Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy

Krauss, Daniel; Ye, Hong; Martínez, Álvaro; Mitchell, Beth; Sebastian, Evelyn; Limbacher, Amy; Gustafson, Gary

doi:10.1016/j.ijrobp.2016.08.011

Cited by 57 publications

(43 citation statements)

References 30 publications

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“…It remains to be seen whether a single dose of 19 Gy will provide adequate long‐term PSA control with mixed results being reported to date by Prada et al . and Krauss et al …”

Section: Discussionmentioning

confidence: 94%

“…In summary, the existing data do not demonstrate significant differences in acute toxicities when delivering more than 1 fraction of HDR but perhaps an improved urinary toxicity profile when delivering just a single fraction of 19 Gy. It remains to be seen whether a single dose of 19 Gy will provide adequate long-term PSA control with mixed results being reported to date by Prada et al and Krauss et al 15,16 There are more limited data in terms of correlations between genitourinary toxicities and dosimetry following HDR brachytherapy. The American College of Radiology Appropriateness Criteria for HDR brachytherapy does not list any recommended dosimetric constraints.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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Introduction: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy 9 6-fractions and 35 men had 13.5 Gy 9 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse shortterm acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

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“…It remains to be seen whether a single dose of 19 Gy will provide adequate long‐term PSA control with mixed results being reported to date by Prada et al . and Krauss et al …”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

View full text Add to dashboard Cite

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“…With 49 months median follow-up, the 4-year estimates of grade-3 GU and gastrointestinal (GI) toxicity was 2% and 0%, respectively, with no grade 4 events, while the 4-year bRFS was 94%. Similarly, Morton et al confirmed with a median follow-up time of 20 months the good tolerance of a single 19 Gy single HDR-BT fraction in terms of toxicity and impact on quality of life (QoL) [15] and Krauss et al reported a 3-year bRFS rate of 93% [16], similar to results observed by Hoskin et al In conclusion, for the authors one single fraction HDR-BT is feasible, weakly toxic, and with promising preliminary results.…”

Section: Introductionmentioning

confidence: 99%

ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial

et al. 2018

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BackgroundStereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, question of how far can the number of fractions with SBRT be reduced is a challenging research matter. As already explored by some authors in the context of brachytherapy, monotherapy appears to be feasible with an acceptable toxicity profile and a promising outcome. The aim of this multicenter phase I/II prospective trialis to demonstrate early evidence of safety and efficacy of a single-fraction SBRT approach for the treatment of localized disease.MethodsPatients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone will be treated with a single SBRT fraction of 19 Gy to the whole prostate gland with urethra-sparing (17 Gy). Intrafractional motion will be monitored with intraprostatic electromagnetic transponders. The primary endpoint of the phase I part of the study will be safety as assessed by CTCAE 4.03 grading scale, while biochemical relapse-free survival will be the endpoint for the phase II. The secondary endpoints include acute and late toxicity, quality of life, progression-free survival, and prostate-cancer specific survival.DiscussionThis is the first multicenter phase I/II trial assessing the efficacy and safety of a single-dose SBRT treatment for patients with localized prostate cancer. If positive, results of ONE SHOT may help to design subsequent phase III trials exploring the role of SBRT monotherapy in the exclusive radiotherapy treatment of localized disease.Trial registrationClinicaltrials.gov identifier: NCT03294889; Registered 27 September 2017.

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“…38 The same phenomenon has been seen in single fraction high dose rate brachytherapy where patients suffered low local control rates, although estimations through the linear quadrant model predicted otherwise. 39 The same was also seen in single fraction carbon ion therapy for early stage lung cancer where 44 to 50 Gy (RBE) was required to achieve satisfactory local control. 40 One reason may be related to the heterogeneity of the tumor.…”

Section: Discussionmentioning

confidence: 89%

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

et al. 2018

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Prognosis is usually grim for those with liver metastasis from colorectal cancer (CRC) who cannot receive resection. Radiation therapy can be an option for those unsuitable for resection, with carbon ion radiotherapy (CIRT) being more effective and less toxic than X‐ray due to its physio‐biological characteristics. The objective of this study is to identify the optimal dose of single fraction CIRT for colorectal cancer liver metastasis. Thirty‐one patients with liver metastasis from CRC were enrolled in the present study. Twenty‐nine patients received a single‐fraction CIRT, escalating the dose from 36 Gy (RBE) in 5% to 10% increments until unacceptable incidence of dose‐limiting toxicity was observed. Dose‐limiting toxicity was defined as grade ≥3 acute toxicity attributed to radiotherapy. The prescribed doses were as follows: 36 Gy (RBE) (3 cases), 40 Gy (2 cases), 44 Gy (4 cases), 46 Gy (6 cases), 48 Gy (3 cases), 53 Gy (8 cases) and 58 Gy (3 cases). Dose‐limiting toxicity was not observed, but late grade 3 liver toxicity due to biliary obstruction was observed in 2 patients at 53 Gy (RBE). Both cases had lesions close to the hepatic portal region, and, therefore, the dose was escalated to 58 Gy (RBE), limited to peripheral lesions. The 3‐year actuarial overall survival rate of all 29 patients was 78%, and the median survival time was 65 months. Local control improved significantly at ≥53 Gy (RBE), with a 3‐year actuarial local control rate of 82%, compared to 28% in lower doses. Treatment for CRC liver metastasis with single‐fraction CIRT appeared to be safe up to 58 Gy (RBE) as long as the central hepatic portal region was avoided.

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Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy

Cited by 57 publications

References 30 publications

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

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