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Song J, Corkum MT, Loblaw DA, Chung HT, Tseng CL, Cheung P, Szumacher E, Liu SK, Chu W, Davidson MTM, Wronski M, Zhang L, Mamedov A, Morton G. Dosimetric Parameters Predictive of Treatment-Related Toxicity in High Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e438-e439. [PMID: 37785424 DOI: 10.1016/j.ijrobp.2023.06.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) High dose-rate (HDR) brachytherapy as monotherapy is an effective treatment for patients with low- and intermediate-risk prostate cancer and is increasingly being offered as a 2-fraction protocol. There is a lack of consensus on the optimal dosimetric planning parameters to use, or whether there is any benefit summating dosimetric parameters from more than one implant. Our goal is to determine planning parameters associated with disease control, toxicity and health-related quality of life (HRQOL). MATERIALS/METHODS Data were collected on 83 patients with low- and intermediate-risk prostate cancer who received 2 fractions of 13.5 Gy HDR brachytherapy without androgen-deprivation therapy as part of a randomized phase II clinical trial. An in-house deformable, registration algorithm was used to co-register and dose-summate the plans from both implants for each patient. Acute and late GU and GI toxicities were measured using CTCAE 4.0 and HRQOL was measured in urinary, bowel, sexual and hormonal domains using the EPIC scores. Treatment efficacy was assessed through PSA measurement and imaging with or without biopsy where indicated. Covariates included baseline clinical factors, disease characteristics and treatment dosimetric parameters. Cox proportional hazards was performed to evaluate covariates impact on treatment toxicity and efficacy, and logistic regression analysis evaluated covariates impact on HRQOL. RESULTS Among the 83 patients, median prostate volume was 46.7cm3. Median summated planning target volume receiving 100% prescription dose (PTV V100%) was 97.4%, median PTV V150% 42.4% and median PTV V200% 15.5%. Median highest dose to the 1cm3 rectum (D1cc) was 66.9% of the prescription dose and median rectum V80% was 0.008cm3. Median urethral D1cc was 99.0% of the prescription dose, median urethral Dmax 121.7% and median urethral D10% 116.2%. Grade ≥2 GI toxicity was uncommon (3.7% acute and 8.5% late), but grade ≥2 GU toxicity was reported in 73.2% (acute) and 46.3% (late) patients. Rectum D1cc and V80% were found to be significantly associated with grade 2 or higher acute GI toxicity, while use of a-blocker at baseline was associated with grade ≥2 acute GU toxicity. Similarly, use of a-blocker was associated with late grade ≥2 GU toxicity, but with no dosimetric associations. No other variables were associated with treatment-related toxicities. Only rectum D1cc was significantly associated with changes in bowel EPIC scores. Estimated 5-year biochemical disease-free survival was 93.9% and 5-year cumulative incidence of local failure was 3.8%. CONCLUSION HDR monotherapy with 27 Gy delivered in 2 fractions in treatment of prostate cancer is well tolerated with high rates of disease control and minimal toxicity. Dose summation between 2 fractions of HDR brachytherapy is feasible, with rectal dose predicting acute GI toxicity. The lack of association between dose metrics and urinary toxicity raises the potential for further dose escalation.
