Photons, Protons, SBRT, Brachytherapy—What Is Leading the Charge for the Management of Prostate Cancer? A Perspective From the GU Editorial Team

Choudhury, Ananya; Henry, Ann; Mitin, Timur; Chen, Ronald; Joseph, Nuradh; Spratt, Daniel E.

doi:10.1016/j.ijrobp.2021.01.003

Cited by 4 publications

(5 citation statements)

References 44 publications

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“…The L-UHF arm used EQD2 85–97 Gy 1.5 and achieved 100% and 97.1% BFFS at 3 years, and the H-UHF group (36 Gy/4 fractions = 108 Gy 1.5 > 100 Gy 1.5 ) showed elevated late toxicity without improved efficacy compared to the DeRT and L-UHF groups. Therefore, at present, according to our findings combined with Western evidence [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], we believe that L-UHF (EQD < 100 Gy 1.5 ) is a feasible UHF schedule.…”

Section: Discussionsupporting

confidence: 63%

“…Royce et al estimated the improvement of tumor control probability up to 95% using high EQD2 of 102 Gy (38.7 Gy in five fractions) compared with 90% when EQD2 of 97 Gy (37.6 Gy in five fractions) was used [ 20 ]. Although the biochemical control rate did not improve as per the literature and our findings [ 2 , 3 , 22 ], Zelefsky et al reported positive biopsy rates of 47.6%, 19.2%, 16.7%, and 7.7% after 32.5 Gy, 35 Gy, 37.5 Gy, and 40 Gy in five fractions, respectively, which suggested the importance of dose escalation [ 24 ]. In addition, although late toxicity was higher than with L-UHF and DeRT, the frequency of toxicity grade ≥3 in the H-UHF group was only 2% in GI and 1% in GU (8% and 10% grade 2), which could be comparable to other studies [ 12 , 16 , 20 , 21 ].…”

Section: Discussionsupporting

confidence: 49%

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Ultrahypofractionated Radiotherapy versus Conventional to Moderate Hypofractionated Radiotherapy for Clinically Localized Prostate Cancer

Yamazaki

Suzuki

Aibe

et al. 2021

Cancers

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The purpose of this study was to compare the toxicity (first endpoint) and efficacy (second endpoint) of ultrahypofractionated radiotherapy (UHF) and dose-escalated conventional to moderate hypofractionated radiotherapy (DeRT) for clinically localized prostate cancer. We compared 253 patients treated with UHF and 499 patients treated with DeRT using multi-institutional retrospective data. To analyze toxicity, we divided UHF into High-dose UHF (H-UHF; equivalent doses of 2 Gy per fraction: EQD2 > 100 Gy1.5) and low-dose UHF (L-UHF; EQD2 ≤ 100 Gy1.5). In toxicity, H-UHF elevated for 3 years accumulated late gastrointestinal and genitourinary toxicity grade ≥ 2 (11.1% and 9.3%) more than L-UHF (3% and 1.2%) and DeRT (3.1% and 4.8%, p = 0.00126 and p = 0.00549). With median follow-up periods of 32.0 and 61.7 months, the actuarial 3-year biochemical failure-free survival rates were 100% (100% and 100% in the L-UHF and H-UHF) and 96.3% in the low-risk group, 96.5% (97.1% and 95.6%) and 94.9% in the intermediate-risk group, and 93.7% (100% and 94.6%) and 91.7% in the high-risk group in the UHF and DeRT groups, respectively. UHF showed equivocal efficacy, although not conclusive but suggestive due to a short follow-up period of UHF. L-UHF using EQD2 ≤ 100 Gy1.5 is a feasible UHF schedule with a good balance between toxicity and efficacy.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 49%

Ultrahypofractionated Radiotherapy versus Conventional to Moderate Hypofractionated Radiotherapy for Clinically Localized Prostate Cancer

Yamazaki

Suzuki

Aibe

et al. 2021

Cancers

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“…Recent advancements in radiotherapy for localized prostate cancer have enabled us to shorten the treatment period using hypofractionations and provide cost effectiveness and patient convenience. In addition to 2.3–3.4 Gy moderate hypofractionation, UHF gained attention for exploiting the low a/b ratio of this tumor and its high radiation fraction size sensitivity 1 – 6 . The recent HYPO-RT-PC phase 3 trial, which showed non-inferiority of ultrahypofractionation (42.7 Gy/7 fractions for 2.5 weeks) compared with conventional fractionation (78 Gy/39 fractions) 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Long-term 3 and large cohort outcomes including meta-analysis from Western countries confirmed the efficacy of UHF 4 , 5 . However, selection of the best treatment option for patients with localized prostate cancer remain difficult due to the many curative treatment options, such as surgery, external beam radiotherapy, and brachytherapy (BT) 6 . BT is an established treatment for localized prostate cancer with excellent dose distribution, including low-dose rate (LDR) BT and high dose rate (HDR) BT 7 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of toxicities between ultrahypofractionated radiotherapy versus brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer

