Salvage radiation therapy after radical prostatectomy: Contribution of a dose escalation to macroscopic local relapses.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. e634-e634
Author(s):  
Imad Eddine Selmaji ◽  
Corina Udrescu ◽  
Tristan Brahmi ◽  
Hamza Samlali ◽  
Ariane Lapierre ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Local Control ◽  
Dose Escalation ◽  
Local Control Rate ◽  
Salvage Radiation Therapy ◽  
Gi Toxicity ◽  
A New Technique ◽  
Targeted Mri

e634 Background: Salvage radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer using 66 Gy may not be enough to treat macroscopic disease. The presence of a macroscopic nodule on the MRI could justify a focal dose escalation. This study evaluates the tolerance and efficacy of a new technique of irradiation including a focal boost to the nodule. Methods: Between 2011 and 2015, 14 patients, with a macroscopic relapse diagnosed on the MRI, underwent targeted MRI-guided biopsies. Three gold markers were implanted into the prostatic bed for a more accurate MRI/CT fusion and image guided IMRT. A dose of 60 Gy was delivered to the prostatic bed followed by a dose escalation to 72Gy on the macroscopic nodule. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated using the CTCAE v4. PSA level and late toxicities were assessed at 1 month and then every 6 months for 3 years. Results: The mean follow-up was 26.2 [18 – 36] months. Two patients had a biochemical failure after salvage RT (one bone metastasis and one lymph node recurrence). The local control rate was 100% and the biochemical control rate was 85.7%. Results for acute and late toxicities are summarized in the table. One patient presented with grade 2 urinary toxicity during the prostatic bed irradiation which lowered to grade 1 when the dose was focalized to the nodule. No grade 2 acute GI toxicity was seen. All late GI and GU toxicities were grade 1. Conclusions: Dose escalation to the macroscopic nodule visible on MRI is feasible using an IMRT-IGRT approach with gold makers. This technique allows a perfect initial local control at 3 years with a good tolerance. [Table: see text]

scholarly journals Dose escalation via brachytherapy boost for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy and combined chemotherapy

2017 ◽  
Vol 58 (5) ◽  
pp. 654-660 ◽  
Author(s):  
Hsing-Lung Chao ◽  
Shao-Cheng Liu ◽  
Chih-Cheng Tsao ◽  
Kuen-Tze Lin ◽  
Steve P Lee ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Local Control ◽  
Dose Escalation ◽  
Intensity Modulated Radiation Therapy ◽  
Intracavitary Brachytherapy ◽  
Intensity Modulated ◽  
Brachytherapy Boost ◽  
Chemoradiation Treatment

ABSTRACT To investigate if dose escalation using intracavitary brachytherapy (ICBT) improves local control for nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiation therapy (IMRT) and concurrent chemoradiation treatment (CCRT). We retrospectively analyzed 232 patients with Stage T1–3 N0–3 M0 NPC who underwent definitive IMRT with or without additional ICBT boost between 2002 and 2013. For most of the 124 patients who had ICBT boost, the additional brachytherapy was given as 6 Gy in 2 fractions completed within 1 week after IMRT of 70 Gy. CCRT with or without adjuvant chemotherapy was used for 176 patients, including 88 with and 88 without ICBT boost, respectively. The mean follow-up time was 63.1 months. The 5-year overall survival and local control rates were 81.5% and 91.5%, respectively. ICBT was not associated with local control prediction (P = 0.228). However, in a subgroup analysis, 75 T1 patients with ICBT boost had significantly better local control than the other 71 T1 patients without ICBT boost (98.1% vs 85.9%, P = 0.020), despite having fewer patients who had undergone chemotherapy (60.0% vs 76.1%, P = 0.038). Multivariate analysis showed that both ICBT (P = 0.029) and chemotherapy (P = 0.047) influenced local control for T1 patients. Our study demonstrated that dose escalation with ICBT can improve local control of the primary tumor for NPC patients with T1 disease treated with IMRT, even without chemotherapy.

