SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines

Oliai, Caspian; Lanciano, Rachelle; Hanlon, Alexandra L.; Lamond, John P.; Arrigo, Stephen; Yang, Jun; Good, Michael; Feng, Jing; Brown, Royce; Garber, Bruce B.; Mooreville, Michael; Brady, Luther W.

doi:10.3389/fonc.2014.00312

Cited by 25 publications

(29 citation statements)

References 22 publications

(28 reference statements)

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“…In our current study, acute and late GU and GI toxicity were low. Minimal GU and GI toxicities have also been reported in other studies using SBRT doses of 35 - 36.25 Gy delivered in 5 fractions [ 19 , 24 , 30 - 34 ]. King, et al reported urinary Grade 1, 2, and 3 toxicity in 23%, 5%, and 3% of patients, respectively, and Grade 1 and 2 rectal toxicity in 12.5% and 2% of patients, respectively [ 33 ].…”

Section: Discussionsupporting

confidence: 59%

“…The late Grade 3 or greater rectal toxicity correlated with the rectal wall receiving 50 Gy > 3 cm. Bernetich, et al showed improved freedom from biochemical failure in intermediate and high-risk patients treated with 37.5 Gy compared to 35-36.25 Gy; however, patients receiving 37.5 Gy experienced slightly higher Grade 3 GU toxicity [ 34 ]. In our study, we were not able to stratify by dose because the majority of patients were treated with 36.25 Gy in 5 fractions, and there were limited numbers of patients treated with higher doses, thus, limiting our ability to conduct analysis with adequate statistical power to assess correlations between dose and incidence of toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry

Davis

Sharma²,

Shumway

et al. 2015

Cureus

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Objectives: To report on initial patient characteristics, treatment practices, toxicity, and early biochemical disease-free survival (bDFS) of localized prostate cancer treated with stereotactic body radiotherapy (SBRT) and enrolled in the RSSearch® Patient Registry.Methods: A retrospective analysis was conducted on patients with clinically localized prostate cancer enrolled in RSSearch® from June 2006 - January 2015. Patients were classified as low-risk (PSA ≤ 10 ng/ml, T1c-T2a, Gleason score ≤ 6), intermediate-risk (PSA 10.1 - 20 ng/ml, T2b-T2c, or Gleason 7), or high-risk (PSA > 20 ng/ml, T3 or Gleason ≥ 8). Toxicity was reported using Common Toxicity Criteria for Adverse Events, version 3. Biochemical failure was assessed using the Phoenix definition (nadir + 2 ng/ml). The Kaplan-Meier analysis was used to calculate bDFS and association of patient and tumor characteristics with the use of SBRT.Results: Four hundred thirty-seven patients (189 low, 215 intermediate, and 33 high-risk) at a median of 69 years (range: 48-88) received SBRT at 17 centers. Seventy-eight percent of patients received 36.25 Gy/5 fractions, 13% received 37 Gy/5 fractions, 6% received 35 Gy/5 fractions, 3% received 38 Gy/4 fractions, and 5% received a boost dose of 19.5-29 Gy following external beam radiation therapy. Median follow-up was 20 months (range: 1–64 months). Genitourinary (GU) and gastrointestinal (GI) toxicities were minimal, with no acute or late Grade 3+ GU or GI toxicity. Late Grade 1 and 2 urinary frequency was 25% and 8%. Late Grade 1 and 2 proctitis was 3% and 2%. Median PSA decreased from 5.8 ng/ml (range: 0.3-43) to 0.88, 0.4, and 0.3 ng/ml at one, two, and three years. Two-year bDFS for all patients was 96.1%. Two-year bDFS was 99.0%, 94.5%, and 89.8% for low, intermediate, and high-risk patients (p < 0.0001). Two-year bDFS was 99.2%, 93.2%, and 90.4% for Gleason ≤ 6, Gleason 7, and Gleason ≥ 8 (p < 0.0001). Two-year bDFS was 96.4%, 97.2%, and 62.5% for PSA ≤ 10 ng/ml, PSA 10.1 - 20 ng/ml, and PSA > 20 ng/ml (p < 0.0001). Clinical T Stage was not significantly associated with bDFS. Conclusions: Early disease outcomes of SBRT for the treatment of clinically localized prostate cancer from a multicenter patient registry compare favorably with reports from single institutions. Acute and late GU and GI toxicities were minimal, and PSA response to SBRT was highly encouraging. Continued accrual and follow-up will be necessary to confirm long-term results.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry

