A Randomized Trial Comparing Hypofractionated and Conventionally Fractionated Three-Dimensional External-Beam Radiotherapy for Localized Prostate Adenocarcinoma

2009 ◽  
Vol 185 (11) ◽  
pp. 715-721 ◽  
Author(s):  
Darius Norkus ◽  
Albert Miller ◽  
Juozas Kurtinaitis ◽  
Uwe Haverkamp ◽  
Sergey Popov ◽  
...  
Keyword(s):  
Randomized Trial ◽  
External Beam Radiotherapy ◽  
Three Dimensional ◽  
Prostate Adenocarcinoma ◽  
External Beam ◽  
Conventionally Fractionated

scholarly journals A randomized trial comparing hypofractionated and conventionally fractionated three-dimensional conformal external-beam radiotherapy for localized prostate adenocarcinoma: A report on the first-year biochemical response

Medicina ◽  
2009 ◽  
Vol 45 (6) ◽  
pp. 469 ◽  
Author(s):  
Darius Norkus ◽  
Albert Miller ◽  
Aista Plieskienė ◽  
Ernestas Janulionis ◽  
Konstantinas Valuckas
Keyword(s):  
Randomized Trial ◽  
Statistical Significance ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Biochemical Response ◽  
First Year ◽  
External Beam ◽  
Chi Square ◽  
Conventionally Fractionated

Objective. This paper describes the first-year biochemical (prostate-specific antigen [PSA]) response of 91 irradiated patients enrolled in a single-institution randomized trial comparing hypofractionated (HFRT) and conventionally fractionated (CFRT) external beam radiotherapy. Material and methods. Forty-four patients in the CFRT treatment arm were irradiated with 74 Gy in 37 fractions (2 Gy per fraction), and 47 in the HFRT arm were treated with 57 Gy, given in 13 fractions of 3 Gy plus 4 fractions of 4.5 Gy. The clinical target volume includes the prostate and a base of seminal vesicles. The proportions of patients who reached PSA nadir (nPSA) lower than or equal to 1.0 ng/mL (nPSA1) and 0.5 ng/mL (nPSA05) were compared. Results. There were 2 non-cancer-related deaths (1 in the CFRT and 1 in the HFRT treatment arms). Biochemical relapse after irradiation was defined in five cases (3 in the CFRT and 2 in the HFRT treatment arms) during a 12-month follow-up. The remaining 84 patients were analyzed. The proportions of patients reaching nPSA1 were 50% and 54.5% in the CFRT and HFRT treatment arms, respectively (chi-square P=0.843). The percentages of patients reaching nPSA05 were 25% and 18.2%, respectively (chi-square P=0.621). The trends toward increasing proportions of biochemical responders (both nPSA1 and nPSA05) during 12 months after radiotherapy were observed, but the difference between trends for treatment arms did not reach a statistical significance. Conclusion. The preliminary results presented here demonstrate that HFRT schedule induces biochemical response rates comparable to those in the CFRT schedule during the first-year follow-up.

Multi-institutional outcomes following LDR brachytherapy in patients with higher-risk prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 238-238
Author(s):  
Ruth Conroy ◽  
Peter Hoskin ◽  
David Bottomley ◽  
Paula Mandall ◽  
Ric Swindell ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Dose Range ◽  
Univariate Analysis ◽  
Hormone Treatment ◽  
Prostate Adenocarcinoma ◽  
Treatment Modalities ◽  
External Beam ◽  
Adjuvant Hormone Therapy ◽  
Mount Vernon ◽  
Ldr Brachytherapy

238 Background: We report the outcomes for a cohort of men with higher risk prostate adenocarcinoma treated with LDR brachytherapy in a multi-institutional UK practice. Methods: 217 men treated between 2003-2007 with Iodine-125 brachytherapy at Christie, Leeds and Mount Vernon were identified from a multi-institutional database. Higher risk was defined as patients with ≥ 2 D’Amico intermediate risk factors (PSA 10-20, GS 7 or clinical T2c) or ≥1 high risk factor (PSA > 20, GS ≥ 8). Kaplan-Meier methods were used to estimate biochemical relapse free survival (BRFS) defined using both Phoenix and ASTRO definitions. A univariate analysis was performed to assess the significance of Gleason score, PSA, T-stage, pre- or post-implant dosimetry, and additional hormones on BRFS. Results: The median age was 65yrs (43–79yrs) with a median PSA follow up of 62months (14–102months). Median pre-implant doses (ranges) were: V150 59.6(43.7–89.8), V200 20.1(11.6–36). 75 patients had post-implant dosimetry, median dose (range) was: D90 132.8Gy (75-192Gy). No patients had external beam radiotherapy. 67 patients had additional hormone treatment, median duration 7 months (3 – 22 months). The 3 and 5 year BRFS as defined by Phoenix were 85.4% and 74.4% and as defined by ASTRO were 76.6% and 69.8%. On univariate analysis there were no statistically significant predictors of inferior outcome. Conclusions: Single modality LDR brachytherapy is a well established treatment for low risk prostate adenocarcinoma reporting excellent long term BRFS. Some authors have advocated the addition of external beam radiotherapy when treating higher risk disease. These results show that good BRFS can be obtained with LDR brachytherapy alone and no additional benefit has been shown by the addition of adjuvant hormone therapy. These results appear comparable with other treatment modalities available to these patients.

