Long-term results of intensity-modulated radiotherapy with three dose-fractionation regimens for localized prostate cancer

Takemoto, Shinya; Shibamoto, Yuta; Sugie, Chikao; Manabe, Yoshihiko; Yanagi, Takeshi; Iwata, Hiromitsu; Murai, Taro; Ishikura, Satoshi

doi:10.1093/jrr/rry089

Cited by 12 publications

(14 citation statements)

References 38 publications

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“…The cumulative incidence of late ≥grade 2 GI complications was only 4.8% in our current study, whereas that after definitive RT ranged from 7% to 15% [19][20][21] . This may be because a lower dose of 64-70 Gy is usually used in SRT as compared with a dose of 76-80 Gy in definitive RT.…”

Section: Discussioncontrasting

confidence: 68%

Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

Tomita

Uchiyama

Mizuno

et al. 2020

Sci Rep

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The safety and efficacy of dose-escalated radiotherapy with intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) remain unclear in salvage radiotherapy (SRT) after radical prostatectomy. We examined the impact of these advanced radiotherapy techniques and dose intensification on the toxicity of SRT. This multi-institutional retrospective study included 421 patients who underwent SRT at the median dose of 66 Gy in 2-Gy fractions. IMRT and IGRT were used for 225 (53%) and 321 (76%) patients, respectively. At the median follow-up of 50 months, the cumulative incidence of late grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities was 4.8% and 24%, respectively. Multivariate analysis revealed that the non-use of either IMRT or IGRT, or both (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.8-5.4, p < 0.001) and use of whole-pelvic radiotherapy (HR 7.6, CI 1.0-56, p = 0.048) were associated with late GI toxicity, whereas a higher dose ≥68 Gy was the only factor associated with GU toxicities (HR 3.1, CI 1.3-7.4, p = 0.012). This study suggested that the incidence of GI toxicities can be reduced by IMRT and IGRT in SRT, whereas dose intensification may increase GU toxicity even with these advanced techniques.Prostate cancer patients with biochemical recurrence (BCR) after radical prostatectomy (RP) have a risk of metastasis and cancer death 1 . Approximately 30% of patients with an adverse feature, such as high Gleason score, develop BCR after RP 2 . Salvage radiotherapy (SRT) is the only curative option for these patients 3,4 . The target volume of SRT is the prostate bed with or without the seminal vesicle 5 , which is situated precisely between the bladder and rectum. In a dosimetric study using consensus guidelines for target volume delineations of SRT, intensity-modulated radiation therapy (IMRT) enabled dose increase within acceptable dose constraints of the organs at risk (OARs) such as the bladder and rectum 6 . Regarding definitive radiotherapy (RT) without RP, the ratio of IMRT markedly increased in the 2000s 7 due to benefits of high-dose prescription 8 . As systematic reviews and meta-analyses revealed that dose escalation improved biochemical control even in SRT 9,10 , dose escalation with IMRT has been employed for patients with BCR after RP [11][12][13] . However, dose-escalated RT, even with the IMRT technique, may increase toxicity. Image-guided radiation therapy (IGRT) enables more accurate setup by computed tomography (CT) immediately before treatment. IGRT is also one of the recent advanced RT techniques, as is IMRT, and is used more commonly with IMRT. However, the safety and efficacy of dose-escalated RT with IMRT and IGRT remain unclear. In addition, whether IMRT and IGRT reduce toxicity in SRT is still unknown. Thus, we examined the impact of advanced RT techniques and dose intensification on the toxicity of SRT after RP. Methods patient selection. We identified 421 patients who received SRT for BCR after RP between 2005 and 2017 at 15 institutions....

