Long-Term Results of NRG Oncology/RTOG 0321 A Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate

Hsu, I-Chow; Rodgers, J.; Shinohara, K.; Purdy, J.A.; Michalski, J.M.; Roach, M.; Vigneault, E.; Ivker, R.; Pryzant, R.M.; Kuettel, M.R.; Taussky, D.; Gustafson, G.S.; Raben, A.; Sandler, H.M.

doi:10.1016/j.ijrobp.2019.06.493

Cited by 5 publications

(2 citation statements)

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“…No grade 3 or higher acute or late toxicities were observed in the current study. The low toxicity is favorable when compared to RTOG 0321, which utilized HDR brachytherapy boost conventionally fractionated external beam radiation, and prior studies of HDR brachytherapy boost with hypofractionated EBRT to the prostate and seminal vesicles without pelvic radiation [ 22 ]. Shahid et al and Tharmalingam et al have both reported very low rates of grade 3 or higher GI and GU toxicities in of 125 and 411 patients treated with a 15 Gy single fraction HDR boost with 37.5 Gy in 2.5 Gy per fraction of EBRT to the prostate and seminal vesicles after roughly 5 years of follow-up [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Phuong

Chan

et al. 2022

Radiat Oncol

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Background To evaluate acute and late genitourinary and gastrointestinal toxicities and patient reported urinary and sexual function following accelerated, hypofractionated external beam radiotherapy to the prostate, seminal vesicles and pelvic lymph nodes and high dose rate (HDR) brachytherapy or stereotactic body radiation therapy (SBRT) prostate boost. Methods Patients at a single institution with NCCN intermediate- and high-risk localized prostate cancer with logistical barriers to completing five weeks of whole pelvic radiotherapy (WPRT) were retrospectively reviewed for toxicity following accelerated, hypofractionated WPRT (41.25 Gy in 15 fractions of 2.75 Gy). Patients also received prostate boost radiotherapy with either HDR brachytherapy (1 fraction of 15 Gy) or SBRT (19 Gy in 2 fractions of 9.5 Gy). The duration of androgen deprivation therapy was at the discretion of the treating radiation oncologist. Toxicity was evaluated by NCI CTCAE v 5.0. Results Between 2015 and 2017, 22 patients with a median age of 71 years completed accelerated, hypofractionated WPRT. Median follow-up from the end of radiotherapy was 32 months (range 2–57). 5%, 73%, and 23% of patients had clinical T1, T2, and T3 disease, respectively. 86% of tumors were Gleason grade 7 and 14% were Gleason grade 9. 68% and 32% of patients had NCCN intermediate- and high-risk disease, respectively. 91% and 9% of patients received HDR brachytherapy and SBRT prostate boost following WPRT, respectively. Crude rates of grade 2 or higher GI and GU toxicities were 23% and 23%, respectively. 3 patients (14%) had late or persistent grade 2 toxicities of urinary frequency and 1 patient (5%) had late or persistent GI toxicity of diarrhea. No patient experienced grade 3 or higher toxicity at any time. No difference in patient-reported urinary or sexual function was noted at 12 months. Conclusions Accelerated, hypofractionated whole pelvis radiotherapy was associated with acceptable GU and GI toxicities and should be further validated for those at risk for harboring occult nodal disease.

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Section: Discussionmentioning

confidence: 99%

Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Phuong

Chan

et al. 2022

Radiat Oncol

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“…High-dose rate (HDR) prostate brachytherapy is a standard-of -care treatment option for favorable risk, 1 unfavorable risk, 2,3 and radiorecurrent 4,5 prostate cancer. HDR brachytherapy involves the insertion of hollow needles into the prostate gland under transrectal ultrasound (TRUS) guidance.…”

Section: Introductionmentioning

confidence: 99%

Observer preference of artificial intelligence‐generated versus clinical prostate contours for ultrasound‐based high dose rate brachytherapy

King,

Kehayias,

Chaunzwa

et al. 2023

Medical Physics

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BackgroundFor trans‐rectal ultrasound (TRUS)‐based high dose rate (HDR) prostate brachytherapy, prostate contouring can be challenging due to artifacts from implanted needles, bleeding, and calcifications.PurposeTo evaluate the geometric accuracy and observer preference of an artificial intelligence (AI) algorithm for generating prostate contours on TRUS images with implanted needles.MethodsWe conducted a retrospective study of 150 patients, who underwent HDR brachytherapy. These patients were randomly divided into training (104), validation (26) and testing (20) sets. An AI algorithm was trained/validated utilizing the TRUS image and reference (clinical) contours. The algorithm then provided contours for the test set. For evaluation, we calculated the Dice coefficient between AI and reference prostate contours. We then presented AI and reference contours to eight clinician observers, and asked observers to select their preference. Observers were blinded to the source of contours. We calculated the percentage of cases in which observers preferred AI contours. Lastly, we evaluate whether the presence of AI contours improved the geometric accuracy of prostate contours provided by five resident observers for a 10‐patient subset.ResultsThe median Dice coefficient between AI and reference contours was 0.92 (IQR: 0.90–0.94). Observers preferred AI contours for a median of 57.5% (IQR: 47.5, 65.0) of the test cases. For resident observers, the presence of AI contours was associated with a 0.107 (95% CI: 0.086, 0.128; p < 0.001) improvement in Dice coefficient for the 10‐patient subset.ConclusionThe AI algorithm provided high‐quality prostate contours on TRUS with implanted needles. Further prospective study is needed to better understand how to incorporate AI prostate contours into the TRUS‐based HDR brachytherapy workflow.

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Patient-reported outcomes after Low-dose-rate versus High-dose-rate brachytherapy boost in combination with external beam radiation for intermediate and high risk prostate cancer

Dhere¹,

Fischer‐Valuck²,

Goyal³

et al. 2021

Brachytherapy

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Long-Term Results of NRG Oncology/RTOG 0321 A Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate

Cited by 5 publications

References 0 publications

Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost

Observer preference of artificial intelligence‐generated versus clinical prostate contours for ultrasound‐based high dose rate brachytherapy

Patient-reported outcomes after Low-dose-rate versus High-dose-rate brachytherapy boost in combination with external beam radiation for intermediate and high risk prostate cancer

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