scholarly journals Salvage Reirradiation Options for Locally Recurrent Prostate Cancer: A Systematic Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Jim Zhong ◽  
Finbar Slevin ◽  
Andrew F. Scarsbrook ◽  
Maria Serra ◽  
Ananya Choudhury ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Radiation Therapy ◽  
Dose Rate ◽  
Systematic Reviews ◽  
External Beam Radiation ◽  
Modified Delphi ◽  
Patient Reported ◽  
Gi Toxicity ◽  
Grade 3

BackgroundReirradiation using brachytherapy (BT) and external beam radiation therapy (EBRT) are salvage strategies with locally radiorecurrent prostate cancer. This systematic review describes the oncologic and toxicity outcomes for salvage BT and EBRT [including Stereotactic Body Radiation Therapy (SBRT)].MethodsAn International Prospective Register of Systematic Reviews (PROSPERO) registered (#211875) study was conducted using Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. EMBASE and MEDLINE databases were searched from inception to December 2020. For BT, both low dose rate (LDR) and high dose rate (HDR) BT techniques were included. Two authors independently assessed study quality using the 18-item Modified Delphi technique.ResultsA total of 39 eligible studies comprising 1967 patients were included (28 BT and 11 SBRT). In 35 studies (90%), the design was single centre and/or retrospective and no randomised prospective studies were found. Twelve BT studies used LDR only, 11 HDR only, 4 LDR or HDR and 1 pulsed-dose rate only. All EBRT studies used SBRT exclusively, four with Cyberknife alone and 7 using both Cyberknife and conventional linear accelerator treatments. Median (range) modified Delphi quality score was 15 (6-18). Median (range) follow-up was 47.5 months (13-108) (BT) and 25.4 months (21-44) (SBRT). For the LDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 71% (48-89.5) and 52.5% (20-79). For the HDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 74% (63-89) and 51% (45-65). For the SBRT studies, the median (range) 2-year bRFS for the SBRT group was 54.9% (40-80). Mean (range) acute and late grade≥3 GU toxicity rates for LDR-BT/HDR-BT/SBRT were 7.4%(0-14)/2%(0-14)/2.7%(0-8.7) and 13.6%(0-30)/7.9%(0-21.3%)/2.7%(0-8%). Mean (range) acute and late grade≥3 GI toxicity rates for LDR-BT/HDR-BT/SBRT were 6.5%(0-19)/0%/0.5%(0-4%) and 6.4%(0-20)/0.1%(0-0.9)/0.2%(0-1.5). One third of studies included Patient Reported Outcome Measures (PROMs).ConclusionsSalvage reirradiation of radiorecurrent prostate cancer using HDR-BT or SBRT provides similar biochemical control and acceptable late toxicity. Salvage LDR-BT is associated with higher late GU/GI toxicity. Challenges exist in comparing BT and SBRT from inconsistencies in reporting with missing data, and prospective randomised trials are needed.

Stereotactic body radiotherapy boost toxicity for high and intermediate-risk prostate cancer: Report of a multi-institutional study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 365-365
Author(s):  
Irving D. Kaplan ◽  
Limor Appelbaum ◽  
Nima Aghdam ◽  
Jarad Martin ◽  
Mark Sidhom ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Dose Rate ◽  
Retrospective Cohort ◽  
External Beam Radiation ◽  
High Dose ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Grade 3