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Affiliation(s)
- J Song
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M T Corkum
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D A Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - H T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S K Liu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - W Chu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M T M Davidson
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Wronski
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Ong WL, Davidson MTM, Cheung P, Chung HT, Chu W, Detsky J, Liu SK, Morton G, Szumacher E, Tseng CL, Vesprini D, Ravi A, McGuffin M, Zhang L, Mamedov A, Deabreu A, Kulasingham-Poon M, Loblaw DA. Dosimetric Predictors of Toxicities and Quality of Life Following Two-Fraction Stereotactic Body Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e425-e426. [PMID: 37785394 DOI: 10.1016/j.ijrobp.2023.06.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is emerging interest in two-fraction stereotactic body radiotherapy (2#SBRT) for localized prostate cancer. However, there is limited data to guide organs at risk (OAR) dose constraints in 2#SBRT. We aim to identify dosimetric predictors of toxicities and quality of life (QoL) using real life patient data from two prospective 2#SBRT trials. MATERIALS/METHODS We included 60 patients who had 2#SBRT in the 2STAR (NCT02031328) and 2SMART (NCT03588819) phase 2 trials. The prescribed dose was 26Gy to the prostate +/- focal boost of 32Gy to the dominant intraprostatic lesions. Toxicities and QoL data were prospectively collected using CTCAEv4 and EPIC26 questionnaires. For QoL, we reported the minimal clinical important changes (MCIC), defined as changes in QoL score of >0.5 standard deviation from baseline QoL score. We evaluated the bladder, urethra, rectum, and penile bulb dosimetry (urethra dosimetry only available in 30 patients in 2SMART trial). Some of the dosimetric parameters were log-transformed to normalize the distribution. Cox regression was used to identify dosimetric predictors for acute and late grade ≥2 GU toxicities. Logistic regression was used to identify dosimetric predictors for late MCIC in urinary, bowel and sexual QoL domains. Backward stepwise selection was used to identify significant dosimetric parameters. For GU toxicities and urinary QoL, three additional clinical factors (age, prostate volume and IPSS) were included in the final model as confounding factors. Receiver operating characteristics curve was used to identify cut-off for significant dosimetric parameters. RESULTS The median follow-up for the cohort was 56 months (range: 39-78 months). The cumulative acute and late grade ³2 GU toxicities were 62% (37/60) and 57% (34/60) respectively. No bladder or urethra dosimetric parameter was associated with acute grade ≥2 GU toxicities. Bladder D0.5cc was significant predictor of late grade ≥2 GU toxicities in univariate model (P = 0.05), but not in multivariate model. Baseline IPSS score was the single strongest predictor for late grade ≥2 GU toxicities (HR = 1.9; 95% CI = 1.1-3.4; P = 0.03). For late QoL outcomes, there were 36% (21/58), 28% (16/58), and 29% (17/58) of patients with MCIC in urinary, bowel and sexual QoL domains respectively. Bladder V10Gy was associated with late urinary MCIC in multivariate model after adjusting for clinical confounders (HR = 2.6, 95% CI = 1.1-6.6; P = 0.04). 48% (14/29) and 24% (7/29) of patients with bladder V10Gy>13.9% and V10Gy≤13.9% respectively had late urinary MCIC. No rectum and penile bulb dosimetry parameters was identified to be associated with late bowel or sexual QoL. CONCLUSION Using real life patient data from prospective clinical trials with medium term follow-up, we identified statistically significant bladder dosimetry parameter predictive of late urinary QoL. This finding could be useful to guide OAR dose constraints in prostate 2#SBRT trials.
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Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - M T M Davidson
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - W Chu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S K Liu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Ravi
- Molli Surgical, Toronto, ON, Canada
| | - M McGuffin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Deabreu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Kulasingham-Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D A Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Correa R, Morton G, Chung H, Tseng C, Cheung P, Chu W, Liu S, McGuffin M, Shahid A, Davidson M, Ravi A, Helou J, Alayed Y, Zhang L, Mamedov A, Loblaw A. PO-1408 Two-fraction prostate SABR vs. two-fraction HDR brachytherapy: does dose heterogeneity matter? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cheung P, Tseng C, Chung H, Chu W, Vesprini D, Liu S, Morton G, Sahgal A, Soliman H, Myrehaug S, Detsky J, Szumacher E, Chung P, Helou J, Emmenegger U, Mamedov A, Shahid A, Zhang L, Loblaw D. Intermittent Androgen Deprivation Therapy Plus Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Corkum M, Loblaw D, Chung H, Tseng C, McGuffin M, Davidson M, Paudel M, Wronski M, Cheung P, Chu W, Szumacher E, Zhang L, Mamedov A, Morton G. Dosimetric Predictors of Toxicity and Quality of Life Following Single Fraction High Dose-Rate Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Starkman R, Alibhai S, Wells RA, Geddes M, Zhu N, Keating MM, Leber B, Chodirker L, Sabloff M, Christou G, Leitch HA, St-Hilaire E, Finn N, Shamy A, Yee K, Storring J, Nevill T, Delage R, Elemary M, Banerji V, Lenis M, Kirubananthaan A, Mamedov A, Zhang L, Rockwood K, Buckstein R. An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring. Leukemia 2019; 34:1394-1406. [PMID: 31811236 DOI: 10.1038/s41375-019-0666-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.
