Ablative Radiotherapy in Prostate Cancer: Stereotactic Body Radiotherapy and High Dose Rate Brachytherapy

Published on Dec 2, 2020in Cancers6.639
· DOI :10.3390/CANCERS12123606
Ting Martin Ma10
Estimated H-index: 10
(UCLA: University of California, Los Angeles),
Oscar Lilleby1
Estimated H-index: 1
(UCPH: University of Copenhagen)
+ 1 AuthorsAmar U. Kishan22
Estimated H-index: 22
(UCLA: University of California, Los Angeles)
Prostate cancer (PCa) is the most common noncutaneous solid organ malignancy among men worldwide. Radiation therapy is a standard of care treatment option that has historically been delivered in the form of small daily doses of radiation over the span of multiple weeks. PCa appears to have a unique sensitivity to higher doses of radiation per fraction, rendering it susceptible to abbreviated forms of treatment. Stereotactic body radiation therapy (SBRT) and high-dose-rate brachytherapy (HDRBT) are both modern radiation modalities that allow the precise delivery of ablative doses of radiation to the prostate while maximally sparing sensitive surrounding normal structures. In this review, we highlight the evidence regarding the radiobiology, oncological outcomes, toxicity and dose/fractionation schemes of SBRT and HDRBT monotherapy in men with low-and intermediate-risk PCa.
#1Rebecca Levin-Epstein (UCLA: University of California, Los Angeles)H-Index: 6
#2Ryan Cook (UCLA: University of California, Los Angeles)H-Index: 17
Last. Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 22
view all 33 authors...
BACKGROUND AND PURPOSE Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). METHO...
#1Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 22
#2Tahmineh Romero (UCLA: University of California, Los Angeles)H-Index: 7
Last. Joanne B. Weidhaas (UCLA: University of California, Los Angeles)H-Index: 35
view all 31 authors...
Abstract Gleason grade group (GG) 5 prostate cancer has been associated with an aggressive natural history, and retrospective data support a role for treatment intensification. However, clinical outcomes remain heterogeneous in this cohort, and intensified treatments carry an increased risk of adverse events. We sought to explore the transcriptomic heterogeneity of GG 5 tumors by querying transcriptomic data from the tumors of 2138 patients with GG 5 disease who underwent prostatectomy. Four dis...
#1Yasir Alayed (KSU: King Saud University)H-Index: 6
#2Harvey Quon (TBCC: Tom Baker Cancer Centre)H-Index: 10
Last. Andrew Loblaw (U of T: University of Toronto)H-Index: 37
view all 18 authors...
Abstract Background Prostate stereotactic ablative radiotherapy (SABR) regimens differ in time, dose, and fractionation. We report an update of a multicentre, Canadian randomized phase II study to investigate the impact of overall treatment time on quality of life (QOL), efficacy, and toxicity. Methods Men with intermediate risk prostate cancer were randomized to 40 Gy in 5 fractions delivered every other day (EOD) versus once per week (QW). Primary outcome was proportion of patients experiencin...
#1Simon P. KeamH-Index: 11
#2Heloise Halse (Peter MacCallum Cancer Centre)H-Index: 8
Last. Paul J NeesonH-Index: 30
view all 16 authors...
Background Prostate cancer (PCa) has a profoundly immunosuppressive microenvironment and is commonly immune excluded with few infiltrative lymphocytes and low levels of immune activation. High-dose radiation has been demonstrated to stimulate the immune system in various human solid tumors. We hypothesized that localized radiation therapy, in the form of high dose-rate brachytherapy (HDRBT), would overcome immune suppression in PCa. Methods To investigate whether HDRBT altered prostate immune co...
#1Gerard Morton (U of T: University of Toronto)H-Index: 38
#2Merrylee McGuffin (U of T: University of Toronto)H-Index: 8
Last. Andrew Loblaw (U of T: University of Toronto)H-Index: 37
view all 13 authors...
BACKGROUND AND PURPOSE: High dose-rate (HDR) brachytherapy as monotherapy is a treatment option for localized prostate cancer, but optimal dose and fractionation is unknown. We report efficacy results of a randomized phase II trial of HDR monotherapy delivered as either one or two fractions. MATERIALS AND METHODS: Eligible patients had low or intermediate risk prostate cancer, prostate volume <60 cc, and no androgen deprivation use. 170 patients were randomized to receive HDR as either a single ...
