Radiobiological comparison of two radiotherapy treatment techniques for high-risk prostate cancer

Hernández, Trinitat García; González, Antonio Ballesteros; Peidro, J. Pastor; Ferrando, Juan V. Roselló; Gonzalez, L. Brualla; Cabanero, D. Granero; Torrecilla, J. López

doi:10.1016/j.rpor.2012.12.006

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…Finally, there is level 1 evidence that five-fraction UHRT delivered once per week improves acute urinary and intestinal quality of life compared with every-other-day delivery [20]. By contrast, repopulation of PCa and how the 'time factor' might affect tumour control is currently unknown, especially for high-grade tumours [21,22] [14], low-dose-rate brachytherapy [24], and UHRT [7]. For this group of patients, any EBRT treatment delivering a dose up to 80-85 Gy 1.5 (e.g.…”

Section: Discussionmentioning

confidence: 99%

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Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Macías

Barrera-Mellado

2019

BJU International

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ObjectivesTo report toxicity (primary endpoint) and biochemical disease-free survival (BDFS) outcomes of a phase II trial evaluating ultra-hypofractionated radiation therapy (UHRT), focusing on patients with unfavourable intermediate-risk and high-risk prostate cancer (PCa). Patients and MethodsFrom 2012 to 2017, 154 patients (92 with unfavourable intermediate-risk or high-risk PCa) were treated with helical TomoTherapy delivering 43.8-45.2 Gy in eight fractions over 3 weeks. Of these, 73% received hormonotherapy (51% neoadjuvant). ResultsThe median (range) follow-up was 48 (19-84) months. For the whole series, crude BDFS and 5-year BDFS rates were 97.4% and 94.3%, respectively. The corresponding figures for unfavourable intermediate-risk and high-risk PCa were 96.7% and 90%, respectively. The crude metastasis-free survival rate was 98% for the unfavourable intermediate-risk and high-risk group. For the whole series, the 5-year cumulative urinary/ intestinal grade 2+ late toxicity was 17.8/7.4%. No grade 4-5 toxicity was observed. One patient experienced late grade 3 toxicity (urinary). ConclusionThis eight-fraction UHRT regimen can be safely delivered to patients with unfavourable intermediate-risk/high-risk PCa. Its relapse rates are similar to those reported for the combination of external beam radiotherapy plus brachytherapy, however, the observed toxicity profile is milder. The disease survival rates compare favourably with historical controls in some other forms of radiotherapy, with similar side effects. Since the low rate of biochemical/ metastasis relapse is encouraging, further research to confirm these results is justified.Keywords stereotactic body radiotherapy, brachytherapy, high risk, hypofractionated radiotherapy, quality of life, #ProstateCancer, #PCSM

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Section: Discussionmentioning

confidence: 99%

“…Prophylactic a-blockers (tamsulosin 0.4 mg/day) or antiinflammatory medications (hydrocortisone enema, given a few millilitres once a day) were routinely administered during radiotherapy. Treatment was completed over a period of [13][14][15][16][17][18][19][20][21][22][23]…”

Section: Treatmentmentioning

confidence: 99%

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Macías

Barrera-Mellado

2019

BJU International

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“…Many studies have compared various radiation delivery regiments e.g. hypofractionated (greater than 2 Gy per fraction) [1] against standard fractionation (1.8 Gy to 2 Gy per fraction) or 3D-CRT vs IMRT [2][3][4][5][6], which indicates that the models and estimation of the model parameters play an important role. In addition, magnetic resonance is a versatile and suitable imaging for radiotherapy enabling visualization of the target structures and organs at risks, as well as tissue characterisation, indicating a new era of imaging-guided radiation therapy [7,8].…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

