Dose Escalation to the Dominant Intraprostatic Lesion Defined by Sextant Biopsy in a Permanent Prostate I-125 Implant: A Prospective Comparative Toxicity Analysis

Gaudet, Marc; Vigneault, Éric; Aubin, Sylviane; Varfalvy, Nicolas; Harel, François; Beaulieu, Luc; Martin, André-Guy

doi:10.1016/j.ijrobp.2009.04.049

Cited by 30 publications

(15 citation statements)

References 29 publications

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“…Gaudet et al . [ 17 ] selectively delivered a brachytherapy hyperdosage of ≥ 216 Gy (150% of the prescribed dose) to the macroscopic tumor, defined according to positive areas on sextant biopsy, in 70 patients with localized prostate cancer treated with permanent seed prostate implant. No difference in acute or late toxicities compared to 120 patients with a standard plan were seen.…”

Section: Discussionmentioning

confidence: 99%

Single blind randomized Phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial

Lips

Heide

Haustermans³

et al. 2011

Trials

159

130

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BackgroundThe treatment results of external beam radiotherapy for intermediate and high risk prostate cancer patients are insufficient with five-year biochemical relapse rates of approximately 35%. Several randomized trials have shown that dose escalation to the entire prostate improves biochemical disease free survival. However, further dose escalation to the whole gland is limited due to an unacceptable high risk of acute and late toxicity. Moreover, local recurrences often originate at the location of the macroscopic tumor, so boosting the radiation dose at the macroscopic tumor within the prostate might increase local control. A reduction of distant metastases and improved survival can be expected by reducing local failure. The aim of this study is to investigate the benefit of an ablative microboost to the macroscopic tumor within the prostate in patients treated with external beam radiotherapy for prostate cancer.Methods/DesignThe FLAME-trial (Focal Lesion Ablative Microboost in prostatE cancer) is a single blind randomized controlled phase III trial. We aim to include 566 patients (283 per treatment arm) with intermediate or high risk adenocarcinoma of the prostate who are scheduled for external beam radiotherapy using fiducial markers for position verification. With this number of patients, the expected increase in five-year freedom from biochemical failure rate of 10% can be detected with a power of 80%. Patients allocated to the standard arm receive a dose of 77 Gy in 35 fractions to the entire prostate and patients in the experimental arm receive 77 Gy to the entire prostate and an additional integrated microboost to the macroscopic tumor of 95 Gy in 35 fractions. The secondary outcome measures include treatment-related toxicity, quality of life and disease-specific survival. Furthermore, by localizing the recurrent tumors within the prostate during follow-up and correlating this with the delivered dose, we can obtain accurate dose-effect information for both the macroscopic tumor and subclinical disease in prostate cancer. The rationale, study design and the first 50 patients included are described.Trial registrationThis study is registered at ClinicalTrials.gov: NCT01168479

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Section: Discussionmentioning

confidence: 99%

Single blind randomized Phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial

Lips

Heide

Haustermans³

et al. 2011

Trials

159

130

View full text Add to dashboard Cite

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“…(8). 36,37 The effect of hypoxia in RT is considerable. 38 Published clinical data expresses the presence of very low values of partial pressure of oxygen (PO2) throughout the diseased portion of the prostate gland in some patients, whereas other diseased glands are well oxygenated.…”

Section: Iid Rationale For the Choice Of Fixed Parameter Valuesmentioning

confidence: 99%

A TCP model for external beam treatment of intermediate‐risk prostate cancer

Walsh

Putten

2013

Medical Physics

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“…The 50 patients treated with dose escalation had a median intraprostatic lesion V 150 of 95.7% intraoperatively and a median urethra D 5 of 167.1% of the prescription dose on a Day 30 postimplant CT scan. The authors found no differences in acute or late toxicities between this dose-escalated group and a reference group treated without dose escalation within a 36-month followup period (28). Crook et al more recently reported on the dosimetry of multiparametric MRI-guided DIL dose escalation using HDR brachytherapy in a series of 26 patients.…”

Section: Discussionmentioning

confidence: 83%

Long-term outcome of magnetic resonance spectroscopic image–directed dose escalation for prostate brachytherapy

et al. 2016

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PURPOSE To report the long-term control and toxicity outcomes of patients with clinically localized prostate cancer, who underwent low-dose-rate prostate brachytherapy with magnetic resonance spectroscopic image (MRSI)–directed dose escalation to intraprostatic regions. METHODS AND MATERIALS Forty-seven consecutive patients between May 2000 and December 2003 were analyzed retrospectively. Each patient underwent a preprocedural MRSI, and MRS-positive voxels suspicious for malignancy were identified. Intraoperative planning was used to determine the optimal seed distribution to deliver a standard prescription dose to the entire prostate, while escalating the dose to MRS-positive voxels to 150% of prescription. Each patient underwent transperineal implantation of radioactive seeds followed by same-day CT for postimplant dosimetry. RESULTS The median prostate D90 (minimum dose received by 90% of the prostate) was 125.7% (interquartile range [IQR], 110.3–136.5%) of prescription. The median value for the MRS-positive mean dose was 229.9% (IQR, 200.0–251.9%). Median urethra D30 and rectal D30 values were 142.2% (137.5–168.2%) and 56.1% (40.1–63.4%), respectively. Median followup was 86.4 months (IQR, 49.8–117.6). The 10-year actuarial prostate-specific antigen relapse–free survival was 98% (95% confidence interval, 93–100%). Five patients (11%) experienced late Grade 3 urinary toxicity (e.g., urethral stricture), which improved after operative intervention. Four of these patients had dose-escalated voxels less than 1.0 cm from the urethra. CONCLUSIONS Low-dose-rate brachytherapy with MRSI-directed dose escalation to suspicious intraprostatic regions exhibits excellent long-term biochemical control. Patients with dose-escalated voxels close to the urethra were at higher risk of late urinary stricture.

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Dose Escalation to the Dominant Intraprostatic Lesion Defined by Sextant Biopsy in a Permanent Prostate I-125 Implant: A Prospective Comparative Toxicity Analysis

Cited by 30 publications

References 29 publications

Single blind randomized Phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial

Single blind randomized Phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial

A TCP model for external beam treatment of intermediate‐risk prostate cancer

Long-term outcome of magnetic resonance spectroscopic image–directed dose escalation for prostate brachytherapy

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