Re: Influence of Local Tumor Control on Distant Metastases and Cancer Related Mortality After External Beam Radiotherapy for Prostate Cancer

AbstractDefinitive radiotherapy for cervical cancer consists of external-beam radiotherapy (EBRT) and brachytherapy. In EBRT, a central shield (CS) reduces the dose to the rectum and bladder. The combination of whole-pelvic (WP)- and CS-EBRT and brachytherapy is the standard radiotherapy protocol in Japan. Despite clinical studies, including multi-institutional clinical trials, showing that the Japanese treatment protocol yields favorable treatment outcomes with low rates of late radiation toxicities, dose–volume parameters for the Japanese treatment protocol remain to be established. We conducted a retrospective dose–volume analysis of 103 patients with uterine cervical cancer treated with the Japanese protocol using computed tomography–based adaptive brachytherapy. The 2-year overall survival and 2-year local control rates according to FIGO stage were 100% and 100% for Stage I, 92% and 94% for Stage II, and 85% and 87% for Stage III–IV, respectively. Late adverse effects in the rectum and bladder were acceptable. Receiver operating characteristic analysis discriminated recurrence within the high-risk clinical target volume (HR-CTV) (n = 5) from no local recurrence (n = 96), with the optimal response obtained at a dose of 36.0 GyEQD2 for HR-CTV D90 and 28.0 GyEQD2 for HR-CTV D98. These values were used as cut-offs in Fisher exact tests to show that high HR-CTV D90 and HR-CTV D98 doses for brachytherapy sessions were significantly associated with tumor control within the HR-CTV. These data suggest a contribution of brachytherapy to local tumor control in WP- and CS-EBRT and brachytherapy combination treatment, warranting validation in multi-institutional prospective studies.

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Radiolabeled anti-EGFR-antibody improves local tumor control after external beam radiotherapy and offers theragnostic potential

Radiotherapy and Oncology ◽

10.1016/j.radonc.2013.12.001 ◽

2014 ◽

Vol 110 (2) ◽

pp. 362-369 ◽

Cited By ~ 36

Author(s):

Lydia Koi ◽

Ralf Bergmann ◽

Kerstin Brüchner ◽

Jens Pietzsch ◽

Hans-Jürgen Pietzsch ◽

...

Keyword(s):

External Beam Radiotherapy ◽

Local Tumor Control ◽

Tumor Control ◽

External Beam ◽

Local Tumor ◽

Egfr Antibody

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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients

BioMed Research International ◽

10.1155/2018/7569590 ◽

2018 ◽

Vol 2018 ◽

pp. 1-16 ◽

Cited By ~ 11

Author(s):

Saskia M. Camps ◽

Davide Fontanarosa ◽

Peter H. N. de With ◽

Frank Verhaegen ◽

Ben G. L. Vanneste

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Ultrasound Imaging ◽

Organs At Risk ◽

External Beam Radiotherapy ◽

Treatment Options ◽

Current Status ◽

Tumor Control ◽

External Beam ◽

Image Guided Radiotherapy

External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.

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Determinants of biochemical failure and distant metastases-free survival in high-risk prostate cancer patients treated with external beam radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.371 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 371-371

Author(s):

Avinash Pilar ◽

Andrew Bayley ◽

Danny Shehata ◽

Zhihui (Amy) Liu ◽

Alejandro Berlin ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Dose Escalation ◽

External Beam Radiotherapy ◽

Distant Metastases ◽

Biochemical Failure ◽

External Beam ◽

Free Survival ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

371 Background: Objectives were to1) identify predictors of biochemical failure(BCF) -free survival (FFS) & distant metastases free-survival (DMFS) in high-risk prostate cancer (HRPC) patients treated with external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT); 2) assess the impact of nodal irradiation & escalation of dose to the nodal volumes in HRPC. Methods: Between Feb 2000 & May 2011, 462 patients with HRPC were treated with EBRT +/- ADT. This spanned an era of technical development; prior to 2002 conventional dose radiotherapy was routinely delivered, between 2002-2008, dose escalation to the prostate & pelvic lymph nodes was undertaken in a phase II trial & subsequently all patients were treated with a dose-escalated protocol. The disease characteristics included, a median PSA of 20ng/ml (range: 1-563), T3-T4 in 33% (n=158), & Gleason grade group (GGG) 3-5 in 72% (n=331). The majority (n=405, 88%) received ADT with EBRT & median duration of ADT was 36 months (range: 0-197). Dose escalated EBRT was utilized in 52% (n=241) & nodal irradiation in 69% (n=317); escalation of dose to nodal volumes was performed in 20% (n=93). Results: The median follow-up was 8.7yrs (range: 0.9-18.9). Median nadir PSA was < 0.05ng/ml (range: <0.05-5.78) with median time to nadir (TTN) of 11 months (range: 2-130). Cumulative incidence rates of BCF at 5 and 10-yrs were 23% & 45%; corresponding rates for DM were 6.6% & 14%, respectively. The 5 & 10-yr FFS rates were 75% & 51%; corresponding DMFS rates were 91.5% & 80%, respectively. On multivariate analysis, T stage (p<0.001), GGG (p<0.001), ADT (p=0.002), dose escalation to prostate (P=0.012) & median nadir PSA (p<0.001) were independent predictors of FFS. The GGG (p=0.007), median nadir PSA (p=<0.001) & Nodal RT (p=0.03) were independent predictors of DMFS. PSA of 20 & TTN predicted neither FFS nor DMFS. Conclusions: Nadir PSA level was an independent predictor of FFS & DMFS. Undetectable PSA level was associated with prolonged FFS & DMFS. Dose escalation to prostate resulted in an improved FFS & Nodal irradiation in an improved DMFS. Further studies are required to identify subgroups that may benefit the most from nodal irradiation.

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

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.12 ◽

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.

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