Extreme Hypofractionation with SBRT in Localized Prostate Cancer

Gómez-Aparicio, María Antonia; Valero, J.; Caballero, B.; García, Rafael; Hernando-Requejo, Ovidio; Montero, Á.; Gómez-Iturriaga, A.; Zilli, Thomas; Ost, Piet; López-Campos, Fernando; Couñago, Felipe

doi:10.3390/curroncol28040257

Cited by 18 publications

(15 citation statements)

References 74 publications

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“…Although toxicity appears to be limited and most reported adverse events were mild or moderate, it must be acknowledged that retrospective studies tend to underestimate negative effects. However, in this context results from other tumour entities can be extrapolated and these data suggest indeed acceptable toxicity for most local treatment modalities 18 49 50 .…”

Section: Discussionmentioning

confidence: 92%

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Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Kimpel,

Dischinger,

Altieri

et al. 2024

Horm Metab Res

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International guidelines emphasise the role of local therapies (LT) for the treatment of advanced adrenocortical carcinoma (ACC). However, large studies are lacking in this field. Therefore, we performed a review of the literature to synthesise current evidence and develop clinical guidance. PubMed database was searched for systematic literature. We identified 119 potentially relevant articles, of which 21 could be included in our final analysis. All were retrospective and reported on 374 patients treated with LT for advanced ACC (12 studies on radiotherapy, 3 on transarterial chemoembolisation and radioembolisation, 4 on image-guided thermal ablation [radiofrequency, microwave ablation, and cryoablation, and two studies reporting treatment with several different LT]). Radiotherapy was frequently performed with palliative intention. However, in most patients, disease control and with higher dosage also partial responses could be achieved. Data for other LT were more limited, but also point towards local disease control in a significant percentage of patients. Very few studies tried to identify factors that are predictive on response. Patients with a disease-free interval after primary surgery of more than 9 months and lesions<5 cm might benefit most. Underreporting of toxicities may be prevalent, but LT appear to be relatively safe overall. Available evidence on LT for ACC is limited. LT appears to be safe and effective in cases with limited disease and should be considered depending on local expertise in a multidisciplinary team discussion.

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Section: Discussionmentioning

confidence: 92%

“…Radiotherapy is an important modality used as curative or palliative treatment in many different cancer types 17 18 . The technology developed in the past years leading to a more accurate and faster therapy with less adverse effects and improved treatment response.…”

Section: Methodsmentioning

confidence: 99%

Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Kimpel,

Dischinger,

Altieri

et al. 2024

Horm Metab Res

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“…Recent advancements in radiotherapy for localized prostate cancer have enabled us to shorten the treatment period using hypofractionations and provide cost effectiveness and patient convenience. In addition to 2.3–3.4 Gy moderate hypofractionation, UHF gained attention for exploiting the low a/b ratio of this tumor and its high radiation fraction size sensitivity 1 – 6 . The recent HYPO-RT-PC phase 3 trial, which showed non-inferiority of ultrahypofractionation (42.7 Gy/7 fractions for 2.5 weeks) compared with conventional fractionation (78 Gy/39 fractions) 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Following the trend of shortening the treatment period in radiotherapy, stereotactic ablative body radiotherapy (SBRT), and high-precision external beam radiotherapy using strict image-guidance 1 enabled us to perform ultrahypofractionated radiotherapy (UHF) using a single fraction dose of 5 Gy or more, which could reduce the burden on healthcare resources 1 – 5 . The biological features of prostate cancer with a low α/β ratio also encouraged the adoption of these hypo-to ultra-hypofractionation worldwide 1 . The recent HYPO-RT-PC randomized control trial provided evidence that UHF is non-inferior to standard conventional fractionation of 78 Gy in 2 Gy fractions 2 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of toxicities between ultrahypofractionated radiotherapy versus brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer

