The role of proton beam therapy for patients with intermediate- and high-risk prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 97-97
Author(s):  
Takeshi Arimura ◽  
Naoaki Kondo ◽  
Kyoko Matsukawa ◽  
Kiyotaka Wada ◽  
Ikumi Kitano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Proton Beam ◽  
Risk Groups ◽  
Proton Beam Therapy ◽  
Clinical Recurrence ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Significant Difference ◽  
Risk Prostate Cancer

97 Background: Although there are many patterns of treatment in localized prostate caner, proton beam therapy has no definite role in them. We aimed to assess the outcomes of proton beam therapy (PBT) alone for patients with intermediate- and high-risk prostate cancer, and to clarify the role of PBT in the treatments. Methods: Between Jan. 2011 and Sep. 2014, 204 patients with intermediate- and high-risk prostate cancer who declined to receive hormonal treatments until biochemical or clinical recurrence were enrolled in the study. All patients were irradiated a 70-78 GyE in 28-39 fractions, and pre-treatment risk groups were classified in accordance with the D’Amico criteria. The 5-year (biochemical or clinical) recurrence-free survival (RFS), late gastrointestinal (GI) and genitourinary (GU) toxicity (NCI-CTCAE ver.4.0) were evaluated. We conducted a survey on sexual quality of life (QOL) every six months to evaluate any long-term damage to the sexual function using the Expanded Prostate Cancer Index Composite (EPIC). Results: The mean age and the follow-up period were 66 (range: 39-86) and 52 months (range: 24-76 months), respectively. The 5-year RFS rates in intermediate- (n = 112) and high- (n = 92) risk groups were 96.9% and 83.4%, respectively. There was a significant difference between the two groups (p = 0.002). The incidence of grade 2+ GI and GU toxicity were 4% and 3%, respectively. We found a significant difference in the GI toxicity between the two radiation protocols of 78GyE/39fractions (n = 6, 11%) and 70GyE/28fractions (n = 0, 0%) (p < 0.01). A 5.8% decrease in average after adjusting for aging was found in sexual summary score in six years after treatment, which was equivalent to aging of three years. Conclusions: Proton beam therapy alone demonstrated favorable results in patients with intermediate- and high-risk prostate cancer. Although more patients and longer follow-up are necessary to confirm the outcomes, these results suggested a hypothesis that proton beam therapy might not require androgen deprivation therapy in the treatment of localized prostate cancer, which could lead to a possibility of preserving of sexual function. Clinical trial information: MPTRC-N2 and N3.

scholarly journals Proton Beam Therapy Alone for Intermediate- or High-Risk Prostate Cancer: An Institutional Prospective Cohort Study

Cancers ◽  
2018 ◽  
Vol 10 (4) ◽  
pp. 116 ◽  
Author(s):  
Takeshi Arimura ◽  
Takashi Yoshiura ◽  
Kyoko Matsukawa ◽  
Naoaki Kondo ◽  
Ikumi Kitano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
High Risk ◽  
Proton Beam ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Proton Beam Therapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals Cost and Toxicity Comparisons of Two IMRT Techniques for Prostate Cancer: A Micro-Costing Study and Weighted Propensity Score Analysis Based on a Prospective Study

2022 ◽  
Vol 11 ◽  
Author(s):  
Ingrid Masson ◽  
Martine Bellanger ◽  
Geneviève Perrocheau ◽  
Marc-André Mahé ◽  
David Azria ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Propensity Score Analysis ◽  
Volumetric Modulated Arc Therapy ◽  
Late Toxicity ◽  
Clinical Effectiveness ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Risk Prostate Cancer ◽  
The Mean

BackgroundIntensity modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) has become the standard treatment for patients with high-risk prostate cancer. Two techniques of rotational IMRT are commonly used in this indication: Volumetric Modulated Arc Therapy (VMAT) and helical tomotherapy (HT). To the best of our knowledge, no study has compared their related costs and clinical effectiveness and/or toxicity in prostate cancer. We aimed to assess differences in costs and toxicity between VMAT and HT in patients with high-risk prostate cancer with pelvic irradiation.Material and MethodsWe used data from the “RCMI pelvis” prospective multicenter study (NCT01325961) including 155 patients. We used a micro-costing methodology to identify cost differences between VMAT and HT. To assess the effects of the two techniques on total actual costs per patient and on toxicity we used stabilized inverse probability of treatment weighting.ResultsThe mean total cost for HT, €2019 3,069 (95% CI, 2,885–3,285) was significantly higher than the mean cost for VMAT €2019 2,544 (95% CI, 2,443–2,651) (p &lt;.0001). The mean ± SD labor and accelerator cost for HT was €2880 (± 583) and €1978 (± 475) for VMAT, with 81 and 76% for accelerator, respectively. Acute GI and GU toxicity were more frequent in VMAT than in HT (p = .021 and p = .042, respectively). Late toxicity no longer differed between the two groups up to 24 months after completion of treatment.ConclusionUse of VMAT was associated with lower costs for IMRT planning and treatment than HT. Similar stabilized long-term toxicity was reported in both groups after higher acute GI and GU toxicity in VMAT. The estimates provided can benefit future modeling work like cost-effectiveness analysis.

