Randomized Trial Comparing Iridium Implant Plus External-Beam Radiation Therapy With External-Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate

Sathya, Jinka; Davis, Ian; Julian, Jim A.; Guo, Qing; Daya, Dean; Dayes, Ian S.; Lukka, Himu; Levine, Mark

doi:10.1200/jco.2005.06.154

Cited by 380 publications

(201 citation statements)

References 20 publications

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“…Increasingly, conformal radiation delivery techniques have safely escalated the dose to the prostate by either increasing the number of daily fractions [1][2][3] or adding a boost [4][5][6][7]. These approaches increase the delivered bioequivalent dose (BED), and consequently the biochemical control rate, but are associated with additional treatment time or, in the case of a brachytherapy boost, an invasive procedure.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

Anwar

Weinberg

Chang

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Background: Patients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcomes. The purpose of this study was to compare the PSA kinetics between CF-EBRT and SBRT in newly diagnosed localized prostate cancer. Materials/methods: 75 patients with low to low-intermediate risk prostate cancer (T1-T2; GS 3 + 3, PSA < 20 or 3 + 4, PSA < 15) treated without hormones with CF-EBRT (>70.2 Gy, <76 Gy) to the prostate only, were identified from a prospectively collected cohort of patients treated at the University of California, San Francisco (1997. Patients were excluded if they failed therapy by the Phoenix definition or had less than 1 year of follow-up or <3 PSAs. 43 patients who were treated with SBRT to the prostate to 38 Gy in 4 daily fractions also met the same criteria. PSA nadir and rate of change in PSA over time (slope) were calculated from the completion of RT to 1, 2 and 3 years post-RT.

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Section: Introductionmentioning

confidence: 99%

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

Anwar

Weinberg

Chang

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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“…Recent prospective randomized trials have demonstrated that low RT doses (≤ 70 Gy) are inadequate for the curative treatment of clinically localized prostate cancer [34][35][36][37]. Moreover, higher doses (≥ 76 Gy) are associated with extended survival rate and reduced distant metastasis as well as improvement in both biochemical and clinical local control for prostate cancer [21,38].…”

Section: Discussionmentioning

confidence: 99%

On the impact of functional imaging accuracy on selective boosting IMRT

Kim

2009

Physica Medica

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In order to quantify the impact of loss of functional imaging sensitivity and specificity on tumor control and normal tissue toxicity for selective boosting IMRT four selective boosting scenarios were designed: SB91-81 (EUD=91Gy for the high risk tumor subvolume and EUD=81Gy for a remaining low risk PTV (rPTV)), SB80-74, SB90-70, and risk-adaptive optimization. For each sensitivity loss level the loss in tumor control probability (ΔTCP) was calculated. For each specificity loss level, the increase in rectal and the bladder toxicity was quantified using the radiobiological indices (equivalent uniform dose (EUD) and normal tissue complication probability (NTCP)) and %-volumes irradiated.The impact of loss in sensitivity on local tumor control was maximal when the prescription dose level for rPTV had the lowest value. The SB90-70 plan had a ΔTCP= 29.6%, the SB91-81 plan had a ΔTCP = 9.5%, while for risk-adaptive optimization a ΔTCP= 4.7% was found. Independent of planning technique loss in functional imaging specificity appears to have a minimal impact on the expected normal tissue toxicity, since an increase in rectal or bladder toxicity as a function of loss in specificity was not observed. Additionally, all plans fulfilled the rectum and the bladder sparing criteria found in the literature for late rectal bleeding and genitourinary complications.Our study shows that the choice of a low-risk classification for the rPTV in selective boosting IMRT may lead to a significant loss in TCP. Furthermore, for the example considered in which normal tissue complications can be limited through the use of a tissue expander it appears that the therapeutic ratio can be improved using a functional imaging technique with a high sensitivity and limited specificity. While for cases were this is not possible an optimal balance between sensitivity and specificity has to be found.

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“…[9][10][11][12] Studies have shown a reduced risk of recurrence with the addition of brachytherapy to EBRT. [13][14][15] An analysis of a cohort of 12,745 highrisk patients found that treatment with brachytherapy (hazard ratio [HR], 0.66; 95% CI, 0.49-0.86) or brachytherapy plus EBRT (HR, 0.77; 95% CI, 0.66-0.90) lowered disease-specific mortality compared with EBRT alone. 16 The addition of ADT to brachytherapy and EBRT is common for patients at high recurrence risk.…”

Section: Pros-9mentioning

confidence: 99%

Prostate Cancer, Version 3.2012 Featured Updates to the NCCN Guidelines

Mohler¹,

Armstrong²,

Bahnson³

et al. 2012

J Natl Compr Canc Netw

228

179

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Randomized Trial Comparing Iridium Implant Plus External-Beam Radiation Therapy With External-Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate

Abstract: The combination of IM plus EBRT was superior to EBRT alone for BCF and postradiation biopsy. This trial provides evidence that higher doses of radiation delivered in a shorter duration result in better local as well as biochemical control in locally advanced prostrate cancer.

Cited by 380 publications

References 20 publications

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

On the impact of functional imaging accuracy on selective boosting IMRT

Prostate Cancer, Version 3.2012 Featured Updates to the NCCN Guidelines

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