Tumor control outcomes of salvage cryotherapy for radiorecurrent prostate cancer at median 12 years follow-up

Abstract Background We aimed to assess the feasibility of a dose painting (DP) procedure, known as simultaneous integrated boost intensity modulated radiation Therapy (SIB-IMRT), for treating prostate cancer with dominant intraprostatic lesions (DILs) based on multi-parametric magnetic resonance (mpMR) images and hierarchical clustering with a machine learning technique. Methods The mpMR images of 120 patients were used to create hierarchical clustering and draw a dendrogram. Three clusters were selected for performing agglomerative clustering. Then, the DIL acquired from the mpMR images of 20 patients were categorized into three groups to have them treated with a DP procedure being composed of three planning target volumes (PTVs) determined as PTV1, PTV2, and PTV3 in treatment plans. The DP procedure was carried out on the patients wherein a total dose of 80, 85 and 91 Gy were delivered to the PTV1, PTV2, and PTV3, respectively. Dosimetric and radiobiologic parameters [Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP)] of the DP procedure were compared with those of the conventional IMRT and Three-Dimensional Conformal Radiation Therapy (3DCRT) procedures carried out on another group of 20 patients. A post-treatment follow-up was also made four months after the radiotherapy procedures. Results All the dosimetric variables and the NTCPs of the organs at risks (OARs) revealed no significant difference between the DP and IMRT procedures. Regarding the TCP of three investigated PTVs, significant differences were observed between the DP versus IMRT and also DP versus 3DCRT procedures. At post-treatment follow-up, the DIL volumes and apparent diffusion coefficient (ADC) values in the DP group differed significantly (p-value < 0.001) from those of the IMRT. However, the whole prostate ADC and prostate-specific antigen (PSA) indicated no significant difference (p-value > 0.05) between the DP versus IMRT. Conclusions The results of this comprehensive clinical trial illustrated the feasibility of our DP procedure for treating prostate cancer based on mpMR images validated with acquired patients’ dosimetric and radiobiologic assessment and their follow-ups. This study confirms significant potential of the proposed DP procedure as a promising treatment planning to achieve effective dose escalation and treatment for prostate cancer. Trial registration: IRCT20181006041257N1; Iranian Registry of Clinical Trials, Registered: 23 October 2019, https://en.irct.ir/trial/34305.

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Long-term results of salvage cryotherapy for prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.108 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 108-108 ◽

Cited By ~ 1

Author(s):

A. Williams ◽

C. Martinez ◽

V. Chalasani ◽

C. Lu ◽

C. Ng ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Disease Recurrence ◽

Free Survival ◽

Salvage Cryotherapy ◽

Disease Free

108 Background: The optimum treatment of Prostate cancer recurrence following external bean radiation therapy (EBRT) remains a controversial topic. The primary problem with comparing salvage techniques following EBRT is the lack of long term data. We reviewed the long- term overall survival, disease-specific survival and disease free survival of patients who have undergone salvage cryotherapy to the prostate gland. Methods: A retrospective analysis was performed on all patients undergoing salvage cryotherapy for locally recurrent prostate cancer after EBRT by a single surgeon at a single institution from 1995-2004. Patients preoperative, perioperative and postoperative data was reviewed and recorded. Should a patient no longer be followed by the urology service the Patients and the patient's primary care physician or urologist were contacted. Mortality data, PSA results, bone scan results and any details of hormone therapy were recorded for this study. Results: 187 patients were included in the current study from which 176 patients had records available for follow up giving a follow up rate of 94%. Mean follow up was 7.46 years (1-14 years). 52 patients were followed for greater than 10 years. Average time to prostate cancer recurrence in patients who developed recurred was 2.3 years and average time to hormone therapy in these patients was 2.8 years. Overall survival at 10 years was high at 87%. Risk factors for recurrence of tumour identified were presalvage PSA, preradiation and presalvage gleason score. Preradiation gleason score had little impact on survival. PSA nadir of >1.0ng/mL was highly predictive of early recurrence. Disease-free survival rates of between 39 and 64% depending on risk factors. Conclusions: Cryotherapy has a definite role in the management of prostate cancer, representing a minimally invasive salvage treatment with acceptable 10 year disease free survival (DFS) of upwards of 39% and specific groups attaining 10 year DFS of 64%. Presalvage PSA and Gleason score are the best predictors of disease recurrence, whilst preradiation gleason score did not correlate with risk of disease recurrence. A PSA Nadir greater than 1 ng/mL indicates a poor prognosis in which early ADT should be strongly considered. No significant financial relationships to disclose.

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LOCAL TUMOR CONTROL WITH SALVAGE CRYOTHERAPY FOR LOCALLY RECURRENT PROSTATE CANCER AFTER EXTERNAL BEAM RADIOTHERAPY

The Journal of Urology ◽

10.1016/s0022-5347(05)66546-9 ◽

2001 ◽

Vol 165 (3) ◽

pp. 867-870 ◽

Cited By ~ 35

Author(s):

JONATHAN I. IZAWA ◽

PAUL PERROTTE ◽

GRAHAM F. GREENE ◽

SHELLIE SCOTT ◽

LAWRENCE LEVY ◽

...

Keyword(s):

Prostate Cancer ◽

External Beam Radiotherapy ◽

Local Tumor Control ◽

Tumor Control ◽

External Beam ◽

Recurrent Prostate Cancer ◽

Local Tumor ◽

Salvage Cryotherapy ◽

Locally Recurrent

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Endoscopic Transnasal Resection of Trigeminal Schwannoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727122 ◽

2021 ◽

Author(s):

Satoshi Kiyofuji ◽

Masahiro Shin ◽

Kenji Kondo ◽

Taichi Kin ◽

Tatsuya Uchida ◽

...

Keyword(s):

Prostate Cancer ◽

Gamma Knife Radiosurgery ◽

Magnetic Resonance Images ◽

Csf Leak ◽

Oculomotor Nerve Palsy ◽

Tumor Control ◽

Skull Base Tumor ◽

Trigeminal Schwannoma ◽

Transnasal Surgery

AbstractTrigeminal schwannoma is a rare skull base tumor that can be managed in a variety of treatments including image observation, surgery, stereotactic radiosurgery, such as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal resection is very effective when the tumor is not invading far laterally, or the risk of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a history of prostate cancer and diabetes presented with left oculomotor nerve palsy over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left cavernous sinus protruding to the left orbit via the superior orbital fissure (Fig. 1). The patient underwent endoscopic transnasal surgery to decompress the mass. The surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection of the mass (Fig. 2). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased from the known prostate cancer. Endoscopic transnasal surgery was especially useful in this case, considering the preoperative known cancer state that management of this benign tumor did not ruin the quality of life of this patient while minimizing hospitalization, as achieving satisfactory tumor control with aid from postoperative GKS, minimizing complications.The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w.

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LOCAL TUMOR CONTROL WITH SALVAGE CRYOTHERAPY FOR LOCALLY RECURRENT PROSTATE CANCER AFTER EXTERNAL BEAM RADIOTHERAPY

The Journal of Urology ◽

10.1097/00005392-200103000-00031 ◽

2001 ◽

pp. 867-870 ◽

Cited By ~ 1

Author(s):

JONATHAN I. IZAWA ◽

PAUL PERROTTE ◽

GRAHAM F. GREENE ◽

SHELLIE SCOTT ◽

LAWRENCE LEVY ◽

...

Keyword(s):

Prostate Cancer ◽

External Beam Radiotherapy ◽

Local Tumor Control ◽

Tumor Control ◽

External Beam ◽

Recurrent Prostate Cancer ◽

Local Tumor ◽

Salvage Cryotherapy ◽

Locally Recurrent

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Assessment of Toxicity After 68Ga-PSMA-PET-Imaging Based Treatment Planning and Dose-Escalation in Radiation Therapy in Prostate Cancer Patients

10.21203/rs.3.rs-147700/v1 ◽

2021 ◽

Author(s):

Kilian Schiller ◽

Sabrina Dewes ◽

Lisa Pfetsch ◽

Marco MME Vogel ◽

Michal Devecka ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Pet Imaging ◽