Duration of androgen deprivation therapy in high risk prostate cancer: Final results of a randomized phase III trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5008-5008 ◽  
Author(s):  
Abdenour Nabid ◽  
Marie-Pierre Garant ◽  
André-Guy Martin ◽  
Jean-Paul Bahary ◽  
Celine Lemaire ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Androgen Deprivation Therapy ◽  
Cox Regression ◽  
Mixed Linear Model ◽  
Androgen Deprivation ◽  
Phase Iii ◽  
High Risk Prostate Cancer ◽  
Significant Difference ◽  
Risk Prostate Cancer

5008 Background: Long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) is a standard treatment for patients with high-risk prostate cancer (HRPC). However, the optimal duration of ADT is not yet defined. The aim of this randomized trial (Clinical Trials.gov, #NCT00223171) was to compare outcomes of RT combined with either 36 or 18 months of ADT. Methods: Patients with HRPC were randomized to pelvic and prostate RT combined with 36 (arm 1) or 18 months (arm 2) of ADT. Overall survival (OS) and quality of life (QoL) were primary end points. OS rates were compared with Cox Regression model and QoL data were analyzed through mixed linear model. Results: 630 patients were randomized, 310 to arm 1 and 320 to arm 2. With a median follow-up of 9.4 years, 290 patients had died (147 arm 1 vs. 143 arm 2). The 10-year OS rate was 62.4% (95% confidence interval [CI] 56.4%, 67.8%) for arm 1 and 62.0% (95% CI 56.1%, 67.3%) for arm 2 (p = 0.8412) with a global hazard ratio (HR) of 1.024 (95% CI 0.813-1.289, p = 0.8411). QoL analysis showed a significant difference (p < 0.001) in 6 scales and 13 items favoring 18 months ADT with two of them presenting a clinically relevant difference in mean scores of ≥10 points. Conclusions: In HRPC, ADT combined with RT can be safely reduced from 36 to 18 months without compromising outcomes or QoL. 18 months of ADT represents a new standard of care in HRPC. Funded by AstraZeneca Pharmaceuticals Clinical trial information: NCT00223171.

Defining High Risk Prostate Cancer With Risk Groups and Nomograms: Implications for Designing Clinical Trials

2006 ◽  
Vol 176 (6S) ◽  
Author(s):  
Mack Roach ◽  
V. Weinberg ◽  
M. Nash ◽  
H.M. Sandler ◽  
P.W. McLaughlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
High Risk ◽  
Risk Groups ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Single-fraction high-dose-rate (HDR) brachytherapy boost and hypofractionated radiation for intermediate- and high-risk prostate cancer: A report of toxicity from a single center experience.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 112-112
Author(s):  
Claire Arthur ◽  
Nooreen Sarah Alam ◽  
Paula Mandall ◽  
Ric Swindell ◽  
P. Anthony Elliott ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Escalation ◽  
Hdr Brachytherapy ◽  
Single Fraction ◽  
Tumour Control ◽  
High Risk Prostate Cancer ◽  
Significant Difference ◽  
Risk Prostate Cancer

112 Background: Single-fraction HDR brachytherapy offers a highly conformal approach to dose escalation for intermediate and high risk prostate cancer and exploits the apparent low α/β ratio of prostate cancer cells. The potential benefit of improving tumour control must be balanced against the heightened risk of toxicity. We assessed and compared toxicity among patients receiving either 12.5 Gy or 15 Gy as a single fraction HDR boost prior to conformal external beam radiotherapy (EBRT). Methods: Between July 2008 and February 2011, 177 patients received HDR brachytherapy prior to conformal EBRT (37.5 Gy in 15 fractions). 95 patients in the early cohort received 12.5 Gy and 82 patients in the later cohort received 15 Gy. The median patient age at presentation was 67 (range 57 – 77) with a median PSA of 16.0 (range 0.29 – 102), median Gleason score 7 (range 6 – 10), clinical stages T1c to T4 and median baseline IPSS was 8 (range 0 – 27). Prospective patient questionnaires - IPSS, LENT SOMA and EPIC QoL - were completed prior to treatment and at regular intervals following EBRT (6 weeks, 6 monthly thereafter). Results: Both treatment groups had similar median IPSS values at 6 weeks (12.5 Gy = 10, 15 Gy = 11); there was no significant difference in values throughout follow-up. Mean LENT SOMA scores for bladder/urethra toxicity peaked at 6 weeks (12.5 Gy = 0.6, 15 Gy = 0.72) with no trend towards greater reporting of maximum values of ≥ 2 in the 15 Gy cohort. Rectum/bowel mean LENT SOMA scores peaked at 6 weeks (12.5 Gy = 0.30, 15 Gy = 0.39). Although a greater proportion of 15 Gy patients reported a maximum score of ≥ 2 at 6 weeks and 6 months compared with the 12.5 Gy patients, this returned to pre-treatment levels at 12 months. Conclusions: We conclude that dose escalation from 12.5 Gy to 15 Gy delivered in a single HDR fraction is not associated with a clinically significant increase in toxicity. We believe that the reported toxicity is acceptable at this level of dose escalation (2 Gy equivalent = 112 Gy, assuming an α/β ratio of 1.5). Ongoing follow-up is required to ascertain tumour control.

