High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions

Nagore, G.; Guerra, José Luis López; Krumina, E.; Lagos, Mark; Ovalles, Beatriz; Miró, Antonio; Beltrán, L. Tudela; Gómez, E.; Praena-Fernandez, Juan Manuel; Campo, Eleonor Rivin del; Azinovic, I.; Gómez-Iturriaga, A.

doi:10.1016/j.radonc.2018.03.022

Cited by 15 publications

(6 citation statements)

References 31 publications

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“…For 2 fraction schemes and BC = 90%, we found that fraction doses of approx. 13.5 Gy are necessary, a value similar to that considered in references [12,25].…”

Section: Discussionmentioning

confidence: 89%

“…Studies involving high-risk patients were considered only if BC was applied for low-or intermediate-risk patients, separately. Table 1 summarizes characteristics of the 13 clinical studies [10,11,12,13,14,19,20,21,22,23,24,25,26] verifying the conditions mentioned above. They include 16 different fractionation schedules, with a number of fractions varying between 1 and 9, for a total of 22 empirical data sets.…”

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

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A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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Purpose: Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT. Material and methods: Published HDR-BT clinical results for low-and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods. Results: We obtained a value of α/β = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively. Conclusions: The α/β obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of α/β explains reasonably well the data available in the region of high doses per fraction considered.

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“…For 2 fraction schemes and BC = 90%, we found that fraction doses of approx. 13.5 Gy are necessary, a value similar to that considered in references [12,25].…”

Section: Discussionmentioning

confidence: 89%

Section: Patients Of Low-and/or Intermediate-risk Were In-mentioning

confidence: 99%

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Guirado

Ruiz-Arrebola

Tornero-López

et al. 2020

jcb

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“…To place the results of the present series in the appropriate context, we extracted the rates of late severe (ie, grade ≥3) toxic events after treatment with other radiotherapy modalities from prospective reports with long-term follow-up for each of the other modalities ( Figure 2 ). 4 , 5 , 6 , 35 , 36 , 37 , 38 , 39 , 40 , 41 Further information about these series can be found in eTable 9 in the Supplement . Overall, the outcomes after SBRT compare very favorably, without evidence of unanticipated late failures or increased late toxic effects.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

et al. 2019

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Importance Stereotactic body radiotherapy harnesses improvements in technology to allow the completion of a course of external beam radiotherapy treatment for prostate cancer in the span of 4 to 5 treatment sessions. Although mounting short-term data support this approach, long-term outcomes have been sparsely reported. Objective To assess long-term outcomes after stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. Design, Setting, and Participants This cohort study analyzed individual patient data from 2142 men enrolled in 10 single-institution phase 2 trials and 2 multi-institutional phase 2 trials of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer between January 1, 2000, and December 31, 2012. Statistical analysis was performed based on follow-up from January 1, 2013, to May 1, 2018. Main Outcomes and Measures The cumulative incidence of biochemical recurrence was estimated using a competing risk framework. Physician-scored genitourinary and gastrointestinal toxic event outcomes were defined per each individual study, generally by Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. After central review, cumulative incidences of late grade 3 or higher toxic events were estimated using a Kaplan-Meier method. Results A total of 2142 men (mean [SD] age, 67.9 [9.5] years) were eligible for analysis, of whom 1185 (55.3%) had low-risk disease, 692 (32.3%) had favorable intermediate-risk disease, and 265 (12.4%) had unfavorable intermediate-risk disease. The median follow-up period was 6.9 years (interquartile range, 4.9-8.1 years). Seven-year cumulative rates of biochemical recurrence were 4.5% (95% CI, 3.2%-5.8%) for low-risk disease, 8.6% (95% CI, 6.2%-11.0%) for favorable intermediate-risk disease, 14.9% (95% CI, 9.5%-20.2%) for unfavorable intermediate-risk disease, and 10.2% (95% CI, 8.0%-12.5%) for all intermediate-risk disease. The crude incidence of acute grade 3 or higher genitourinary toxic events was 0.60% (n = 13) and of gastrointestinal toxic events was 0.09% (n = 2), and the 7-year cumulative incidence of late grade 3 or higher genitourinary toxic events was 2.4% (95% CI, 1.8%-3.2%) and of late grade 3 or higher gastrointestinal toxic events was 0.4% (95% CI, 0.2%-0.8%). Conclusions and Relevance In this study, stereotactic body radiotherapy for low-risk and intermediate-risk disease was associated with low rates of severe toxic events and high rates of biochemical control. These data suggest that stereotactic body radiotherapy is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.

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“…For the OAR, the dose in a particular volume x (D x ) is constrained to an organ-specific limit. The detailed HDR-BT treatment planning protocol is summarized in Table 2 and is based on [8]. The HDR-BT treatment plan (Figure 1 Item 5) is generated by expert radiotherapy technologists, based on inverse planning by simulated annealing [43] and manual finetuning, using the Oncentra ® Brachy treatment planning software, and reviewed by a radiation oncologist.…”

Section: Hdr-bt Treatment Plan and Dose Calculationmentioning

confidence: 99%

“…In HDR-BT monotherapy for prostate cancer, several clinical trials have shown that even ultrahypofractionated treatments of 2-4 fractions lead to excellent overall disease-free survival in low-risk and favorable intermediate-risk cancer patients [6][7][8]. On the other hand, the treatments are still linked with genitourinary and gastrointestinal toxicities [9].…”

Section: Introductionmentioning

confidence: 99%

A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy

Androulakis

Mestrom

Christianen

et al. 2022

Cancers

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In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.

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High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions

Cited by 15 publications

References 31 publications

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy

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High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions

Cited by 15 publications

References 31 publications

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy

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Product

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High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions