PACE Study. Hypofractionation 17/12/2014. Traditional Model of Fractionation 200 Response. What s the fraction sensitivity of prostate cancer?
|
|
- Madlyn Pearson
- 5 years ago
- Views:
Transcription
1 0 0 17/12/ Outline of today s talk PACE Study Background rationale for PACE? Dr Nicholas van As A bit about technology. What is PACE? How can I get involved? London: 1 December Hypofractionation Traditional Model of Fractionation 200 Response 150 Late adverse effects α/β<10gy 100 Tumour control α/β 10Gy Fraction size (Gy) Courtesy of Prof.John Yarnold New Model of Tumour Fractionation 200 Response 150 Breast and prostate cancer α/β<10gy What s the fraction sensitivity of prostate cancer? Other tumours α/β 10Gy Fraction size (Gy) Courtesy of Prof.John Yarnold 1
2 Gy in 39 fractions Gy in 5 fractions BED if α/β ratio = 5 BED if α/β ratio = 4 BED if α/β ratio = 3 BED if α/β ratio = 2.7 BED if α/β ratio = Gy 117 Gy 130 Gy 135 Gy 182 Gy 88 Gy 101 Gy 123Gy 134 Gy 211 Gy Is using hypofrctionation, dose escalation by stealth? Radiation dose response trials radiotherapy Dose 1 prostate cancer (usuallyt1b T4N0M0) randomize no. patients radiotherapy Dose 2 Prostate cancer dose escalation trials Prostate cancer dose escalation trials Institute no pts dose comparisonlhrha MD Anderson US vs 78Gy ICR/RMH UK vs 74 Gy ± MRC RT01 UK vs 74 Gy ± Netherlands NL vs 78Gy ± FNC LCC F vs 78Gy Mass/Loma Linda US vs 78Gy RTOG US vs 78Gy Netherlands - Photons Netherlands - Photons Peeters et al 2006 Prostate cancer dose escalation trials 2
3 St. Thomas Hospital; 1991 (UK)( ) Radical external beam radiotherapy for localised carcinoma of the prostate using a hypofractionation technique Retrospective 232 patients, clinically localized PCA. RT 36/6 Conclusion: Comparable results to other series, early and late morbidity acceptable Collins CD, Clin Oncol (R Coll Radiol) May;3(3): Christie Hospital, UK; 2009 ( ) Hypofractionated conformal radiotherapy in carcinoma of the prostate: five-year outcome analysis Retrospective. 705 men with T1-T4N0 PCA, 4F conformal RT dose 3.13 Gy/fx. Conclusion: Similar tumor control and toxicity to standard Gy Livsey JE, Int J Radiat Oncol Biol Phys Dec 1;57(5): Randomised evidence A Prospective Phase III Randomized Trial of Hypofractionation Versus Conventional Fractionation in Patients with High-Risk Prostate Cancer 80/40 (2 Gy/fx) vs 62/20 (3.1 Gy/fx) 3-year bpfs conventional 79% vs hypofx 87% Conclusion: Hypofractionated schedule superior for biochemical control, comparable for late toxicity CHHiP : Phase III Trial of Conventional or Hypofractionated High Dose intensity Modulated Radiotherapy in Prostate Cancer Conventional 74Gy 37F 7.4w Hypofractionated 60Gy 20F 4w Hypofractionated 57Gy 19F 3.8w Part 1 Pilot randomised phase I : 2 centres (n=150) Part 2 Preliminary phase III study : 6 centres (n=450) Part 3 Full Phase III trial : 20 centres (n=3000) Arcangeli G, Int J Radiat Oncol Biol Phys Jan 2. [Epub ahead of print] Evidence for profound hypofractionation Randomised trials 3
