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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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Glicksman R, Liu S, Cheung P, Vesprini D, Chu W, Chung H, Morton G, Deabreu A, Davidson M, Ravi A, Musunuru H, Helou J, Ho L, Zhang L, Loblaw D. Elective Nodal Ultra Hypofractionated Radiation for Prostate Cancer: Safety and Efficacy From Four Prospective Clinical Trials. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.307] [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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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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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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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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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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Musunuru H, Deabreu A, Davidson M, Ravi A, Hlou J, Ho L, Cheung P, Vesprini D, Liu S, Chu W, Chung H, Zhang L, Loblaw A. EP-1341: Pelvic SABR with HDR boost in intermediate and high risk prostate cancer (spare): early results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31776-0] [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: 11/29/2022]
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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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Helou J, Nicolae A, Musunuru H, Davidson M, Commisso K, Deabreu A, Marquez A, Cheung P, Chung H, Chu W, Ravi A, Loblaw D. Two Stereotactic Ablative Radiation Therapy Treatments (2STAR) for Localized Prostate Cancer: Feasibility and Early Results. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1116] [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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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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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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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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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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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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Morton G, Loblaw A, Chung H, Sankreacha R, Law N, Zhang L, Deabreu A. 231 oral IS SINGLE FRACTION 15 GY THE PREFERRED BOOST DOSE FOR PROSTATE CANCER? Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70353-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: 10/18/2022]
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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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Quon HC, Cheung P, Loblaw DA, Morton G, Szumacher E, Danjoux C, Choo R, Thomas G, Kiss A, Deabreu A. Quality of life after pelvic radiotherapy with hypofractionated IMRT boost and long-term hormone therapy for locally advanced prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.75] [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
75 Background: Combined radiotherapy (RT) and long-term hormonal therapy (HT) is a standard treatment option for high-risk prostate cancer. Dose escalated RT alone has been shown to improve disease free survival. Increased sensitivity of prostate cancer to high doses per fraction has led to hypofractionation as a method to radiobiologically escalate dose.We report on the quality of life of patients treated with combined hypofractionated RT and HT. Methods: A prospective phase I/II study enrolling patients with any of: clinical T3, PSA ≥20, or Gleason 8-10. Forty-five Gy (1.8 Gy/fraction) was delivered to the pelvic nodes with a concomitant 22.5 Gy intensity-modulated RT boost to the prostate, for a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions over 5 weeks. Hormonal therapy was administered for 2-3 years. Patient reported outcomes were measured at baseline and every 6 months using the validated Expanded Prostate Cancer Index Composite (EPIC) questionnaire, which measures urinary, bowel, sexual, and hormonal domains. Results: Sixty patients with a minimum 24 months of patient-reported outcomes were analyzed. Mean scores comparing baseline to 24 month values are reported. There were no statistically significant changes in the urinary summary scores (86.3 vs. 86.0, p=0.45) or any of the urinary subscales (function, bother, incontinence, irritative/obstructive). Domain summary score decreases were observed in: bowel by 4.4% (94.7 vs. 90.3, p<0.01), sexual by 27% (44.5 vs. 17.5, p<0.01), and hormonal by 11.9% (93.1 vs. 81.2, p<0.01). Examining time trends in outcomes, most changes occurred within the first 6 months with smaller changes thereafter. Conclusions: Hypofractionated RT combined with long-term HT is associated with good patient-reported urinary and bowel outcomes at 24 months. Sexual and hormonal summary scores are affected, largely due to continued androgen deprivation therapy. Further follow-up is needed to document patient reported outcomes after testosterone recovery. No significant financial relationships to disclose.
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Affiliation(s)
- H. C. Quon
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P. Cheung
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. A. Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G. Morton
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E. Szumacher
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C. Danjoux
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R. Choo
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G. Thomas
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A. Kiss
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A. Deabreu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mayo Clinic, Rochester, MN; Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Quon H, Loblaw D, Morton G, Szumacher E, Danjoux C, Choo R, Thomas G, Kiss A, Deabreu A, Cheung P. Patient Reported Outcomes after Hypofractionated Radiotherapy and Long-term Androgen Deprivation for High-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.817] [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: 10/19/2022]
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Quon H, Loblaw DA, Morton G, Szumacher E, Danjoux C, Choo R, Thomas G, Kiss A, Deabreu A, Cheung P. Phase I/II trial of combined hormonal therapy and hypofractionated accelerated radiotherapy with concomitant intensity-modulated boost for high-risk prostate cancer: Toxicity analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4634] [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: 11/20/2022] Open
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Morton G, Loblaw D, Sankreacha R, Deabreu A, Zhang L, Szumacher E, Danjoux C, Cheung P, Thomas G. 33 CAN HIGH DOSE-RATE (HDR) BRACHYTHERAPY BE GIVEN AS A SINGLE FRACTION WHEN USED AS A BOOST WITH EXTERNAL BEAM RADIOTHERAPY (EBRT) TO TREAT PROSTATE CANCER? A COMPARISON OF TWO FRACTIONATION SCHEDULES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72420-9] [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: 10/27/2022]
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Morton G, Loblaw D, Sankreacha R, Deabreu A, Zhang L, Cheung P, Danjoux C, Szumacher E, Vigneault E, Springer C. 69 oral: A Comparison of Single Fraction 15 GY High Dose-Rate Brachytherapy Boost With Fractionated Boost in Prostate Cancer. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(15)34326-7] [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: 12/01/2022]
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