scholarly journals Acute toxicity of hypofractionated intensitymodulated radiotherapy for prostate cancer

2015 ◽  
Vol 22 (2) ◽  
pp. 76 ◽  
Author(s):  
C.S. Drodge ◽  
O. Boychak ◽  
S. Patel ◽  
N. Usmani ◽  
J. Amanie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Acute Toxicity ◽  
Cancer Patients ◽  
Rectal Wall ◽  
Intensity Modulated Radiotherapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Chief Complaints

BackgroundDose-escalated hypofractionated radiotherapy (hfrt) using intensity-modulated radiotherapy (imrt), with inclusion of the pelvic lymph nodes (plns), plus androgen suppression therapy (ast) in high-risk prostate cancer patients should improve patient outcomes, but acute toxicity could limit its feasibility.MethodsOur single-centre phase ii prospective study enrolled 40 high-risk prostate cancer patients. All patients received hfrt using imrt with daily megavoltagecomputed tomography imaging guidance, with 95% of planning target volumes (ptv68 and ptv50) receiving 68 Gy and 50 Gy (respectively) in 25 daily fractions. The boost volume was targeted to the involved plns and the prostate (minus the urethra plus 3 mm and minus 3 mm from adjacent rectal wall) and totalled up to 75 Gy in 25 fractions. Acute toxicity scores were recorded weekly during and 3 months after radiotherapy (rt) administration.ResultsFor the 37 patients who completed rt and the 3-month follow-up, median age was 65.5 years (range: 50–76 years). Disease was organ-confined (T1c–T2c) in 23 patients (62.1%), and node-positive in 5 patients (13.5%). All patients received long-term ast. Maximum acute genitourinary (gu) and gastrointestinal (gi) toxicity peaked at grade 2 in 6 of 36 evaluated patients (16.6%) and in 4 of 31 evaluated patients (12.9%) respectively. Diarrhea and urinary frequency were the chief complaints. Dose–volume parameters demonstrated no correlation with toxicity. The ptv treatment objectives were met in 36 of the 37 patients.ConclusionsThis hfrt dose-escalation trial in high-risk prostate cancer has demonstrated the feasibility of administering 75 Gy in 25 fractions with minimal acute gi and gu toxicities. Further follow-up will report late toxicities and outcomes.

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]

Phase I trial of total androgen blockade, weekly docetaxel, and image-guided intensity-modulated radiotherapy for localized high-risk prostate adenocarcinoma.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 96-96
Author(s):  
Stephen J. Ramey ◽  
Ali Reza Golshayan ◽  
Thomas E. Keane ◽  
Andrew S. Kraft ◽  
Uzair Bashir Chaudhary ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Intensity Modulated Radiotherapy ◽  
High Dose ◽  
Weekly Docetaxel ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Grade 3

96 Background: High-risk prostate cancer patients have high rates of treatment failure and improved outcomes are needed. Docetaxel has shown efficacy in hormone-resistant prostate cancer and can act as a radiosensitizer. Dose escalation studies with radiation therapy have found improved freedom from failure rates. The addition of androgen deprivation therapy (ADT) improves overall survival. Therefore, this phase I study was designed to find the maximum tolerable dose (MTD) of weekly docetaxel when combined with high-dose image-guided intensity-modulated radiotherapy (IGRT) and ADT in patients with high-risk prostate cancer. Methods: Men with high-risk adenocarcinoma of the prostate (≥T2c, or PSA ≥20ng/ml, or Gleason ≥8) were treated with weekly docetaxel (given at 10-30 mg/m2, increasing by 5 mg/m2until the MTD was reached) concurrently with IGRT of 77.4 Gy in 43 fractions to the prostate and 45 Gy in 25 fractions to the proximal seminal vesicles. ADT consisted of a gonadotropin-releasing hormone agonist (GnRHa) and bicalutamide beginning 2 months before chemoradiation and continuing 2 months concurrently. The GnRHa was then continued for an additional 24 months. Results: 19 patients began combined chemoradiation between April 2006 and December 2010. Median follow-up is 32 months. No dose-limiting toxicities (DLTs) were seen in patients treated with docetaxel doses up to 25 mg/m2. However, at the 30 mg/m2level, 2 of 4 patients experienced DLTs of both grade 3 fatigue and grade 3 upper GI toxicity, indicating the MTD had been exceeded. At last follow-up, 2 patients had died, one from metastatic prostate cancer and the other from heart failure. A second patient demonstrated biochemical failure by the Phoenix criteria at 46 months, giving an actuarial biochemical disease-free survival (bDFS) at 3 years of 94.7%. All patients had ≥grade 2 erectile dysfunction but no other ≥grade 2 long-term toxicities were identified. Conclusions: Weekly docetaxel may be combined with high-dose IGRT and long-term ADT up to a MTD of 25 mg/m2. Long-term side effects with this regimen were minimal, and bDFS rate is encouraging. Clinical trial information: NCT00099086.