4 19 20 Phase III study of HYPOfractionated RadioTherapy of intermediate risk localised Prostate Cancer Fractionation schedule and treatment durations: Conventional arm: 39 fractions of 2.0 Gy, = 78.0 Gy. Non randomised data Hypofractionated arm: radiotherapy is given working-days with 7 fractions of 6.1 Gy, = 42.7 Gy. Prof Anders Widmark Stereotactic Body Radiotherapy for Intermediate-risk Organ-confined Prostate Cancer: Interim Toxicity and Quality of Life Outcomes from a Multi-Institutional Study Robert Meier, MD Swedish Cancer Institute, Seattle WA I. Kaplan 2, A. Beckman 3, G. Henning 4, S. Woodhouse 5, S. Williamson 6, N. Mohideen 7, D. Herold 8, C. Cotrutz 1, M. Sanda 2 2 Beth Israel Deaconess Medical Center, Boston, MA 3 Central Baptist Hospital, Lexington, KY 4 St. Joseph Mercy Hospital System, Ypsilanti, MI 5 Community Cancer Center, Normal, IL 6 Capital Health System, Trenton, NJ 7 Northwest Community Hospital, Arlington Heights, IL 8 Jupiter Medical Center, Jupiter, FL 129 patients enrolled December 2007 through April centers Follow up 2 4½ yrs Median 36 months Central pathology review Data courtesy of Bob Meier Age (yrs) Clinical Stage Initial PSA (ng/ml) Gleason Score Prostate Vol (cc) Patient Characteristics Mean 69 Range T1a 0 T1b 2 (2%) T1c 100 (76%) T2a 19 (15%) T2b 8 (6%) Mean 6.49 Range (26%) (54%) (20%) Mean 42 Range Data courtesy of Bob Meier Data courtesy of Bob Meier 4
5 Median PSA (ng/ml) 17/12/2014 PSA Response # Pts (129) (122) (114) (72) (17) Months after Treatment (# pts) SBRT for Localized Prostate Cancer: 5 year outcomes Debra Freeman and Christopher King Data courtesy of Bob Meier Results 43 pts.with minimum 5 yr. follow up 5 yr. biochemical progression-free survival of 92.7% Mean post-treatment PSA = biochemical failures (33 mos, 37 mos, 42 mos); all biopsy-confirmed Toxicity 30 Results No grade 3 rectal toxicity One grade 3 urinary toxicity (dysuria), following repeated instrumentation No incontinence reported ED rate 18-48% King, et al, have reported pooled data from a consortium of institutions treating with the Cyberknife system 1100 patients with a median follow up of 36 months Biochemical relapse free survival (brfs) at 5 years was 95%, 84%, and 81% for low, intermediate, and high risk disease, respectively 5
6 Prostate SBRT 32 Good outcomes PSA and toxicity Technology But without randomisation, where is the evidence that this is equivalent to conventionally fractionated IMRT? 34 Arc therapy RapidArc VMAT 35 6
7 38 CyberKnife Question 1: PACE Is SBRT equivalent to surgery for men with localised prostate cancer? 7
8 Question 2 44 PACE Study Overview Study Scheme Is SBRT as good, or better, than current standard radiotherapy regimens? Early Stage Prostate Cancer Surgical Consideration Yes No Randomize n=858 Randomize n=858 Laparoscopic prostatectomy SBRT 36.25Gy/5# SBRT 36.25Gy/5# Conventional IGRT (78Gy/39#) Study treatments Pace Study Objectives Prostatectomy: Laparoscopic or robot-assisted laparoscopic Conventional radiotherapy: Image-guided (fiducials) IMRT 78Gy/39# daily No androgen deprivation therapy SBRT: Robotic or gantry-based 36.25Gy/5# daily or alternate daily No androgen deprivation therapy Primary objectives: To determine whether prostate SBRT is noninferior to laparoscopic prostatectomy. To determine whether prostate SBRT is noninferior to conventional radiotherapy (imageguided IMRT). Primary end-point: biochemical progression-free survival at 5 years. 47 Pace Study Objectives Pace Study Inclusion Criteria Secondary objective: To determine the relative benefits of prostatectomy, conventional radiotherapy and SBRT, with respect to: local failure distant failure disease-free survival disease-specific survival overall survival toxicity quality of life (generic and organ specific domains) Low and intermediate risk organ confined prostate cancer Clinical and MRI stage T1c T2c, N0-X, M0-X Gleason score 3+4 PSA 20 ng/ml (completed within 60 days of registration) Histological confirmation of prostate adenocarcinoma, min 10 biopsy core WHO performance status 0 2 Prostate volume 90 cc Ability of the research subject to understand and the willingness to sign a written informed consent document 8