Evaluating the tolerability of a simultaneous focal boost to the gross tumor in prostate SABR: A toxicity and quality-of-life comparison of two prospective trials.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 319-319
Author(s):  
Yasir Alayed ◽  
Melanie Davidson ◽  
William Chu ◽  
Stanley K. Liu ◽  
Chia-Lin Tseng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Important Change ◽  
Phase Ii Trials ◽  
Two Phase ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Significant Difference ◽  
Risk Prostate Cancer

319 Background: Dose-escalated SABR to the whole prostate may be associated with better outcomes, but at a risk of increased toxicity. An alternative approach is to focally boost the dominant intraprostatic lesion (DIL) seen on MRI. We report the toxicity and quality of life (QOL) outcomes of two phase II trials of prostate and pelvic SABR, with or without a simultaneous DIL boost. Methods: The first trial treated patients with high-risk prostate cancer (PCa) to a dose of 40 Gy to the prostate and 25 Gy to the pelvis in 5 fractions. The second trial treated patients with intermediate-risk and high-risk PCa to a dose of 35 Gy to the prostate, 25 Gy to the pelvis, and a DIL boost up to 50 Gy in 5 fractions. Acute toxicities, late toxicities and QOL were assessed. Results: 30 patients were enrolled in each trial. In the focal boost cohort, the median DIL D90% was 48.3 Gy. There was no significant difference in acute grade ≥2 GI or GU toxicity between the two trials, or cumulative worst late GI or GU toxicity up to 24 months. There was no significant difference in QOL domain scores or minimally clinical important change between the two trials. Conclusions: Prostate and pelvic SABR with a simultaneous DIL boost was feasible and did not lead to a significant change in toxicity or QOL when compared to a cohort that did not receive a focal boost. Further follow-up will be required to assess long-term outcomes. Clinical trial information: NCT02911636.

Prostate-specific antigen associates with extensive lymph node invasion in high-risk prostate cancer

2018 ◽  
Vol 104 (4) ◽  
pp. 307-311 ◽  
Author(s):  
Antonio B Porcaro ◽  
Paolo Corsi ◽  
Davide Inverardi ◽  
Marco Sebben ◽  
Alessandro Tafuri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Lymph Node ◽  
High Risk ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
High Risk Prostate Cancer ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
The Difference

Objective: To evaluate clinical predictors of lymph node invasion (LNI) in patients with high-risk prostate cancer undergoing radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). Methods: A contemporary cohort of 116 patients, who underwent ePLND during RP, was retrospectively evaluated. Patients were classified into 3 groups including cases without LNI (group 1), with 1 to 3 positive nodes (group 2; limited LNI), and with more than 3 positive nodes (group 3; extensive LNI). The multinomial logistic regression model (multivariate analysis) evaluated the risk of LNI. Results: Overall, 30 patients (25.9%) had LNI, which was limited in 17 cases (14.7%) and extensive in 13 subjects (11.2%). Median prostate-specific antigen (PSA) was higher in cases with limited (11.4 ng/mL) or extensive (23.5 ng/mL) LNI than cases without (7.3 ng/mL) and the difference was significant ( p <.0001). Median proportion of biopsy-positive cores was higher in limited (0.64) or extensive (0.54) LNI than cases without (0.34) and the difference was significant ( p < .0001). The distribution of other factors did not show any significant difference among the groups. On multivariate analysis, only higher values of PSA significantly affected the odds of extensive LNI when compared to cases without (odds ratio, 1.054; p = .005); PSA showed a fair discrimination power (area under the curve 0.792). Conclusion: PSA was the only independent predictor of extensive LNI and could be an important preoperative factor for stratifying high-risk patients.

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