High dose rate (HDR) monotherapy for early stage prostate cancer: toxicity results utilizing the common toxicity criteria

Gustafson, Gary; Demanes, D.; Rodríguez, Robert; Mitchell, C.; Ravanera, R; Edmundson, Greg; Martínez, Álvaro

doi:10.1016/s0360-3016(03)01053-8

Cited by 9 publications

(5 citation statements)

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“…Publications on prostate cancer patients treated with conventional fractionated EBRT combined with hypofractionated IMRT boosts 96 of 2 fractions of 5-8 Gy (median follow-up of 63 months) or with concomitant boosts 97,98 in 28 fractions of 2.5 Gy and 25 fractions of 2.7 Gy (median follow-up of 46 and 39 months, respectively) concluded that these treatments were feasible and well tolerated. The results on EBRT treatments in combination with HDRBT boosts 65,66,[99][100][101][102][103][104][105] with median follow-up ranging from 40 to 105 months (2 fractions Â 5-15 Gy, 3 fractions Â 3-6.5 Gy, or 4 fractions Â 3-6 Gy) and extreme hypofractionated treatments of HDRBT delivered as monotherapy [106][107][108][109][110][111][112] at median follow-up of 22-65 months (3 fractions Â 10.5 Gy, 4 fractions Â 8.5-9.5 Gy, 6 fractions Â 6.75-7 Gy, 8 fractions Â 6 Gy, or 9 fractions Â 6 Gy) or stereotactic body radiosurgery [113][114][115] 119,120 median follow-up: 32 months for the hypofractionation regimens and 35 months for the conventional). Despite differences in dose prescription, delivery methods, patient selection according to prognostic factors, short follow-up in many studies, and the use of androgen deprivation therapy in some patients, the clinical experience with hypofractionation seems to be consistent with a low a/b ratio for prostate cancer.…”

Section: Feasibility Of the Hypofractionation Regimensmentioning

confidence: 99%

What do we know about the α/β for prostate cancer?

2012

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Since last decade, the debate on the parameter which reflects prostate cancer sensitivity to fractionation in a radiotherapy treatment, the α/β, has become extensive. Unlike most tumors, the low labeling indices (LI) and large potential doubling time that characterize the prostate tumor led some authors to consider that it may behave as a late responding tissue. So far, the existing studies with regard to this subject point to a low value of α/β, around 2.7 Gy, which may be considered as a therapeutic gain in relation to surrounding normal tissues by using fewer and larger fractions. The aim of this paper is to review several estimates that have been made in the last few years regarding the prostate cancer α/β both from clinical and experimental data, as well as the set of factors that have potentially influenced these evaluations.

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Section: Feasibility Of the Hypofractionation Regimensmentioning

confidence: 99%

What do we know about the α/β for prostate cancer?

2012

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“…1 In this work, a conservative assumption of 10 min per patient is used to account for higher fraction doses ͑e.g., boost therapy͒ or large PTV volumes. [9][10][11][12][13][14] Hence, the K p value employed for 192 Ir calculations, K p ͑ 192 Ir͒, in Eq. ͑3͒ is 6700 Gy m 2 per patient.…”

Section: B Analytical Calculationsmentioning

confidence: 99%

Comparison of radiation shielding requirements for HDR brachytherapy using and sources

et al. 2006

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169Yb has received a renewed focus lately as an alternative to 192Ir sources for high dose rate (HDR) brachytherapy. Following the results of a recent work by our group which proved 169Yb to be a good candidate for HDR prostate brachytherapy, this work seeks to quantify the radiation shielding requirements for 169Yb HDR brachytherapy applications in comparison to the corresponding requirements for the current 192Ir HDR brachytherapy standard. Monte Carlo simulation (MC) is used to obtain 169Yb and 192Ir broad beam transmission data through lead and concrete. Results are fitted to an analytical equation which can be used to readily calculate the barrier thickness required to achieve a given dose rate reduction. Shielding requirements for a HDR brachytherapy treatment room facility are presented as a function of distance, occupancy, dose limit, and facility workload, using analytical calculations for both 169Yb and 192Ir HDR sources. The barrier thickness required for 169Yb is lower than that for 192Ir by a factor of 4-5 for lead and 1.5-2 for concrete. Regarding 169Yb HDR brachytherapy applications, the lead shielding requirements do not exceed 15 mm, even in highly conservative case scenarios. This allows for the construction of a lead door in most cases, thus avoiding the construction of a space consuming, specially designed maze. The effects of source structure, attenuation by the patient, and scatter conditions within an actual treatment room on the above-noted findings are also discussed using corresponding MC simulation results.

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“…Studies have suggested a low a/b ratio for the prostate as the rationale for the potential biologic dose and economic gain in treating prostate cancer using hypofractionated RT (1)(2)(3)(4). Multiple institutional clinical studies have reported the feasibility of hypofractionated prostate cancer treatment (5)(6)(7)(8)(9). To attain the goal of SBRT, conformal techniques are necessary to deliver the high dose safely with a rapid dose falloff to control the excessive risk of radiation damage.…”

Section: Introductionmentioning

confidence: 99%