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Affiliation(s)
- R Starkman
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Alibhai
- Geriatric Medicine/Oncology, University Health Network, Toronto, ON, Canada
| | - R A Wells
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Geddes
- Hematology/Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - N Zhu
- Hematology/Oncology, University of Alberta Hospital, Edmonton, AB, Canada
| | - M M Keating
- Hematology/Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - B Leber
- Hematology/Oncology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - L Chodirker
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Sabloff
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - G Christou
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - H A Leitch
- Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - E St-Hilaire
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - N Finn
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - A Shamy
- Hematology/Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - K Yee
- Hematology/Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - J Storring
- Hematology/Oncology, McGill University Health Centre-Royal Victoria Hospital, Montreal, QC, Canada
| | - T Nevill
- Hematology/Oncology, Vancouver General Hospital, Vancouver, BC, Canada
| | - R Delage
- Hematology/Oncology, Centre de recherche du CHU de Quebec-Universite Laval, Quebec City, QC, Canada
| | - M Elemary
- Hematology, Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - V Banerji
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - M Lenis
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Kirubananthaan
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Rockwood
- Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Buckstein
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Loblaw D, Quon H, Ong A, Alayed Y, Cheung P, Chu W, Chung H, Vesprini D, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Zhang L, Mamedov A, Deabreu A. Accelerating Prostate Stereotactic Ablative Body Radiotherapy (SABR): Efficacy and Toxicity of a Randomized Phase II Study of 11 Versus 29 Days Overall Treatment Time (PATRIOT Study; ClinicalTrials.gov NCT01423474). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cheung P, Morton G, Chung H, Vesprini D, Chu W, Liu S, Tseng C, Sahgal A, Soliman H, Myrehaug S, Szumacher E, Chung P, Helou J, Emmenegger U, Erler D, Mamedov A, Chan S, Zhang L, Loblaw D. Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Roy S, Loblaw A, Cheung P, Chu W, Chung HT, Vesprini D, Ong A, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Helou J, Zhang L, Mamedov A, Deabreu A, Quon HC. Prostate-specific Antigen Bounce After Stereotactic Body Radiotherapy for Prostate Cancer: A Pooled Analysis of Four Prospective Trials. Clin Oncol (R Coll Radiol) 2019; 31:621-629. [PMID: 31126725 DOI: 10.1016/j.clon.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
AIMS We conducted a pooled analysis of four prospective stereotactic body radiotherapy (SBRT) trials of low- and intermediate-risk prostate cancer to evaluate the incidence of prostate-specific antigen (PSA) bounce and its correlation with the time-dose-fraction schedule. The correlation between bounce with PSA response at 4 years (nadir PSA < 0.4 ng/ml) and biochemical failure-free survival (BFFS) was also explored. MATERIALS AND METHODS The study included four treatment groups: 35 Gy/five fractions once per week (QW) (TG-1; n = 84); 40 Gy/five fractions QW (TG-2; n = 100); 40 Gy/five fractions every other day (TG-3; n = 73); and 26 Gy/two fractions QW (TG-4; n = 30). PSA bounce was defined as a rise in PSA by 0.2 ng/ml (nadir + 0.2) or 2 ng/ml (nadir + 2.0) above nadir followed by a decrease back to nadir. Patients with fewer than three follow-up PSA tests were excluded from the pooled analysis. RESULTS In total, 287 patients were included, with a median follow-up of 5.0 years. The pooled 5-year cumulative incidence of bounce by nadir + 2.0 was 8%. The 2-year cumulative incidences of PSA bounce by nadir + 0.2 were 28.9, 21, 19.6 and 16.7% (P = 0.12) and by nadir + 2.0 were 7.2, 8, 2.7 and 6.7% (P = 0.32) for TG-1 to TG-4, respectively. Multivariable analysis revealed that for nadir + 2.0, pre-treatment PSA (odds ratio 0.49; 95% confidence interval 0.26-0.97) correlated with PSA bounce. Although PSA bounce by nadir + 0.2 (odds ratio 0.10; 95% confidence interval 0.04-0.24) and nadir + 2.0 (odds ratio 0.29; 95% confidence interval 0.09-0.93) was associated with a lower probability of PSA response at 4 years, there was no association between bounce by nadir + 0.2 (hazard ratio 0.36; 95% confidence interval 0.08-1.74) or nadir + 2 (hazard ratio 1.77; 95% confidence interval 0.28-11.07) with BFFS. CONCLUSION The incidence of PSA bounce was independent of time-dose-fraction schedule for prostate SBRT. One in 13 patients experienced a bounce high enough to be misinterpreted as biochemical failure, and clinicians should avoid early salvage interventions in these patients. There was no association between PSA bounce and BFFS.
