ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

Rodda, S.; Tyldesley, Scott; Morris, William; Keyes, Mira; Halperin, Ross; Pai, Howard; McKenzie, Michael; Duncan, Graeme; Morton, Gerard; Hamm, Jeremy; Murray, Nevin

doi:10.1016/j.ijrobp.2017.01.008

Cited by 256 publications

(156 citation statements)

References 29 publications

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“…It is interesting that there was only little correlation between urethral stricture and dose to the prostate in the ASCENDE-RT [12]. Similarly, in our meta-regression analysis, the BED did not show an association with urethral stricture development.…”

Section: Discussioncontrasting

confidence: 45%

“…This study also found the highest incidence of urinary adverse events among RTs with EBRT + BT [11]. Furthermore, despite having an improved biochemical recurrence-free survival (b-RFS) by combining BT with EBRT [12], several studies also demonstrate an increased risk of developing urethral strictures or urinary toxicity compared to other treatment modalities [10][11][12][13][14]. Interestingly in our analysis, 23 studies used HDR-BT, and 18 out of these studies used HDR-BT as a boost with EBRT.…”

Section: Discussionmentioning

confidence: 56%

“…The latest report by the American Brachytherapy Society Task Group have demonstrated that combined modality RT have superior biochemical control in high-risk PCa than dose-escalated EBRT [18]. The report cited three randomized trials, one of which was the large ASCENDE-RT that found that combined EBRT with LDR-BT is twice as likely to be associated with b-RFS than dose-escalated EBRT alone [12]. However, this trial also showed no statistically significant differences in overall survival between the two groups.…”

Section: Discussionmentioning

confidence: 99%

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Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis

Awad

Gaither

Osterberg

et al. 2018

Prostate Cancer Prostatic Dis

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis

Awad

Gaither

Osterberg

et al. 2018

Prostate Cancer Prostatic Dis

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“…The toxicity of prostate UHRT relative to the combination of EBRT plus brachytherapy or other forms of moderate hypofractionated or conventional fractionated EBRT has been the subject of debate [5,36,37]. Figure 5 shows that late grade 2-5 toxicities in the present study were similar to those from centres using five-fraction UHRT and compare favourably with other radiation therapies.…”

Section: Discussionsupporting

confidence: 50%

“…To set in context the outcomes of the present trial, we gathered the data on BDFS rates and grade 3+ toxicity of several trials [5,7,8,[25][26][27][28][29][30] with a minimum 5-year follow-up ( Fig. 5).…”

Section: Discussionmentioning

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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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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Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

et al. 2019

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Importance Stereotactic body radiotherapy harnesses improvements in technology to allow the completion of a course of external beam radiotherapy treatment for prostate cancer in the span of 4 to 5 treatment sessions. Although mounting short-term data support this approach, long-term outcomes have been sparsely reported. Objective To assess long-term outcomes after stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. Design, Setting, and Participants This cohort study analyzed individual patient data from 2142 men enrolled in 10 single-institution phase 2 trials and 2 multi-institutional phase 2 trials of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer between January 1, 2000, and December 31, 2012. Statistical analysis was performed based on follow-up from January 1, 2013, to May 1, 2018. Main Outcomes and Measures The cumulative incidence of biochemical recurrence was estimated using a competing risk framework. Physician-scored genitourinary and gastrointestinal toxic event outcomes were defined per each individual study, generally by Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. After central review, cumulative incidences of late grade 3 or higher toxic events were estimated using a Kaplan-Meier method. Results A total of 2142 men (mean [SD] age, 67.9 [9.5] years) were eligible for analysis, of whom 1185 (55.3%) had low-risk disease, 692 (32.3%) had favorable intermediate-risk disease, and 265 (12.4%) had unfavorable intermediate-risk disease. The median follow-up period was 6.9 years (interquartile range, 4.9-8.1 years). Seven-year cumulative rates of biochemical recurrence were 4.5% (95% CI, 3.2%-5.8%) for low-risk disease, 8.6% (95% CI, 6.2%-11.0%) for favorable intermediate-risk disease, 14.9% (95% CI, 9.5%-20.2%) for unfavorable intermediate-risk disease, and 10.2% (95% CI, 8.0%-12.5%) for all intermediate-risk disease. The crude incidence of acute grade 3 or higher genitourinary toxic events was 0.60% (n = 13) and of gastrointestinal toxic events was 0.09% (n = 2), and the 7-year cumulative incidence of late grade 3 or higher genitourinary toxic events was 2.4% (95% CI, 1.8%-3.2%) and of late grade 3 or higher gastrointestinal toxic events was 0.4% (95% CI, 0.2%-0.8%). Conclusions and Relevance In this study, stereotactic body radiotherapy for low-risk and intermediate-risk disease was associated with low rates of severe toxic events and high rates of biochemical control. These data suggest that stereotactic body radiotherapy is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.

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ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

Abstract: The incidence of acute and late GU morbidity was higher after LDR-PB boost, and there was a nonsignificant trend for worse GI morbidity. No differences in the frequency of erectile dysfunction were observed.

Cited by 256 publications

References 29 publications

Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis

Prostate cancer radiation and urethral strictures: a systematic review and meta-analysis

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

Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

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