Prostate-specific antigen kinetics and biochemical control following stereotactic body radiation therapy, high dose rate brachytherapy, and low dose rate brachytherapy: A multi-institutional analysis of 3502 patients

Levin-Epstein, Rebecca; Cook, Ryan; Wong, J.K.; Stock, Richard G.; Demanes, D. Jeffrey; Collins, Sean P.; Aghdam, Nima; Suy, Simeng; Mantz, C.A.; Katz, Alan J.; Nickols, Nicholas G.; Miszczyk, Leszek; Napieralska, Aleksandra; Namysł-Kaletka, A.; Prionas, Nicolas D.; Bagshaw, H.P.; Buyyounouski, Mark K.; Cao, Minsong; Mahal, Brandon A.; Shabsovich, David; Dang, Alexander; Yuan, Ye; Rettig, Matthew B.; Chang, Albert; Jackson, W. Clay; Spratt, Daniel E.; Lehrer, Eric J.; Zaorsky, Nicholas G.; Kupelian, Patrick A.; Steinberg, Michael L.; Horwitz, Eric M.; Jiang, Naomi; Kishan, Amar U.

doi:10.1016/j.radonc.2020.07.014

Cited by 23 publications

(17 citation statements)

References 21 publications

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“…We limited our study to model toxicity, recurrence in the first 20 years, and associated short-term costs and utilities based on evidence that long-term outcomes were non-differential across treatment modalities [ 5 ]. Therefore, our results should not be interpreted as such that reflect the total cost of treatment or the entirety of the quality of life of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that the long-term outcomes, including overall survival, long-term management and biochemical recurrence were non-differential across treatment modalities [ 2 , 5 , 24 ]. Therefore, the model was limited to costs and health utility outcomes from which we expect differences across the modalities would exist.…”

Section: Methodsmentioning

confidence: 99%

“…Currently, there is a high level of evidence on the effectiveness of radiation therapy in improving local control, biochemical control and overall survival when used in this group of population [ 2 ]. However, several new treatment modalities have emerged within the radiation treatment options in the last decades, but all have relatively equivalent survival outcomes [ 2 , 3 , 4 , 5 ]. Therefore, treatment choice is often driven by differences in patient and provider preferences that are largely part based on treatment time, cost and toxicity profile.…”

Section: Introductionmentioning

confidence: 99%

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Cost–Utility Analysis of Radiation Treatment Modalities for Intermediate-Risk Prostate Cancer

et al. 2021

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Introduction: Variable costs of different radiation treatment modalities have played an important factor in selecting the most appropriate treatment for patients with intermediate-risk prostate cancer. Methods: Analysis using a Markov model was conducted to simulate 20-year disease trajectory, quality-adjusted life years (QALYs) and health system costs of a cohort of intermediate-risk prostate cancer patients with mean age of 60 years. Clinical outcomes on toxicity and disease recurrence were measured and a probabilistic sensitivity analysis was performed, varying input parameters simultaneously according to their distributions. Results: Among the six radiation treatment modalities, including conventionally fractionated intensity-modulated radiation therapy (IMRT), hypofractionated IMRT, IMRT combined with high-dose-rate (HDR) brachytherapy, HDR brachytherapy monotherapy, low-dose-rate brachytherapy monotherapy, and stereotactic body radiotherapy (SBRT), SBRT was found to be more cost-effective when compared with LDR-b and other treatment modalities, resulting in an incremental cost–utility ratio of $2985 per QALY. Conclusions: Stereotactic body radiotherapy is the most cost-effective radiation treatment modality in treatment of intermediate-risk prostate cancer, while treatment toxicity and cost data are the key drivers of the cost–utility. Further work is required with long-term follow-up for SBRT.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost–Utility Analysis of Radiation Treatment Modalities for Intermediate-Risk Prostate Cancer

et al. 2021

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“…( 127 ) demonstrated that LDR-BT gives rise to lower nadir PSAs (nPSAs) and longer continued decay compared to SBRT and HDR-BT, without significant differences in biochemical recurrence-free survival (RFS). They also noted that whether the difference in prostate-specific antigen (PSA) kinetic implicates the efficacy when LDR and HDR were used as a boost to EBRT requires further investigation ( 127 ). A national population-based study compared the GI, GU, skeletal-related events (SREs), and prostate cancer-specific mortality (PCSM) at 5 years in 54,642 patients with intermediate-risk, high-risk, and locally advanced prostate cancer.…”

Section: I-125 Brachytherapy In Solid Tumorsmentioning

confidence: 99%

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

Wei

Mengyuan

et al. 2021

Front. Oncol.

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Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.

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“…The applicability of SBRT to men with unfavorable intermediate and high risk disease continues to evolve. An increasing number of series have characterized promising biochemical outcomes for this specific cohort (17,(23)(24)(25)(26). Reflecting these emerging data, the National Comprehensive Cancer Network (NCCN) begrudgingly supports the use of SBRT for men with unfavorable intermediate or high risk disease "…if delivering longer courses of EBRT would present a medical or social hardship (27)".…”

mentioning

confidence: 99%

Editorial: The Evolving Landscape of Stereotactic Body Radiation Therapy for the Management of Prostate Cancer

2020

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Prostate-specific antigen kinetics and biochemical control following stereotactic body radiation therapy, high dose rate brachytherapy, and low dose rate brachytherapy: A multi-institutional analysis of 3502 patients

Cited by 23 publications

References 21 publications

Cost–Utility Analysis of Radiation Treatment Modalities for Intermediate-Risk Prostate Cancer

Cost–Utility Analysis of Radiation Treatment Modalities for Intermediate-Risk Prostate Cancer

Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions

Editorial: The Evolving Landscape of Stereotactic Body Radiation Therapy for the Management of Prostate Cancer

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