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Section: Discussioncontrasting

confidence: 68%

Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

Tomita

Uchiyama

Mizuno

et al. 2020

Sci Rep

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“…Table 2 summarizes the clinical outcomes after IMRT, PBT and CIRT, along with a comparison of the efficacies and safety parameters. 8,[25][26][27][28][29][30][31][32][33][34][35][36][37][38] PBT and CIRT outcomes in Japanese patients were reported recently in a multicenter collaborative clinical study. 37,38 Iwata et al reported long-term outcomes from a multi-institutional survey of PBT for prostate cancer carried out by the Japanese Radiation Oncology Study Group.…”

Section: Local Particle Beam Rt: Mainly In the 2000smentioning

confidence: 89%

“…Table summarizes the clinical outcomes after IMRT, PBT and CIRT, along with a comparison of the efficacies and safety parameters . PBT and CIRT outcomes in Japanese patients were reported recently in a multicenter collaborative clinical study .…”

Section: Scientific Statementsmentioning

confidence: 99%

Particle therapy for prostate cancer: The past, present and future

et al. 2019

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Although prostate cancer control using radiotherapy is dose‐dependent, dose–volume effects on late toxicities in organs at risk, such as the rectum and bladder, have been observed. Both protons and carbon ions offer advantageous physical properties for radiotherapy, and create favorable dose distributions using fewer portals compared with photon‐based radiotherapy. Thus, particle beam therapy using protons and carbon ions theoretically seems suitable for dose escalation and reduced risk of toxicity. However, it is difficult to evaluate the superiority of particle beam radiotherapy over photon beam radiotherapy for prostate cancer, as no clinical trials have directly compared the outcomes between the two types of therapy due to the limited number of facilities using particle beam therapy. The Japanese Society for Radiation Oncology organized a joint effort among research groups to establish standardized treatment policies and indications for particle beam therapy according to disease, and multicenter prospective studies have been planned for several common cancers. Clinical trials of proton beam therapy for intermediate‐risk prostate cancer and carbon‐ion therapy for high‐risk prostate cancer have already begun. As particle beam therapy for prostate cancer is covered by the Japanese national health insurance system as of April 2018, and the number of facilities practicing particle beam therapy has increased recently, the number of prostate cancer patients treated with particle beam therapy in Japan is expected to increase drastically. Here, we review the results from studies of particle beam therapy for prostate cancer and discuss future developments in this field.

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“…For GU toxicity, Carvalho, et al made a systematic review and meta-analysis and reported around 28% of late GU toxicity at 12 months or more after EBRT [ 31 ]. Takemoto reported 7.9–12.4% of GU Grade ≥2 ratio at 6–10 years using IMRT in Japan [ 32 ]. For HDR+EBRT, Ishiyama et al reported 5- and 10-year accumulated rates of late Grade ≥2 GU toxicities were 16.7% and 26.7% in 3424 Asian patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

Yamazaki

Suzuki

Masui

et al. 2021

Cancers

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To examine the efficacy of dose escalating radiotherapy into patients with cT3b or T4 localized prostate cancer, we compared Group A (86 conventional dose external beam radiotherapy: EBRT group, treated with 70–72Gy) and group B (39 high dose EBRT group (HDEBRT group, 74–80 Gy) and 124 high-dose-rate brachytherapy (HDR) + EBRT (HDR boost)) using multi-institutional retrospective data. The actuarial 5-year biochemical disease-free survival (bDFS) rate, prostate cancer specific survival rate (PSS), and overall survival rate (OS) were 75.8%, 96.8%, and 93.5%. Group B showed superior 5-year bDFS rate (81.2%) as compared to the group A (66.5%) (p < 0.0001) with a hazard ratio of 0.397. Equivocal 5-year PSS (98.3% and 94.8% in group B and group A) and OS (both 93.7%) were found between those groups. Accumulated late grade ≥2 toxicities in gastrointestinal and genitourinary tracts were similar among those three groups. Therefore, both HDEBRT and HDR boost could be good options for improving the bDFS rate in cT3–T4 localized prostate cancer without affecting PSS and OS.

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Long-term results of intensity-modulated radiotherapy with three dose-fractionation regimens for localized prostate cancer

Cited by 12 publications

References 38 publications

Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

Particle therapy for prostate cancer: The past, present and future

Radiotherapy for Clinically Localized T3b or T4 Very-High-Risk Prostate Cancer-Role of Dose Escalation Using High-Dose-Rate Brachytherapy Boost or High Dose Intensity Modulated Radiotherapy

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