Interim report of image-guided conformal high-dose-rate brachytherapy for patients with unfavorable prostate cancer: the William Beaumont Phase II dose-escalating trial

Martínez, Álvaro; Kestin, Larry L.; Stromberg, Jannifer S.; Gonzalez, Jose A.; Wallace, Michelle; Gustafson, Gary; Edmundson, Gregory K.; Spencer, W. F.; Vicini, Frank A.

doi:10.1016/s0360-3016(00)00436-3

Cited by 102 publications

(46 citation statements)

References 60 publications

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“…In order to overcome the inherent uncertainties of combining different datasets of LDRBT For details on reported parameters see Table II. and EBRT (different dose distributions and specifications, derivation of data from different institutions yielding potential differences in responses to staging and scoring, and possible differences in RBEs of permanent implants), Brenner et al 13 analyzed outcomes from EBRT treatments plus HDRBT boosts reported by Martinez et al 65 In the HDRBT protocol, treatment was delivered in two or three implants of 192 Ir escalated from 5.5 to 6.5 Gy (three implants) and from 8.25 to 10.5 Gy (two implants). Analysis was performed using standard models of tumor cure based on Poisson statistics combined with the LQ formalism.…”

Section: The Contribution Of Hdrbt Boostsmentioning

confidence: 99%

“…Publications on prostate cancer patients treated with conventional fractionated EBRT combined with hypofractionated IMRT boosts 96 of 2 fractions of 5-8 Gy (median follow-up of 63 months) or with concomitant boosts 97,98 in 28 fractions of 2.5 Gy and 25 fractions of 2.7 Gy (median follow-up of 46 and 39 months, respectively) concluded that these treatments were feasible and well tolerated. The results on EBRT treatments in combination with HDRBT boosts 65,66,[99][100][101][102][103][104][105] with median follow-up ranging from 40 to 105 months (2 fractions Â 5-15 Gy, 3 fractions Â 3-6.5 Gy, or 4 fractions Â 3-6 Gy) and extreme hypofractionated treatments of HDRBT delivered as monotherapy [106][107][108][109][110][111][112] at median follow-up of 22-65 months (3 fractions Â 10.5 Gy, 4 fractions Â 8.5-9.5 Gy, 6 fractions Â 6.75-7 Gy, 8 fractions Â 6 Gy, or 9 fractions Â 6 Gy) or stereotactic body radiosurgery [113][114][115] 119,120 median follow-up: 32 months for the hypofractionation regimens and 35 months for the conventional). Despite differences in dose prescription, delivery methods, patient selection according to prognostic factors, short follow-up in many studies, and the use of androgen deprivation therapy in some patients, the clinical experience with hypofractionation seems to be consistent with a low a/b ratio for prostate cancer.…”

Section: Feasibility Of the Hypofractionation Regimensmentioning

confidence: 99%

“…One year later, Wang et al 16 reanalyzed the data from Martinez et al 65,66 with a longer follow-up, allowing for maturity and stability in the data and a new clinical dataset 57,67 from EBRT dose-escalation to determine the standard uncertainties of parameters. Using the same formalism as before, 15 an a/b ratio of 3.1 Gy (68% CI 1.5, 5.7) was reported by these authors.…”

Section: The Contribution Of Hdrbt Boostsmentioning

confidence: 99%

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What do we know about the α/β for prostate cancer?

2012

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Since last decade, the debate on the parameter which reflects prostate cancer sensitivity to fractionation in a radiotherapy treatment, the α/β, has become extensive. Unlike most tumors, the low labeling indices (LI) and large potential doubling time that characterize the prostate tumor led some authors to consider that it may behave as a late responding tissue. So far, the existing studies with regard to this subject point to a low value of α/β, around 2.7 Gy, which may be considered as a therapeutic gain in relation to surrounding normal tissues by using fewer and larger fractions. The aim of this paper is to review several estimates that have been made in the last few years regarding the prostate cancer α/β both from clinical and experimental data, as well as the set of factors that have potentially influenced these evaluations.

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Section: The Contribution Of Hdrbt Boostsmentioning

confidence: 99%

Section: Feasibility Of the Hypofractionation Regimensmentioning

confidence: 99%

Section: The Contribution Of Hdrbt Boostsmentioning

confidence: 99%

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What do we know about the α/β for prostate cancer?

2012

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“…High total dose in 2 Gy per fraction is safe and efficient, which was published many times over past years. On the other hand, high dose brachytherapy in prostate cancer uses hypofractionation with equal outcomes [36,37,38,39,40]. The low alpha/beta ratio in prostate cancer cells makes rationale for hypofractionation.…”

Section: Discussionmentioning

confidence: 99%

Acute toxicity of robotic ultrahypofractionated radiotherapy CyberKnifeTM in prostate cancer patients

Głowacki¹,

Majewski²,

Wojcieszek³

et al. 2015

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Our purpose was to evaluate the toxicity of CyberKnife TM based fractionated stereotactic radiotherapy (FSRT) in prostate cancer patients. One-hunred-thirty-two men with low (62) and intermediate (70) prostate cancer were enrolled in our prospective study. Mean age was 69. Total dose of 36,25 Gy in 5 fractions was prescribed. Image guided FSRT was performed on CyberKnife. Minimum follow-up ranged from 3 to 28 months. EORTC/RTOG scale was used to evaluate toxicity. A total of 47%, 10% and 2% of patients presented grade 1, 2 and 3 acute genitourinary toxicity, respectively. In 25% and 3% of patients, respectively, grade 1 and 2 acute gastrointestinal toxicity was observed. No significant association between acute grade ≥ 2 toxicity and clinical factors: age, androgen deprivation therapy or infections were found. Neither CTV nor PTV volumes had significant impact on acute grade ≥ 2 toxicity. Late toxicity was assessed in 104 patients. In 16% and 1% of patients late GU toxicity in grade 1 and 2, respectively, was presented. Late GI toxicity grade 1, 2 and 3 occurred in 8%, 3% and 1% of patients, respectively. The acute toxicity rates of fractionated stereotactic radiotherapy are low. Early data suggest also low late toxicity rates.

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“…The urethra is considered to be rather resistant to irradiation. However, urethral strictures, urethral necrosis, urinary incontinence have been reported [30,35,36]. Galalae et al have identified trans-urethral resection of the prostate (TUR-P) less then 6 months before irradiation as a risk factor, and they reduced the urinary tract toxicity by excluding patients with previous history of TUR-P [36].…”

Section: Side Effectsmentioning

confidence: 99%