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

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.

scholarly journals The feasibility of a dose painting procedure to treat prostate cancer based on mpMR images and hierarchical clustering

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Seyed Masoud Rezaeijo ◽  
Bijan Hashemi ◽  
Bahram Mofid ◽  
Mohsen Bakhshandeh ◽  
Arash Mahdavi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Hierarchical Clustering ◽  
Specific Antigen ◽  
Post Treatment ◽  
Tumor Control ◽  
Agglomerative Clustering ◽  
Dose Painting ◽  
Significant Difference

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.

Stereotactic body radiotherapy for treatment of organ-confined prostate cancer: Efficacy and quality of life at 4 years.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 88-88
Author(s):  
A. J. Katz ◽  
M. Santoro
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Radiation Therapy Oncology Group ◽  
Biochemical Failure ◽  
Free Survival ◽  
Pre Treatment ◽  
Grade 3

88 Background: The purpose of this study is to assess the efficacy and toxicity of stereotactic body radiotherapy for organ confined prostate cancer patients. Methods: Fifty T1cN0M0 prostate carcinoma patients (42 low- and 8 intermediate-risk) received 5 fractions of 7 Gy SBRT with Cyberknife to a total dose of 35 Gy delivered over 5 consecutive days. Mean patient age was 69.5 years and mean pre-treatment PSA was 5.7 ng/mL. All patients received 1500 mg of amifostine intrarectally prior to each SBRT fraction. Patients were treated to the 83%-87% contour line with 5-mm margins added to the gross tumor volume at all borders except for the rectum where a 3-mm margin was added. During treatment, 4 gold fiducial seeds were continuously tracked. Toxicity was assessed using the Radiation Therapy Oncology Group toxicity scale; biochemical failure was assessed by the Phoenix criteria, and quality of life was assessed with the Expanded Prostate Cancer Index Composite Questionnaire (EPIC). Results: At a median follow-up of 48 months (range, 46-53 months) one biochemical failure has occurred. Three patients died of intercurrent disease. The median PSA at 48 months is 0.10 ng/mL (range, 0.01-3.5 ng/mL). At 42 months, 42 of 47 patients had achieved a PSA of 0.5 ng/mL or less. Toxicity has been minimal with no grade 3+ toxicities. Actuarial 48 month rates for grade 2 urinary and rectal toxicity-free survival were 95.5% and 97.8%, respectively. Mean EPIC bowel and urinary quality of life returned to baseline by 18 months and remain at baseline values at 36 months. Of the 36 patients that were potent prior to treatment 29 (80.5%) maintained potency. Conclusions: At 48 months median follow-up the promising biochemical control, minimal toxicity and the promising potency preservation rates are highly encouraging. [Table: see text]

scholarly journals Bleeding Risk Following Stereotactic Body Radiation Therapy for Localized Prostate Cancer in Men on Baseline Anticoagulant or Antiplatelet Therapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Abigail Pepin ◽  
Sarthak Shah ◽  
Monica Pernia ◽  
Siyuan Lei ◽  
Marilyn Ayoob ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Median Time ◽  
Bleeding Risk ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Antiplatelet Medication ◽  
Before And After