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Affiliation(s)
- S Roy
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada
| | - A Loblaw
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - P Cheung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - W Chu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H T Chung
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - D Vesprini
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ong
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - A Chowdhury
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | | | - G Pang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - R Korol
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - M Davidson
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Ravi
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - B McCurdy
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - J Helou
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - L Zhang
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Mamedov
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - A Deabreu
- Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - H C Quon
- Tom Baker Cancer Center, Department of Oncology, University of Calgary, Calgary, Canada.
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Alayed Y, Cheung P, Chu W, Chung H, Davidson M, Ravi A, Helou J, Zhang L, Mamedov A, Commisso A, Commisso K, Loblaw A. PO-0840 Two StereoTactic Ablative Radiotherapy Treatments for Localized Prostate Cancer (2STAR). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31260-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roy S, Loblaw D, Cheung P, Chu W, Chung H, Vesprini D, Ong A, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Helou J, Zhang L, Mamedov A, Deabreu A, Quon H. PSA Bounce after Stereotactic Body Radiation Therapy for Prostate Cancer: Pooled Analysis from 4 SBRT Trials Evaluating Different Time-Dose-Fraction Schedules. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Adzhigaliev R, Bautin A, Pasyuga V, Ilov N, Berezhnoy S, Belov S, Petrova O, Alexeev V, Yusupova E, Mamedov A, Ryzhkov A, Vlasova E, Tarasov D. Effect of morphine on the inflammatory response in cardiac surgery patients: a randomized trial. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bauman G, Chen J, Rodrigues G, Commisso K, Mamedov A, Musunuru H, Davidson M, Mills T, Warner A, Loblaw D. Extreme Hypofractionation for High Risk Prostate Cancer: Dosimetric Correlations With Rectal Bleeding. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loblaw D, Cheung P, Pang G, Mamedov A, D'Alimonte L, Deabreu A, Commisso K, Zhang L, Quon H, Musunuru H, Helou J. Dose Escalation for Prostate Stereotactic Ablative Radiation Therapy: Late Outcomes from Two Prospective Clinical Trials. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shahid N, Loblaw A, Chung H, Cheung P, Szumacher E, Danjoux C, Sankreacha R, Zhang L, Deabreu A, Mamedov A, Morton G. Long-term Toxicity and Health-related Quality of Life after Single-fraction High Dose Rate Brachytherapy Boost and Hypofractionated External Beam Radiotherapy for Intermediate-risk Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:412-420. [DOI: 10.1016/j.clon.2017.01.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
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Lin Y, Saskin A, Wells RA, Lenis M, Mamedov A, Callum J, Buckstein R. Prophylactic RhCE and Kell antigen matching: impact on alloimmunization in transfusion-dependent patients with myelodysplastic syndromes. Vox Sang 2016; 112:79-86. [DOI: 10.1111/vox.12455] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Lin
