Image guided dose escalated prostate radiotherapy: still room to improve

Martin, Jarad; Bayley, Andrew; Bristow, Robert G.; Chung, Peter; Gospodarowicz, Mary K.; Ménard, Cynthia; Milosevic, Michael; Rosewall, Tara; Warde, Padraig; Catton, Charles

doi:10.1186/1748-717x-4-50

Cited by 62 publications

(54 citation statements)

References 38 publications

(40 reference statements)

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“…Therefore, although there is no doubt that HF offers major potential advantages to patients and to the economy of health systems, their development should not be at the expense of a lower likelihood of tumour control as well as of an unacceptable late toxicity. Published data shows that HF protocols seem not to be associated with an unacceptable late toxicity as documented by our [12] and other groups [7][8][9][10][11][13][14][15]. The analysis carried out in the present study provides some clinical evidence to further justify trends already emerging toward HF conformal technology in clinically localized prostate cancer.…”

Section: Discussionsupporting

confidence: 49%

“…However, at the present the main concern is the uncertainty about normal tissue toxicity of such HF protocols. Although clinical reports [7][8][9][10][11][12][13][14][15] have found acceptable levels of morbidity and reasonable PSA control rates using doses of 2.5-3 Gy, clinical data are sparse and, although promising, require further validation. If the hypothesis that the prostate cancer α / β ratio is lower than normal tissue is correct, then the optimal fractional dose is likely to be even higher than the doses tested thus far, but if incorrect, the result may be increased normal tissue toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer

et al. 2010

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OBJECTIVE To test the hypothesis that three-dimensional hypofractionated radiotherapy (3D-HFRT) is well tolerated and not worse than 3-D conventional RT (3D-CRT) for oncological outcome. PATIENTS AND METHODS In all, 162 men with hystologically confirmed prostate adenocarcinoma were included in the analysis. In all, 82 men were treated with 3D-HFRT (15 fractions of 3.62 Gy delivered 3 times/week; a total dose of 54.3 Gy). This group was retrospectively compared with 80 men who met the same inclusion criteria and who were treated with 3D-CRT (39 fractions of 2 Gy delivered daily; a total dose of 78 Gy). A short course of hormone therapy was administered concomitantly with the RT. RESULTS Only one (1.7%) patient in the 3D-CRT group and two (4.0%) in the 3D-HFRT group had Grade 3 genitourinary toxicity. There was late gastrointestinal morbidity of >= grade 3 in only 5.1% of men treated with 3D-HFRT and in 4.0% of men treated with 3D-CRT. In both groups there was no Grade 4 toxicity. At the median (range) follow-up of 45 (39.4-51) months for the 3D-HFRT group and 57.5 (54.9-59.1) months for 3D-CRT group the progression rate was 18/82 (21.9%) and 20/80 (25.0%), respectively, with no significant worsening in the risk of biochemical failure (BCF; log-rank test, P = 0.222). CONCLUSIONS In the present study, men with clinically localized prostate cancer had similar levels of morbidity irrespective of whether they received HFRT or CRT without any worsening in the early risk of BCF. Thus, the present data provide some clinical evidence to justify trends already emerging toward HF regimens for treating clinically localised prostate cancer

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer

et al. 2010

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“…16,17,29,30 Zelefsky et al compared the toxicity and outcomes of high-dose (86.4 Gy) radiotherapy delivered by IGRT with GM implantation versus non-IGRT. 17 The incidence of grade !2 GU toxicity was significantly lower in the IGRT group than in the non-IGRT group (10.4% vs 20%), and multivariate analysis showed that IGRT was associated with a decreased incidence of late GU toxicity.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic outcomes of neoadjuvant and concurrent androgen‐deprivation therapy and intensity‐modulated radiation therapy with gold marker implantation for intermediate‐risk and high‐risk prostate cancer

et al. 2015

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The 5-year distant metastasis-free survival rate was significantly lower for very high-risk patients than for intermediate-and high-risk patients (82.6% vs 99.4% and 96.5%, respectively; P < 0.01). The 5-year biochemical relapse-free survival rates significantly declined with increasing prostate cancer risk (P < 0.01), and were 95.9%, 87.2%, and 73.1% for the intermediate-risk, high-risk and very high-risk patients, respectively. Acute genitourinary and gastrointestinal toxicity grade !3 were not observed in any of the patients. Late grade 3 genitourinary toxicity occurred in 0.3% of patients. Conclusion: Combination androgen-deprivation therapy and 76-Gy intensity-modulated radiation therapy with gold marker implantation offers good therapeutic outcomes with few serious complications in patients with intermediate-and high-risk prostate cancer.

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“…These toxicities are similar to those reported with modern dose-escalated image-guided intensity modulated radiotherapy (IGRT) according to the Princess Margaret Hospital (PMH) experience. 25 Seventy patients have had a 3-year biopsy and 97% were negative. This is better than the PMH experience, where 46% of patients had positive biopsies.…”

Section: The Alternative To Brachytherapymentioning

confidence: 99%

Be it resolved that in the modern era, the best method for dose escalation is brachytherapy: The con position

Loblaw¹

2012

CUAJ

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Image guided dose escalated prostate radiotherapy: still room to improve

Cited by 62 publications

References 38 publications

Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer

Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer

Therapeutic outcomes of neoadjuvant and concurrent androgen‐deprivation therapy and intensity‐modulated radiation therapy with gold marker implantation for intermediate‐risk and high‐risk prostate cancer

Be it resolved that in the modern era, the best method for dose escalation is brachytherapy: The con position

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