9 Pace Study Exclusion Criteria Recruitment Clinical stage T3 or greater Gleason score 4+3 Prior pelvic radiotherapy Prior androgen deprivation therapy Prior treatment for prostate cancer (active surveillance ok) Life expectancy < 5 years Previous malignancy in last five years except BCC or SCC skin Currently 160 patients have been recruited by two UK centres. Experience has been that patients are keen to participate in this study and accept randomisation. Recruitment is lower than anticipated at this point due to delays in sponsorship transfer from Accuray inc. to Royal Marsden. Sponsorship is now resolved, and recuitment is expected to complete in early 2017; at least 20 centres in the UK and internationally are keen to participate. Adverse Events and Quality of Life Assessment Pace Study Quality Assurance Adverse Events Grading CTCAEv4 and RTOG scales International Prostate Symptom Score (IPSS) International Index of Erectile Function (IIEF) Vaizey patient questionnaire to assess bowel function EPIC patient questionnaire to assess urinary, bowel, sexual function Surgery QA minimum number of procedures per year >20 data on surgical margin positivity and postoperative complications SBRT and RT Calibration, daily and intermittent QA performed as per local guidelines Approved by the Physics Chair Planning QA Benchmark Study first patient for each treatment allocation pre-treatment one patient per year post-treatment Data management and results 54 Data management and results Trial now sponsored by Hospital NHS Foundation Trust Unrestricted grant provided by Accuray inc. All the data will be analysed by the Clinical Trials Unit of the Institute for Cancer Research, UK IDMC (independent data monitoring committee) Prof Søren Bentzen Prof Joe O Sulivan Dr TSC Raj (Trial Persad steering committee) Prof Anthony Zietman Prof Mark Emberton Dr Ann Henry Prof Gert De Meerler Dr John Norrie 9
10 55 56 Contacts Chief Investigator: Dr Nicholas van As Research fellow: Dr Daniel Henderson Thank you 10
CyberKnife SBRT for Prostate Cancer
CyberKnife SBRT for Prostate Cancer Robert Meier, MD Swedish Radiosurgery Center Swedish Cancer Institute Seattle, WA 2017 ESTRO Meeting, Vienna Austria 5-year safety, efficacy & quality of life outcomes
More informationPhase II study of FFF-SBRT in 5 fractions for low and intermediate risk prostate cancer
Phase II study of FFF-SBRT in 5 fractions for low and intermediate risk prostate cancer Ciro Franzese, G D Agostino, E Clerici, E Villa, A Tozzi, T Comito, C Iftode, AM Ascolese, F De Rose, S Pentimalli,
More informationProstate Cancer Appraisal Addendum: Stereotactic Body Radiation Therapy (SBRT)
Prostate Cancer Appraisal Addendum: Stereotactic Body Radiation Therapy (SBRT) The Institute for Clinical and Economic Review (ICER) has published appraisals on multiple management options for clinically-localized,
More informationUniversity of California, Los Angeles, Los Angeles, CA, 2 FROS Radiation Oncology and CyberKnife Center, Flushing, NY, 3
Long-Term Outcomes of Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Adenocarcinoma: A Multi-Institutional Consortium Study A. U. Kishan 1, A. Katz 2, C. A. Mantz 3, F. I.
More informationWould SBRT Hypofractionated Approach Be as Good? Then Why Bother With Brachytherapy?
