Late toxicity and biochemical control in 554 prostate cancer patients treated with and without dose escalated image guided radiotherapy

Kok, David; Gill, Suki; Bressel, Mathias; Byrne, Keelan; Kron, Tomas; Fox, Chris; Duchesne, Gillian; Tai, Keen Hun; Foroudi, Farshad

doi:10.1016/j.radonc.2013.04.007

Cited by 59 publications

(26 citation statements)

References 22 publications

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“…No randomized or prospective studies have been conducted so far to draw comparisons between 3DCRT or IMRT and IGRT. In line with our study data, five retrospective analyses [37–41] found a decrease in both acute GI and GU toxicity [41], as well as late GU [37,39,40] and GI [38–40] toxicity.…”

Section: Discussionsupporting

confidence: 91%

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

et al. 2017

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BackgroundTo identify predictors of acute and late rectal toxicity following prostate cancer radiotherapy (RT), while integrating the potential impact of RT technique, dose escalation, and moderate hypofractionation, thus enabling us to generate a nomogram for individual prediction.MethodsIn total, 972 patients underwent RT for localized prostate cancer, to a total dose of 70 Gy or 80 Gy, using two different fractionations (2 Gy or 2.5 Gy/day), by means of several RT techniques (3D conformal RT [3DCRT], intensity-modulated RT [IMRT], or image-guided RT [IGRT]). Multivariate analyses were performed to identify predictors of acute and late rectal toxicity. A nomogram was generated based on the logistic regression model used to predict the 3-year rectal toxicity risk, with its accuracy assessed by dividing the cohort into training and validation subgroups.ResultsMean follow-up for the entire cohort was 62 months, ranging from 6 to 235. The rate of acute Grade ≥2 rectal toxicity was 22.2%, decreasing when combining IMRT and IGRT, compared to 3DCRT (RR = 0.4, 95%CI: 0.3–0.6, p<0.01). The 5-year Grade ≥2 risks for rectal bleeding, urgency/tenesmus, diarrhea, and fecal incontinence were 9.9%, 4.5%, 2.8%, and 0.4%, respectively. The 3-year Grade ≥2 risk for overall rectal toxicity increased with total dose (p<0.01, RR = 1.1, 95%CI: 1.0–1.1) and dose per fraction (2Gy vs. 2.5Gy) (p = 0.03, RR = 3.3, 95%CI: 1.1–10.0), and decreased when combining IMRT and IGRT (RR = 0.50, 95% CI: 0.3–0.8, p<0.01). Based on these three parameters, a nomogram was generated.ConclusionsDose escalation and moderate hypofractionation increase late rectal toxicity. IMRT combined with IGRT markedly decreases acute and late rectal toxicity. Performing combined IMRT and IGRT can thus be envisaged for dose escalation and moderate hypofractionation. Our nomogram predicts the 3-year rectal toxicity risk by integrating total dose, fraction dose, and RT technique.

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Section: Discussionsupporting

confidence: 91%

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

et al. 2017

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“…Zelefsky et al, 70 Kok et al 71 and Sveistrup et al 72 compared large cohorts of patients retrospectively, where the main difference was the use or not of FMs for image guidance. All report improvements in urinary and gastrointestinal toxicity for the FM groups.…”

Section: Clinical Impact Of Prostate Fiducial Marker Image-guided Radmentioning

confidence: 99%

Fiducial marker guided prostate radiotherapy: a review

O’Neill¹,

Jain²,

Hounsell³

et al. 2016

The British Journal of Radiology

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Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.

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“…The national Comprehensive Cancer network (nCCn) recommends that a three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) should be used to treat localized and locally advanced prostate cancer. In the past two decades, many nonrandomized clinical trials (Michalski et al 2012;Kok et al 2013;goldner et al 2009;D'ambrosio et al 2008) have suggested that dose escalation in the eBRT can bring excellent clinical outcomes with acceptable toxicity. nonetheless, the relationship between outcomes such as overall survival (OS) and prostate cancer-specific survival (PCSS) in the randomized controlled trials is still unclear.…”

Section: Introductionmentioning

confidence: 99%

High dose versus conventional dose in external beam radiotherapy of prostate cancer: a meta-analysis of long-term follow-up

Hou

Bai

2014

J Cancer Res Clin Oncol

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This was the first meta-analysis of trials with long-term follow-up to indicate that HDRT is superior to CDRT in terms of preventing BF in localized prostate cancer patients. However, this advantage did not translate into an improvement in OS and PCSS. This was also the first meta-analysis to suggest that the HDRT in three-dimensional conformal radiotherapy (3D-CRT) significantly increases the late G ≥ 2 GU toxicity. Thus, the dose escalation in 3D-CRT should be discreetly used in the treatment of prostate cancer due to the increase in late toxicities.

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Late toxicity and biochemical control in 554 prostate cancer patients treated with and without dose escalated image guided radiotherapy

Cited by 59 publications

References 22 publications

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

Nomogram to predict rectal toxicity following prostate cancer radiotherapy

Fiducial marker guided prostate radiotherapy: a review

High dose versus conventional dose in external beam radiotherapy of prostate cancer: a meta-analysis of long-term follow-up

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