Patient‐reported outcomes after 3‐dimensional conformal, intensity‐modulated, or proton beam radiotherapy for localized prostate cancer

Gray, Phillip J.; Paly, Jonathan J.; Yeap, Beow Y.; Sanda, Martin G.; Sandler, Howard M.; Michalski, Jeff M.; Talcott, James A.; Coen, John J.; Hamstra, Daniel A.; Shipley, William U.; Hahn, Stephen M.; Zietman, Anthony L.; Bekelman, Justin E.; Efstathiou, Jason A.

doi:10.1002/cncr.27956

Cited by 85 publications

(68 citation statements)

References 46 publications

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“…Prospectively collected quality-of-life scores during the first 2 years were similar in 1243 men after pbt and 204 men after imrt 77 . Gray et al 78 reported that pbt, conformal photon rt, and imrt all result in similar clinically meaningful reductions in bowel (but not urinary) quality-of-life scores at 24 months.…”

Section: Prostatementioning

confidence: 98%

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

et al. 2014

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able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents who have the greatest risk for long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head-and-neck, breast, lung, gastrointestinal tract, and pelvic cancers, including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.

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Section: Prostatementioning

confidence: 98%

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

et al. 2014

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“…The bowel QOL score is at its lowest 1 or 2 months after treatment, but improves slowly thereafter to near baseline by 1-2 years after treatment [3][4][5]. In our series, most moderate to big problems were seen at 1 month post-SBRT with approximately 10% of patients reporting moderate to big problems with bowel urgency and/or frequency ( Figure 4).…”

Section: Discussionmentioning

confidence: 54%

“…Proctitis following prostate cancer radiotherapy is a critical quality of life issue [1][2][3][4] and the principle doselimiting toxicity [14][15][16]. Currently, there is limited data on proctitis following SBRT for prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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Proctitis Following Stereotactic Body Radiation Therapy for Prostate Cancer

Joh

Chen

Porter

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Background: Proctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer. Methods: Between February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT.

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“…Proton therapy provides an advantage over IMRT by reducing the radiation dose delivered to normal tissues outside of the target volume 4, 5. Image‐guided treatment delivery, as well as use of endorectal balloons (ERB), have been historically employed to allow for tighter planning target margins thus decreasing the volume of rectum exposed to high radiation doses 6, 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®

Hedrick

Fagundes

Case

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to investigate the consistency of rectal sparing using multiple periodic quality assurance computerized tomography imaging scans (QACT) obtained during the course of proton therapy for patients with prostate cancer treated with a hydrogel spacer. Forty‐one low‐ and intermediate‐risk prostate cancer patients treated with image‐guided proton therapy with rectal spacer hydrogel were analyzed. To assess the reproducibility of rectal sparing with the hydrogel spacer, three to four QACTs were performed for each patient on day 1 and during weeks 1, 3, and 5 of treatment. The treatment plan was calculated on the QACT and the rectum V90%, V75%, V65%, V50%, and V40% were evaluated. For the retrospective analysis, we evaluated each QACT and compared it to the corresponding treatment planning CT (TPCT), to determine the average change in rectum DVH points. We were also interested in how many patients exceeded an upper rectum V90% threshold on a QACT. Finally, we were interested in a correlation between rectum volume and V90%. On each QACT, if the rectum V90% exceeded the upper threshold of 6%, the attending physician was notified and the patient was typically prescribed additional stool softeners or laxatives and reminded of dietary compliance. In all cases of the rectum V90% exceeding the threshold, the patient had increased gas and/or stool, compared to the TPCT. On average, the rectum V90% calculated on the QACT was 0.81% higher than that calculated on the TPCT. The average increase in V75%, V65%, V50%, and V40% on the QACT was 1.38%, 1.59%, 1.87%, and 2.17%, respectively. The rectum V90% was within ± 1% of the treatment planning dose in 71.2% of the QACTs, and within ± 5% in 93.2% of the QACTs. The 6% threshold for rectum V90% was exceeded in 7 out of 144 QACTs (4.8%), identified in 5 of the 41 patients. We evaluated the average rectum V90% across all QACTs for each of these patients, and it was found that the rectum V90% never exceeded 6%. 53% of the QACTs had a rectum volume within 5 cm3 of the TPCT volume, 68% were within 10 cm3. We found that patients who exceeded the threshold on one or more QACTs had a lower TPCT rectal volume than the overall average. By extrapolating patient anatomy from three to four QACT scans, we have shown that the use of hydrogel in conjunction with our patient diet program and use of stool softeners is effective in achieving consistent rectal sparing in patients undergoing proton therapy.

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Patient‐reported outcomes after 3‐dimensional conformal, intensity‐modulated, or proton beam radiotherapy for localized prostate cancer

Abstract: BACKGROUND-Recent studies have suggested differing toxicity patterns for patients with prostate cancer who receive treatment with 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), or proton beam therapy (PBT).

Cited by 85 publications

References 46 publications

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Proctitis Following Stereotactic Body Radiation Therapy for Prostate Cancer

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®

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Patient‐reported outcomes after 3‐dimensional conformal, intensity‐modulated, or proton beam radiotherapy for localized prostate cancer

Abstract: BACKGROUND-Recent studies have suggested differing toxicity patterns for patients with prostate cancer who receive treatment with 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), or proton beam therapy (PBT).

Cited by 85 publications

References 46 publications

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Proctitis Following Stereotactic Body Radiation Therapy for Prostate Cancer

Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR®

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Product

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Validation of rectal sparing throughout the course of proton therapy treatment in prostate cancer patients treated with SpaceOAR^®