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 <.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.

Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiotherapy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 47-47
Author(s):  
Sergio Faria ◽  
Russel RUO ◽  
Fabio Cury ◽  
Marie Duclos ◽  
Luis Souhami
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Target Volume ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Risk Prostate Cancer

47 Background: Two recent large randomized trials confirm that 60Gy in 20 fractions is an effective regimen compared to conventionally fractionated escalated doses in localized prostate cancer. However, in these two trials the prostate was the only target volume irradiated. The purpose of this study is to report acute and late toxicity in patients with high-risk prostate cancer treated with the same moderate hypofractionated radiotherapy (HypoRT) to two target volumes at the same time: prostate and pelvic nodes. Methods: High-risk prostate cancer patients received 60Gy/20 fractions (4 weeks) to the prostate while the pelvic-nodes received 44Gy delivered with intensity modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) during the same 20 fractions. ADT started 2-3 months before HypoRT. Acute and late toxicity were prospectively assessed according to CTCAE.v3. Results: 105 patients treated between September/2010 and November/2013 were reviewed. Median follow up is 41 months. Median ADT duration was 18 months. Acute grade > 2 gastrointestinal (GI) or genitourinary (GU) toxicity was seen in 17% and 17% respectively, with only 1 and 3 patients experiencing GI and GU acute grade 3 toxicity, respectively. The worst grade > 2 late GI and GU toxicity was seen in 7% and 8% of patients, respectively. There was no grade 4-5 toxicity. At the last follow-up, the rates of grade = 2 GI and GU toxicity were 5% and 3%, respectively with no residual grade > 3 toxicity. The 48-month actuarial progression free survival is 82%. We found only 8 publications on this topic, all delivered the HypoRT in 25-28 fractions, but only one has long-term toxicity. Conclusions: ADT with HypoRT delivered with IMRT and SIB to the prostate (60Gy) and pelvic nodes (44Gy) in 20 fractions is feasible and well tolerated after 41months of median follow-up. Our approach shortens treatment duration, is convenient and its results support a needed randomized trial. Clinical trial information: NCT02107287.

Early radiation response between GnRH agonist versus antagonist combined with radiotherapy in high-risk prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 97-97 ◽  
Author(s):  
Gilles Crehange ◽  
Alexandre Cochet ◽  
Adele Cueff ◽  
Etienne Martin ◽  
Philippe Maingon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gnrh Agonist ◽  
Peripheral Zone ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Central Gland ◽  
The Mean ◽  
Early Radiation ◽  
Pathway Inhibition

97 Background: Degarelix, a GnRH antagonist, provides a very rapid and sustained testosterone suppression alongside with the VEGF pathway inhibition through the FSH receptors. This raises the question as to whether high risk localized prostate cancer (HRPCa) could respond differently to radiotherapy (RT) + Degarelix when compared with RT + GnRH agonist. Methods: 30 HRPCa patients were treated with exclusive RT combined with a GnRH agonist (n= 19) or Degarelix (n= 11). MRSI was performed before the start of hormones and 3 months after the end of RT. Choline (tumor metabolism) and citrate (healthy prostate metabolism) were quantified with MR spectroscopy and the slopes of gadolinium wash-in (SWI) and wash-out (SWO) were assessed in the peripheral zone (PZ), the central gland (CG) and the tumor with DCE-MRI. Results: At baseline, 14 patients had a T3 (46.7%) and 9 patients (30%) had a GS≥8. The median PSA values were 12.7 ng/mL [3.0-153.7] for agonists and 14.0 ng/mL [6.8-23.6] for Degarelix (p=ns). The mean prostate volumes (Pvol) were 32.0±15.5 mL for agonist and 33.0±10.0 mL for Degarelix (p=ns). The median dose of RT was 78Gy in each group, [72.0-80.0] with agonist and [70.2-80.0] with Degarelix. There were no significant differences in choline, citrate, SWI and SWO in the PZ, the CG and the tumor. At 3 months, Pvol were 20.8±8.0 mL for agonist and 21.4±6.2 mL for Degarelix (p=0.71) and the mean and median PSA values for agonist vs Degarelix were 0.5±0.8 ng/mL vs 0.1±0.1 ng/mL and 0.1 ng/mL [0.02-2.8] vs 0.1 ng/mL [0.005-0.3], respectively. Citrate was significantly decreased with Degarelix in the PZ (4.3±4.4 vs 1.1±0.8, p=0.0142), in the CG (4.0±4.0 vs 1.1±1.0, p=0.009) but not in the tumor (2.5±2.6 vs 1.7±1.9, p=0.23). Choline concentrations were similar between both groups in the PZ, the CG and the tumor. There was a trend towards a lower contrast uptake in the tumor with Degarelix (mean SWI and SWO: 134.6±56.2 s-1 vs 104.1±36.3 s-1, p=0.13 and 259.6±103.1 s-1 vs 306.1±70.4 s-1, p=0.15). Conclusions: Degarelix combined with RT offers a significant early, more profound metabolic atrophy in the prostate, but not in the tumor. There is a trend towards a lower tumor vascularization with Degarelix compared with GnRH agonists.