Sachpazidis

Mavroidis

Zamboglou

et al. 2020

Preprint

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Purpose: To evaluate the applicability and estimate the radiobiological parameters of linear-quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV). The TCP describes the dose–response of prostate after definitive radiotherapy (RT). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI-GTV based on multivariate logistic regression model.Methods: The study included 129 intermediate and high-risk prostate cancer patients (cN0 and cM0), who were treated with image-guided intensity modulated radiotherapy (IMRT) +/- androgen deprivation therapy with a median follow-up period of 81.4 months (range: 42.0 - 149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI-GTV was delineated retrospectively based on a pre-treatment multi-parametric MR imaging (mpMRI), which was co-registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality. Furthermore, we also fitted the clinical data to TCP model for the two considered targets for the 5-year follow-up after radiation treatment, where our cohort was composed of a total number of 108 patients, of which 19 were biochemical relapse (BR) patients. Results: For the median follow-up period of 81.4 months (range: 42.0 - 149.0) months, our results indicated an appropriate α/β = 1.3 Gy for prostate gland and α/β = 2.9 Gy for mpMRI-GTV. Only for prostate gland, EQD2 and gEUD2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear-quadratic Poisson TCP model for prostate gland and α/β = 1.3 Gy were D50 = 66.8 Gy with 95%CI [64.6 Gy, 69.0 Gy], and γ = 3.81 with 95%CI [2.58, 5.20]. For mpMRI-GTV and α/β = 2.9 Gy, D50 was 68.1 Gy with 95%CI [66.1 Gy, 70.0 Gy], and γ = 4.45 with 95%CI [3.00, 6.12]. The fitness of the model was better for prostate gland. For the multivariate logistic model, the gEUD2Gy for prostate gland showed a very high significant predictive value (p = 0.001), whereas regarding mpMRI-GTV only its volume showed a significance (p = 0.01). Finally, for the 5-year follow-up after the radiation treatment, our results for the prostate gland were: D50=64.6Gy [61.6Gy, 67.4Gy], γ=3.08 [2.03, 4.35], α/β=2.2Gy (95%CI was undefined). For the mpMRI-GTV, the optimizer was unable to deliver any reasonable results for the expected clinical D50 and α/β. The results for the mpMRI-GTV were: D50=50.1Gy [44.6Gy, 56.0Gy], γ=0.84 [0.53, 1.21], α/β=0.0Gy (95%CI was undefined). Conclusion: The linear-quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI-GTV. This is compatible with the results of the comparison of the dose distributions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD 2Gy . Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences.

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“…In the techniques of stereotactic radiosurgery [1] it is planned to give high dose fractionation, which increases the likelihood of a local cure. However, the higher dose fractionation causes more "load" to critical organs [2]. To minimize the increase of the dose in critical organs should be used the latest techniques of irradiation.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery of prostate cancer – dose distribution for VMAT and CyberKnife techniques

Ślosarek

Osewski

Grządziel

et al. 2016

Polish Journal of Medical Physics and Engineering

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New capabilities of biomedical accelerators allow for very precise depositing of the radiation dose and imaging verification during the therapy. In addition, computer algorithms calculating dose distributions are taking into account the increasing number of physical effects. Therefore, administration of high dose fractionation, which is consistent with radiobiology used in oncology, becomes safer and safer. Stereotactic radiosurgery (SRS), which is very precise irradiation with high dose fractionation is increasingly widespread use in radiotherapy of prostate cancer. For this purpose different biomedical accelerators are used. The aim of this study is to compare dose distributions for two techniques: VMAT and CyberKnife. Statistical analysis was performed for the two groups of patients treated by VMAT technique (25 patients), and CyberKnife technique (15 patients). The analysis shows that the dose distributions are comparable, both in the treated area (prostate) and in the critical organs (rectum, urinary bladder, femoral heads). The results show that stereotactic radiosurgery of prostate cancer can be carried out on CyberKnife accelerator as well as on the classical accelerator with the use of VMAT technique.

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Radiobiological comparison of two radiotherapy treatment techniques for high-risk prostate cancer

Abstract: A comparison between two radiotherapy techniques is presented. The SIBIMRT technique reduces EQD2 and NTCP for α/β oar from 2 to 8 Gy.

Cited by 10 publications

References 24 publications

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial

Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition

Stereotactic radiosurgery of prostate cancer – dose distribution for VMAT and CyberKnife techniques

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