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
| | - A. Saskin
- Odette Cancer Centre; Toronto ON Canada
| | - R. A. Wells
- Odette Cancer Centre; Toronto ON Canada
- Division of Hematology; Sunnybrook Health Sciences Centre; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
| | - M. Lenis
- Odette Cancer Centre; Toronto ON Canada
| | | | - J. Callum
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
| | - R. Buckstein
- Odette Cancer Centre; Toronto ON Canada
- Division of Hematology; Sunnybrook Health Sciences Centre; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
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Cheung P, Morton G, Szumacher E, Danjoux C, Chung H, Vesprini D, Choo C, Chu W, Deabreu A, Mamedov A, Zhang L, Loblaw D. Concomitant Hypofractionated Intensity Modulated Radiation Therapy Boost For Localized High-Risk Prostate Cancer: Five-Year Results of a Prospective Trial. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Quon H, Ong A, Cheung P, Chu W, Chung H, Vesprini D, Chowdhury A, Panjwani D, Pang G, Korol R, Davidson M, Ravi A, McCurdy B, Zhang L, Bucher O, Mamedov A, Deabreu A, Lylyk E, Loblaw D. PATRIOT Trial: Randomized Phase 2 Study of Prostate Stereotactic Body Radiation Therapy Comparing 11 Versus 29 Days Overall Treatment Time. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gladwish A, Loblaw A, Cheung P, Morton G, Chung H, Deabreu A, Pang G, Mamedov A. Accelerated hypofractioned postoperative radiotherapy for prostate cancer: a prospective phase I/II study. Clin Oncol (R Coll Radiol) 2015; 27:145-52. [PMID: 25577669 DOI: 10.1016/j.clon.2014.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 10/10/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
AIMS To present the initial findings of a single institution, phase I/II study investigating hypofractionated radiotherapy in patients undergoing post-prostatectomy treatment. MATERIALS AND METHODS Patients requiring postoperative radiotherapy were prospectively enrolled. Dose was prescribed to the prostate bed with 51 Gy in 17 daily fractions. Androgen deprivation was optional. Acute and late gastrointestinal/genitourinary toxicity were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 and quality of life was assessed using the Expanded Prostate Cancer Index Composite evaluation tool. Prostate-specific antigen (PSA) was evaluated at every follow-up. RESULTS Thirty patients were enrolled between 2009 and 2011. The median age was 65 years and most had Gleason 7 disease (86%) with pT2c or pT3a (82%). Positive margins were documented in 67% of the patients. The median pre-treatment PSA was 0.12 ng/ml. The median follow-up was 24 months. Overall toxicity was low, with >80% of patients having ≤ grade 1 acute toxicity in both genitourinary and gastrointestinal realms. Similarly, only two patients (6%) experienced grade 2/3 late gastrointestinal/genitourinary toxicity. Quality of life scores were also indicative of a well-tolerated treatment. PSA failure was seen in five patients (17%). CONCLUSIONS We present a hypofractionated schedule of postoperative prostate radiotherapy that is both well tolerated in terms of both toxicity and quality of life measures. Initial PSA control is encouraging. Further evaluation with a longer follow-up and a larger cohort is warranted.
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Affiliation(s)
- A Gladwish
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - A Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Institute for Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Canada.
