIONS Stereotactic body radiation therapy is feasible for Japanese patients with prostate cancer, with acceptable acute toxicity. Age, genitourinary toxicity at baseline and bladder mean dose predict grade 2 acute genitourinary toxicity.
Collapse
Affiliation(s)
- Makoto Ito
- Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan
| | - Yasuo Yoshioka
- Radiation Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Japan.,Department of Radiation Oncology, Toyota Memorial Hospital, Toyota, Japan
| | - Yuuki Takase
- Department of Radiology, Nagoya University Hospital, Nagoya, Japan
| | - Junji Suzuki
- Department of Radiation Oncology, Toyota Memorial Hospital, Toyota, Japan
| | - Takuma Matsunaga
- Department of Radiation Oncology, Toyota Memorial Hospital, Toyota, Japan
| | - Hironori Takahashi
- Department of Radiation Oncology, Toyota Memorial Hospital, Toyota, Japan
| | - Arisa Takeuchi
- Department of Radiation Oncology, Anjo Kosei Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Anjo, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan
| | - Souichirou Abe
- Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kazuhiro Ohtakara
- Department of Radiation Oncology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan
| | - Takahito Okuda
- Department of Radiation Oncology, Toyota Memorial Hospital, Toyota, Japan
| |
Collapse
|
6
|
Wang K, Mavroidis P, Royce TJ, Falchook AD, Collins SP, Sapareto S, Sheets NC, Fuller DB, El Naqa I, Yorke E, Grimm J, Jackson A, Chen RC. Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response. Int J Radiat Oncol Biol Phys 2020; 110:237-248. [PMID: 33358229 DOI: 10.1016/j.ijrobp.2020.09.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Ultrahypofractionationed radiation therapy for prostate cancer is increasingly studied and adopted. The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiotherapy therefore aimed to review studies examining toxicity and quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer and model its effect. METHODS AND MATERIALS We performed a systematic PubMed search of prostate SBRT studies published between 2001 and 2018. Those that analyzed factors associated with late urinary, bowel, or sexual toxicity and/or quality of life were included and reviewed. Normal tissue complication probability modelling was performed on studies that contained detailed dose/volume and outcome data. RESULTS We found 13 studies that examined urinary effects, 6 that examined bowel effects, and 4 that examined sexual effects. Most studies included patients with low-intermediate risk prostate cancer treated to 35-40 Gy. Most patients were treated with 5 fractions, with several centers using 4 fractions. Endpoints were heterogeneous and included both physician-scored toxicity and patient-reported quality of life. Most toxicities were mild-moderate (eg, grade 1-2) with a very low overall incidence of severe toxicity (eg, grade 3 or higher, usually <3%). Side effects were associated with both dosimetric and non-dosimetric factors. CONCLUSIONS Prostate SBRT appears to be overall well tolerated, with determinants of toxicity that include dosimetric factors and patient factors. Suggested dose constraints include bladder V(Rx Dose)Gy <5-10 cc, urethra Dmax <38-42 Gy, and rectum Dmax <35-38 Gy, though current data do not offer firm guidance on tolerance doses. Several areas for future research are suggested.
Collapse
Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sean P Collins
- Department of Radiation Oncology, Georgetown University Hospital, Washington, DC
| | - Stephen Sapareto
- Department of Medical Physics, Banner Health System, Phoenix, Arizona
| | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, Florida
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas.
| |
Collapse
|
7
|
Pan X, Levin-Epstein R, Huang J, Ruan D, King CR, Kishan AU, Steinberg ML, Qi XS. Dosimetric predictors of patient-reported toxicity after prostate stereotactic body radiotherapy: Analysis of full range of the dose-volume histogram using ensemble machine learning. Radiother Oncol 2020; 148:181-188. [PMID: 32388444 DOI: 10.1016/j.radonc.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to evaluate the associations between dosimetric parameters and patient-reported outcomes, and to identify latent dosimetric parameters that most correlate with acute and subacute patient-reported urinary and rectal toxicity after prostate stereotactic body radiotherapy (SBRT) using machine learning methods. MATERIALS AND METHODS Eighty-six patients who underwent prostate SBRT (40 Gy in 5 fractions) were included. Patient-reported health-related quality of life (HRQOL) outcomes were derived from bowel and bladder symptom scores on the Expanded Prostate Cancer Index Composite (EPIC-26) at 3 and 12 months post-SBRT. We utilized ensemble machine learning (ML) to interrogate the entire dose-volume histogram (DVH) to evaluate relationships between dose-volume parameters and HRQOL changes. The latent predictive dosimetric parameters that were most associated with HRQOL changes in urinary and rectal function were thus identified. An external cohort of 26 prostate SBRT patients was acquired to further test the predictive models. RESULTS Bladder dose-volume metrics strongly predicted patient-reported urinary irritative and incontinence symptoms (area under the curves [AUCs] of 0.79 and 0.87, respectively) at 12 months. Maximum bladder dose, bladder V102.5%, bladder volume, and conformity indices (V50/VPTV and V100/VPTV) were most predictive of HRQOL changes in both urinary domains. No strong rectal toxicity dosimetric association was identified (AUC = 0.64). CONCLUSION We demonstrated the application of advanced ML methods to identify a set of dosimetric variables that most highly correlated with patient-reported urinary HRQOL. DVH quantities identified with these methods may be used to achieve outcome-driven planning objectives to further reduce patient-reported toxicity with prostate SBRT.
