Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer

Bekelman, Justin E.; Lee, William R.

doi:10.1016/j.ijrobp.2016.11.038

Cited by 17 publications

(18 citation statements)

References 13 publications

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“…Moreover, it is plausible that in men with no or minimal comorbidity and a long life expectancy, this could translate to an OS benefit with longer follow-up (95% CI upper bound for OS HR approaches 1 at 1.07). While encouraging, given the cost savings of the HRT approach and resulting patient convenience and potential improved access to care [10,11], the cancer control results must be balanced with the risk for the potential of greater late grade 2 or higher GU toxicity, given that the median follow-up is not long enough to assess whether late GU toxicity may be significantly worse with HRT as compared with CRT. Specifically, the pooled RR for late grade 2 or higher GU toxicity was 1.18 (95% CI, 0.98-1.43; p = 0.08).…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that hypofractionated radiotherapy (HRT), or delivering a larger dose per treatment in fewer total treatments, may be used to improve the therapeutic ratio, delivering a higher biologic dose to the prostate gland while reducing or maintaining the biologic dose to adjacent organs. Moreover, prior investigators have established that additional benefits of HRT include dramatically reduced treatment time, which increase patient convenience and access to treatment, and decrease cost [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Conventional Versus Hypofractionated Radiation Therapy for Localized Prostate Cancer: A Meta-analysis of Randomized Noninferiority Trials

Royce

Lee

Keum

et al. 2019

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conventional Versus Hypofractionated Radiation Therapy for Localized Prostate Cancer: A Meta-analysis of Randomized Noninferiority Trials

Royce

Lee

Keum

et al. 2019

European Urology Focus

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“…Bekelman and Lee noted that ‘the benefits of moderate hypofractionation for patients and for practice efficiency outweigh the short‐term lower revenues per patient associated with reduced fractions delivered. As moderate hypofractionation diffuses into clinical practice, payers ought to share savings with providers to incentivize its use and compensate providers for better clinical care’ . Uptake of hypofractionation within the breast cancer radiation community has been steadily increasing, but by no means universal, since the publication of the 10‐year results of the OCOG hypofractionated breast radiotherapy trial in 2010 .…”

Section: Potential Barriers To Implementationmentioning

confidence: 99%

Moderate hypofractionation for prostate cancer: A user's guide

et al. 2018

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Three large randomised controlled trials have been published in the last year demonstrating the non-inferiority of moderate hypofractionation compared to conventional fractionation for localised prostate cancer with respect to both disease control and late toxicity at 5 years. Furthermore, no clinically significant differences in patient-reported outcomes have emerged. More mature follow-up data are now also available from phase 2 studies confirming that moderate hypofractionation is associated with low rates of significant toxicity at 10 years. Moving forward it is likely that appropriate patient selection, integration of androgen deprivation and attention to optimising technique will play a more important role than modest differences in dose-fractionation schedules. Here we briefly review the evidence, discuss issues of patient selection and provide an approach to implementing moderately hypofractionated radiation therapy for prostate cancer in clinical practice.

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“…Over the last few decades, radiotherapy has become increasingly conformal through improvements in treatment planning and the introduction of new delivery techniques. This accurate dose delivery has led to a growth in research into how to further protect healthy tissues, including the use of hypofractionated treatments (1,2) and high dose rate FLASH radiotherapy treatments (3)(4)(5). However, research is also discovering ways to enable greater tumour radiosensitisation through drug radiotherapy combination approaches (6), including the use of metal-based nanoparticles (7).…”

Section: Introductionmentioning

confidence: 99%

Impact of Superparamagnetic Iron Oxide Nanoparticles on In Vitro and In Vivo Radiosensitisation of Cancer Cells

Russell

Dunne

Russell

et al. 2020

Preprint

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Purpose The recent implementation of MR-Linacs has highlighted theranostic opportunities of contrast agents in both imaging and radiotherapy. There is a lack of data exploring the potential of superparamagnetic iron oxide nanoparticles (SPIONs) as radiosensitisers. This study aimed to characterise the uptake and radiobiological effects of SPIONs in tumour cell models in vitro and to provide proof-of-principle application in a xenograft tumour model. Methods SPION uptake was measured using ICP-MS in 6 cancer cell lines; H460, MiaPaCa2, DU145, MCF7, U87 and HEPG2. The impact of SPIONs on radiobiological response was determined by measuring DNA damage using 53BP1 immunofluorescence and cell survival. Measured dose enhancement factors (DEFs) were with the predicted DEFs based on physical absorption estimations. In vivo efficacy was demonstrated using a subcutaneous H460 xenograft tumour model in SCID mice by following intra-tumoural injection of SPIONs. Results SPIONs significantly increased DNA damage in all cell lines with the exception of U87 cells at a dose of 1 Gy, 1 hr post-irradiation. Levels of DNA damage correlated with the cell survival, in which all cell lines except U87 cells showed an increased sensitivity (P < 0.05) in the linear quadratic curve fit for 1 hr exposure to 0.1 mM SPIONs. There was also a 30.1 % increase in the number of DNA damage foci found for HEPG2 cells at 2 Gy. No strong correlation was found between SPION uptake and DNA damage at any dose, yet the biological consequences of SPIONs on radiosensitisation were found to be much greater, with DEFs up to 1.28 ± 0.03, compared with predicted physical dose enhancement levels of 1.0001. In vivo , intra-tumoural injection of SPIONs combined with radiation showed significant tumour growth delay compared to animals treated with radiation or SPIONs alone (p < 0.05). Conclusions SPIONs showed radiosensitising effects in 5 out of 6 cancer cell lines. No correlation was found between the cell-specific uptake of SPIONs into the cells and DNA damage levels. The in vivo study found a significant decrease in the tumour growth rate.

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Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer

Cited by 17 publications

References 13 publications

Conventional Versus Hypofractionated Radiation Therapy for Localized Prostate Cancer: A Meta-analysis of Randomized Noninferiority Trials

Conventional Versus Hypofractionated Radiation Therapy for Localized Prostate Cancer: A Meta-analysis of Randomized Noninferiority Trials

Moderate hypofractionation for prostate cancer: A user's guide

Impact of Superparamagnetic Iron Oxide Nanoparticles on In Vitro and In Vivo Radiosensitisation of Cancer Cells

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