| | - P Cheung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - G Morton
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - H Chung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - A Deabreu
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - G Pang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - A Mamedov
- Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
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Musunuru H, Sethukavalan P, Cheung P, Morton G, D’Alimonte L, Deabreu A, Mamedov A, Zhang L, Chung H, Loblaw A. Comparison of Active Surveillance, Low-Dose-Rate Brachytherapy, Stereotactic Ablative Body Radiation Therapy, and Standard External Beam in Low-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Helou J, Elias E, Zhang L, Cheung P, Deabreu A, D'Alimonte L, Perakaa S, Mamedov A, Cardoso M, Loblaw A. Dosimetric and Patient Correlates of Quality of Life After Prostate Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rakov DV, Zhukova NA, Rizvanov IK, Mamedov A. Comparative Characterization of Mass Spectral Methods for the Study of IMIDAZO[1,5-a]QUINOXALIN-4-Ones. Chem Heterocycl Compd (N Y) 2014. [DOI: 10.1007/s10593-014-1467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Maclennan A, Nelubina O, Mamedov A, Blinder Z, Mamedova L. Anatomo-functional endoscopic classification of velopharyngeal ring after palatoplasty. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Loblaw D, Sethukavalan P, Cheung P, Morton G, D'Alimonte L, Deabreu A, Mamedov A, Zhang L, Chung H, Nam R. Comparison of Biochemical and Toxicity Outcomes From a Contemporaneous Cohort Study of Low-Risk Prostate Cancer Treated With Different Radiation Techniques. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prica A, Tseng E, Wells R, Mamedov A, Zhang L, Lenis M, Buckstein R. P-127 Predictors of azacitidine response: A prospective longitudinal assessment. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70175-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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England J, Zhang L, Mamedov A, Buckstein R, Wells R. P-267 MDS in Canada: Does bigger income lead to better outcomes? Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prica A, Tseng E, Wells R, Alibhai S, Lam A, Mamedov A, Chodirker L, Zhang L, Khalaf D, Lenis M, Buckstein R. P-257 The effects of azacitidine on quality of life: A prospective longitudinal assessment. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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D'Alimonte L, Loblaw A, Cheung P, Deabreu A, Mamedov A, Liying Z, Pang G, Nam R. Long Term Outcomes of a Novel Five Fraction Hypofractionated Protocol for Low Risk Prostate Cancer. J Med Imaging Radiat Sci 2013. [DOI: 10.1016/j.jmir.2012.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Quon H, Loblaw D, Cheung P, Tang C, Pang G, Morton G, Mamedov A, D'Alimonte L, Deabreu A, Tirona R. Dose Escalation of 5-Fraction Radiation Therapy for Prostate Cancer: Quality of Life Comparison of 2 Prospective Trials. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Quon H, Cheung P, Chu W, Vesprini D, Chung H, Pang G, Deabreu A, Mamedov A, D'Alimonte L, Loblaw A. Phase I/II Study of Extreme Hypofractionation for Localized Prostate Cancer: Acute Toxicity and Quality of Life. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Buckstein R, Alibhai S, Lam A, Mamedov A, Zhang L, Lee C, Thompson K, Cheung M, Wells R. 143 The health-related quality of life of MDS patients is impaired and most predicted by transfusion dependence, hemoglobin and age. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70145-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D'Souza N, Loblaw DA, Mamedov A, Klotz E, Sugar L, Nam R. Got central prostate pathology review? A cross-sectional audit of 2009 versus 2003 outcomes. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
196 Background: Prostate cancer is the most common non-cutaneous cancer in Canadian men; over 24,000 will be newly diagnosed and 4,300 will die from it in 2010. Estimating an individual's risk of disease spreading across the capsule and probability of recurrence with different treatment modalities is common practice in prostate cancer management and often drive the choice or extent of treatment options. A strong predictor of recurrence and organ confined disease is tumor grade. The literature recognizes differences in grading prostate cancer between genitourinary and non-specialized pathologists; we previously reported a 30% change in risk category (Low, GS 2-6; Int., GS 7; High, GS 8-10). However, this report was based on data from 2003/2004. A repeat audit was necessary given Gleason grading practice changes following the 2005 ISUP Consensus Conference. Methods: Log books from 2009/10 where our Genitourinary Pathologists (GUP) reviewed prostate needle core biopsies were used to identify cases; a retrospective chart review was completed. The following variables were extracted: 1° Gleason score; 2° Gleason score; number of sites; % Gleason 4/5 pattern (overall); perineural invasion (present/absent); extracapsular extension (present/absent). Descriptive statistics were used to summarize the results. Results: The charts of 132 patients having a GUP biopsy review were extracted. Seventeen percent (22/132) of cases changed risk category. Of the 47 low risk cases, 23% (11/47) were up-graded in risk category (21% by 1 category; 2% by 2 categories). Of the 46 intermediate risk cases, 15% (7/46) were up-graded and 2% (1/46) were down-graded. Of the 39 high risk cases, only 8% (3/39) were down-graded by 1 risk category. Comparatively, there was a 43% reduction in risk category change between 2003/04 (30%) and 2009/10 (17%). Conclusions: Despite this reduction, a clinically significant proportion of patients changed pathologic risk category upon GUP review. Thus, it is recommended that prostate cancer pathology be routinely reviewed by a GUP as a best practice to optimize management and quality of care. Strategies are still needed to address disparities in pathologic grading and represent a potential area for further investigation. No significant financial relationships to disclose.