PurposePatients on anticoagulant/antiplatelet medications are at a high risk of bleeding following external beam radiation therapy for localized prostate cancer. SBRT may reduce the bleeding risk by decreasing the volume of bladder/rectum receiving high doses. This retrospective study sought to evaluate the rates of hematuria and hematochezia following SBRT in these patients.MethodsLocalized prostate cancer patients treated with SBRT from 2007 to 2017 on at least one anticoagulant/antiplatelet at baseline were included. The minimum follow-up was 3 years with a median follow-up of 72 months. Patients who had a rectal spacer placed prior to SBRT were excluded. Radiotherapy was delivered in 5 fractions to a dose of 35 Gy or 36.25 Gy utilizing the CyberKnife system. Hematuria and hematochezia were prospectively assessed before and after treatment using the Expanded Prostate Cancer Index Composite (EPIC-26). Toxicities were scored using the CTCAE v4. Cystoscopy and colonoscopy findings were retrospectively reviewed.ResultsForty-four men with a median age of 72 years with a history of taking at least one anticoagulant and/or antiplatelet medication received SBRT. Warfarin (46%), clopidogrel (34%) and rivaroxaban (9%) were the most common medications. Overall, 18.2% experienced hematuria with a median time of 10.5 months post-SBRT. Altogether, 38.6% experienced hematochezia with a median time of 6 months post-SBRT. ≥ Grade 2 hematuria and hematochezia occurred in 4.6% and 2.5%, respectively. One patient required bladder neck fulguration and one patient underwent rectal cauterization for multiple non-confluent telangiectasia. There were no grade 4 or 5 toxicities. Cystoscopy revealed bladder cancer (40%) and benign prostatic bleeding (40%) as the most common hematuria etiology. Colonoscopy demonstrated hemorrhoids (54.5%) and radiation proctitis (9.1%) as the main causes of hematochezia. There was no significant change from the mean baseline EPIC-26 hematuria and hematochezia scores at any point during follow up.ConclusionIn patients with baseline anticoagulant usage, moderate dose prostate SBRT was well tolerated without rectal spacing. High grade bleeding toxicities were uncommon and resolved with time. Baseline anticoagulation usage should not be considered a contraindication to prostate SBRT.

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 Ozone Therapy in the Management of Persistent Radiation-Induced Rectal Bleeding in Prostate Cancer Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Bernardino Clavo ◽  
Norberto Santana-Rodriguez ◽  
Pedro Llontop ◽  
Dominga Gutierrez ◽  
Daniel Ceballos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Rectal Bleeding ◽  
Ozone Therapy ◽  
Serious Adverse Events ◽  
Before And After ◽  
Radiation Induced ◽  
Grade 3 ◽  
To Receive

Introduction. Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options. We present our experience with ozone therapy in the management of such refractory rectal bleeding.Methods. Patients (n=12) previously irradiated for prostate cancer with persistent or severe rectal bleeding without response to conventional treatment were enrolled to receive ozone therapy via rectal insufflations and/or topical application of ozonized-oil. Ten (83%) patients had Grade 3 or Grade 4 toxicity. Median follow-up after ozone therapy was 104 months (range: 52–119).Results. Following ozone therapy, the median grade of toxicity improved from 3 to 1 (p<0.001) and the number of endoscopy treatments from 37 to 4 (p=0.032). Hemoglobin levels changed from 11.1 (7–14) g/dL to 13 (10–15) g/dL, before and after ozone therapy, respectively (p=0.008). Ozone therapy was well tolerated and no adverse effects were noted, except soft and temporary flatulence for some hours after each session.Conclusions. Ozone therapy was effective in radiation-induced rectal bleeding in prostate cancer patients without serious adverse events. It proved useful in the management of rectal bleeding and merits further evaluation.

scholarly journals Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Simon Kirste ◽  
Stephanie G. C. Kroeze ◽  
Christoph Henkenberens ◽  
Nina-Sophie Schmidt-Hegemann ◽  
Marco M. E. Vogel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Multicenter Study ◽  
Recurrent Prostate Cancer ◽  
Ct Guided ◽  
Prostate Bed ◽  
Psma Pet ◽  
Pet Ct ◽  
Grade 3 ◽  
Retrospective Multicenter Study

BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study.MethodsData of 394 patients with oligo-recurrent 68Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p &lt;0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone.ConclusionsIn this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.

scholarly journals Moderately Hypofractionated Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost for Prostate Cancer: Five-Year Toxicity Results from a Prospective Phase I/II Trial

2020 ◽  
Author(s):  
Anthony Ricco ◽  
Nitai Mukhopadhyay ◽  
Xiaoyan Deng ◽  
Diane Holdford ◽  
Vicki Skinner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Phase I ◽  
Intensity Modulated Radiation Therapy ◽  
Prevalence Rates ◽  
Intensity Modulated ◽  
Integrated Boost ◽  
Grade 3 ◽  
Moderate Hypofractionation

