Is robotic arm stereotactic body radiation therapy ‘virtual high-dose rate brachytherapy’ effective for prostate cancer? An analysis of comparative effectiveness using published data

Zaorsky, Nicholas G.; Hurwitz, Mark; Dicker, Adam P.; Showalter, Timothy N.; Den, Robert B.

doi:10.1586/17434440.2015.994606

Cited by 8 publications

(8 citation statements)

References 61 publications

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“…We currently offer HDR monotherapy to patients with low and intermediate risk prostate cancer, as combination therapy for high‐risk disease, and in the salvage setting. With the advancement in sterotactic body radiation therapy, robotic surgery, HDR brachytherapy will continue to be an excellent and cost‐effective treatment option for patients …”

Section: Discussionmentioning

confidence: 99%

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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Introduction: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy 9 6-fractions and 35 men had 13.5 Gy 9 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse shortterm acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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“…CyberKnife Ò ) was introduced (around 2001), it was marketed as being able to deliver ''extremely" hypofractionated external beam RT, and it was shown to recapitulate HDR-BT plans to form a ''virtual HDR-BT" (plans juxtaposed in Fig. 2) [64]. Notably, however, SBRT may be delivered with any type of linear accelerator (robotic arm or gantry) [61,64].…”

Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

“…2) [64]. Notably, however, SBRT may be delivered with any type of linear accelerator (robotic arm or gantry) [61,64]. Although studies using SBRT have been published [20][21][22][23], they are limited by their exclusion of intermediate-and high-risk patients, and relatively small number of patients treated [61].…”

Section: Key Question 1: Psa Kineticsmentioning

confidence: 99%

Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer

Zaorsky

Shaikh

Murphy

et al. 2016

Cancer Treatment Reviews

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We review radiation therapy (RT) options available for prostate cancer, including external beam (EBRT; with conventional fractionation, hypofractionation, stereotactic body RT [SBRT]) and brachytherapy (BT), with an emphasis on the outcomes, toxicities, and contraindications for therapies. PICOS/PRISMA methods were used to identify published English-language comparative studies on PubMed (from 1980 to 2015) that included men treated on prospective studies with a primary endpoint of patient outcomes, with ⩾70 patients, and ⩾5year median follow up. Twenty-six studies met inclusion criteria; of these, 16 used EBRT, and 10 used BT. Long-term freedom from biochemical failure (FFBF) rates were roughly equivalent between conventional and hypofractionated RT with intensity modulation (evidence level 1B), with 10-year FFBF rates of 45-90%, 40-60%, and 20-50% (for low-, intermediate-, and high-risk groups, respectively). SBRT had promising rates of BF, with shorter follow-up (5-year FFBF of >90% for low-risk patients). Similarly, BT (5-year FFBF for low-, intermediate-, and high-risk patients have generally been >85%, 69-97%, 63-80%, respectively) and BT+EBRT were appropriate in select patients (evidence level 1B). Differences in overall survival, distant metastasis, and cancer specific mortality (5-year rates: 82-97%, 1-14%, 0-8%, respectively) have not been detected in randomized trials of dose escalation or in studies comparing RT modalities. Studies did not use patient-reported outcomes, through Grade 3-4 toxicities were rare (<5%) among all modalities. There was limited evidence available to compare proton therapy to other modalities. The treatment decision for a man is usually based on his risk group, ability to tolerate the procedure, convenience for the patient, and the anticipated impact on quality of life. To further personalize therapy, future trials should report (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education status; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics.

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“…SBRT has become increasingly popular since the 2000s, and since its inception, it has been marketed as a noninvasive alternative to HDR-BT 4,29,47. EBRT and BT have different dosimetric characteristics in terms of conformity and heterogeneity, as well as normal-tissue sparing (shown in Figure 1).…”

Section: Theoretical Benefits Of Robotic Arm Vs Gantry Sbrtmentioning

confidence: 99%

“…EBRT and BT have different dosimetric characteristics in terms of conformity and heterogeneity, as well as normal-tissue sparing (shown in Figure 1). For example, for BT, there is greater dose heterogeneity, with higher dose regions near the catheters,37 whereas with EBRT the dose is generally more homogeneous 29. There is currently no evidence that gantry or robotic arm SBRT provides a more favorable BED for the tumor while lowering the BED to the normal tissues.…”

Section: Theoretical Benefits Of Robotic Arm Vs Gantry Sbrtmentioning

confidence: 99%

A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

Avkshtol¹,

Lango²,

Hayes³

et al. 2016

RRU

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Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years) and acute and late toxicity (<6% grade 3–4 late toxicities). Other outcomes (eg, overall and cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.

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Is robotic arm stereotactic body radiation therapy ‘virtual high-dose rate brachytherapy’ effective for prostate cancer? An analysis of comparative effectiveness using published data

Cited by 8 publications

References 61 publications

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer

A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

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