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Affiliation(s)
- N. D'Souza
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. A. Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A. Mamedov
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E. Klotz
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L. Sugar
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R. Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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33
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Quon HC, Loblaw DA, Cheung P, Cesta A, Holden L, Tang CI, Pang G, Morton G, Mamedov A, Deabreu A. Predicting intrafraction displacement of the prostate during a five-fraction radiotherapy regimen: Implications for stereotactic body radiotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: Accurate characterization of prostate displacement during stereotactic body radiotherapy (RT) may help optimize margins to maximize complication and disease-free survival. Also, if individual patients with large intrafraction displacement can be identified, additional interventions can be undertaken. Methods: Fifty-three men treated on a phase I/II study of extreme hypofractionation were selected for the study. A total dose of 35 Gy in 5 fractions was delivered with intensity modulated radiotherapy (IMRT). Daily image guidance was performed using gold seed fiducials. Position verification was obtained with orthogonal electronic portal images taken immediately before and after each fraction. Prostate shifts were recorded in 3 dimensions. Results: The mean intrafraction prostate displacements were -0.03 ± 0.61 mm (1SD), 0.21 ± 1.50 mm, and -0.86 ± 1.73 mm in the lateral, superior-inferior, and anterior-posterior directions, respectively. The mean intrafraction displacement during the first two fractions is moderately correlated with the displacement in the remaining 3 fractions, with correlation coefficients of 0.63 and 0.47 in the SI and AP directions, respectively. Conclusions: The mean intrafraction prostate displacement during a course of extreme hypofractionated radiotherapy is small. A strategy using the first two fractions to predict future displacements >5mm shows promise and warrants further validation. No significant financial relationships to disclose.
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Affiliation(s)
- H. C. Quon
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - D. A. Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - P. Cheung
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - A. Cesta
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - L. Holden
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - C. I. Tang
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - G. Pang
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - G. Morton
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - A. Mamedov
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
| | - A. Deabreu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Calvary Mater Newcastle, Newcastle, Australia
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Jethava V, Vesprini D, Loblaw DA, Mamedov A, Nam R, Klotz L. A review of radical prostatectomy outcomes in active surveillance patients—The Sunnybrook experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
104 Background: Prostate cancer is the most prevalent non-cutaneous cancer among North American men. Approximately 50% of these are favorable risk cancers; the NCCN guideline recommends active surveillance for these patients. Patients are generally followed by serial PSAs, DREs and/or TRUS-guided biopsies with triggers identified for each test. Consequently, about 30% of these cancers will be reclassified to a higher risk and require definitive treatment. Cases treated with radical prostatectomy (rP) give important insights into the biology of these cancers. Methods: The ASURE database of active surveillance patients was used to identify cases; a retrospective chart review was completed. The following variables were extracted: primary reason for rP; % biochemical failure; % of patients requiring salvage radiation or hormone therapy; Gleason score (GS), tumor size staging and nodal status in the rP specimen; cause and rate of mortality; proportion of patients treated for PSA-doubling times less then 3 years presenting with a GS greater than 7. Descriptive statistics were used to summarize the results. Results: Of 566 patients in the ASURE database, the charts of 26 patients having an rP were extracted. The primary cause for an rP was a PSA-doubling times less than 3 years (57% of patients) followed by a biopsy indicating a GS of 4+3 or greater (19%). 7% of patients (2/26) were not reclassified but preferred to be treated with rP. 4 patients had biochemical failure (15%) all 4 had salvage therapy. There was 1 cause-specific death. 85% of rP specimens had GS 7, while the remaining had GS 6. Half of these GS 7 individuals had PSA doubling times of less than 3 years. Conclusions: Radical prostatectomy appears to be an effective deferred treatment for patients who are reclassified on active surveillance as evidenced by low prostate-cancer mortality, low rates of biochemical failure acceptable use of salvage therapy. Of interest is that the majority patients with PSAdt < 3 y have Gleason 7 disease on specimen. No significant financial relationships to disclose.