Yamazaki

Masui

Suzuki

et al. 2022

Sci Rep

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To compare gastrointestinal (GI) and genitourinary (GU) toxicities in patients with localized prostate cancer treated with ultrahypofractionated radiotherapy (UHF) or brachytherapy [BT; low dose rate, LDR or high dose rate (HDR) with or without external beam radiotherapy (EBRT)]. We compared 253 UHF and 1664 BT ± EBRT groups. The main outcomes were the incidence and severity of acute and late GU and GI toxicities. The secondary endpoint was biochemical control rate. Cumulative late actuarial GU toxicity did not differ for grade ≥ 2 (8.6% at 5-years in UHF and 13.3% in BT ± EBRT, hazard ratio [HR], 0.7066; 95% CI, 0.4093–1.22, p = 0.2127). Actuarial grade ≥ 2 late GI toxicity was higher in UHF (5.8% at 5-years, HR: 3.619; 95% CI, 1.774–7.383, p < 0.001) than in BT ± EBRT (1.1%). In detailed subgroup analyses, the high-dose UHF group (H-UHF) using BED ≥ 226 Gy1.5, showed higher GI toxicity profiles than the other subgroups (HDR + EBRT, LDR + EBRT, and LDR monotherapy, and L-UHF BED < 226 Gy1.5) with equivalent GU toxicity to other modalities. With a median follow-up period of 32 months and 75 months, the actuarial biochemical control rates were equivalent between the UHF and BT ± EBRT groups. UHF showed equivalent efficacy, higher GI and equivalent GU accumulated toxicity to BT ± EBRT, and the toxicity of UHF was largely dependent on the UHF schedule.

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“…Modern RT, including IMRT and hypofractionation, has a central role among the available treatment options. However, currently, there is no level 1 evidence on the survival advantages of brachytherapy, SBRT, or protons over another form of radiation therapy ( 23 ). In particular, CHHiP ( 24 ) and HYPRO30 trials ( 25 ) demonstrated that hypofractionated schemes, exploiting the low α/β ratio of PCa, constitute a valid treatment option for HR patients.…”

Section: Discussionmentioning

confidence: 99%

Mixed-Beam Approach for High-Risk Prostate Cancer Carbon-Ion Boost Followed by Photon Intensity-Modulated Radiotherapy: Preliminary Results of Phase II Trial AIRC-IG-14300

et al. 2021

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PurposeThis study represents a descriptive analysis of preliminary results of a Phase II trial on a novel mixed beam radiotherapy (RT) approach, consisting of carbon ions RT (CIRT) followed by intensity-modulated photon RT, in combination with hormonal therapy, for high-risk prostate cancer (HR PCa) with a special focus on acute toxicity.MethodsPrimary endpoint was the evaluation of safety in terms of acute toxicity. Secondary endpoints were early and long-term tolerability of treatment, quality of life (QoL), and efficacy. Data on acute and late toxicities were collected according to RTOG/EORTC. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and sexual activity by IIEF-5.ResultsTwenty-six patients were enrolled in the study, but only 15 completed so far the RT course and were included. Immediately after CIRT, no patients experienced GI/GU toxicity. At 1 and 3 months from the whole course RT completion, no GI/GU toxicities greater than grade 2 were observed. QoL scores were overall satisfactory.ConclusionsThe feasibility of the proposed mixed treatment schedule was assessed, and an excellent acute toxicity profile was recorded. Such findings instil confidence in the continuation of this mixed approach, with evaluation of long-term tolerability and efficacy.

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Photons, Protons, SBRT, Brachytherapy—What Is Leading the Charge for the Management of Prostate Cancer? A Perspective From the GU Editorial Team

Cited by 4 publications

References 44 publications

Ultrahypofractionated Radiotherapy versus Conventional to Moderate Hypofractionated Radiotherapy for Clinically Localized Prostate Cancer

Ultrahypofractionated Radiotherapy versus Conventional to Moderate Hypofractionated Radiotherapy for Clinically Localized Prostate Cancer

Comparison of toxicities between ultrahypofractionated radiotherapy versus brachytherapy with or without external beam radiotherapy for clinically localized prostate cancer

Mixed-Beam Approach for High-Risk Prostate Cancer Carbon-Ion Boost Followed by Photon Intensity-Modulated Radiotherapy: Preliminary Results of Phase II Trial AIRC-IG-14300

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