Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer

Kuban, Deborah A.; Tucker, Susan L.; Dong, Lei; Starkschall, George; Huang, Eugene; Cheung, Min Rex; Lee, Andrew K.; Pollack, Alan

doi:10.1016/j.ijrobp.2007.06.054

Cited by 1,129 publications

(635 citation statements)

References 21 publications

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“…The additional strengths of the present study include higher radiation doses and longer follow-up. Dose-escalated RT has been shown to improve FFBF through better local control (20)(21)(22). This benefit with higher doses might allow differences in local control related to secondary factors, such as the NTDR, to be more apparent.…”

Section: Discussionmentioning

confidence: 99%

Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

D’Ambrosio

Horwitz

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-The protraction of external beam radiotherapy (RT) time is detrimental in several disease sites. In prostate cancer, the overall treatment time can be considerable, as can the potential for treatment breaks. We evaluated the effect of elapsed treatment time on outcome after RT for prostate cancer.Methods and Materials-Between April 1989 and November 2004, 1,796 men with prostate cancer were treated with RT alone. The nontreatment day ratio (NTDR) was defined as the number of nontreatment days divided by the total elapsed days of RT. This ratio was used to account for the relationship between treatment duration and total RT dose. Men were stratified into low risk (n = 789), intermediate risk (n = 798), and high risk (n = 209) using a single-factor model. Results-The 10-year freedom from biochemical failure (FFBF) rate was 68% for a NTDR <33% vs. 58% for NTDR ≥33% (p = 0.02; BF was defined as a prostate-specific antigen nadir + 2 ng/mL). In the low-risk group, the 10-year FFBF rate was 82% for NTDR <33% vs. 57% for NTDR ≥33% (p = 0.0019). The NTDR was independently predictive for FFBF (p = 0.03), in addition to T stage (p = 0.005) and initial prostate-specific antigen level (p < 0.0001) on multivariate analysis, including Gleason score and radiation dose. The NTDR was not a significant predictor of FFBF when examined in the intermediate-risk group, high-risk group, or all risk groups combined.Conclusions-A proportionally longer treatment duration was identified as an adverse factor in low-risk patients. Treatment breaks resulting in a NTDR of ≥33% (e.g., four or more breaks during a 40-fraction treatment, 5 d/wk) should be avoided.

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Section: Discussionmentioning

confidence: 99%

Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

D’Ambrosio

Horwitz

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…Dose‐escalated external beam radiotherapy (e.g., 7400–7800 cGy) using intensity modulated radiotherapy (RT) has been shown to improve biochemical control among patients with intermediate‐risk prostate cancer1 and so has become the standard of care. However, this approach involves prolonged treatment lasting 7–8 weeks and so increases the burden of treatment on both the patient and the clinic.…”

Section: Introductionmentioning

confidence: 99%

Automated prediction of dosimetric eligibility for hypofractionated prostate radiotherapy

Lausch

Lamey

Zeng

2017

J Applied Clin Med Phys

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Clinical implementation of hypofractionated prostate radiotherapy (PROFIT trial, NCT003046759) represents an opportunity to significantly reduce the burden of treatment on the patient and clinic. However, efficacy was only demonstrated among the patient demographic who could meet the trial dose constraints and so it is necessary to emulate this triage step in clinical practice. The purpose of this study was to build a convenient tool to address the challenge of determining patient eligibility for hypofractionated treatment within the clinic. The tool was implemented within the EclipseTM treatment planning system using the scripting environment. Prior to planning a new case, the script computes and displays in a plot the fractional overlap of rectal and bladder wall with the planning target volume. Radial decision boundaries separate the plot into three zones and the new case is then classified as “feasible”, “uncertain”, or “not feasible”. The radial decision boundaries were derived from a retrospective analysis of the overlap values and dosimetric eligibility of 150 patients with intermediate risk prostate cancer. Two‐fold cross validation with repetitions demonstrated an average prediction accuracy of over 90%. The tool has been integrated into our clinical planning workflow to enable early identification of the need for planning consults and rapid a‐priori determination of dosimetric eligibility for hypofractionated radiotherapy. The tool can be readily adopted by other centres since the underlying metrics can be evaluated without scripting if desired.

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“…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. However, escalating the dose to the prostate has also led to an increase in ≥grade 2 rectal toxicity rates 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

“…However, escalating the dose to the prostate has also led to an increase in ≥grade 2 rectal toxicity rates 15, 16, 17. Grade ≥ 2 rectal toxicity has been shown to be significantly associated with the volume of rectum receiving > 70 Gy (V70) 14. Thus, techniques to minimize the rectal V70 are likely to translate into clinically meaningful benefits.…”

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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Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer

Cited by 1,129 publications

References 21 publications

Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

Automated prediction of dosimetric eligibility for hypofractionated prostate radiotherapy

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

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