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Affiliation(s)
- V. Jethava
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. Vesprini
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. A. Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A. Mamedov
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R. Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L. Klotz
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Choo R, Woo T, Barnes E, Assaad D, Antonyshyn O, Mckenzie D, Fialkov J, Breen D, Mamedov A. What is the Microscopic Tumor Extent beyond Clinically Delineated Gross Tumor Boundary in Nonmelanoma Skin Cancers? Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Choo R, Woo T, Barnes E, Assaad D, Antonyshyn O, Mckenzie D, Fialkov J, Breen D, Mamedov A. 42 Evaluation of the Microscopic Tumor Extent Beyond Clinically Delineated Gross Tumor Boundary in Nonmelanoma Skin Cancers. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Stieb DM, Beveridge RC, Brook JR, Smith-Doiron M, Burnett RT, Dales RE, Beaulieu S, Judek S, Mamedov A. Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada. J Expo Anal Environ Epidemiol 2000; 10:461-77. [PMID: 11051536 DOI: 10.1038/sj.jea.7500112] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Existing studies of the association between air pollution, aeroallergens and emergency department (ED) visits have generally examined the effects of a few pollutants or aeroallergens on individual conditions such as asthma or chronic obstructive pulmonary disease. In this study, we considered a wide variety of respiratory and cardiac conditions and an extensive set of pollutants and aeroallergens, and utilized prospectively collected information on possible effect modifiers which would not normally be available from purely administrative data. The association between air pollution, aeroallergens and cardiorespiratory ED visits (n = 19,821) was examined for the period 1992 to 1996 using generalized additive models. ED visit, air pollution and aeroallergen time series were prefiltered using LOESS smoothers to minimize temporal confounding, and a parsimonious model was constructed to control for confounding by weather and day of week. Multipollutant and multi-aeroallergen models were constructed using stepwise procedures and sensitivity analyses were conducted by season, diagnosis, and selected individual characteristics or effect modifiers. In single-pollutant models, positive effects of all pollutants but NO2 and COH were observed on asthma visits, and positive effects on all respiratory diagnosis groups were observed for O3, SO2, PM10, PM2.5, and SO4(2-). Among cardiac conditions, only dysrhythmia visits were positively associated with all measures of particulate matter. In the final year-round multipollutant models, a 20.9% increase in cardiac ED visits was attributed to the combination of O3 (16.0%, 95% CI 2.8-30.9) and SO2 (4.9%, 95%CI 1.7-8.2) at the mean concentration of each pollutant. In the final multipollutant model for respiratory visits, O3 accounted for 3.9% of visits (95% CI 0.8-7.2), and SO2 for 3.7% (95% CI 1.5-6.0), whereas a weak, negative association was observed with NO2. In multi-aeroallergen models of warm season asthma ED visits, Ascomycetes, Alternaria and small round fungal spores accounted for 4.5% (95% CI 1.8-7.4), 4.7% (95% CI 1.0-8.6) and 3.0% (95% CI 0.8-5.1), respectively, of visits at their mean concentrations, and these effects were not sensitive to adjustment for air pollution effects. In conclusion, we observed a significant influence of the air pollution mix on cardiac and respiratory ED visits. Although in single-pollutant models, positive associations were noted between ED visits and some measures of particulate matter, in multipollutant models, pollutant gases, particularly ozone, exhibited more consistent effects. Aeroallergens were also significantly associated with warm season asthma ED visits.
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Affiliation(s)
- D M Stieb
- Environmental Health Directorate, Health Canada, Ottawa, ON.
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