Hypofractionation for radiotherapy of prostate cancer using a low alfa/beta ratio – possible reasons for concerns? An example of five dimensional radiotherapy

Lennernäs, Bo; Nilsson, Sten; Levitt, Seymour H.

doi:10.3109/0284186x.2011.562536

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…Another factor that has not been considered in many clinical studies is the heterogeneous nature of tumour tissue [33]. Most tumours have both poorly and well-differentiated cells [34]; this heterogeneity leads to a heterogeneous α/β ratio across the tumour site (poorly differentiated cells have a higher α/β than well-differentiated cells).…”

Section: Risks Associated With Hypofractionation In Breast and Prostamentioning

confidence: 99%

“…Consequently, a hypofractionated treatment could be sparing poorly differentiated sections of the tumour relative to the nearby organs at risk. Simulation of this effect showed that treatment efficacy decreases for a hypofractionated schedule even if 5–10% of the cells in the tumour are poorly differentiated [33]. The variation in genetic mutations across the tumour volume also contributes to its heterogeneity; it has previously been shown that there is as much inter-patient variability as there is intra-patient variability when considering the genetic mutations in biopsies of many tumour types [35].…”

Section: Risks Associated With Hypofractionation In Breast and Prostamentioning

confidence: 99%

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Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits

Ray¹,

Sibson²,

Kiltie³

2015

Clinical Oncology

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Breast cancer and prostate cancer are the most common cancers diagnosed in women and men, respectively, in the UK, and radiotherapy is used extensively in the treatment of both. In vitro data suggest that tumours in the breast and prostate have unique properties that make a hypofractionated radiotherapy treatment schedule advantageous in terms of therapeutic index. Many clinical trials of hypofractionated radiotherapy treatment schedules have been completed to establish the extent to which hypofractionation can improve patient outcome. Here we present a concise description of hypofractionation, the mathematical description of converting between conventional and hypofractionated schedules, and the motivation for using hypofractionation in the treatment of breast and prostate cancer. Furthermore, we summarise the results of important recent hypofractionation trials and highlight the limitations of a hypofractionated treatment regimen.

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Section: Risks Associated With Hypofractionation In Breast and Prostamentioning

confidence: 99%

Section: Risks Associated With Hypofractionation In Breast and Prostamentioning

confidence: 99%

Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits

Ray¹,

Sibson²,

Kiltie³

2015

Clinical Oncology

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“…Several clinical studies and reviews have analysed this type of biological dose escalation strategy and have found excellent clinical results without the higher risk of radiotherapy side effects (Ritter ; Lennernäs et al . ; Spyropoulou & Kardamakis ; Moraes et al . ; Yamazaki et al .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Zemplényi

Kaló

Kovács³

et al. 2016

Eur J Cancer Care

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The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

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“…found that estimations of a/b values changes significantly in heterogeneous as compared to the routinely-used homogenous TCP models [27]. Lennernas et al [28] raised concerns about assuming an overall low a/b for prostate cancer since this cancer is very heterogeneous. They calculated the relative effect of the treatment by integrations of different ratios in different tumor sub-volumes and showed that just a small portion (5%) of cells with a higher a/b can dramatically change the overall effect of the treatment [28].…”

Section: Discussionmentioning

confidence: 99%

Histopathology-derived modeling of prostate cancer tumor control probability: Implications for the dose to the tumor and the gland

Ghobadi

Jong

Hollmann

et al. 2016

Radiotherapy and Oncology

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Hypofractionation for radiotherapy of prostate cancer using a low alfa/beta ratio – possible reasons for concerns? An example of five dimensional radiotherapy

Cited by 14 publications

References 10 publications

Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits

Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Histopathology-derived modeling of prostate cancer tumor control probability: Implications for the dose to the tumor and the gland

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