Sexual quality of life following prostate intensity modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial

Hamstra, Daniel A.; Mariados, Neil; Sylvester, John; Shah, Dhiren; Gross, Eric; Hudes, Richard; Beyer, David; Kurtzman, Steven; Bogart, Jeffrey A.; Hsi, R.A.; Kos, Michael; Ellis, Rodney J.; Logsdon, Mark D.; Zimberg, S.H.; Forsythe, Kevin; Zhang, Hong; Soffen, Edward M.; Francke, Patrick; Mantz, C.A.; Rossi, Peter J.; DeWeese, Theodore L.; Daignault‐Newton, Stephanie; Fischer‐Valuck, Benjamin W.; Chundury, Anupama; Bosch, Walter; Michalski, Jeff M.

doi:10.1016/j.prro.2017.07.008

Cited by 47 publications

(43 citation statements)

References 24 publications

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“…SOH has been incorporated into the radiotherapeutic management of prostate cancer in numerous cancer centers as a result of the proven benefits in reducing rectal toxicity and improving QOL . Optimal treatment planning techniques are essential to maximize the benefits of SOH.…”

Section: Discussionmentioning

confidence: 99%

Maximizing rectal dose sparing with hydrogel: A retrospective planning study

Paetkau

Gagne

Pai

et al. 2019

J Applied Clin Med Phys

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External beam radiation therapy for prostate cancer can result in urinary, sexual, and rectal side effects, often impairing quality of life. A polyethylene glycol‐based product, SpaceOAR© hydrogel (SOH), implanted into the connective tissue between the prostate gland and rectum can significantly reduce the dose received by the rectum and hence risk of rectal toxicity. The optimal way to manage the hydrogel and rectal structures for plan optimization is therefore of interest. In 13 patients, computerized tomography (CT) scans were taken pre‐ and post‐SpaceOAR© implant. A prescription of 60 Gy in 20 fractions was planned on both scans. Six treatment plans were produced per anonymized dataset using either a structure of rectum plus the hydrogel, termed composite rectum wall (CRW), or rectal wall (RW) as an inverse optimization structure and intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) as a treatment technique. Dose‐volume histogram metrics were compared between plans to determine which optimization structure and treatment technique offered the maximum rectal dose sparing. RW structures offered a statistically significant decrease in rectal dose over CRW structures, whereas the treatment technique (IMRT vs VMAT) did not significantly affect the rectal dose. There was improvement seen in bladder and penile bulb dose when VMAT was used as a treatment technique. Overall, treatment plans using the RW optimization structure offered the lowest rectal dose while VMAT treatment technique offered the lowest bladder and penile bulb dose.

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Section: Discussionmentioning

confidence: 99%

Maximizing rectal dose sparing with hydrogel: A retrospective planning study

Paetkau

Gagne

Pai

et al. 2019

J Applied Clin Med Phys

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“…Другой, менее распространенный вариант, -введение по аналогичной методике биодеградирующих баллонов. Недавно опубликованные отдаленные результаты рандомизированного исследования III фазы показали, что помимо существенного снижения выраженности прямокишечной лучевой токсичности в группе, в которой применялись спейсеры, отмечен более высокий уровень статуса ЭФ: через 37 мес наблюдения после ЛТ у 66,7 % мужчин сохранялась способность к совершению полового акта, в то время как в контрольной группе этот показатель составил 37,5 % (р <0,001) [54,55]. Детальный анализ лечебных планов позволил сделать предположение, что в основе этого феномена лежит оптимизация дозовой нагрузки, в частности в области ЛПЧ, за счет снижения при дозиметрических расчетах веса такого важного ограничивающего фактора, как прямая кишка.…”

Section: онкоурология 3'2020 том 16 Cancer Urology 3'2020 Vol 16unclassified

Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

Novikov¹,

Новиков²,

Protoshchak³

et al. 2020

Onkourologiâ

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In recent years, significant changes have taken place in the treatment of prostate cancer. Modern radiation treatment technologies are beginning to take a leading position not only in localized and locally-advanced forms of the disease, but also in the case of oligometastatic process. This encourages a natural interest in various aspects of radiation therapy of prostate cancer, in particular its effects on erectile function status. Analysis of domestic literature shows the complete absence of publications on the technical possibilities of radiation therapy to preserve potency after treatment. The purpose of this work was to highlight this critical issue.