Tumor Control ◽

Patient Centered ◽

Psma Pet ◽

Before And After ◽

Pre Treatment ◽

Grade 3

Abstract PURPOSE: Effective tumor control in prostate cancer demands elevated radiation doses given its low alpha/beta ratio. We investigated in primary and recurrent prostate cancer whether dose-escalated-radiation therapy (DE-RT) based on 68Ga-PSMA-PET positive lesions yields increased toxicity. METHODS: We evaluated 90 patients (salvage DE-RT: 67 patients, DE-re-RT: 11 patients, definite DE-RT: 12 patients) who were treated based on a pre-treatment hybrid 68Ga-PSMA. Findings from pre-treatment hybrid 68Ga-PSMA-PET could result in an adaption of radiation planning. Common Toxicity Criteria of Adverse Effects (Version 4.03) were used to assess toxicity, this was done before the initiation and at the end of DE-RT, as well as at the first and last follow-up (F/U) examination. We evaluated the change in toxicity for each interval for the collective as well as in a per-patient analysis.RESULTS: Findings in 68Ga-PSMA-PET-imaging resulted in a change of TNM-stage in 61.1% and an adapted treatment concept in 71.1% of patients. When comparing overall toxicity before DE-RT and at the last follow-up, 5.9% treatment-related side effects (grade 1-3) occurred with 1.7% of them being severe (grade 3). In a patient-centered approach we examined the intra-individual changes in toxicity before and after DE-RT. At the last F/U, the majority out of 80 patients (range: 61.3-93.8%) stated unchanged toxicity rates compared to the toxicity examined at the initiation of RT.CONCLUSION: The rate of treatment-related toxicity (grade 1-2) due to DE-RT in our cohort is 4.2%. For grade 3 toxicity it is 1.7%, respectively. The overall level of toxicity is highest during and shortly after completion of DE-RT (+7.4%) and improves over time until the last reported F/U (+5.9%). Compared to historical data, the toxicity profile of DE-RT is not increased. Therefore it is possible to apply DE-RT with the aim to increase tumor control by precisely treating all involved areas according to PSMA-PET-imaging.

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Multi-institutional retrospective analysis of ultrahypofractionated radiotherapy for Japanese prostate cancer patients

Scientific Reports ◽

10.1038/s41598-021-92307-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hiromichi Ishiyama ◽

Hideyasu Tsumura ◽

Hisato Nagano ◽

Motoi Watanabe ◽

Eiichi Mizuno ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Retrospective Analysis ◽

Cancer Patients ◽

Specific Antigen ◽

Tumor Control ◽

Short Term ◽

Grade 3 ◽

Toxicity Criteria

AbstractTo report outcomes and risk factors of ultrahypofractionated (UHF) radiotherapy for Japanese prostate cancer patients. This multi-institutional retrospective analysis comprised 259 patients with localized prostate cancer from 6 hospitals. A total dose of 35–36 Gy in 4–5 fractions was prescribed for sequential or alternate-day administration. Biochemical failure was defined according to the Phoenix ASTRO consensus. Toxicities were assessed using National Cancer Institute Common Toxicity Criteria version 4. Tumor control and toxicity rates were analyzed by competing risk frames. Median follow-up duration was 32 months (range 22–97 months). 2- and 3-year biochemical control rates were 97.7% and 96.4%, respectively. Initial prostate-specific antigen (p < 0.01) and neoadjuvant androgen deprivation therapy (p < 0.05) were identified as risk factors for biochemical recurrence. 2- and 3-year cumulative ≥ Grade 2 late genitourinary (GU) toxicities were 5.8% and 7.4%, respectively. Corresponding rates of gastrointestinal (GI) toxicities were 3.9% and 4.5%, respectively. Grade 3 rates were lower than 1% for both GU and GI toxicities. No grade 4 or higher toxicities were encountered. Biologically effective dose was identified as a risk factor for ≥ Grade 2 late GU and GI toxicities (p < 0.05). UHF radiotherapy offered effective, safe treatment for Japanese prostate cancer with short-term follow-up. Our result suggest higher prescribed doses are related to higher toxicity rates.

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