Davis

Sharma²,

Shumway

et al. 2015

Cureus

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“…Similarly, as in metaanalyses and in the aforementioned large single center patients’ group, the authors also report very good results in the smaller single center series. Bernetich et al, in a group of 142 patients irradiated to a TD of 35-36.25 Gy in 5 fractions, present a 5-year 100% success rate bFFS for very low risk (VLR), 91.7% for LR, 90% for IR and 86.7% for HR patients [ 20 ]. Fuller et al report a decrease in PSA median from 5.4 before treatment (4 x 9.5 Gy) to 0.05 ng/ml 5 years later (bFFS 96.2%) in the group of 79 LR and IR patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

Miszczyk

Napieralska

Namysł-Kaletka

et al. 2015

CEJU

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IntroductionProstrate cancer (PC) is one of the most common malignancies and is frequently treated with an 8-week course of radiotherapy. CyberKnife (CK) based radioablation enables completion of therapy within 5-9 days. The aim of this study is an evaluation of the effectiveness and tolerance of CyberKnife-based radioablation in prostate cancer patients.Material and methods200 PC patients (94 low risk [LR], 106 intermediate risk [IR]) underwent CK irradiation every other day (fraction dose [fd] 7.25 Gy, total dose [TD] 36.25 Gy, time 9 days). PSA varied from 1.1 to 19.5 (median 7.7) and T stage from T1c to T2c. The percentage of patients with Androgen Deprivation Therapy (ADT), GI (gastrointestinal) and GU (genitourinary) toxicity (EORTC/RTOG scale), and PSA were checked at 1, 4 and 8 months, and thereafter every 6 months – up to a total of 26 months – post-treatment.ResultsThe percentage of patients without ADT increased from 47.5% to 94.1% after 26 months. The maximum percentage of acute G3 adverse effects was 0.6% for GI, 1% for GU and G2 – 2.1% for GI and 8.5% for GU. No late G3 toxicity was observed. The maximum percentage of late G2 toxicity was 0.7% for GI and 3.4% for GU. Median PSA decreased from 7.7 to 0.1 ng/ml during FU. One patient relapsed and was treated with salvage brachytherapy.ConclusionsWe conclude that CK-based radioablation in low and intermediate risk PC patients is an effective treatment modality enabling OTT reduction and presents a very low percentage of adverse effects.

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“…Our previous publication described the effect of higher SBRT dose on outcome and will not be further discussed here (9). …”

Section: Resultsmentioning

confidence: 99%

The Comparison of Stereotactic Body Radiation Therapy and Intensity-Modulated Radiation Therapy for Prostate Cancer by NCCN Risk Groups

et al. 2016

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ObjectivesThe primary objective of this study is to compare freedom from biochemical failure (FFBF) between stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT) for patients with organ confined prostate cancer treated between 2007 through 2012 utilizing the 2015 National Comprehensive Cancer Network (NCCN) risk stratification guidelines. A secondary objective is to compare our updated toxicity at last follow-up compared with pretreatment with respect to bowel, bladder, sexual functioning, and need for invasive procedures between the two groups.MethodsWe retrospectively reviewed 270 consecutive men treated with either SBRT (n = 150) or IMRT (n = 120) at a community hospital with two distinct radiation departments and referral patterns. Charts were reviewed for pretreatment and treatment factors including race, age, clinical T stage, initial PSA, Gleason score, use of androgen deprivation therapy, treatment with SBRT vs. IMRT, as well as stratification by 2015 NCCN guidelines. Kaplan–Meier (KM) methodology was used to estimate FFBF, with statistical comparisons accomplished using log rank tests. Multivariable Cox proportional hazard modeling was used to establish independent factors prognostic of biochemical failure. Descriptive statistics were used to describe toxicity graded by a modified Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring system.ResultsSignificant prognostic factors in univariate analysis for FFBF included NCCN risk groups (p = 0.0032), grade (p = 0.019), and PSA (p = 0.008). There was no significant difference in FFBF between SBRT vs. IMRT (p = 0.46) with 6-year actuarial FFBF of 91.9% for SBRT and 88.9% for IMRT. Multivariable analysis revealed only the NCCN risk stratification to be significant predictor for FFBF (p = 0.04). Four-year actuarial FFBF by NCCN risk stratification was 100% very low risk, 100% low risk, 96.5% intermediate risk, 94.5% high risk, and 72.7% very high risk. There were no grade 3 gastrointestinal or genitourinary toxicities for either SBRT or IMRT at last follow-up.ConclusionNo significant difference in FFBF was found between SBRT and IMRT for organ confined prostate cancer in multivariable analysis within this retrospective data set. Overall toxicity was low. The 2015 NCCN risk stratification was validated in this population and was the only significant factor for FFBF in multivariable analysis.

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SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines

Cited by 25 publications

References 22 publications

Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry

Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

The Comparison of Stereotactic Body Radiation Therapy and Intensity-Modulated Radiation Therapy for Prostate Cancer by NCCN Risk Groups

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