Hypofractionation for Prostate Cancer: Interim Results of a Randomized Trial

Pollack, Alan; Li, T.; Buyyounouski, Mark K.; Horwitz, Eric M.; Price, Robert A.; Feigenberg, S.J.; Konski, André; Greenberg, Richard E.; Uzzo, Robert G.; Ma, C

doi:10.1016/j.ijrobp.2009.07.203

Cited by 19 publications

(5 citation statements)

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“…Pollack et al 80,81 randomized 303 patients of intermediate and high risk prostate cancer treated with 26 fractions of 2.7 Gy or 38 fractions of 2 Gy. The rational for the design of the hypofractionated schedule was based on the potential therapeutic gain assuming an a/b ratio of 1.5 Gy.…”

Section: Estimations From Hypofractionation Randomized Trialsmentioning

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: Estimations From Hypofractionation Randomized Trialsmentioning

confidence: 99%

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

2012

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“…Patients were randomly assigned to receive 26 fractions of hypofractionated IMRT or 38 fractions of standard IMRT with or without concurrent androgen deprivation therapy. At a median of 39 months after treatment, the investigators observed no significant difference in biochemical failure or adverse GI or GU effects [46]. To address the concern that hypofractionated radiation schedules potentially can increase toxicity to normal organs situated close to the prostate, multiple studies have looked at toxicity profiles of hypofractionated regimens using both 3D-CRT and IMRT to doses of 50 to 70 Gy and have reported that toxicities are comparable to conventional radiation schedules [45••, 47-49].…”

Section: Hypofractionationmentioning

confidence: 94%

Technological Advances in Radiation Therapy for Prostate Cancer

Choi

Hung

2010

Curr Urol Rep

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Radiation therapy (RT) for prostate cancer has made huge strides over the past two decades. The addition of image guidance has allowed radiation oncologists to ensure accurate delivery of increasingly precise radiation treatment plans using newer conformal therapy methods such as three-dimensional conformal RT, intensitymodulated RT, and proton beam RT. Regardless of the specific treatment technique, patients can depend on the treatment to target the moving prostate effectively while significantly sparing adjacent tissues, thereby reducing the morbidity of having to undergo prostate cancer therapy. This review summarizes the recent technical advances made in radiation dose delivery, including target volume definition, treatment planning, treatment delivery methods, and positional verification methods during RT.

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“…Common definitions of treatment failure after definitive prostate cancer radiotherapy (RT), such as the Phoenix criteria [ 4 ], use longitudinal PSA measurements to assess persistence or recurrence of disease. However, 2- to 3-years after completion of definitive RT, residual prostate cancer cells can be seen on biopsy in 40–50% of men who otherwise appear disease-free [ 5 , 6 ]. Post-treatment positive biopsies are strong predictors for biochemical progression, metastatic disease, and prostate cancer-specific mortality [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Changes and Predictive Value of Multiparametric MRI Features for Prostate Cancer Patients Treated with MRI-Guided Lattice Extreme Ablative Dose (LEAD) Boost Radiotherapy

Algohary

Alhusseini

Breto

et al. 2022

Cancers

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Simple Summary In this study, we investigated the longitudinal changes and predictive value of multiparametric MRI (mpMRI) features of prostate cancer patients receiving Lattice Extreme Ablative Dose (LEAD) boost radiotherapy (RT). Ninety-five mpMRI from 25 patients, acquired pre-RT and at 3 time points following RT were analyzed. Five regions of interest were analyzed, related to tumor, peritumoral, and normally-appearing tissues. We identified significant changes in the imaging parameters following RT in all regions. By using selected features at the four scan points and their differences (Δ radiomics), we were able to build viable predictive models for endpoint biopsy positivity. Our study demonstrates that RT causes significant changes to quantitative imaging features in both tumorous and normally-appearing tissues. Because of the noninvasive nature of the mpMRI, acquiring multiple exams post-RT is feasible to monitor treatment response. Several quantitative imaging features are promising predictors of treatment failure based on post-treatment positive biopsy, a strong marker for clinically relevant endpoints. Abstract We investigated the longitudinal changes in multiparametric MRI (mpMRI) (T2-weighted, Apparent Diffusion Coefficient (ADC), and Dynamic Contrast Enhanced (DCE-)MRI) of prostate cancer patients receiving Lattice Extreme Ablative Dose (LEAD) radiotherapy (RT) and the capability of their imaging features to predict RT outcome based on endpoint biopsies. Ninety-five mpMRI exams from 25 patients, acquired pre-RT and at 3-, 9-, and 24-months post-RT were analyzed. MRI/Ultrasound-fused biopsies were acquired pre- and at two-years post-RT (endpoint). Five regions of interest (ROIs) were analyzed: Gross tumor volume (GTV), normally-appearing tissue (NAT) and peritumoral volume in both peripheral (PZ) and transition (TZ) zones. Diffusion and perfusion radiomics features were extracted from mpMRI and compared before and after RT using two-tailed Student t-tests. Selected features at the four scan points and their differences (Δ radiomics) were used in multivariate logistic regression models to predict the endpoint biopsy positivity. Baseline ADC values were significantly different between GTV, NAT-PZ, and NAT-TZ ( p -values < 0.005). Pharmaco-kinetic features changed significantly in the GTV at 3-month post-RT compared to baseline. Several radiomics features at baseline and three-months post-RT were significantly associated with endpoint biopsy positivity and were used to build models with high predictive power of this endpoint (AUC = 0.98 and 0.89, respectively). Our study characterized the RT-induced changes in perfusion and diffusion. Quantitative imaging features from mpMRI show promise as being predictive of endpoint biopsy positivity.

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Hypofractionation for Prostate Cancer: Interim Results of a Randomized Trial

Cited by 19 publications

References 0 publications

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

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

Technological Advances in Radiation Therapy for Prostate Cancer

Longitudinal Changes and Predictive Value of Multiparametric MRI Features for Prostate Cancer Patients Treated with MRI-Guided Lattice Extreme Ablative Dose (LEAD) Boost Radiotherapy

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