365 Background: External beam radiation therapy (EBRT) with androgen suppression (AS) and low dose rate (LDR)brachytherapy boost has been shown to improve biochemical progression free survival in unfavorable intermediate risk and high-risk prostate cancer (PC) compared to EBRT and AS. Excellent rates of local control in locally advanced prostate cancer with EBRT with high dose rate brachytherapy (HDR) boost. Prostate Stereotactic Radiosurgery (SBRT) may be an alternative to brachytherapy in patients with unfavorable intermediate and high-risk PC. Here we report the toxicity of pelvic lymph node/prostate EBRT and SBRT as the radiation boost in a large retrospective cohort. Methods: 473 patients with intermediate or high-risk PC, from the Radiosurgery Society Registry, Beth Israel Deaconess Medical Center, Georgetown University, and 5 Australian centers, were included. Patients received treatment from 3/2004- 9/2018 were the basis of this IRB approved retrospective study. The prostate and pelvis nodes were treated with between 36-50.4 Gy in 1.8/2.0 Gy fractions of radiation therapy EBRT. Patients received a SBRT boost to the prostate. Boost dose was 19-19.5 Gy (range 19-36.25 Gy). 274 and 199 patients presented with unfavorable or high-risk disease. The median follow-up was 33 months (IQR:18-63). Results: 33 deaths of 473 patients occurred in this cohort, 8 of which were caused by PC. There were 13.9% (n=66) acute Grade 1 or 2 GI toxicities (11.8% grade 1, 2.1% grade 2). There were 27.7% (n=131) acute Grade 1 or 2 GU toxicities (19.2% grade 1, 8.5% grade 2). No severe acute GU or GI toxicities were reported. There were 32 (6.8%) Grade 1 and 3 (0.6%) Grade 2 late GI toxicities. There were 9 (1.9%) Grade 3 and 1 (0.2%) Grade 4 late GI toxicities. There were 60 (12.7%) Grade 1 and 23 (4.9%) Grade 2 late GU toxicities. 15 (3.2%) Grade 3, but no Grade 4 late GU toxicity were reported. Conclusions: In this large multi-institutional retrospective cohort SBRT boost to pelvic/prostate EBRT had acceptable acute and late toxicities. The high dose per fraction of SBRT is similar to the dose delivered with HDR. This data raises the hypothesis that SBRT boost should be evaluated in additional clinical trials.

Salvage brachytherapy for locally recurrent prostate cancer following definitive radiation therapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 118-118
Author(s):  
Marisa Kollmeier ◽  
Niyati Harneja ◽  
Mary Lin ◽  
Sean Matthew McBride ◽  
Michael J. Zelefsky
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Urinary Incontinence ◽  
Dose Rate ◽  
Median Time ◽  
Recurrent Prostate Cancer ◽  
Salvage Brachytherapy ◽  
Gi Toxicity ◽  
Locally Recurrent ◽  
Grade 3

118 Background: To report the toxicity and outcomes of patients undergoing salvage brachytherapy for locally recurrent prostate cancer. Methods: Between 4/03 and 4/15, 98 patients with biopsy-proven locally recurrent prostate cancer underwent low dose rate (LDR-125Gy) (n=37) or high dose rate (HDR-32Gy in 4 fractions) (n=61) brachytherapy. The median PSA at relapse was 2.57ng/mL (range 0.43-13.5) with median time to relapse was 6 years (range 0.96-14.4y). Gleason score at relapse was upgraded from initial Gleason score in 67 patients (70%) with 38 patients graded ≥8 at relapse. 44 patients also received hormone therapy (median duration of 17.3 months) pre and post-salvage brachytherapy. Patients were followed q3-6months with PSA and symptom assessment. Acute and late (>90days) genitourinary (GU) and gastrointestinal (GI) toxicity was recorded using CTCAE v 4.0 and International Prostate Symptom Score (IPSS). Nadir+ 2 definition was used for PSA failure. Kaplan-Meier method was used for survival analyses. Results: Median followup is 31 months (range 1-101 mos). Median peak IPSS score was 19 with a median time to peak IPSS of 4 mos. Overall, mean change in IPSS from baseline was +2.4. Acute grade ≥3 GU and GI toxicity occurred in 6% and 0%, respectively. Late grade ≥3 GU and GI toxicity occurred in 6% and 4%, respectively. Six patients (6%) developed late urethral strictures requiring intervention, 3 of whom developed subsequent urinary incontinence. Urinary incontinence requiring pads occurred in 16% (16/98). 1 patient developed gross hematuria requiring irrigation. Rectal bleeding was the most common late GI toxicity (14%); however only 2 patients required intervention. PSA relapse occurred in 26/98 (27%) patients and 14/98 (14%) developed distant metastasis during the followup period. The 3 year PSA RFS, DMFS and OS was 70.1%, 92%, and 90.5%, respectively. Conclusions: Salvage brachytherapy is curative for a significant proportion of patients with locally recurrent prostate cancer following radiation therapy. Urinary symptoms peak at 4 months post-brachytherapy. The rate of moderate to severe GU or GI toxicity is 5-15%. Further efforts to reduce toxicity including focal approaches are ongoing.

