Stereotactic body radiation therapy for low and intermediate risk prostate cancer—Results from a multi-institutional clinical trial

Hannan, Raquibul; Tumati, Vasu; Xie, Xian Jin; Cho, L. Chinsoo; Kavanagh, Brian D.; Brindle, Jeffrey; Raben, David; Nanda, Akash; Cooley, Susan; Kim, D. W Nathan; Pistenmaa, David; Lotan, Yair; Timmerman, Robert

doi:10.1016/j.ejca.2016.02.014

Cited by 135 publications

(90 citation statements)

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“…Outcome data from eight SBRT studies of patients with early-stage prostate cancer with a combined patient cohort of n=2007 were included (17)(18)(19)(20)(21)(22)(23)(24). This included 1,281 low-risk, 622 intermediate-risk and 104 highrisk patients.…”

Section: Resultsmentioning

confidence: 99%

“…This included 1,281 low-risk, 622 intermediate-risk and 104 highrisk patients. Rates of bPFS reported ranged from 77.1% to 100% (17)(18)(19)(20)(21)(22)(23)(24), at endpoints ranging 2-7 years post treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Rates of grade1 GU toxicity reported in SBRT studies (n=1048) ranged from 13.3 to 71% (17,(19)(20)(21)(22)(23)25), grade 2 from 12 to 25% and grade 3 from 0 to 4%. No grade 4 or higher acute GU toxicities were reported.…”

Section: Resultsmentioning

confidence: 99%

“…Aim: Stereotactic body radiation therapy (SBRT)is [12][13][14][15][16][17][18][19][20][21][22][23][24][25] respectively,, respectively, in the CF-EBRT cohort. Incidence of acute grade 1, 2, and 3 gastrointestinal toxicities were reported in the range of respectively, of the SBRT cohort compared to 16…”

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confidence: 99%

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Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

Linney

Barrett

2018

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

Linney

Barrett

2018

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“…Еще более высокие результаты биохимического контроля опухоли (100% в течение 3 лет и 98,5% в течение 5 лет) были до-стигнуты путем ступенчатой эскалации до СОД 50 Гр за 5 сеансов в исследовании первой-второй фазы [10,11]. К сожалению, при эскалации дозы до максимального уровня у значительной части пациентов в этом исследо-вании развились тяжелые поздние лучевые повреждения прямой кишки и мочеполовой системы, связанные с пре-вышением толерантных доз на органы риска [12].…”

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Methodological aspects of extreme hypofractionated external beam radiotherapy for prostate cancer with target volume immobilization by an endorectal balloon

Roytberg¹,

Usychkin²,

Boiko³

2016

Onkol. Z. im. P.A. Gercena

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1 клиника оАо «медицина», москва, россия; 2 московский научно-исследовательский онкологический институт им. П.А. Герцена -филиал ФГБу «национальный медицинский исследовательский радиологический центр» минздрава россии, москва, россия Цель -изучить методические особенности эффективности иммобилизации мишени облучения эндоректальным балло-ном при крупнофракционной дистанционной лучевой терапии (кФДЛт) рака предстательной железы. Материал и мето-ды. Лечение по методике кФДЛт получили 15 пациентов с локализованным раком предстательной железы. Суммарная очаговая доза (СоД) составила 40 Гр за 5 сеансов при ежедневном облучении в разовой очаговой дозе (роД) 8 Гр. Перед разметкой и каждым сеансом лечения в прямую кишку вводили специальный эндоректальный баллон для иммобилизации предстательной железы, а также мочевой катетер Фолея для визуализации уретры и введения контраста в мочевой пузырь. Лечение проводили по методике арк-терапии с объемной модуляцией интенсивности излучения (VmAT) и использованием режима облучения без сглаживающего фильтра (FFF mode). Визуальный контроль и коррекцию положения мишени во время лечения (IGRT) проводили по компьютерной томографии в конусном пучке на столе линейного ускорителя (CBCT) и по имплантированным в предстательную железу четырем рентгеноконтрастным меткам, видимым на ортогональных ки-ловольтных снимках (kV Image Pair). Величину отклонения меток за время сеанса облучения от их референсного положе-ния анализировали ретроспективно. Полученные данные были использованы для вычисления отступов для планируемого объема мишени облучения (отступ CTV-PTV). Результаты. Средняя величина отклонения меток в предстательной железе, иммобилизированной эндоректальным баллоном, за интервалы времени между получением снимков составила от 0,1±0,4 до 0,59±0,51 мм. При этом в 100, 97 и 99% измерений величина отклонения меток не превышала 2 мм для вертикальной, краниокаудальной и латеральной осей соответственно. отступы CTV-PTV, вычисленные по данным величины отклонения рентгеноконтрастных меток за время сеанса облучения между получением снимков, составили от 1,27 до 1,89 мм. Выво-ды. Эндоректальный баллон эффективно иммобилизирует предстательную железу во время сеанса лечения по методике кФДЛт, что в сочетании с коротким временем подведения дозы за счет технологии VmAT с режимом FFF позволяет уменьшить отступы CTV-PTV до 2 мм. Objective -to study the methodological features of the efficiency of target volume immobilization with an endorectal balloon during extremely hypofractionated image-guided radiotherapy (IGRT) for prostate cancer. Material and methods. Fifteen patients with localized prostate cancer were treated with an extremely hypofractionated IGRT using 40 Gy in 5 sessions of daily radiation in a single focal dose (sFD) of 8 Gy. A special transrectal Pro-Tekt balloon was used to immobilize the prostate during CT/mRsimulation and treatment sessions. Image-guidance and correction of the target position during treatment (IGRT) were done by cone beam computed tomography on the linear accelerator (CB...