Stereotactic pelvic radiotherapy with HDR boost for dose escalation in intermediate and high-risk prostate cancer (SPARE): Efficacy, survival, and late toxicity outcomes.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 328-328
Author(s):  
Andrew Loblaw ◽  
Bindu Musunuru ◽  
Patrick Cheung ◽  
Danny Vesprini ◽  
Stanley K. Liu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Treatment Protocol ◽  
Late Toxicity ◽  
Hdr Brachytherapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost

328 Background: The ASCO/CCO guidelines recommend brachytherapy boost for all eligible intermediate- or high-risk localized prostate cancer patients. We present efficacy, survival and late toxicity outcomes in patients treated on a prospective, single institutional protocol of MRI dose painted HDR brachytherapy boost (HDR-BT) followed by pelvic stereotactic body radiotherapy (SBRT) and androgen deprivation therapy (ADT). Methods: A phase I/II study was performed where intermediate (IR) or high-risk (HR) prostate cancer patients received HDR-BT 15Gy x 1 to the prostate and up to 22.5Gy to the MRI nodule and followed by gantry-based SBRT 25Gy in 5 weekly fractions delivered to pelvis, seminal vesicles and prostate. ADT was used for 6-18 months. CTCAEv3 was used to assess toxicities and was captured q6months x 5 years. Biochemical failure (BF; nadir + 2 definition), nadir PSA, proportion of patients with PSA < 0.4 ng/ml at 4 years (4yPSARR), incidence of salvage therapy, cause specific survival and overall survival were calculated. Day 0 was HDR-BT date for all time-to-event analyses. Results: Thirty-two patients (NCCN 3% favorable IR, 47% unfavorable IR and 50% HR) completed the planned treatment with a median follow-up of 50 months; 31 of these had an MRI nodule. Four patients had BF with actuarial 4-year BF rate of 11.5%; 3 of these received salvage ADT. Median nPSA was 0.02 ng/ml; 4yPSARR was 68.8%. One patient died (of prostate cancer) at 45 months. For late toxicities, grade 1, 2 and 3+ GU and GI toxicities were: 40.6%, 37.5%, 3% and 28.1%, 0%, 0%, respectively. Conclusions: This novel treatment protocol incorporating MRI-dose painted HDR brachytherapy boost and SBRT pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible, effective and well tolerated. Clinical trial information: 12345678. [Table: see text]

scholarly journals Hypofractionated External Beam Irradiation with Single HDR Iridium 192 Boost in the Treatment of intermediate and High Risk Prostate Cancer Patients Initial acute and late side effects

2020 ◽  
Vol 5 (10) ◽  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Late Toxicity ◽  
External Beam ◽  
Beam Irradiation ◽  
External Beam Irradiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Iridium 192 ◽  
Gi Toxicity

Purpose: Dose escalation has been shown to improve biochemical outcome in the treatment of prostate cancer. The use of precision radiotherapy whether using IMRT, proton’s or other appropriate means have been utilized in an effort to reduce side effects while engaging in dose escalation. However, it is well known that best way to ensure precision delivery of radiation is with the use of brachytherapy. In prostate cancer the use of HDR brachytherapy exploits the low α/β ratios. We sought to evaluate our combination of moderate hypofractionated external beam irradiation with a single HDR boost in terms of acute/late toxicity in patients with intermediate and high risk prostate cancer. Method: 69 patients whose age range from 49 to 83 (med = 69 y.o.) years old were offered treatment utilizing the combination of moderate hypofractionated external beam irradiation and single HDR boost. The external beam irradiation consists of 17 fractions of 250 cGy per fraction, which using BED evaluation most closely approximated our previous more conventionally delivered external beam (23 fractions/200 cGy per fraction) irradiation in this setting. All patients were treated with either 3D conformal or IMRT; within 2 weeks of completion of external beam irradiation a single 1500 cGy iridium 192 implant was delivered. Our dose constraints have been previously published but our stated goal was to delivered 98% of the dose to the prostate treatment volume identified by ultrasound. 29 patients received ADT at the discretion of the treating Urology team. Follow up has been maintained on all patients and has ranged from 11 to 53 months (median 37 months). Results: Assessment of acute / late toxicity was assessed using the RTOG/EORTC criteria. Overall 36/69 (52%) developed ACUTE GI toxicity. 49% developed Gr I/II while two patients developed Gr III. 14.5% reported late GI toxicity, all were GR I / II. Without surprise 98% reported acute GU toxicity. Of these 67/69 had Gr I/II with a single patient reporting GR III. However, after 6 months only 8 (11.5%) had persistent GR I/II issues. An additional patient went on to develop GR III toxicity. Conclusion: While further follow up will be required before definitive statements can be made regarding the oncologic effectiveness of this treatment combination, the early toxicity profiles are very encouraging. We continue to offer this treatment regimen for select intermediate/high risk prostate cancer patients.

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