scholarly journals Acute toxicity and quality of life in high risk prostate cancer patients: Updated results of randomized hypofractionation trial

2018 ◽  
Vol 23 (4) ◽  
pp. 284-289 ◽  
Author(s):  
Agata Karklelyte ◽  
Konstantinas Povilas Valuckas ◽  
Romas Griskevicius ◽  
Ernestas Janulionis ◽  
Eduardas Aleknavicius
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
High Risk ◽  
Acute Toxicity ◽  
Cancer Patients ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals Long term outcomes between adjuvant radiotherapy and combined radiotherapy with hormonal treatment after radical prostatectomy in high risk prostate cancer

2021 ◽  
Vol 42 (1) ◽  
pp. 7-12
Author(s):  
Chalermchai Kiatbamrungpunt, ◽  
◽  
Chaiyong Nualyong ◽  
Sittiporn Srinualnad ◽  
Sunai Leewansangtong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Combined Treatment ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Objective: To determine the oncological outcome of adjuvant treatment between radiotherapy (RT) alone and combined radiotherapy with androgen deprivation therapy (ADT) in high risk prostate cancer patients after radical prostatectomy (RP). Materials and Methods: All medical records of high risk-prostate cancer patients (including PSA > 20 ng/ml, pT3-pT4 or Gleason score 8-10) who underwent RP in Siriraj Hospital between 2000 and 2016 were retrospectively reviewed. Demo-graphic data, pathological staging, types of adjuvant treatment, time to follow up and time to biochemical recurrence (BCR) were analyzed. Results: Undetectable PSA after RP was achieved in 1009 out of 1221 high risk prostate cancer patients who had been followed up at least 6 months after surgery. Pathological staging pT2, pT3, pT4 and N1 was 23.8%, 73%, 0.8% and 4.7%, respectively. Forty one percent received adjuvant treatment (41 adjuvant RT alone, 74 combined adjuvant RT and ADT, 303 ADT alone). Median follow up time in the adjuvant RT group and combined treatment group was 63.8 months (8.9 - 210.7). BCR rates were 22% (9 of 41) for adjuvant RT and 12.2% (9 of 74) for adjuvant combined treatment. 10-year BCR-free survival in the two groups was 70.2% and 83.8%, respectively. There was no statistical difference between adjuvant RT and adjuvant combined treatment in terms of survival benefit (Hazard Ratio 0.40; p = 0.057). Conclusion: Adjuvant radiotherapy after radical prostatectomy increases long term survival outcomes for high risk prostate cancer patients. This study shows that combined adjuvant RT and ADT may improve BCR-free survival.

Pelvic lymph node recurrence in high-risk prostate cancer following prostate-only radiotherapy

2021 ◽  
pp. 1-5
Author(s):  
Sameed Hussain ◽  
Muhammad Imran Wajid ◽  
Muhammad Omer ◽  
Muhammad Yousuf Khan ◽  
Talha Maqsood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Abstract Introduction: High-risk prostate cancer is the most common presentation at our institute among patients with non-metastatic prostate cancer. Traditionally, pelvic lymph nodes were given a prophylactic dose of radiotherapy while the prostate was given a curative dose of radiation. This study aims to evaluate patterns of failure in patients who had prostate-only radiation at our centre. Materials and Methods: All high-risk prostate cancer patients who underwent radical radiotherapy to prostate only since 2014 were retrospectively analysed. Local T stage, baseline prostate-specific antigen (PSA) and Gleason score were recorded. Bone scan and staging CT scan data were collected. Various dose levels prescribed to prostate were analysed. The follow-up records of these patients were assessed. Patients who failed in pelvic lymph nodes were recorded separately. Overall survival and failure-free survival were calculated using Kaplan–Meier curve. Results: One-hundred five patients fulfilling the inclusion criteria were analysed. Only three patients developed recurrence in pelvic lymph node following prostate-only radiotherapy (PORT). Five year overall survival was 77% while failure-free survival was 64%. Forty patients had a PSA failure after a median follow-up of 62 months. Conclusions: Most high-risk prostate cancer patients who progress following hormone therapy and PORT have metastases outside pelvis. Till further conclusive evidence is available PORT can be considered as a safe option.

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