scholarly journals Stereotactic Body Radiotherapy for Prostate Cancer

2020 ◽  
Vol 14 (3) ◽  
pp. 155798832092724
Author(s):  
Neil R. Parikh ◽  
Amar U. Kishan
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
External Beam Radiotherapy ◽  
Standard Of Care ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Safety And Efficacy ◽  
Conventional Fractionation ◽  
Normal Tissues ◽  
High Level

Prostate cancer remains the most common and second most deadly cancer diagnosed amongst U.S. men. External beam radiotherapy is a standard-of-care definitive treatment option for localized prostate cancer and historically constituted an 8–9-week treatment course comprised of 39–45 doses of 1.8–2.0 Gy each (conventional fractionation, CF). Based on the notion that prostate cancer may respond favorably to a higher dose per day, considerable research efforts have been focused on characterizing the safety and efficacy profile of shorter and shorter radiation courses. Ultrahypofractionation (UHF) involves condensing the radiation course into just 5–7 treatments of 6–8 Gy each. When utilizing modern techniques that allow the precise sculpting of a dose distribution that delivers high doses to the prostate and lower doses to surrounding normal tissues over five or fewer treatments, this treatment is called stereotactic body radiotherapy (SBRT). Two randomized trials (HYPO-RT-PC and PACE-B) have compared UHF to longer radiation courses. The former demonstrated that UHF and CF have similar long-term toxicity and efficacy, while the latter demonstrated that modern SBRT has equivalent short-term toxicity as well. A separate report from a consortium of studies data provides prospective, albeit nonrandomized, data supporting the longer-term safety and efficacy of SBRT specifically. Thus, mounting high-level evidence suggests that SBRT is an acceptable standard care of option for men with localized prostate cancer.

scholarly journals Late urinary toxicity modeling after stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer

2015 ◽  
Vol 55 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Thomas P. Kole ◽  
Michael Tong ◽  
Binbin Wu ◽  
Siyuan Lei ◽  
Olusola Obayomi-Davies ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Localized Prostate Cancer ◽  
Definitive Treatment

Trends and clinico-sociodemographic determinants of stereotactic body radiotherapy use for localized prostate cancer: A National Cancer Database study.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e545-e545
Author(s):  
Brandon Arvin Virgil Mahal ◽  
Yu-Wei Chen ◽  
Vinayak Muralidhar ◽  
David Yang ◽  
Amandeep R. Mahal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
External Beam Radiotherapy ◽  
National Cancer Data Base ◽  
Localized Prostate Cancer ◽  
Cancer Data ◽  
Definitive Therapy ◽  
Sociodemographic Determinants ◽  
To Receive

e545 Background: Stereotactic body radiotherapy (SBRT) represents an emerging and cautiously guideline-approved definitive therapy option for prostate cancer, though long-term data on efficacy and toxicity is still pending. Herein, we sought to determine contemporary national SBRT trends and clinico-sociodemographic determinants associated with its use in prostate cancer. Methods: The National Cancer Data Base (NCDB) was queried to identify 181,544 patients diagnosed with localized prostate cancer from 2004-2012 who received external beam radiotherapy. Multivariable logistic regression adjusted for sociodemographic and clinical factors was used to identify independent determinants of SBRT use. Results: Rate of SBRT use for localized prostate cancer increased from 0.05% in 2004 to 4.87% in 2012 ( Ptrend< 0.001). SBRT was more likely to be delivered at academic centers, to patients with Medicare, and to patients who were white, younger, healthier, from wealthier and more educated zipcodes, and who had lower risk disease features (all P< 0.001). Relative to Whites, men from more affluent zipcodes, or men with low stage or grade prostate cancer, Blacks, Hispanics, and men from less affluent zipcodes and men with high stage or grade prostate cancer were less likely to receive SBRT after multivariable adjustment, with adjusted hazard ratios of 0.66, 0.35, 0.33, 0.07, and 0.21, respectively (all P< 0.001). Conclusions: The absolute national rate of SBRT use as definitive therapy for prostate cancer has increased nearly 100-fold over the last decade. Men who are White, younger, healthier, from more affluent zipcodes and with favorable disease characteristics are more likely to receive an emerging form of radiotherapy with unknown long-term efficacy and toxicity.

scholarly journals Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study

2021 ◽  
Author(s):  
E. Sutton ◽  
◽  
J. A. Lane ◽  
M. Davis ◽  
E. I. Walsh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Qualitative Interviews ◽  
Well Being ◽  
Localized Prostate Cancer ◽  
Short Term ◽  
Age Related ◽  
Qualitative Interview Study ◽  
Long Term Treatment

Abstract Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.

scholarly journals Addition of Androgen-Deprivation Therapy or Brachytherapy Boost to External Beam Radiotherapy for Localized Prostate Cancer: A Network Meta-Analysis of Randomized Trials

2020 ◽  
Vol 38 (26) ◽  
pp. 3024-3031 ◽  
Author(s):  
William C. Jackson ◽  
Holly E. Hartman ◽  
Robert T. Dess ◽  
Sam R. Birer ◽  
Payal D. Soni ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Randomized Trials ◽  
Practice Patterns ◽  
Meta Analysis ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
External Beam ◽  
Brachytherapy Boost ◽  
Meta Analyses

PURPOSE In men with localized prostate cancer, the addition of androgen-deprivation therapy (ADT) or a brachytherapy boost (BT) to external beam radiotherapy (EBRT) have been shown to improve various oncologic end points. Practice patterns indicate that those who receive BT are significantly less likely to receive ADT, and thus we sought to perform a network meta-analysis to compare the predicted outcomes of a randomized trial of EBRT plus ADT versus EBRT plus BT. MATERIALS AND METHODS A systematic review identified published randomized trials comparing EBRT with or without ADT, or EBRT (with or without ADT) with or without BT, that reported on overall survival (OS). Standard fixed-effects meta-analyses were performed for each comparison, and a meta-regression was conducted to adjust for use and duration of ADT. Network meta-analyses were performed to compare EBRT plus ADT versus EBRT plus BT. Bayesian analyses were also performed, and a rank was assigned to each treatment after Markov Chain Monte Carlo analyses to create a surface under the cumulative ranking curve. RESULTS Six trials compared EBRT with or without ADT (n = 4,663), and 3 compared EBRT with or without BT (n = 718). The addition of ADT to EBRT improved OS (hazard ratio [HR], 0.71 [95% CI, 0.62 to 0.81]), whereas the addition of BT did not significantly improve OS (HR, 1.03 [95% CI, 0.78 to 1.36]). In a network meta-analysis, EBRT plus ADT had improved OS compared with EBRT plus BT (HR, 0.68 [95% CI, 0.52 to 0.89]). Bayesian modeling demonstrated an 88% probability that EBRT plus ADT resulted in superior OS compared with EBRT plus BT. CONCLUSION Our findings suggest that current practice patterns of omitting ADT with EBRT plus BT may result in inferior OS compared with EBRT plus ADT in men with intermediate- and high-risk prostate cancer. ADT for these men should remain a critical component of treatment regardless of radiotherapy delivery method until randomized evidence demonstrates otherwise.

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