Toxicity at 1 year after Stereotactic Body Radiotherapy in 3 Fractions for Localized Prostate Cancer

Published on Mar 19, 2021in International Journal of Radiation Oncology Biology Physics5.859
· DOI :10.1016/J.IJROBP.2021.03.027
Alessandro Magli12
Estimated H-index: 12
,
Alessia Farneti9
Estimated H-index: 9
+ 7 AuthorsGiuseppe Sanguineti37
Estimated H-index: 37
Sources
Abstract
Abstract Purpose To assess the toxicity profile of prostate cancer stereotactic radiotherapy (SBRT) in 3 fractions. Methods and Materials This is a prospective, multicenter phase II toxicity study enrolling patients with low to favorable intermediate risk prostate cancer. Before simulation 3-4 fiducial markers along with a rectal spacer were placed. The target (prostate only) was prescribed 40 Gy, while the maximum dose to the urethra was limited to 33 Gy with the highest priority at planning; less stringent objectives were placed on the bladder whose filling was controlled via a Foley catheter. Treatment was delivered every other day. Toxicity was prospectively scored with CTCAE and several PROs collected. The maximum allowed prevalence rate of grade 2+ GU toxicity at 1 year was set at 15% and the study was sized accordingly. Results Between November 2015 to May 2019, 59 patients were enrolled by 3 participating Institutions. Acute gastrointestinal (GI) toxicity was occasional and mild, while 11.9% and 1.7% developed acute GR2 and GR3 GU toxicity, respectively. No patient had persistent treatment-related GR2+ GU toxicity at 12 months after SBRT, and thus the null hypothesis is rejected. We observed a clinically relevant worsening of both IPSS and ICIQ-SF scores at 12 months compared to baseline. Moreover, we found a strong association between all selected bladder dose/volume metrics at planning and ICIQ-SF worsening at 12 months, while for IPSS, the correlation with bladder dose metrics was marginal. Conclusions At 12 months, the toxicity profile of SBRT in 3 fractions is acceptable.
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#2Naomi Y. Jiang (UCLA: University of California, Los Angeles)H-Index: 3
Last. Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 19
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BACKGROUND AND PURPOSE The optimal dose for prostate stereotactic body radiotherapy (SBRT) is still unknown. This study evaluated the dose-response relationships for prostate-specific antigen (PSA) decay and biochemical recurrence (BCR) among 4 SBRT dose regimens. MATERIALS AND METHODS In 1908 men with low-risk (50.0%), favorable intermediate-risk (30.9%), and unfavorable intermediate-risk (19.1%) prostate cancer treated with prostate SBRT across 8 institutions from 2003 to 2018, we examined 4 r...
3 CitationsSource
#1Maud JaccardH-Index: 8
#2Thomas Zilli (Geneva College)H-Index: 21
Last. Raymond Miralbell (Geneva College)H-Index: 62
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PURPOSE To present the radiotherapy quality assurance (RTQA) results from a prospective multicenter phase II randomized trial of short vs. protracted urethra-sparing stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa). METHODS Between 2012 and 2015, 165 PCa patients from nine centers were randomized and treated with SBRT delivered either every-other-day (arm A, n=82) or once-a-week (arm B, n=83). 36.25 Gy in 5 fractions were prescribed to the prostate with (n=92) or without...
2 CitationsSource
#1Xiaoying Pan (UCLA: University of California, Los Angeles)H-Index: 1
#2Rebecca Levin-Epstein (UCLA: University of California, Los Angeles)H-Index: 6
Last. X. Sharon Qi (UCLA: University of California, Los Angeles)H-Index: 15
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Abstract Background and purpose This study aims to evaluate the associations between dosimetric parameters and patient-reported outcomes after prostate stereotactic body radiotherapy (SBRT) using machine learning methods, and to identify latent dosimetric parameters that most correlate with acute and subacute patient-reported urinary and rectal toxicity. Materials and methods Eighty-six patients who underwent prostate SBRT (40 Gy in 5 fractions) were included. Patient-reported health-related qua...
