Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response

Wang, Kyle; Mavroidis, Panayiotis; Royce, Trevor J.; Falchook, Aaron D.; Collins, Sean P.; Sapareto, Stephen A.; Sheets, Nathan; Fuller, Donald B.; Naqa, Issam El; Yorke, Ellen; Grimm, Jimm; Jackson, Andrew; Chen, Ronald C.

doi:10.1016/j.ijrobp.2020.09.054

Cited by 51 publications

(39 citation statements)

References 59 publications

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“…Indeed, an American Society for Radiation Oncology/American Society of Clinical Oncology/American Urological Association (ASTRO/ASCO/AUA) guideline included recommendations regarding the use of ultrahypofractionation (eg, SBRT) in the treatment of low-intermediate risk prostate cancer [ 16 ]. Evidence has accumulated that SBRT for patients with low and intermediate risk prostate cancer is associated with excellent biochemical outcomes and acceptably low toxicity rates [ 17 ]. However, caution is advised when dose-escalated SBRT aimed at maximizing tumor control for more aggressive disease is needed, in view of the non-negligible risk of high grade toxicity [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking

et al. 2021

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Purpose/objectives To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilotÒ System) to account for intra-fractional organ motion. Material/methods Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. Results All patients completed the treatment in the expected time (10.2 +/− 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of the fractions, either during setup or beam delivery. Conclusions Our preliminary findings show that dose intensified SBRT for unfavorable prostate tumors does not come at the cost of an increased toxicity, provided that a reliable technique for real time prostate monitoring is ensured. Fast FFF beams contributed to reduce intra-fractional motion. These observations need to be confirmed on a larger scale and a longer follow up.

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Section: Introductionmentioning

confidence: 99%

Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking

et al. 2021

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“…While GU side-effect of Grade 1 was 44%, grades 2 and 3 toxicity was 2% and 0% after SBRT (10). According to the review of Wang et al (11), after SBRT for PC, most toxicities were grade 1-2 with a very low overall incidence of grade 3-5 toxicity (usually < 3%). According to Hwang et al (12), after SBRT with periprostatic hydrogel spacer (SpaceOAR; Augmenix) for localized PC, no grade 3-5 GU or GI toxicity was recorded.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life After Definitive Linac Stereotactic Radiotherapy for Prostate Cancer: Longitudinal Study

Yamashita

Ogita

Sawayanagi

et al. 2021

Preprint

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Prostate cancer represents the second most common malignancy in the world and majority of patients have diagnosis of localized disease. We examined quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer. We included patients treated between 2016 and 2020. Inclusion criteria were: adenocarcinoma of the prostate; class risks low, intermediate, and high; WHO performance status 0-2. QoL was measured using the Functional Assessment of Cancer Therapy - Prostate (FACT-P). 439 patients were included, treated with SBRT. Median age was 73. Median follow-up was 34 months. FACT P-TOI (p < 0.0001), FACT G Total (p = 0.0003), and FACT P-total (p < 0.0001) declined at 1 month after the last SBRT, then recovered, and returned to the same level as before treatment at 3-4 month. The decrease in QoL at the first month was particularly remarkable in patients who received long-term hormone injections (36% patients). One month after the end of SBRT, about 22% patients were "quite a bit” or more in trouble with any side effect. We showed the longitudinal changes of quality of life by FACT-P after SBRT for prostate cancer. Prostate SBRT appears to be overall well tolerated.

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“…A review of studies conducted between 2001 and 2018 evaluating genitourinary, gastrointestinal, and sexual effects in patients treated with SBRT has recently been published [28], describing a relationship between dose received and genitourinary and gastrointestinal toxicity. However, there are few studies that examine the possible relationship between erectile dysfunction and dose to organs at risk (OAR) [29].…”

Section: Reviews and Meta-analyses Of Non-randomized Studiesmentioning

confidence: 99%

Extreme Hypofractionation with SBRT in Localized Prostate Cancer

et al. 2021

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Prostate cancer is the most commonly diagnosed cancer among men around the world. Radiotherapy is a standard of care treatment option for men with localized prostate cancer. Over the years, radiation delivery modalities have contributed to increased precision of treatment, employing radiobiological insights to shorten the overall treatment time, improving the control of the disease without increasing toxicities. Stereotactic body radiation therapy (SBRT) represents an extreme form of hypofractionated radiotherapy in which treatment is usually delivered in 1–5 fractions. This review assesses the main efficacy and toxicity data of SBRT in non-metastatic prostate cancer and discusses the potential to implement this scheme in routine clinical practice.

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Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response

Cited by 51 publications

References 59 publications

Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking

Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking

Quality of Life After Definitive Linac Stereotactic Radiotherapy for Prostate Cancer: Longitudinal Study

Extreme Hypofractionation with SBRT in Localized Prostate Cancer

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