Image-guided, whole-pelvic, intensity-modulated radiotherapy for biochemical recurrence following radical prostatectomy in high-risk prostate cancer patients

Byun, Sang Jun; Kim, Young Seok; Ahn, Hanjong; Kim, Choung‐Soo

doi:10.1371/journal.pone.0190479

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…This study furthers understanding of the clinical implications of BCR after RP and the treatment effect of WPRT during SRT, confirming the results of previous studies demonstrating that WPRT (with or without ADT) can reduce the incidence of subsequent secondary biochemical relapse [11, 13]. With regard to the potential increase in toxicity following WPRT compared with PBRT in the postprostatectomy RT setting, several studies have demonstrated that the risk of developing late GI toxicity is significantly reduced with intensity modulated radiotherapy compared with three-dimensional conformal radiotherapy [15, 23, 24].…”

Section: Discussionsupporting

confidence: 79%

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Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

et al. 2019

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Purpose To investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy. Methods Data from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared. Results Data from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26–0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL. Conclusions These data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.

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Section: Discussionsupporting

confidence: 79%

“…Patients subsequently underwent either PBRT or WPRT. Details of the radiation technique used have been described previously [13–15]. In brief, the clinical target volume (CTV) of WPRT included prostate bed, seminal vesicle, and presacral, obturator, internal iliac, and external iliac nodal regions.…”

Section: Methodsmentioning

confidence: 99%

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

et al. 2019

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“…In the rest of this paper, we refer to the plans from the generated fluence maps as ‘synthetic plans’ and the dose distributions from these plans as ‘synthetic dose distributions’. We compared the synthetic dose distributions and clinical dose distributions according to the constraints used in our institution 24 , which are homogeneity index (HI), conformity index (CI), V 72.6Gy of the PTV, V 60Gy of rectum, V 60Gy of bladder, D max of femoral heads, D mean of penile bulb and absolute volume of bowel receiving 45 Gy. To calculate HI 25 and CI 26 , we used Eqs (1) and (2), respectively.…”

Section: Resultsmentioning

confidence: 99%

Fluence-map generation for prostate intensity-modulated radiotherapy planning using a deep-neural-network

Lee

Kim

Kwak

et al. 2019

Sci Rep

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A deep-neural-network (DNN) was successfully used to predict clinically-acceptable dose distributions from organ contours for intensity-modulated radiotherapy (IMRT). To provide the next step in the DNN-based plan automation, we propose a DNN that directly generates beam fluence maps from the organ contours and volumetric dose distributions, without inverse planning. We collected 240 prostate IMRT plans and used to train a DNN using organ contours and dose distributions. After training was done, we made 45 synthetic plans (SPs) using the generated fluence-maps and compared them with clinical plans (CP) using various plan quality metrics including homogeneity and conformity indices for the target and dose constraints for organs at risk, including rectum, bladder, and bowel. The network was able to generate fluence maps with small errors. The qualities of the SPs were comparable to the corresponding CPs. The homogeneity index of the target was slightly worse in the SPs, but there was no difference in conformity index of the target, V60Gy of rectum, the V60Gy of bladder and the V45Gy of bowel. The time taken for generating fluence maps and qualities of SPs demonstrated the proposed method will improve efficiency of the treatment planning and help maintain the quality of plans.

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“…pT3a No Mo was the post-operative TNM classification, G2, 4-5 Gleason, stage III. On 27 January 2003, biochemical recurrence (BCR) (two consecutive values higher than 0.2 ng/mL) was detected [41,42] with a serum PSA level of 0.60 ng/mL. On 1 April 2003, a PSA level of 1.17 ng/mL was found.…”

Section: Six Cases Reports and Methodsmentioning

confidence: 99%

Treatment of Metastatic or High-Risk Solid Cancer Patients by Targeting the Immune System and/or Tumor Burden: Six Cases Reports

Nicolini

Morganti

Carpi

2019

IJMS

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This article summarizes the histories of six patients with different solid tumors treated with a new strategy based on tumor burden reduction and immune evasion as potential targets. All six patients were at a high risk of relapse and were likely to have a minimal residual disease following conventional therapy: biochemical recurrence (BCR) following radical prostatectomy (RP) (two prostate cancers patients), removal of distant metastases (one colorectal and one breast cancer), and complete response (CR) of distant metastases to conventional therapy (one breast cancer and one esophageal–gastric junction cancer). Four of the patients, two after RP and BCR, one after removal of a single pulmonary metastasis from breast cancer, and one after CR to chemotherapy of peritoneal metastases and ascites from an esophageal–gastric junction primary cancer, regularly received cycles of a new drug schedule with the aim of inhibiting immune suppression (IT). In these four patients, preliminary laboratory tests of peripheral blood suggested an interleukin (IL)-2/IL-12 mediated stimulation of cellular immune response with a concomitant decrease in vascular endothelial growth factor (VEGF) immune suppression. The fifth case was a breast cancer patient with distant metastases in CR, while receiving beta-interferon and interleukin-2 in addition to conventional hormone therapy. To date, all five patients are alive and doing well and they have been unexpectedly disease-free for 201 and 78 months following BCR, 28 months following the removal of a single pulmonary metastases, 32 months following CR to chemotherapy of peritoneal metastases and ascites, and 140 months following diagnosis of multiple bone metastases, respectively. The sixth patient, who had colorectal cancer and multiple synchronous liver metastases and underwent nine surgical interventions for metastatic disease, although not disease-free, is doing well 98 months after primary surgery. Our six cases reports can be interpreted with the hypothesis that immune manipulation and/or a concomitant low tumor burden favored their clinical outcome.

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Image-guided, whole-pelvic, intensity-modulated radiotherapy for biochemical recurrence following radical prostatectomy in high-risk prostate cancer patients

Cited by 7 publications

References 32 publications

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

Fluence-map generation for prostate intensity-modulated radiotherapy planning using a deep-neural-network

Treatment of Metastatic or High-Risk Solid Cancer Patients by Targeting the Immune System and/or Tumor Burden: Six Cases Reports

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