1 CitationsSource
#1Luca F. Valle (UCLA: University of California, Los Angeles)H-Index: 8
#1Luca F. Valle (UCLA: University of California, Los Angeles)H-Index: 3
Last. Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 19
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Purpose: Dosimetric predictors of toxicity after Stereotactic Body Radiation Therapy (SBRT) are not well established. We sought to develop a multivariate model that predicts Common Terminology Criteria for Adverse Events (CTCAE) late grade 2 or greater genitourinary (GU) toxicity by interrogating the entire dose-volume histogram (DVH) from a large cohort of prostate cancer patients treated with SBRT on prospective trials. Methods: 339 patients with late CTCAE toxicity data treated with prostate ...
1 CitationsSource
#1Abigail Pepin (GW: George Washington University)H-Index: 3
#2Nima Aghdam (Georgetown University)H-Index: 6
Last. Sean P. Collins (Georgetown University)H-Index: 64
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Stereotactic body radiation therapy (SBRT) provides similar clinical outcomes as other radiation modalities for prostate cancer. Data reporting on the safety of SBRT after TURP is limited. Herein, we report our experience using SBRT to deliver hypofractionated radiotherapy in patients with a history of TURP including physician-reported toxicities and patient-reported quality of life. Forty-seven patients treated with SBRT from 2007 to 2016 at Georgetown University Hospital for localized prostate...
2 CitationsSource
#1Thomas Zilli (Geneva College)H-Index: 21
#2Sandra JorcanoH-Index: 13
Last. Raymond Miralbell (Geneva College)H-Index: 62
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BACKGROUND: To present the 18 months results from a prospective multicenter phase II randomized trial of short vs protracted urethra-sparing stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa). METHODS: Between 2012 and 2015, a total of 170 PCa patients were randomized to 36.25 Gy in 5 fractions (6.5 Gy x 5 to the urethra) delivered either every other day (EOD, arm A, n = 84) or once a week (QW, arm B, n = 86). Genitourinary (GU) and gastrointestinal (GI) toxicity (CTCAE v4...
5 CitationsSource
#1Douglas Brand (ICR: Institute of Cancer Research)H-Index: 5
#2Alison Tree (ICR: Institute of Cancer Research)H-Index: 20
Last. N OommenH-Index: 1
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Summary Background Localised prostate cancer is commonly treated with external-beam radiotherapy. Moderate hypofractionation has been shown to be non-inferior to conventional fractionation. Ultra-hypofractionated stereotactic body radiotherapy would allow shorter treatment courses but could increase acute toxicity compared with conventionally fractionated or moderately hypofractionated radiotherapy. We report the acute toxicity findings from a randomised trial of standard-of-care conventionally ...
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#1Anders Widmark (Umeå University)H-Index: 48
#2Adalsteinn Gunnlaugsson (Lund University)H-Index: 13
Last. Per Nilsson (Lund University)H-Index: 33
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Summary Background Hypofractionated radiotherapy for prostate cancer has gained increased attention due to its proposed high radiation-fraction sensitivity. Recent reports from studies comparing moderately hypofractionated and conventionally fractionated radiotherapy support the clinical use of moderate hypofractionation. To date, there are no published randomised studies on ultra-hypofractionated radiotherapy. Here, we report the outcomes of the Scandinavian HYPO-RT-PC phase 3 trial with the ai...
154 CitationsSource
#1William C. Jackson (UM: University of Michigan)H-Index: 16
#2Jessica Silva (UM: University of Michigan)H-Index: 1
Last. Daniel E. Spratt (UM: University of Michigan)H-Index: 50
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Purpose Utilization of stereotactic body radiation therapy (SBRT) for treatment of localized prostate cancer is increasing. Guidelines and payers variably support the use of prostate SBRT. We therefore sought to systematically analyze biochemical recurrence-free survival (bRFS), physician-reported toxicity, and patient-reported outcomes after prostate SBRT. Methods and Materials A systematic search leveraging Medline via PubMed and EMBASE for original articles published between January 1990 and ...
67 CitationsSource
#1Michael J. Zelefsky (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 117
#2Marisa A. Kollmeier (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 33
Last. Brett W. Cox (Lenox Hill Hospital)H-Index: 1
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Purpose To report toxicity outcomes, prostate-specific antigen (PSA) relapse, and cumulative incidence posttreatment biopsy results among patients treated on a prospective dose escalation study using ultra-hypofractionated stereotactic body radiation therapy (SBRT) for patients with low- and intermediate-risk prostate cancer. Methods and Materials A total of 136 patients were enrolled in a phase 1 dose-escalation study to determine the tolerance of escalating radiation dose levels of SBRT for th...
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