PACE: Analysis of acute toxicity in PACE-B, an international phase III randomized controlled trial comparing stereotactic body radiotherapy (SBRT) to conventionally fractionated or moderately hypofractionated external beam radiotherapy (CFMHRT) for localized prostate cancer (LPCa).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 1-1 ◽  
Author(s):  
Nicholas John Van As ◽  
Douglas Brand ◽  
Alison Tree ◽  
Peter James Ostler ◽  
William Chu ◽  
...  
Keyword(s):  
Acute Toxicity ◽  
Treatment Time ◽  
External Beam Radiotherapy ◽  
Radiation Therapy Oncology Group ◽  
Phase Iii ◽  
Treatment Schedule ◽  
External Beam ◽  
Clinical Failure ◽  
Gu Toxicity ◽  
Conventionally Fractionated

1 Background: External beam radiotherapy (EBRT) is a curative treatment for LPCa. Large randomised controlled trials (RCTs) have shown moderately hypofractionated regimens (2.5–3 Gy/fraction(f)) as non-inferior to conventionally fractionated regimens (2 Gy/f). PACE-B aims to demonstrate non-inferiority of SBRT compared to CFMHRT for biochemical or clinical failure. Compared to CFMHRT, SBRT reduces patient (pt) attendances but compressed overall treatment time may influence acute toxicity severity. Methods: PACE is a phase III open-label multiple-cohort RCT. Men with LPCa, stage T1-T2, ≤ Gleason 3 + 4, PSA ≤ 20 ng/mL, unsuitable for surgery or preferring EBRT, were eligible for the PACE-B cohort. Between 08/12-01/18, 874 pts (38 centres) were randomised (1:1) to SBRT or CFMHRT. SBRT dose was 36.25 Gy/5f in 1-2 weeks (wks), CFMHRT as 78 Gy/39f over 7.5 wks, or 62 Gy/20f in 4 wks. Androgen deprivation therapy was not permitted. Clinician reported acute toxicity was assessed at baseline, 2-weekly during CFMHRT and at 2, 4, 8 & 12 wks post-treatment. Key toxicity outcomes were worst grade 2+ Radiation Therapy Oncology Group (RTOG) genitourinary (GU) and gastrointestinal (GI) acute toxicities, compared by Chi-square test with alpha 0.05 divided between the two measures. Results: By per protocol analysis n=430 received CFMHRT, n=414 received SBRT. Key characteristics seen in the CFMHRT and SBRT groups respectively were: mean age: 69.5 vs 69.3 years; T-stage ≥T2b: 51.8% vs 56.6%; Gleason Score 3+4: 80.2% vs 85.0%; PSA 10-20 ng/mL: 30.9% vs 31.6%. RTOG G2+ toxicity was not significantly different for GI events (CMFHRT 52/430 (12.1%) vs SBRT 42/414 (10.1%), p=0.368), nor GU events (CFMHRT 117/430 (27.2%) vs SBRT 96/414 (23.2%), p=0.179). Conclusions: Despite an accelerated treatment schedule, RTOG assessments show similar rates of acute GI and GU toxicity for SBRT and CFHFRT. Pt follow-up in PACE-B continues and results of late toxicity and biochemical/clinical failure are awaited. Clinical trial information: NCT01584258.

High-Dose-Rate Brachytherapy Boost and Conformal External Beam Radiotherapy for Primary or Recurrent Localized Prostate Adenocarcinoma

Brachytherapy ◽  
2013 ◽  
Vol 12 ◽  
pp. S71
Author(s):  
Luis Larrea ◽  
Enrique Lopez Munoz ◽  
Paola Antonini ◽  
Banos Maria Carmen ◽  
Maria Angeles Garcia ◽  
...  
Keyword(s):  
Dose Rate ◽  
External Beam Radiotherapy ◽  
Prostate Adenocarcinoma ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
High Dose Rate Brachytherapy ◽  
Brachytherapy Boost
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