Improved Clinical Outcomes With High-Dose Image Guided Radiotherapy Compared With Non-IGRT for the Treatment of Clinically Localized Prostate Cancer

2012 ◽  
Vol 84 (1) ◽  
pp. 125-129 ◽  
Author(s):  
Michael J. Zelefsky ◽  
Marisa Kollmeier ◽  
Brett Cox ◽  
Anthony Fidaleo ◽  
Dahlia Sperling ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
Image Guided Radiotherapy ◽  
Image Guided

Clinical outcomes with high-dose image guided radiotherapy (IGRT) compared with non-IGRT for the treatment of clinically localized prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 12-12
Author(s):  
Michael J. Zelefsky ◽  
Marisa Kollmeier ◽  
Brett Wayne Cox ◽  
Xin Pei ◽  
Margie Hunt
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
Tumor Control ◽  
High Dose ◽  
External Beam ◽  
Fiducial Markers ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Risk Patients

12 Background: To compare toxicity profiles and biochemical tumor control outcomes between patients treated with high-dose image-guided radiotherapy (IGRT) and high-dose intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer. Methods: 186 patients with prostate cancer were treated with IGRT to a dose of 86.4 Gy with daily correction of the target position based upon kilovoltage imaging of implanted prostatic fiducial markers. This group of patients was retrospectively compared with a similar cohort of 190 patients who were treated with IMRT to the same prescription dose without, implanted fiducial markers in place (non-IGRT). In both groups the margins used for the prostate were the same. The median follow-up time was 2.8 years (range, 2-4 years). Results: A significant reduction in late urinary toxicity was observed for IGRT patients compared with the non-IGRT patients. The 3-year likelihood of urinary toxicity for the IGRT and non-IGRT cohorts were 10.4% and 20.0%, respectively (p=0.02).Multivariate analysis identifying predictors for late urinary toxicity demonstrated that, in addition to the baseline IPSS, IGRT was associated with significantly less late urinary toxicity compared with non-IGRT. The incidence of late rectal toxicity was low for both treatment groups (1.0% and 1.6%, respectively; p = 0.81). No differences in prostate-specific antigen relapse–free survival outcomes were observed for low- and intermediate-risk patients when treated with IGRT and non-IGRT. For high-risk patients a significant improvement was observed at 3-years for patients treated with IGRT compared with non-IGRT. Conclusions: IGRT is associated with a reduction in late urinary toxicity and improvement in biochemical tumor control after definitive high-dose external beam radiotherapy compared with high-dose IMRT. These data suggest that, for definitive radiotherapy, the placement of fiducial markers and daily tracking of target positioning should be the preferred mode of external beam radiotherapy delivery for the treatment of prostate cancer.

Salvage image-guided radiotherapy to the prostate after cryotherapy failure.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. e637-e637
Author(s):  
Austin B Hopper ◽  
John Paul Einck ◽  
Ajay Pal Sandhu
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Primary Treatment ◽  
External Beam Radiation ◽  
High Dose ◽  
Beam Radiation ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Gu Toxicity ◽  
Treatment Margins

e637 Background: Cryotherapy is used in increasing frequency for the primary treatment of localized prostate cancer. While it is known that local recurrence can occur in > 20% of patients treated with primary cryotherapy there is a paucity of data on salvage treatments after failure. The use of external beam radiation therapy is an attractive option after cryotherapy failure but there is little data on efficacy and toxicity. We evaluate our data on a group of patients treated with image-guided dose-escalated radiotherapy (IGRT) at our institution. Methods: An IRB-approved database of patients treated with IGRT for prostate cancer from 2005 to 2013 was used to identify patients who underwent primary cryotherapy followed by salvage IGRT. Patients’ EMR were reviewed for age, cryotherapy-to-salvage interval, pre/post-salvage PSA and Gleason score (GS). All patients were treated with dose-escalated IGRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily CBCT or kv imaging to implanted fiducial markers. Narrative notes were used to identify GU/GI toxicity and scored according to CTCAE v4.03. The Phoenix definition of nadir + 2 was used to determine disease control following RT. Results: 5 patients were identified within the study period as having received salvage RT after primary cryotherapy. Mean age at the time of salvage RT was 74 (range 65-80). Median cryotherapy-salvage interval was 49 months (range 25-97) and prior to RT patients had GS of 7 (n = 3) or 8 (n = 2) and mean PSA of 8.1 ng/mL (range 4.2-14.38). Median total dose and follow-up were 76.7 Gy (range 75.6 – 81.0) and 52 months (range 6-63). One patient’s PSA did not decline post-RT and developed metastases while four patients responded post-RT with one experiencing biochemical recurrence after 30 months. No patients had acute GU/GI toxicities grade 2 or higher; one experienced late grade 2 GU toxicity (dysuria) which resolved with medication. There were no late grade 3 toxicities. Conclusions: High-dose radiotherapy as salvage treatment after cryotherapy failure is tolerated without significant GU or GI toxicities. Additionally, salvage IGRT is a viable option for long-term biochemical control in cases of local recurrence and warrants additional study.

scholarly journals Safety of image-guided radiotherapy in definitive radiotherapy for localized prostate cancer: a population-based analysis

2021 ◽  
Vol 94 (1121) ◽  
pp. 20200456
Author(s):  
Yao-Hung Kuo ◽  
Ji-An Liang ◽  
Guan-Heng Chen ◽  
Chia-Chin Li ◽  
Chun-Ru Chien
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Mortality ◽  
Phase Iii ◽  
Localized Prostate Cancer ◽  
Image Guided Radiotherapy ◽  
Definitive Radiotherapy ◽  
Image Guided ◽  
The Impact

Objectives: Image-guided radiotherapy (IGRT) is a recommended advanced radiation technique that is associated with fewer acute and chronic toxicities. However, one Phase III trial showed worse overall survival in the IGRT arm. The purpose of this observational study is to evaluate the impact of IGRT on overall survival. Methods: We used the Taiwan Cancer Registry Database to enroll cT1-4N0M0 prostate cancer patients who received definitive radiotherapy between 2011 and 2015. We used inverse probability treatment weighting (IPW) to construct balanced IGRT and non-IGRT groups. We compared the overall survival of those in the IGRT and non-IGRT groups. Supplementary analyses (SA) were performed with alternative covariates in propensity score (PS) models and PS approaches. The incidence rates of prostate cancer mortality (IPCM), other cancer mortality (IOCM), and cardiovascular mortality (ICVM) were also evaluated. Results: There were 360 patients in the IGRT arm and 476 patients in the non-IGRT arm. The median follow-up time was 50 months. The 5-year overall survival was 88% in the IGRT arm and 86% in the non-IGRT arm (adjusted hazard ratio [HR] of death = 0.93; 95% CI, 0.61–1.45; p = 0.77). The SA also showed no significant differences in the overall survival between those in the IGRT and non-IGRT arms. Both groups did not significantly differ in terms of IPCM, IOCM, and ICVM. Conclusions: The overall survival of localized prostate cancer patients who underwent IGRT was not inferior to those who did not. Advances in knowledge: We demonstrated that the overall survival for prostate cancer patients with IGRT was not worse than those who did not undergo IGRT; this important outcome comparison has not been previously examined in the general population.

Sign in / Sign up

Export Citation Format

Share Document