Effects of interruptions of external beam radiation therapy on outcomes in patients with prostate cancer

Lango, Miriam; Zaorsky, Nicholas G.; Li, Tianyu; Churilla, Thomas M.; Viterbo, Rosalia; Sobczak, M.L.; Smaldone, Marc C.; Chen, David Y.T.; Uzzo, Robert G.; Hallman, M.A.; Horwitz, Eric M.

doi:10.1111/1754-9485.12675

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…Dong et al [15] reported outcomes on PCa patients treated with a dose ≥ 74 Gy, excluding those on ADT, and found no differences with outcomes in disease risk group using a 4 fraction threshold to define a lengthy treatment break. D’ambrosio et al [16] identified an increased non-treatment day ratio (NTDR, number of non-treatment days divided by the total elapsed days of RT) as an adverse factor in PCa patients treated with a median dose of 76 Gy, specifically in low-risk patients, but not intermediate, high, or all groups combined.…”

Section: Discussionmentioning

confidence: 99%

“…Although the analyses by Amdur predated the PSA era, they included patients who would currently be staged as T3b. The remaining analyses [12,13,15,17] found no difference in patients with or without TI. In addition, all previous studies used EBRT treatments with photons.…”

Section: Introductionmentioning

confidence: 86%

“…Several retrospective analyses examined the effect of TI in PCa patients treated with definitive EBRT with varying and conflicting results [11] , [12] , [13] , [14] , [15] , [16] , [17] . D’ambrosio et al found TI to be an adverse factor for biochemical failure (BF) in low risk patients, whereas Thames et al found inferior BF rates in low and intermediate risk patients.…”

Section: Introductionmentioning

confidence: 99%

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Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry

Han

Chang²,

Rosen

et al. 2020

Clinical and Translational Radiation Oncology

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Introduction: To date, no studies examining the effect of treatment interruptions (TI) with proton beam therapy (PBT) have been published. The goal of our study was to determine the predictors of TI amongst patients with prostate cancer (PCa) treated with PBT and to determine whether TI are associated with biochemical failure (BF). We hypothesized that any correlation between TI and biochemical control would be more pronounced in high risk groups. Methods: Data for 4278 patients with PCa was obtained from the prospectively collected Proton Collaborative Group (PCG) data registry. Univariate and multivariate logistic regression analysis (MVA) was used to model possible predictors of BF. A subset analysis was performed for high risk patients treated with ADT and PBT. Finally, propensity score (PS) analysis was performed to account for any indication bias caused by lack of randomization. Results: Total treatment duration (OR, 1.05 [1.04-1.06]; p < 0.001) increased the likelihood of TI on MVA. TI did not have a statistically significant correlation with BF (OR, 1.44 [0.86-2.39]; p = 0.162) amongst PS matched patients. However, on subset analyses of high risk group patients with PS matching, there was a trend towards worse BF in patients with TI (OR 3.85; 95%CI (0.96-15.44); p = 0.057). Conclusion: In the first analysis of its kind, the results suggest that TI in high risk PCa patients treated with PBT and ADT have worse BF rates. Interventions such as increased patient education, proper maintenance of proton facilities, and decreasing total treatment duration with alternative fractionation schedules may help avoid the unintended negative effects on tumor control due to TI. However, future analyses on a larger patient population is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry

Han

Chang²,

Rosen

et al. 2020

Clinical and Translational Radiation Oncology

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“…L'impact de l'étalement sur le contrôle du cancer de prostate est très discuté [28]. Certaines études récentes, basées sur des patients traités avec des doses supérieures ou égales à 70 Gy, ne retrouvent aucun effet de la durée totale de traitement sur tous les paramètres considérés (contrôle local, survie sans métastases, survie spécifique, survie globale) [29]. A contrario, dans une étude plus ancienne, Thames et al ont retrouvé un effet délétère de l'étalement, et en particulier, paradoxalement, chez les patients à faible risque [30].…”

Section: Cancer De La Prostateunclassified

Compensation de la dose totale en cas d’interruption temporaire de radiothérapie externe dans le contexte de la pandémie de COVID-19 : mise au point pratique

Azria

Hennequin

Giraud

2020

Cancer/Radiothérapie

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L'étalement est un facteur important de récidive locale et indirectement d'évolution à distance, notamment en cas de durée de traitement allongée. La pandémie actuelle a un impact sur les patients en cours de radiothérapie qui doivent interrompre leur traitement de manière parfois prolongée du fait de la nécessité de soins respiratoires induits par le COVID-19. Les modèles utilisés de compensation de la dose totale en cas d'interruption prolongée de la radiothérapie sont connus, mais il nous a semblé important de synthétiser afin que chaque oncologue radiothérapeute puisse proposer un traitement le plus optimal possible tant en termes de risque de récidive locale que de protection des tissus sains. L'objectif de ce type de recommandation est d'homogénéiser les pratiques de l'ensemble de la discipline. AbstractOverall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it temps, en rapport avec la capacité de la tumeur à se diviser. Une majoration de la dose totale devient alors nécessaire afin de compenser cette repopulation tumorale.En pratique, si une interruption d'une durée « t » est survenue dans l'intervalle de temps initialement prévu de traitement « T », la durée d'allongement du traitement sera exactement de durée « t » mais avec une dose de compensation supérieure à la dose totale initialement prévue, à condition de contrôler la tolérance sur les tissus sains environnants.Cette notion d'« extra-dose » est nécessaire car le traitement est souvent repris dans la période de repopulation avec une iso-TCP50 nécessairement supérieure. Cela est valable si le fractionnement classique est maintenu et que la reprise de la radiothérapie n'inclut pas de séance le week-end et/ou n'utilise pas un hyperfractionnement quotidien.

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“…For instance, a 1991 pooled analysis of Radiation Therapy Oncology Group trials 75-06 and 77-06 found no correlation between treatment time and local control or overall survival in a heterogenous patient population treated to 65 Gy, and similar findings were reported in a more recent study for patients treated to at least 74 Gy. 3,4 Conversely, Amdur et al noted that prolonged treatment times over 8 weeks for prostate cancer treated to 65-70 Gy had inferior local control, as did another analysis by Liauw and colleagues (although no difference was noted above 74 Gy). 5,6 Notably, most of these studies were not conducted with patients treated with dose-escalated radiotherapy and ADT.…”

Section: Introductionmentioning

confidence: 95%

Optimal timing of radiotherapy in high risk prostate cancer: Do missed days matter?

Hasan

Gorovets

Lehrer

et al. 2021

Clinical and Translational Radiation Oncology

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Effects of interruptions of external beam radiation therapy on outcomes in patients with prostate cancer

Abstract: Unintentional treatment breaks during dose escalated external beam radiation therapy for PCa did not cause a significant difference in outcomes, although duration of follow up limits the strength of this conclusion.

Cited by 11 publications

References 30 publications

Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry

Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry

Compensation de la dose totale en cas d’interruption temporaire de radiothérapie externe dans le contexte de la pandémie de COVID-19 : mise au point pratique

Optimal timing of radiotherapy in high risk prostate cancer: Do missed days matter?

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