Would SBRT Hypofractionated Approach Be as Good? Then Why Bother With Brachytherapy? Yasuo Yoshioka, MD Department of Radiation Oncology Osaka University Graduate School of Medicine Osaka, Japan Disclosure
More informationExternal Beam Radiation Therapy for Low/Intermediate Risk Prostate Cancer
External Beam Therapy for Low/Intermediate Risk Prostate Cancer Jeff Michalski, M.D. The Carlos A. Perez Distinguished Professor of Department of and Siteman Cancer Center Learning Objectives Understand
More informationHigh Risk Localized Prostate Cancer Treatment Should Start with RT
High Risk Localized Prostate Cancer Treatment Should Start with RT Jason A. Efstathiou, M.D., D.Phil. Assistant Professor of Radiation Oncology Massachusetts General Hospital Harvard Medical School 10
More informationLinac Based SBRT for Low-intermediate Risk Prostate Cancer in 5 Fractions: Preliminary Report of a Phase II Study with FFF Delivery
Linac Based SBRT for Low-intermediate Risk Prostate Cancer in 5 Fractions: Preliminary Report of a Phase II Study with FFF Delivery FILIPPO ALONGI MD Radiation Oncology & Radiosurgery Istituto Clinico
More informationAdvances in external beam radiotherapy
International Conference on Modern Radiotherapy: Advances and Challenges in Radiation Protection of Patients Advances in external beam radiotherapy New techniques, new benefits and new risks Michael Brada
More informationNew research in prostate brachytherapy
New research in prostate brachytherapy Dr Ann Henry Associate Professor in Clinical Oncology University of Leeds and Leeds Cancer Centre PIVOTAL boost opening 2017 To evaluate - The benefits of pelvic
More informationDoes RT favor RP in long term Quality of Life? Juanita Crook MD FRCPC Professor of Radiation Oncology University of British Columbia
Does RT favor RP in long term Quality of Life? Juanita Crook MD FRCPC Professor of Radiation Oncology University of British Columbia Disclosures Advisory Board/honoraria: Varian Advisory Board: Breast
More informationCYBERKNIFE SBRT FOR THE TREATMENT OF PROSTATE CANCER: 5 VS. 44 FRACTIONS THE PHILADELPHIA CYBERKNIFE CENTER EXPERIENCE
CYBERKNIFE SBRT FOR THE TREATMENT OF PROSTATE CANCER: 5 VS. 44 FRACTIONS THE PHILADELPHIA CYBERKNIFE CENTER EXPERIENCE Olusola Obayomi-Davies M.D. Philadelphia CyberKnife Center September 26 th, 2017 Disclosure
More informationFuture Directions in Prostate Cancer: The Case for Protons. John J. Coen, MD Helen & Harry Gray Cancer Center
Future Directions in Prostate Cancer: The Case for Protons John J. Coen, MD Helen & Harry Gray Cancer Center November 14, 2012 Protons and prostate cancer Early proton experience at the MGH The case for
More informationExternal Beam Radiotherapy for Prostate Cancer
External Beam Radiotherapy for Prostate Cancer Chomporn Sitathanee, Radiation Oncology Unit Ramathibodi Hospital, Mahidol University Roles of RT in prostate cancer Definitive RT; intact prostate Post radical
More informationHypofractionation for Prostate Cancer: the Present Luca Incrocci, MD PhD
Hypofractionation for Prostate Cancer: the Present Luca Incrocci, MD PhD Professor of Genito-Urinary Radiotherapy Erasmus MC Cancer Institute Rotterdam, The Netherlands Themadag Prostaatcarcinoom 15 maart
More informationIrreversible Electroporation for the Treatment of Recurrent Prostate Cancer
Irreversible Electroporation for the Treatment of Recurrent Prostate Cancer after prostatectomy, radiation therapy and HiFU R. Schwartzberg, E. Günther, N. Klein, S. Zapf, R. El-Idrissi, J. Cooper, B.
More information18-Oct-16. Take home messages. An update for GPs on modern radiation therapy & hormones for prostate cancer. Session plan
An update for GPs on modern radiation therapy & hormones for prostate cancer A/Prof Jeremy Millar Director Radiation Oncology, Alfred Health Clinical lead Prostate Cancer Outcomes Registry, Monash University
More informationSection: Therapy Effective Date: October 15, 2016 Subsection: Therapy Original Policy Date: December 7, 2011 Subject:
Last Review Status/Date: September 2016 Page: 1 of 10 Description High-dose rate (HDR) temporary prostate brachytherapy is a technique of delivering a high-intensity radiation source directly to the prostate
More information1. CyberKnife Centers of San Diego, CA 2. Coast Urology La Jolla, CA 3. Sletten Cancer Center Great Falls, MT