Yamazaki

Masui

Suzuki

et al. 2022

Sci Rep

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To compare gastrointestinal (GI) and genitourinary (GU) toxicities in patients with localized prostate cancer treated with ultrahypofractionated radiotherapy (UHF) or brachytherapy [BT; low dose rate, LDR or high dose rate (HDR) with or without external beam radiotherapy (EBRT)]. We compared 253 UHF and 1664 BT ± EBRT groups. The main outcomes were the incidence and severity of acute and late GU and GI toxicities. The secondary endpoint was biochemical control rate. Cumulative late actuarial GU toxicity did not differ for grade ≥ 2 (8.6% at 5-years in UHF and 13.3% in BT ± EBRT, hazard ratio [HR], 0.7066; 95% CI, 0.4093–1.22, p = 0.2127). Actuarial grade ≥ 2 late GI toxicity was higher in UHF (5.8% at 5-years, HR: 3.619; 95% CI, 1.774–7.383, p < 0.001) than in BT ± EBRT (1.1%). In detailed subgroup analyses, the high-dose UHF group (H-UHF) using BED ≥ 226 Gy1.5, showed higher GI toxicity profiles than the other subgroups (HDR + EBRT, LDR + EBRT, and LDR monotherapy, and L-UHF BED < 226 Gy1.5) with equivalent GU toxicity to other modalities. With a median follow-up period of 32 months and 75 months, the actuarial biochemical control rates were equivalent between the UHF and BT ± EBRT groups. UHF showed equivalent efficacy, higher GI and equivalent GU accumulated toxicity to BT ± EBRT, and the toxicity of UHF was largely dependent on the UHF schedule.

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“…Stereotactic body radiation therapy (SBRT), also called stereotactic ablative radiotherapy (SABR), is a technique that can deliver higher doses in hypofractionated regimens and has shown comparable biochemical control and morbidity to standard fractionation schedules in prospective randomized trials [ 13 , 16 ]. Results with SBRT in limited numbers of patients with low-risk prostate cancer suggest that this approach is feasible, with comparable efficacy and safety to other forms of radiation therapy [ 17 , 18 , 19 ].…”

Section: External Beam Radiation Therapymentioning

confidence: 99%

Targeted Radiation and Immune Therapies—Advances and Opportunities for the Treatment of Prostate Cancer

et al. 2023

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Prostate cancer is the most diagnosed malignancy in men in the United States and the second leading cause of cancer-related death. For localized disease, radiation therapy is a standard treatment that is often curative. For metastatic disease, radiation therapy has been primarily used for palliation, however, several newer systemic radiation therapies have been demonstrated to significantly improve patient outcomes and improve survival. In particular, several targeted radionuclide therapies have been approved for the treatment of advanced-stage cancer, including strontium-89, samarium-153, and radium-223 for bone-metastatic disease, and lutetium-177-labeled PSMA-617 for patients with prostate-specific membrane antigen (PSMA)-expressing metastatic castration-resistant prostate cancer (mCRPC). Contrarily, immune-based treatments have generally demonstrated little activity in advanced prostate cancer, with the exception of the autologous cellular vaccine, sipuleucel-T. This has been attributed to the presence of an immune-suppressive prostate cancer microenvironment. The ability of radiation therapy to not only eradicate tumor cells but also potentially other immune-regulatory cells within the tumor immune microenvironment suggests that targeted radionuclide therapies may be well poised to combine with immune-targeted therapies to eliminate prostate cancer metastases more effectively. This review provides an overview of the recent advances of targeted radiation agents currently approved for prostate cancer, and those being investigated in combination with immunotherapy, and discusses the challenges as well as the opportunities in this field.

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Extreme Hypofractionation with SBRT in Localized Prostate Cancer

Cited by 18 publications

References 74 publications

Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Comparison of toxicities between ultrahypofractionated radiotherapy versus brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer

Targeted Radiation and Immune Therapies—Advances and Opportunities for the Treatment of Prostate Cancer

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