Impact of Intensity-Modulated Radiation Therapy on Local Control in Primary Soft-Tissue Sarcoma of the Extremity

2008 ◽  
Vol 26 (20) ◽  
pp. 3440-3444 ◽  
Author(s):  
Kaled M. Alektiar ◽  
Murray F. Brennan ◽  
John H. Healey ◽  
Samuel Singer
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Intensity Modulated Radiation Therapy ◽  
Local Control Rate ◽  
Bone Resection ◽  
Close Margin ◽  
Intensity Modulated

Purpose One of the concerns about intensity-modulated radiation therapy (IMRT) is that its tight dose distribution, an advantage in reducing RT morbidity to surrounding normal structures, might compromise tumor coverage. The purpose of this study is to determine if such concern is warranted in soft-tissue sarcoma (STS) of the extremity. Methods Between 02/02 and 05/05, 41 adult patients with primary STS of the extremity were treated with limb-sparing surgery and adjuvant IMRT. The margins were positive/within 1 mm in 21. Tumor size was more than 10 cm in 68% of patients and grade was high in 83%. Preoperative IMRT was given to 7 patients (50 Gy) and postoperative IMRT (median dose, 63 Gy) was given to 34 patients. Complete gross resection including periosteal stripping/bone resection was required in 11, and neurolysis/nerve resection in 24. Results With a median follow-up time of 35 months, two (4.8%) of 41 patients developed local recurrence. The 5-year actuarial local control rate was 94% (95% CI, 86% to 100%). The local control rate was also 94% for patients with negative or positive/close margin. Other prognostic factors such as age, size, and grade did not impact local control either. The 5-year distant control rate was 61% (95% CI, 45% to 76%) and the overall survival rate was 64% (95% CI, 45% to 84%). Conclusion IMRT in STS of the extremity provides excellent local control in a group of patients with high risk features. This suggests that the precision with which IMRT dose is distributed has a beneficiary effect in sparing normal tissue and improving local control.

Salvage radiation therapy after radical prostatectomy with the use of new technologies in radiation oncology

2016 ◽  
Vol 21 (1-2) ◽  
pp. 26-31
Author(s):  
S. I Tkachev ◽  
V. B Matveev ◽  
Petr V. Bulychkin
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
New Technologies ◽  
Treatment Options ◽  
Clinical Recurrence ◽  
Salvage Radiation Therapy ◽  
Prostate Bed ◽  
Grade 3

Introduction: prostate cancer (PCa) is the second cancer after lung one among all males. The main treatmentfor patients with localized prostate cancer is a radical prostatectomy (RP). After RP PCa occurs in patients at the T1-T2 stage - in 25 - 35% of all cases and in patients at the T3 stage - in 33.5 - 66% of all cases. Currently, one of the treatment options for patients with recurrence PCa after RP is a «salvage» radiation therapy. Materials and methods: medical records of 59 patients with PCa recurrence after radical prostatectomy (pT1-3pN0M0) were analyzed. Biochemical recurrence was observed in 25 (42,4%) and clinical recurrence in 34 (57,6%) patients. Radiotherapy have been prescribed to the regional lymphatic nodes to 44,0 Gy of 2,0 Gy each, to the prostate bed to 66,0 Gy of 2,0 Gy each and if the region of the clinical recurrence was identified - to 72 Gy of 2,0 Gy. Treatment was realized on linear electron accelerators using 3D technology radiotherapy: 3DCRT, IMRT, VMAT. Results: all 59 patients were treated by the «salvage» radiotherapy. Median follow-up was 48 months (24-91). Biochemical control w as achieved in 51 (86.4%) patients, locoregional control in 58 (98.3%) patients. No acute and late grade 3 or greater toxicities were observed.

scholarly journals Radiotherapy for patients with locoregional and oligometastatic relapses of prostate cancer after radical prostatectomy

2020 ◽  
Vol 16 (3) ◽  
pp. 102-108
Author(s):  
P. V. Bulychkin ◽  
S. I. Tkachev ◽  
V. B. Matveev ◽  
A. V. Klimov ◽  
F. A. Kossov
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Chemotherapy Treatment ◽  
Salvage Radiation Therapy ◽  
Prostate Bed ◽  
High Incidence ◽  
Solitary Metastases ◽  
Radiotherapy Treatment

Materials and methods. In our study, 21 patients with recurrent prostate cancer after radical prostatectomy and oligometastases were treated by salvage radiation therapy, which included radiotherapy treatment of recurrent tumors, regional pelvic lymph nodes, the prostate bed and stereotactic body radiation therapy to detected solitary metastases.Results. The average follow-up period was 19 ± 3.5 months. At the same time, 12 (57 %) of 21 patients are currently under observation for more than 1 year, and 1 patient for more than 5 years without signs of a biochemical recurrence. The indicator of biochemical control of the disease was 86 % (18 / 21 patients) with an average follow-up period of 19 months.Conclusion. It seems to us that further study of this problem can replace today's palliative standard of treatment for this special category of patients — hormonal and chemotherapy treatment, which has low effectiveness at a high incidence of toxicity.

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