Abstract Background In this phase I/II trial, five-year physician-assessed toxicity and patient reported quality of life data is reported for patients undergoing moderately hypofractionated intensity modulated radiation therapy (IMRT) for prostate cancer using a simultaneous integrated boost (SIB) and pelvic lymph node (LN) coverage. Materials and Methods Patients with T1-T2 localized prostate cancer were prospectively enrolled, receiving risk group based coverage of prostate +/- seminal vesicles (SVs) +/- pelvic lymph nodes (LNs). Low risk (LR) received 69.6 Gy/29 fractions to the prostate, while intermediate risk (IR) and high risk (HR) patients received 72Gy/30fx to the prostate and 54Gy/30fx to the SVs. If predicted risk of LN involvement > 15%, 50.4Gy/30fx was delivered to pelvic LNs. Androgen deprivation therapy was given to IR and HR patients. Results There were 55 patients enrolled and 49 patients evaluable at a median follow up of 60 months. Included were 11 (20%) LR, 23 (41.8%) IR, and 21 (38.2%) HR patients. Pelvic LN treatment was given in 25 patients (51%). Prevalence rates of late grade 2 GI toxicity at 1, 3, and 5 years was 5.8%, 3.9%, and 5.8% respectively, with no grade 3 events. Prevalence rates of late grade 2 GU toxicity at 1, 3, and 5 years rates were 15.4%, 7.7%, and 13.5% respectively, with three grade 3 events (5.8%). The biochemical relapse free survival at 5 years was 88.3%. There were no local, regional, or distant failures, with all patients still alive at last follow up. Conclusions Moderate hypofractionation of localized prostate cancer utilizing a SIB technique and LN coverage produces tolerable acute/late toxicity. Given equivalent efficacy between moderate hypofractionation schedules, the optimal regimen will be determined by long-term toxicity reported from both the physician and patient perspective.

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

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.

Long-term clinical and toxicity outcomes of hypofractionated intensity-modulated radiation therapy for clinically localized prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 49-49
Author(s):  
Rupesh Kotecha ◽  
Michael A. Weller ◽  
Gaurav Marwaha ◽  
Jason Hearn ◽  
Patrick Kupelian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Conventional Fractionation ◽  
Gi Toxicity ◽  
Grade 3

49 Background: As an alternative to dose-escalated conventionally fractionated radiotherapy, hypofractionation capitalizes on the unique radiobiology of prostate cancer cells. This study reports the long-term clinical outcomes and late treatment-related toxicities in patients with clinically localized prostate adenocarcinoma treated with hypofractionated radiation therapy at a single tertiary-care institution. Methods: Between 1996 and 2008, 822 patients were treated with hypofractionated intensity modulated radiation therapy (IMRT) (70 Gy in 2.5 Gy/fraction) directed to the prostate gland with or without coverage of the seminal vesicles over a 5.5 week period. Actuarial rates of biochemical relapse free survival by the nadir + 2 definition (bRFS), distant metastasis free survival (DMFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity outcomes were available and measured according to the National Cancer Institute Common Toxicity Criteria (v3) in 773 (94%) of the patients. Results: The median follow-up was 8.5 years (range: 0-14.2 years). The overall 10-year bRFS, DMFS, and OS rates were 69.6%, 86.4%, and 71.7%, respectively. By National Comprehensive Cancer Network (NCCN) low-, intermediate-, and high-risk groups, the 10-year bRFS rates were 86.9%, 74.1%, and 41.3%, respectively. The rate of grade 2 or worse late genitourinary (GU) and gastrointestinal (GI) toxicity rates were 17.2% and 5.6 %. Only 1.4% of patients experienced late equal to or greater than grade 3 GU toxicity and 1.0% experienced late greater than or equal to grade 3 GI toxicity. Of those who had any toxicity during the follow-up period, 47% and 65% of patients experienced resolution or improvement in their GU and GI symptoms, respectively. Conclusions: Hypofractionated IMRT for localized prostate cancer provides excellent long-term relapse-free survival rates that are comparable to historical studies using conventional fractionation. With modern IMRT and image guidance, HFRT has an acceptably low incidence of late GU and GI toxicities, and appears to be a suitable treatment alternative to conventional fractionation.

Sign in / Sign up

Export Citation Format

Share Document