scholarly journals Volumetric Modulated Arc Therapy of the Pelvic Lymph Nodes to the Aortic Bifurcation in Higher Risk Prostate Cancer: Early Toxicity Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Gina Hesselberg ◽  
Gerald Fogarty ◽  
Lauren Haydu ◽  
Nicole Dougheney ◽  
Phillip Stricker
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Toxicity Profile ◽  
Aortic Bifurcation ◽  
Pelvic Lymph Nodes ◽  
Arc Therapy ◽  
Grade 3 ◽  
Early Toxicity

Background. Treatment of pelvic lymph nodes (PLNs) in higher risk prostate carcinoma is controversial. The primary focus of the study was to evaluate the early toxicity profile for this cohort of patients treated with Volumetric Modulated Arc Therapy (VMAT).Methods. Patient, tumour, and treatment characteristics of those who received VMAT from May 2010 to December 2012 were analysed. A simplified contouring process of the PLNs to the aortic bifurcation was developed based on consensus guidelines. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were documented according to the Radiation Therapy Oncology Group (RTOG) Version 2 Guidelines. Successive Prostate Specific Antigen (PSA) values after treatment were measured on average 3 months apart.Results. 113 patients were treated between May 2010 to December 2012 with a median follow-up of 14 months. No patients experienced acute grade 3 or 4 GU and GI toxicity. Only 1 patient experienced a late grade 3 GU complication. No late grade 4 GU or GI events have yet occurred.Conclusions. This study reviews the first Australian experience of VMAT in the treatment of pelvic lymph nodes in prostate cancer, specifically to the level of the aortic bifurcation. It demonstrates a favorable acute toxicity profile whilst treating large PLN volumes with optimal dose coverage.

scholarly journals Proton Therapy of Prostate and Pelvic Lymph Nodes for High Risk Prostate Cancer: Acute Toxicity

2021 ◽  
Vol 8 (2) ◽  
pp. 41-50
Author(s):  
Richard Choo ◽  
David W. Hillman ◽  
Thomas Daniels ◽  
Carlos Vargas ◽  
Jean Claude Rwigema ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Acute Toxicity ◽  
Lymph Nodes ◽  
Seminal Vesicles ◽  
Pelvic Lymph Nodes ◽  
Gu Toxicity ◽  
Risk Prostate Cancer ◽  
Gi Toxicity ◽  
Grade 3

Abstract Purpose To assess acute gastrointestinal (GI) and genitourinary (GU) toxicities of intensity-modulated proton therapy (IMPT) targeting the prostate/seminal vesicles and pelvic lymph nodes for prostate cancer. Materials and Methods A prospective study (ClinicalTrials.gov: NCT02874014), evaluating moderately hypofractionated IMPT for high-risk or unfavorable intermediate-risk prostate cancer, accrued a target sample size of 56 patients. The prostate/seminal vesicles and pelvic lymph nodes were treated simultaneously with 6750 and 4500 centigray radiobiologic equivalent (cGyRBE), respectively, in 25 daily fractions. All received androgen-deprivation therapy. Acute GI and GU toxicities were prospectively assessed from 7 GI and 9 GU categories of the Common Terminology Criteria for Adverse Events (version 4), at baseline, weekly during radiotherapy, and 3-month after radiotherapy. Fisher exact tests were used for comparisons of categorical data. Results Median age was 75 years. Median follow-up was 25 months. Fifty-five patients were available for acute toxicity assessment. Sixty-two percent and 2%, respectively, experienced acute grade 1 and 2 GI toxicity. Grade 2 GI toxicity was proctitis. Sixty-five percent and 35%, respectively, had acute grade 1 and 2 GU toxicity. The 3 most frequent grade 2 GU toxicities were urinary frequency, urgency, and obstructive symptoms. None had acute grade ≥ 3 GI or GU toxicity. The presence of baseline GI and GU symptoms was associated with a greater likelihood of experiencing acute GI and GU toxicity, respectively. Of 45 patients with baseline GU symptoms, 44% experienced acute grade 2 GU toxicity, compared with only 10% among 10 with no baseline GU symptoms (P = 0.07). Although acute grade 1 and 2 GI and GU toxicities were common during radiotherapy, most resolved at 3 months after radiotherapy. Conclusion A moderately hypofractionated IMPT targeting the prostate/seminal vesicles and regional pelvic lymph nodes was well tolerated with no acute grade ≥ 3 GI or GU toxicity. Patients with baseline GU symptoms had a higher rate of acute grade 2 GU toxicity.