#1Alison Tree (ICR: Institute of Cancer Research)H-Index: 22
#2Clare Griffin (ICR: Institute of Cancer Research)H-Index: 15
Last. David P. Dearnaley (The Royal Marsden NHS Foundation Trust)H-Index: 110
view all 4 authors...
316Background: CHHiP (CRUK/06/016) is a multicentre randomised controlled trial which investigated the use of moderately hypofractionated radiotherapy (RT) dose schedules for treatment of localised...
#1David P. Dearnaley (The Royal Marsden NHS Foundation Trust)H-Index: 110
#2Clare Griffin (ICR: Institute of Cancer Research)H-Index: 15
Last. Emma Hall (ICR: Institute of Cancer Research)H-Index: 60
view all 17 authors...
325Background: CHHiP is a non-inferiority trial to determine efficacy and safety of hypofractionated radiotherapy for localised prostate cancer (PCa). Five year results indicated that moderate hypo...
#1Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 22
#2Fang-I Chu (UCLA: University of California, Los Angeles)H-Index: 10
Last. Howard M. Sandler (Cedars-Sinai Medical Center)H-Index: 98
view all 27 authors...
Abstract Background The importance of local failure (LF) after treatment of high-grade prostate cancer (PCa) with definitive radiotherapy (RT) remains unknown. Objective To evaluate the clinical implications of LF after definitive RT. Design, setting, and participants Individual patient data meta-analysis of 992 patients (593 Gleason grade group [GG] 4 and 399 GG 5) enrolled in six randomized clinical trials. Outcome measurements and statistical analysis Multivariable Cox proportional hazard mod...
#1Hannah Tharmalingam (NU: Northwood University)H-Index: 5
#2Y. Tsang (NU: Northwood University)H-Index: 6
Last. Peter Hoskin (University of Manchester)H-Index: 95
view all 10 authors...
Abstract Background HDR brachytherapy alone is effective for the treatment of localised prostate cancer when given in 2–4 or more fractions. Single dose treatment has been explored in small cohort studies to date. This paper reports a large patient population with localised prostate cancer treated with single dose HDR brachytherapy delivering 19 Gy providing early outcome data from this approach. Patients and methods Seven centres across the UK collaborated in this national protocol to deliver 1...
#1Juanita CrookH-Index: 57
#2Marina MarbánH-Index: 2
Last. Deidre BatchelarH-Index: 14
view all 3 authors...
Brachytherapy has become an essential pillar in all-stages of localized prostate cancer, where dose escalation has been demonstrated to improve outcome. HDR brachytherapy has evolved over the decades to be administered in 1-2 fractions. As either monotherapy or in combination with external beam, it offers many advantages over other treatment alternatives. Precise control over dose delivery allows focal dose escalation while sculpting dose around critical organs to maintain excellent tolerance. T...
Cited By3
#1Sophia C. Kamran (Harvard University)H-Index: 16
#2Jason A. Efstathiou (Harvard University)H-Index: 57
Radiation therapy plays a crucial role for the management of genitourinary malignancies, with technological advancements that have led to improvements in outcomes and decrease in treatment toxicities. However, better risk-stratification and identification of patients for appropriate treatments is necessary. Recent advancements in imaging and novel genomic techniques can provide additional individualized tumor and patient information to further inform and guide treatment decisions for genitourina...
#1Yao Fan (CQMU: Chongqing Medical University)
#2Hui Fan (LMB: Laboratory of Molecular Biology)
Last. Xiaohou Wu (CQMU: Chongqing Medical University)H-Index: 17
view all 4 authors...
Tumor suppressor genes RB1 and TP53 are altered frequently in prostate cancer (PC), whether RB1 and TP53 inactivation promotes radioresistance remains unclear. Herein, we demonstrated that RB1 loss enhanced ionizing radiation (IR)-induced DNA damage to inhibit cell proliferation and promote cellular senescence through a TP53-dependent pathway in LNCaP cells. Furthermore, the stabilization of TP53 was regulated by ATM-mediated phosphorylation of MDM2 at Ser395. However, inactivation of RB1/TP53 r...
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