Donald B. Fuller, M.D. 1, John Naitoh, M.D. 2, Mark Reilly, M.D. 3, Chad Lee, Ph.D 1. 1. CyberKnife Centers of San Diego, CA 2. Coast Urology La Jolla, CA 3. Sletten Cancer Center Great Falls, MT Typically,
More informationOpen clinical uro-oncology trials in Canada
Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1
More informationProstate SBRT Heterogeneous Dose Distribution: Rationale, Methods, Outcomes and Future Direction: 2017 Update
Prostate SBRT Heterogeneous Dose Distribution: Rationale, Methods, Outcomes and Future Direction: 2017 Update DONALD B. FULLER, M.D. RADIATION ONCOLOGIST GENESIS HEALTHCARE Disclosure & Disclaimer The
More informationModern Dose Fractionation and Treatment Techniques for Definitive Prostate RT
Modern Dose Fractionation and Treatment Techniques for Definitive Prostate RT Daniel J Bourgeois, III MD, MPH Board Certified Radiation Oncologist Southeast Louisiana Radiation Oncology Group (SLROG) Disclosures
More informationEORTC radiation Oncology Group Intergroup collaboration with RTOG EORTC 1331-ROG; RTOG 0924
EORTC radiation Oncology Group Intergroup collaboration with RTOG EORTC 1331-ROG; RTOG 0924 Title of the Study Medical Condition Androgen deprivation therapy and high dose radiotherapy with or without
More informationAn Update on Radiation Therapy for Prostate Cancer
An Update on Radiation Therapy for Prostate Cancer David C. Beyer, MD, FACR, FACRO, FASTRO Arizona Oncology Services Phoenix, Arizona Objectives Review significant new data Identify leading trends in PCa
More informationProstate Cancer in comparison to Radiotherapy alone:
Prostate Cancer in comparison to Radiotherapy alone: 1 RTOG 86-10 (2001) 456 patients with > a-goserelin 2 month before RTand during RT + Cyproterone acetate (1 month) vs b-pelvic irradiation (50 gy) +
More informationClinical Commissioning Policy Proposition: Proton Beam Therapy for Cancer of the Prostate
Clinical Commissioning Policy Proposition: Proton Beam Therapy for Cancer of the Prostate Reference: NHS England B01X09 First published: March 2016 Prepared by NHS England Specialised Services Clinical
More informationProstate Cancer UK Best Practice Pathway: ACTIVE SURVEILLANCE
Prostate Cancer UK Best Practice Pathway: ACTIVE SURVEILLANCE Low risk localised PSA < 10 ng/ml and Gleason score 6, and clinical stage T1 - T2a Intermediate risk localised PSA 10-20 ng/ml, or Gleason
More informationRadiotherapy Advances
Radiotherapy Advances Not Radiotherapy Principles IMRT IGRT Image Fusion Planning Introduction IMRT = Intensity Modulated RadioTherapy Restriction: IMRT with photon beams IMRT: Highly conformal technique
More informationAdjuvant and Salvage Radiation for Prostate Cancer. Savita Dandapani, MD, PhD
Adjuvant and Salvage Radiation for Prostate Cancer Savita Dandapani, MD, PhD DISCLOSURES I am a consultant for Reflexion, receive funding from Bayer, and on the Speaker s Bureau with Astra Zeneca. Post-prostatectomy
More informationOpen clinical uro-oncology trials in Canada
Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1
More informationThe Paul Evans Memorial Lecture Functional radiotherapy targeting using focused dose escalation. Roberto Alonzi Mount Vernon Cancer Centre
The Paul Evans Memorial Lecture Functional radiotherapy targeting using focused dose escalation Roberto Alonzi Mount Vernon Cancer Centre Overview Introduction and rationale for focused dose escalation
More informationThe Royal Marsden. Prostate case study. Presented by Mr Alan Thompson Consultant Urological Surgeon
Prostate case study Presented by Mr Alan Thompson Consultant Urological Surgeon 2 Part one Initial presentation A 62 year old male solicitor attends your GP surgery. He has rarely seen you over the last
More informationErectile Dysfunction (ED) after Radiotherapy (RT) for Prostate Cancer. William M. Mendenhall, MD
Erectile Dysfunction (ED) after Radiotherapy (RT) for Prostate Cancer William M. Mendenhall, MD Meta-Analysis of Probability of Maintaining Erectile Function after Treatment of Localized Cancer Treatment
More informationInnovazioni tecnologiche in Radioterapia" Sergio Fersino Radioterapia Oncologica
Innovazioni tecnologiche in Radioterapia" Sergio Fersino Radioterapia Oncologica 2014 HYPOFRACTIONATION & PROSTATE CANCER HYPOFRACTIONATION & PROSTATE CANCER: TECHNOLOGY: HIGH CONFORMAL DOSE & IMAGING
More informationClinical Case Conference