Collapse
Affiliation(s)
- Xiaoying Pan
- School of Computer Science and Technology, Xi'an University of Posts & Telecommunications, China; Shaanxi Key Laboratory of Network Data Analysis and Intelligent Processing, Xi'an University of Posts and Telecommunications, China; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Rebecca Levin-Epstein
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Jiahao Huang
- School of Computer Science and Technology, Xi'an University of Posts & Telecommunications, China
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States
| | - X Sharon Qi
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States.
| |
Collapse
|
8
|
Dosimetric predictors of toxicity and quality of life following prostate stereotactic ablative radiotherapy. Radiother Oncol 2020; 144:135-140. [DOI: 10.1016/j.radonc.2019.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
|
9
|
Patient and Dosimetric Predictors of Genitourinary and Bowel Quality of Life After Prostate SBRT: Secondary Analysis of a Multi-institutional Trial. Int J Radiat Oncol Biol Phys 2018; 102:1430-1437. [DOI: 10.1016/j.ijrobp.2018.07.191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
|
10
|
Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
Collapse
Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| |
Collapse
|
11
|
Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward. TUMORI JOURNAL 2017; 103:395-404. [DOI: 10.5301/tj.5000681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Abstract
One of the most relevant achievements of Professor Gianni Bonadonna was the implementation of the methodology of controlled clinical trials in medical oncology. It is valid for all cancer types, oncological disciplines and clinical endpoints, both survival and toxicity. This narrative review reports on the status of the current knowledge of the radiation-induced urinary syndrome after external-beam radiotherapy for prostate cancer. In recent years, the syndrome has been the object of large-scale prospective observational trials specifically devoted to investigating the association of patient and treatment features with acute/late urinary toxicity. The first results of these trials allow initial attempts at predictive modeling, which can serve as a basis for the optimization of patient selection and treatment planning.
Collapse
|
12
|
Underwood TSA, Voog JC, Moteabbed M, Tang S, Soffen E, Cahlon O, Lu HM, Zietman AL, Efstathiou JA, Paganetti H. Hydrogel rectum-prostate spacers mitigate the uncertainties in proton relative biological effectiveness associated with anterior-oblique beams. Acta Oncol 2017; 56:575-581. [PMID: 28075206 DOI: 10.1080/0284186x.2016.1275781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Anterior-oblique (AO) proton beams can form an attractive option for prostate patients receiving external beam radiotherapy (EBRT) as they avoid the femoral heads. For a cohort with hydrogel prostate-rectum spacers, we asked whether it was possible to generate AO proton plans robust to end-of-range elevations in linear energy transfer (LET) and modeled relative biological effectiveness (RBE). Additionally we considered how rectal spacers influenced planned dose distributions for AO and standard bilateral (SB) proton beams versus intensity-modulated radiotherapy (IMRT). MATERIAL AND METHODS We studied three treatment strategies for 10 patients with rectal spacers: (A) AO proton beams, (B) SB proton beams and (C) IMRT. For strategy (A) dose and LET distributions were simulated (using the TOPAS Monte Carlo platform) and the McNamara model was used to calculate proton RBE as a function of LET, dose per fraction, and photon α/β. All calculations were performed on pretreatment scans: inter- and intra-fractional changes in anatomy/set-up were not considered. RESULTS For 9/10 patients, rectal spacers enabled generation of AO proton plans robust to modeled RBE elevations: rectal dose constraints were fulfilled even when the variable RBE model was applied with a conservative α/β = 2 Gy. Amongst a subset of patients the proton rectal doses for the planning target volume plans were remarkably low: for 2/10 SB plans and 4/10 AO plans, ≤10% of the rectum received ≥20 Gy. AO proton plans delivered integral doses a factor of approximately three lower than IMRT and spared the femoral heads almost entirely. CONCLUSION Typically, rectal spacers enabled the generation of anterior beam proton plans that appeared robust to modeled variation in RBE. However, further analysis of day-to-day robustness would be required prior to a clinical implementation of AO proton beams. Such beams offer almost complete femoral head sparing, but their broader value relative to IMRT and SB protons remains unclear.
Collapse
Affiliation(s)
- Tracy S. A. Underwood
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Justin C. Voog
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maryam Moteabbed
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shikui Tang
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | | | - Oren Cahlon
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Hsiao-Ming Lu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|