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

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.

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A dosimetric comparison of ultra-hypofractionated passively scattered proton radiotherapy and stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer

Acta Oncologica ◽

10.3109/0284186x.2014.953260 ◽

2014 ◽

Vol 54 (6) ◽

pp. 825-831 ◽

Cited By ~ 8

Author(s):

Thomas P. Kole ◽

R. Charles Nichols ◽

Song Lei ◽

Binbin Wu ◽

Soon N. Huh ◽

...

Keyword(s):

Prostate Cancer ◽

Stereotactic Body Radiotherapy ◽

Localized Prostate Cancer ◽

Definitive Treatment ◽

Proton Radiotherapy ◽

Dosimetric Comparison ◽

Scattered Proton

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Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries

Strahlentherapie und Onkologie ◽

10.1007/s00066-021-01820-2 ◽

2021 ◽

Author(s):

Mohamed Shelan ◽

Daniel M. Aebersold ◽

Clemens Albrecht ◽

Dirk Böhmer ◽

Michael Flentje ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Oncology ◽

Working Party ◽

Phase Iii ◽

Localized Prostate Cancer ◽

Definitive Treatment ◽

Cancer Society ◽

Fractionation Schedule ◽

German Speaking ◽

Moderate Hypofractionation

Abstract Purpose Various randomized phase III clinical trials have compared moderately hypofractionated to normofractionated radiotherapy (RT). These modalities showed similar effectiveness without major differences in toxicity. This project was conducted by the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society. We aimed to investigate expert opinions on the use of moderately hypofractionated RT as a definitive treatment for localized prostate cancer in German-speaking countries. Methods A 25-item, web-based questionnaire on moderate-hypofractionation RT was prepared by an internal committee. The experts of the DEGRO were asked to complete the questionnaire. Results Fourteen active members of DEGRO completed the questionnaire. The questions described indications for selecting patients eligible to receive moderate hypofractionation based on clinical and pathological factors such as age, urinary symptoms, and risk-group. The questions also collected information on the technical aspects of selection criteria, including the definition of a clinical target volume, the use of imaging, protocols for bladder and rectal filling, the choice of a fractionation schedule, and the use of image guidance. Moreover, the questionnaire collected information on post-treatment surveillance after applying moderately hypofractionated RT. Conclusion Although opinions varied on the use of moderate-hypofractionation RT, the current survey reflected broad agreement on the notion that moderately hypofractionated RT could be considered a standard treatment for localized prostate cancer in German-speaking countries.

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EP-1517 The long-term result of stereotactic body radiotherapy for localized prostate cancer

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)31937-1 ◽

2019 ◽

Vol 133 ◽

pp. S820-S821

Author(s):

Y. Lin ◽

S. Wang

Keyword(s):

Prostate Cancer ◽

Stereotactic Body Radiotherapy ◽

Localized Prostate Cancer ◽

Term Result ◽

Long Term Result

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3 Single shot stereotactic body radiotherapy for localized prostate cancer: Case report

Physica Medica ◽

10.1016/j.ejmp.2018.09.016 ◽

2018 ◽

Vol 56 ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

N. Koutsouvelis ◽

G. Dipasquale ◽

A. Dubouloz ◽

M. Jaccard ◽

R. Miralbell ◽

...

Keyword(s):

Prostate Cancer ◽

Case Report ◽

Stereotactic Body Radiotherapy ◽

Localized Prostate Cancer ◽

Cancer Case ◽

Single Shot ◽

Prostate Cancer Case

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Low Utilization of Androgen Deprivation Therapy Among Men Receiving Stereotactic Body Radiotherapy for Localized Prostate Cancer in the United States

European Urology Oncology ◽

10.1016/j.euo.2020.06.006 ◽

2020 ◽

Author(s):

Trevor J. Royce ◽

Jeffrey M. Switchenko ◽

Chao Zhang ◽

Daniel E. Spratt ◽

Ronald C. Chen ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Androgen Deprivation Therapy ◽

Stereotactic Body Radiotherapy ◽

The United States ◽

Androgen Deprivation ◽

Localized Prostate Cancer

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Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized Prostate Cancer: A Phase III Randomized Controlled Trial

Journal of Clinical Oncology ◽

10.1200/jco.19.01904 ◽

2020 ◽

Vol 38 (6) ◽

pp. 593-601 ◽

Cited By ~ 17

Author(s):

Shawn Malone ◽

Soumyajit Roy ◽

Libni Eapen ◽

Choan E ◽

Robert MacRae ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Phase Iii ◽

Localized Prostate Cancer ◽

Definitive Treatment ◽

Rank Test ◽

Log Rank Test ◽

Significant Difference ◽

Grade 3

PURPOSE Dose-escalated radiotherapy (RT) with androgen-deprivation therapy (ADT) is a standard definitive treatment of localized prostate cancer (LPCa). The optimal sequencing of these therapies is unclear. Our phase III trial compared neoadjuvant versus concurrent initiation of ADT in combination with dose-escalated prostate RT (PRT). PATIENTS AND METHODS Patients with newly diagnosed LPCa with Gleason score ≤ 7, clinical stage T1b to T3a, and prostate-specific antigen < 30 ng/mL were randomly allocated to neoadjuvant and concurrent ADT for 6 months starting 4 months before RT (neoadjuvant group) or concurrent and adjuvant ADT for 6 months starting simultaneously with RT (concurrent group). The primary end point was biochemical relapse-free survival (bRFS). Stratified log-rank test was used to compare bRFS and overall survival (OS). Incidence of grade ≥ 3 late RT-related toxicities was compared by log-rank test. RESULTS Overall, 432 patients were randomly assigned to the neoadjuvant (n = 215) or concurrent group (n = 217). At 10 years, bRFS rates for the two groups were 80.5% and 87.4%, respectively. Ten-year OS rates were 76.4% and 73.7%, respectively. There was no significant difference in bRFS ( P = .10) or OS ( P = .70) between the two groups. Relative to the neoadjuvant group, the hazard ratio for the concurrent group was 0.66 (95% CI, 0.41 to 1.07) for bRFS and 0.94 (95% CI, 0.68 to 1.30) for OS. No significant difference was observed in the 3-year incidence of late RT-related grade ≥ 3 GI (2.5% v 3.9%) or genitourinary toxicity (2.9% v 2.9%). CONCLUSION In our study, there was no statistically significant difference in bRFS between the two treatment groups. Similarly, no difference was seen in OS or late RT-related toxicities. On the basis of these results, both neoadjuvant and concurrent initiations of short-term ADT with dose-escalated PRT are reasonable standards of care for LPCa.

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