Hypofractionated, dose escalation radiotherapy for high-risk prostate cancer: The primary endpoint of a group led phase III trial. (PCS5).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 123-123 ◽  
Author(s):  
Tamim Niazi ◽  
Abdenour Nabid ◽  
Redouane Bettahar ◽  
Linda S. Vincent ◽  
Andre-Guy Martin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Lymph Nodes ◽  
Primary Endpoint ◽  
Dose Escalation ◽  
Phase Iii ◽  
Phase Iii Trial ◽  
Pelvic Lymph Nodes ◽  
Androgen Suppression ◽  
Grade 3

123 Background: The low α\β ratio of prostate cancer (PCa), 1.5-2, suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of hypofractionated radiation treatment (HFRT). Most available data of moderate HFRT have focused on low, intermediate and/or mixed risk groups. We therefore conducted the first randomized trial of moderately HFRT in high-risk PCa patients and present the primary safety analysis of side effects at 2 years. Methods: We conducted a Canadian multi-centric phase III trial of conventional fractionated radiation therapy (CFRT) vs. intensity-modulated HFRT in men with high-risk PCa as per NCCN definition. From February 2012 to March 2015, 329 patients were randomized in a 1:1 ratio to receive either CFRT or HFRT. All patients received neo-adjuvant, concurrent and adjuvant androgen suppression, with a median duration of 24 months. CFRT consisted of 76 Gy in 2 Gy per fraction to the prostate where 46 Gy was delivered to the pelvic lymph nodes. HFRT consisted of concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate and 45 Gy, in 1.8Gy per fraction to the pelvic lymph nodes. The primary endpoint was to compare the toxicities at 6 months and at 24 months using the CTCAE v.4. Results: Of the329 patients, 164 were randomized to HFRT and 165 to CFRT. The minimum, median and maximum follow-up were 24, 40 and 60 months respectively. At 24 months, 12 patients in the CFRT arm and 15 patients in the HFRT arm had grade 2 or worse gastrointestinal (GI)-related adverse events (HR:1.32 [0.62.2.83] 95% CI; P=NS). Similarly, 11 patients in the CFRT arm and 3 patients in HFRT arm had grade 2 or higher genitourinary (GU) toxicities (HR:0.26 [0.07-0.94] 95% CI; P=0.037). In the HFRT arm, there were 3 grade 3 GI and one grade 3 GU related toxicities. In the CFRT arm there were 3 grade 3 GU and no grade 3 GI related toxicities. There were no grade 4 toxicities in either arm. Conclusions: This is the first hypofractionated dose escalated radiotherapy study in high-risk PCa patients treated with contemporary radiation and androgen suppression. Our results indicate that moderate HFRT to high risk PCa patients is equally well tolerated as CFRT at 2 years. Clinical trial information: NCT01444820.

Late rectal bleeding after volumetric-modulated arc therapy for localised prostatic cancer

2018 ◽  
Vol 18 (02) ◽  
pp. 165-168
Author(s):  
Yutaka Naoi ◽  
Kana Yamada ◽  
Chie Kurokawa ◽  
Hiroaki Kunogi ◽  
Yoshiro Sakamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Adverse Effects ◽  
Rectal Bleeding ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Arc Therapy ◽  
Late Adverse Effects ◽  
Grade 3

AbstractAimLate adverse effects following radiation therapy for prostate cancer involve the urinary and lower gastrointestinal tracts, with continuous rectal bleeding being the most serious issue. We focused on late adverse effects, particularly rectal bleeding after volumetric-modulated arc therapy (VMAT), for patients with locally advanced prostate cancer.Materials and MethodsSeventy-three patients with localized prostate cancer were treated with radiation therapy using VMAT with an image-guided radiation therapy system. Patient age at the start of irradiation ranged from 54 to 81 years (median, 71 years). The follow-up period ranged from 23 to 87 months (median, 57 months). The prescribed total irradiation dose was 76 Gy in 38 fractions.ResultsLate rectal bleeding was observed in 14 (19%) patients, with nine (12.3%), four (5.5%), and one (1.4%) being classified as grades 1, 2, and 3, respectively. One grade 3 patient with rectal bleeding had severe diabetes and was administered intravenous warfarin for cardiomyopathy.FindingsVMAT may provide better accuracy and involve fewer time constraints for patients compared with other intensity-modulated radiation therapy (IMRT) methods. The incidence of late rectal bleeding in VMAT is almost equivalent to that of other IMRT methods.

Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

2017 ◽  
Vol 16 (4) ◽  
pp. 423-430
Author(s):  
Kannan Perisamy ◽  
Ashutosh Mukherji ◽  
Saravanan Kandasamy ◽  
K. Sathyanarayan Reddy
Keyword(s):  
Radiation Therapy ◽  
Treatment Time ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Large Field ◽  
Concomitant Boost ◽  
Arc Therapy ◽  
Grade 3 ◽  
Boost Radiation

AbstractIntroductionVolumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.Materials and methodsIn this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.ResultsAll patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.ConclusionVMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

On the pre-clinical validation of a commercial model-based optimisation engine: Application to volumetric modulated arc therapy for patients with lung or prostate cancer

2014 ◽  
Vol 113 (3) ◽  
pp. 385-391 ◽  
Author(s):  
Antonella Fogliata ◽  
Francesca Belosi ◽  
Alessandro Clivio ◽  
Piera Navarria ◽  
Giorgia Nicolini ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Volumetric Modulated Arc Therapy ◽  
Clinical Validation ◽  
Model Based ◽  
Arc Therapy
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