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“…2) Increasingly, SBRT is being used to treat both intermediate‐grade and high‐grade prostate cancer, either as a monotherapy in 4 or 5 fractions or as a boost with 2 fractions after pelvic radiotherapy; and, recently, several investigators have begun studying the feasibility of treating prostate cancer with a single fraction (clinicaltrials.gov identifier NCT03294889). 3) There are theoretical reasons to believe that CIRT, because of the tighter penumbra, should allow increased sparing of neurovascular structures and the penile bulb, resulting in improved erectile function and favorably impacting quality of life . 4) The higher RBE and sharper lateral fields of CIRT, permitting biologic and physical dose escalation, should improve local control more than might be expected with photon‐based or proton‐based SBRT .…”

Section: Challenges and Future Directionsmentioning

confidence: 99%

“…One site under discussion by our own group (NAPTA), in collaboration with the leadership of a number of centers with CIRT capability involves the design of a large phase II/III clinical trial for unfavorable intermediate and high-risk prostate cancer. The rationale for choosing this cancer site is as follows: (1) prostate cancer is one of the most common cancers treated definitively with radiation in the world, and is the most common cancer treated with CIRT 3,29 ; (2) increasingly SBRT is being used to treat both intermediate and high grade prostate cancer either as a monotherapy in 4 to 5 fractions or as a boost with 2 fractions after pelvic radiotherapy and recently a number of investigators have begun studying the feasibility of treating prostate cancer with a single fraction 39 (ClinicalTrials.gov Identifier: NCT03294889); (3) there are theoretical reasons to believe that CIRT, due to the tighter penumbra, should allow increased sparing of neurovascular structures and the penile bulb resulting in improved erectile function and favorably impacting quality of life 45–47 ; (4) the higher RBE and sharper lateral fields of CIRT, permitting biological and physical dose escalation, should improve local control more than might be expected with photon or proton based SBRT 43,44 ; (5) hypoxia and other mechanisms of radiation resistance thought to confer resistance to photon based EBRT may be overcome with CIRT 26,48–50 ; (6) intermediate endpoints such as PSA nadir and /or time to metastatic disease could be used to support the viability of CIRT 37,39,51,52 .…”

Section: Challenges and Future Directionsmentioning

confidence: 99%

Clinical trials involving carbon‐ion radiation therapy and the path forward

Lazar

Schulte

Faddegon

et al. 2018

Cancer

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To describe the international landscape of clinical trials in carbon ion radiotherapy (CIRT), we reviewed the current status of 63 ongoing clinical trials (median: 47 subjects) involving CIRT identified from the clinicaltrials.gov trial registry and World Health Organization International Clinical Trials Platform Registry. We evaluated the potential for these trials to define the role of this modality in the treatment of specific cancer types, and to identify major challenges and opportunities to advance this technology. A significant body of literature suggests the potential for advantageous dose distributions and in preclinical biologic studies the enhanced effectiveness for CIRT compared to photons and protons. Additionally, clinical evidence, though limited, from phase I/II trials indicates the potential for CIRT to improve cancer outcomes. However, at present, high level phase III randomized clinical trial evidence does not exist. While there has been an increase in the number of trials investigating CIRT since 2010, and the number of countries and sites offering CIRT is slowly growing, this progress has excluded other countries. We propose several recommendations to study this modality in order to accelerate progress in the field, including to (1) increase the number of multi-national randomized clinical trials (2) leveraging existing CIRT facilities to launch larger multi-national trials directed at common cancers combined with high level quality assurance; and (3) developing more compact and less expensive “next generation” treatment systems integrated with radiobiological research and pre-clinical testing.

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Sexual quality of life following prostate intensity modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial

Abstract: The use of a hydrogel spacer decreased dose to the penile bulb, which was associated with improved erectile function compared with the control group based on patient-reported sexual QOL.

Cited by 47 publications

References 24 publications

Maximizing rectal dose sparing with hydrogel: A retrospective planning study

Maximizing rectal dose sparing with hydrogel: A retrospective planning study

Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

Clinical trials involving carbon‐ion radiation therapy and the path forward

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