Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

Shelan, Mohamed; Abo-Madyan, Yasser; Welzel, Grit; Bolenz, Christian; Kosakowski, Julia; Behnam, Nadim; Wenz, Frederik; Lohr, Frank

doi:10.1186/1748-717x-8-276

Cited by 34 publications

(24 citation statements)

References 21 publications

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“…Irradiation of pelvic lymph nodes was performed to a dose of 44 Gy if positive nodes were found at surgery or if lymph node resection was deemed insufficient, and the preoperative risk of lymph node involvement was >15% based on the Roach-Formula. Detailed results of the radiotherapy regimens applied have been reported elsewhere (18). Further patient characteristics are detailed in Table I.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, modern series indicated early salvage radiotherapy, initiated at the earliest sign of measurable PSA, to be beneficial in terms of biochemical and clinical endpoints (15, 16). Severe toxicity of salvage radiotherapy is generally reported to be low (17) but even in modern series, there is a residual risk of grade 3/4 bowel or urinary toxicity (18). …”

mentioning

confidence: 99%

“…Accurate detection would further reduce geographical miss and most probably enhance therapeutic ratio, by dose escalation to small residual volumes (18) …”

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confidence: 99%

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Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning?

Buergy

Sertdemir²,

Weidner

et al. 2018

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Abstract. Background Prostate carcinoma is the second most common cancer in males (1) and although mortality rates have decreased in European countries and the United States (US), it still accounts for more than 258,000 deaths worldwide (2). According to the USpopulation-based Surveillance, Epidemiology, and End Results Program database, ~80% of men with newly diagnosed prostate carcinoma had localized disease at the time of diagnosis (3). Most of these patients selected radical prostatectomy or external beam radiotherapy as their primary treatment option (4,5). Recurrence rates after radical prostatectomy differ widely between around 10% of patients and more than 30% within 5 years (6-8), depending on Gleason score and other risk factors (6). In patients with positive surgical margins, it can be estimated that 20-40% of tumors recur (9, 10) and the majority of patients with biochemical relapse are diagnosed as having local recurrence (11). Radiotherapy as salvage treatment has been shown to improve biochemical control in patients with residual disease or biochemical relapse (12, 13). Stephenson et al. estimated that biochemical control can be achieved by radiotherapy in 48% of patients when salvage treatment starts before the prostatespecific antigen (PSA) level reaches 0.5 ng/ml; if administered at a PSA level of 0.5 ng/ml and above, only 26% of patients treated were free from (further) relapse (14). These results have been confirmed by modern series which additionally showed a clinical benefit in terms of distant metastasis-free survival, disease-specific mortality, and all-cause mortality (15). Furthermore, modern series indicated early salvage radiotherapy, initiated at the earliest sign of measurable PSA, to be beneficial in terms of biochemical and clinical endpoints (15, 16). Severe toxicity of salvage radiotherapy is generally reported to be low (17) but even in modern series, there is a residual risk of grade 3/4 bowel or urinary toxicity (18). 125This article is freely accessible online. (28,29). In a comparative study (29), radiotherapy plans contoured according to consensus guidelines failed to meet QUANTEC (30), and RADICALS (31) trial dose constraints in 75%, and 40% of cases, respectively. These inconsistencies indicate that our current approaches to salvage treatment of prostate carcinoma after radical prostatectomy should be reassessed. Improvement of therapeutic efficacy could be achieved by reducing geographical miss and side-effects by accurate detection of residual disease.Detection of residual prostate carcinoma is possible by magnetic resonance imaging (MRI) and positron-emission tomography-computed tomography (PET-CT). Evidence on restaging of biochemically relapsed patients with PET-CT was recently reviewed by Umbehr et al. (32). The authors analyzed 12 studies and found a pooled sensitivity and specificity of 85%, and 88%, respectively (mean PSA=7.9 ng/ml). In patients with early relapse (PSA <1 ng/ml), however, the authors found no convincing evidence for the use of PET-CT.MRI with (...

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning?

Buergy

Sertdemir²,

Weidner

et al. 2018

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“…Dose‐escalated external beam radiation therapy (EBRT) (≥ 78 Gy) has replaced the previous standard dose of ~70 Gy as the new “standard of care” for the treatment of prostate cancer 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Dose‐escalated EBRT significantly improves biochemical progression‐free survival in most patients, and also overall survival in patients with intermediate‐ or high‐risk disease 7, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

Chung

Polf

Badiyan

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to evaluate whether a spacer inserted in the prerectal space could reduce modeled rectal dose and toxicity rates for patients with prostate cancer treated in silico with pencil beam scanning (PBS) proton therapy. A total of 20 patients were included in this study who received photon therapy (12 with rectal spacer (DuraSeal™ gel) and 8 without). Two PBS treatment plans were retrospectively created for each patient using the following beam arrangements: (1) lateral‐opposed (LAT) fields and (2) left and right anterior oblique (LAO/RAO) fields. Dose volume histograms (DVH) were generated for the prostate, rectum, bladder, and right and left femoral heads. The normal tissue complication probability (NTCP) for ≥grade 2 rectal toxicity was calculated using the Lyman–Kutcher–Burman model and compared between patients with and without the rectal spacer. A significantly lower mean rectal DVH was achieved in patients with rectal spacer compared to those without. For LAT plans, the mean rectal V70 with and without rectal spacer was 4.19 and 13.5%, respectively. For LAO/RAO plans, the mean rectal V70 with and without rectal spacer was 5.07 and 13.5%, respectively. No significant differences were found in any rectal dosimetric parameters between the LAT and the LAO/RAO plans generated with the rectal spacers. We found that ≥ 9 mm space resulted in a significant decrease in NTCP modeled for ≥grade 2 rectal toxicity. Rectal spacers can significantly decrease modeled rectal dose and predicted ≥grade 2 rectal toxicity in prostate cancer patients treated in silico with PBS. A minimum of 9 mm separation between the prostate and anterior rectal wall yields the largest benefit.

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“…Increasing levels of prostate-specific antigen (PSA) following surgery due to biochemical relapse (BCR) typically precede the development of clinical recurrence. In the setting of BCR without detectable distant metastases, salvage radiotherapy to the prostate bed is an established therapeutic option (1)(2)(3)(4)(5)(6), based on the assumption that all residual cancer cells are located there. Two different immediate results might be observed: success, as indicated by PSA decline (possibly followed by relapse during follow-up), or failure, as indicated by unaffected PSA progression.…”

Section: Introductionmentioning

confidence: 99%

Continuous prostate-specific antigen rise despite salvage radiotherapy following radical prostatectomy: Pattern of clinical relapse and predictive factors

et al. 2015

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Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

Cited by 34 publications

References 21 publications

Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning?

Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning?

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

Continuous prostate-specific antigen rise despite salvage radiotherapy following radical prostatectomy: Pattern of clinical relapse and predictive factors

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