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Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer

et al. 2021

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IMPORTANCE Ultra-high single-dose radiotherapy (SDRT) represents a potential alternative to curative extreme hypofractionated stereotactic body radiotherapy (SBRT) in organ-confined prostate cancer.OBJECTIVE To compare toxic effect profiles, prostate-specific antigen (PSA) responses, and quality-of-life end points of SDRT vs extreme hypofractionated SBRT. DESIGN, SETTING, AND PARTICIPANTSThe PROSINT single-institution phase 2 randomized clinical trial accrued, between September 2015 and January 2017, 30 participants with intermediate-risk prostate cancer to receive SDRT or extreme hypofractionated SBRT. Androgen deprivation therapy was not permitted. Data were analyzed from March to May 2020.INTERVENTIONS Patients were randomized in a 1:1 ratio to receive 5 × 9 Gy SBRT (control arm) or 24 Gy SDRT (test arm). MAIN OUTCOMES AND MEASURESThe primary end point was toxic effects; the secondary end points were PSA response, PSA relapse-free survival, and patient-reported quality of life measured with the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaires.RESULTS A total of 30 men were randomized; median (interquartile range) age was 66.3 (61.2-69.9) and 73.6 (64.7-75.9) years for the SBRT and SDRT arms, respectively. Time to appearance and duration of acute and late toxic effects were similar in the 2 trial arms. Cumulative late actuarial urinary toxic effects did not differ for grade 1 (hazard ratio [HR], 0.41; 90% CI, 0.13-1.27) and grade 2 or greater (HR, 1.07; 90% CI, 0.21-5.57). Actuarial grade 1 late gastrointestinal (GI) toxic effects were comparable (HR, 0.37; 90% CI, 0.07-1.94) and there were no grade 2 or greater late GI toxic effects. Declines in PSA level to less than 0.5 ng/mL occurred by 36 months in both study arms. No PSA relapses occurred in favorable intermediate-risk disease, while in the unfavorable category, the actuarial 4-year PSA relapse-free survival values were 75.0% vs 64.0% (HR, 0.76; 90% CI, 0.17-3.31) for SBRT vs SDRT, respectively. The EPIC-26 median summary scores for the genitourinary and GI domains dropped transiently at 1 month and returned to pretreatment scores by 3 months in both arms. The IPSS-derived transient late urinary flare symptoms occurred at 9 to 18 months in 20% (90% CI, 3%-37%) of patients receiving SDRT. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial among patients with intermediate-risk prostate cancer, SDRT was safe and associated with low toxicity, and the tumor control and quality-of-life end points closely match the SBRT arm outcomes. Further studies are encouraged to explore indications for SDRT in the cure of prostate cancer.

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Stereotactic body radiation therapy for low and intermediate risk prostate cancer—Results from a multi-institutional clinical trial

Abstract: SBRT treatment results in excellent biochemical control rates at 5 years for LR and IR PCa patients although doses greater than 47.5 Gy in five fractions led to increased severe late toxicity.

Cited by 135 publications

References 39 publications

Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

Methodological aspects of extreme hypofractionated external beam radiotherapy for prostate cancer with target volume immobilization by an endorectal balloon

Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer

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