Gastrointestinal toxicities following radiation therapy for localized prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 64-64
Author(s):  
G. L. Lu-Yao ◽  
S. Kim ◽  
D. Moore ◽  
W. Shih ◽  
Y. Lin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Proton Therapy ◽  
Background Radiation ◽  
Early Years ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Gi Toxicity ◽  
3D Crt

64 Background: Radiation therapy (RAD) is commonly employed to treat localized prostate cancer; however, representative data regarding treatment related toxicities compared to conservative management (CM) is sparse. Methods: We performed a population-based cohort study, using Medicare claims data linked to the Surveillance, Epidemiology, and End Results data, to evaluate gastrointestinal (GI) toxicities in men aged 65-85 years treated with either primary RAD or CM for T1-T2 prostate cancer diagnosed in 1992-2005. In this study, only GI toxicities requiring interventional procedures occurring after 6 months of cancer diagnosis were included. Competing risk models were used with the following covariates: year of diagnosis, comorbidity, age, tumor stage, cancer grade, hormone use within 1 year of diagnosis, region, race, poverty and marital status. Results: Among 41,859 patients in this study, 28,021 patients received radiation therapy, 19,287 with external beam radiation therapy (EBRT) alone, and 5,138 with brachytherapy alone. The most common GI toxicity was GI bleeding or ulceration. GI toxicity rates were 6.1% after 3D-conformal therapy (3D-CRT), 2.8% after intensity modulated radiation therapy (IMRT), 2.6% after brachytherapy, 8.2% after proton therapy and 1.1% for CM patients. In the multivariate models, RAD group was associated with a higher hazard of GI toxicities (hazard ratio [HR] 4.68; 95% CI, 3, 93-5.58) than CM. Comparing to 3D-CRT, brachytherapy (HR 0.62; 95% CI, 0.51-0.75) and IMRT (HR 0.67; 95% CI, 0.55-0.82) are associated with a lower hazard of GI toxicities, while proton therapy is associated with a higher hazard of GI toxicities (HR 2.15; 95% CI, 1.45-3.17). Conclusions: Radiation therapy is associated with a higher risk of GI toxicities than CM. Among different modalities of radiation therapy, protons therapy is associated with the highest risk of GI toxicities, followed by 3D-CRT, IMRT, and brachytherapy. The increased GI toxicities for patients with proton therapy may reflect a learning curve in the early years. No significant financial relationships to disclose.

scholarly journals Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Matthew Sean Peach ◽  
Timothy N. Showalter ◽  
Nitin Ohri
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Radiation Therapy ◽  
Late Toxicity ◽  
Gastrointestinal Toxicity ◽  
Acute Injury ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Gastrointestinal Injury ◽  
Organ Systems

A small but meaningful percentage of men who are treated with external beam radiation therapy for prostate cancer will develop late gastrointestinal toxicity. While numerous strategies to prevent gastrointestinal injury have been studied, clinical trials concentrating on late toxicity have been difficult to carry out. Identification of subjects at high risk for late gastrointestinal injury could allow toxicity prevention trials to be performed using reasonable sample sizes. Acute radiation therapy toxicity has been shown to predict late toxicity in several organ systems. Late toxicities may occur as a consequential effect of acute injury. In this systematic review of published reports, we found that late gastrointestinal toxicity following prostate radiotherapy seems to be statistically and potentially causally related to acute gastrointestinal morbidity as a consequential effect. We submit that acute gastrointestinal toxicity may be used to identify at-risk patients who may benefit from additional attention for medical interventions and close follow-up to prevent late toxicity. Acute gastrointestinal toxicity could also be explored as a surrogate endpoint for late effects in prospective trials.

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