Clinical Case Conference Intermediate-risk prostate cancer 08/06/2014 Long Pham Clinical Case 64 yo man was found to have elevated PSA of 8.65. TRUS-biopies were negative. Surveillance PSA was 7.2 in 3
More informationProstate Cancer Incidence
Prostate Cancer: Prevention, Screening and Treatment Philip Kantoff MD Dana-Farber Cancer Institute Professor of fmedicine i Harvard Medical School Prostate Cancer Incidence # of patients 350,000 New Cases
More informationNew Technologies for the Radiotherapy of Prostate Cancer
Prostate Cancer Meyer JL (ed): IMRT, IGRT, SBRT Advances in the Treatment Planning and Delivery of Radiotherapy. Front Radiat Ther Oncol. Basel, Karger, 27, vol. 4, pp 315 337 New Technologies for the
More informationStereotactic ablative body radiation for prostate cancer SABR
Stereotactic ablative body radiation for prostate cancer SABR John Armstrong. Sinead Callinan. Luke Rock. Beacon Hospital, Dublin, Ireland Low- Intermediate Risk Prostate Comparing treatment choices IMRT
More informationProstate Cancer. 3DCRT vs IMRT : Hasan Murshed
Prostate Cancer 3DCRT vs IMRT : the second debate Hasan Murshed Take home message IMRT allows dose escalation. Preliminary data shows IMRT technique improves cancer control while keeping acceptable morbidity
More informationNeoplasie prostatiche Radioterapia: le nuove strategie
Neoplasie prostatiche Radioterapia: le nuove strategie Dr. PL Losardo U.O.C di Radioterapia Azienda Ospedaliero-Universitaria di Parma Parma, 19.5.2015 VS Very Low risk Low risk Intermediate risk High
More informationOpen clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD
Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED PLACEBO-CONTROLLED, DOUBLE-BLIND
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
Measure #104 (NQF 0390): Prostate Cancer: Adjuvant Hormonal Therapy for High Risk or Very High Risk Prostate Cancer National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL
More informationProstate Cancer UK s Best Practice Pathway
Prostate Cancer UK s Best Practice Pathway TREATMENT Updated August 2018 To be updated in vember Active surveillance What is the patient s stage of disease? Low risk localised PSA < 10 ng/ml and Gleason
More informationStrategies of Radiotherapy for Intermediate- to High-Risk Prostate Cancer
Strategies of Radiotherapy for Intermediate- to High-Risk Prostate Cancer Daisaku Hirano, MD Department of Urology Higashi- matsuyama Municipal Hospital, Higashi- matsuyama- city, Saitama- prefecture,
More informationProstate Cancer Dashboard
Process Risk Assessment Risk assessment: family history assessment of family history of prostate cancer Best Observed: 97 %1 ; Ideal Benchmark:100% measure P8 2 Process Appropriateness of Care Pre-treatment
More informationUnderstanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD
Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics
More informationHow can we best use HDR brachytherapy to escalate dose in intermediate and high risk disease? Gerard Morton Associate Professor
How can we best use HDR brachytherapy to escalate dose in intermediate and high risk disease? Gerard Morton Associate Professor Objectives Why should we escalate dose? What HDR dose and fractionation should
More informationOverview of Radiotherapy for Clinically Localized Prostate Cancer
Session 16A Invited lectures: Prostate - H&N. Overview of Radiotherapy for Clinically Localized Prostate Cancer Mack Roach III, MD Department of Radiation Oncology UCSF Helen Diller Family Comprehensive
More informationCLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD
Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer AN OPEN-LABEL, MULTICENTER, RANDOMIZED PHASE II
More informationProstate Cancer: 2010 Guidelines Update
Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer
More informationProstate cancer: Update from the BCCA
Prostate cancer: Update from the BCCA Tom Pickles Clinical Professor, UBC Topics 1. Incidence & Utilization rates 2. New developments with External Beam RT IGRT, VMAT and other enhancements Optimizing
More informationProton beam therapy for prostate cancer. 1. What is the clinical effectiveness of proton beam therapy in the treatment of prostate cancer?
QUESTION(S) TO BE ADDRESSED Proton beam therapy for prostate cancer 1. What is the clinical effectiveness of proton beam therapy in the treatment of prostate cancer? 2. What is the cost effectiveness of
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #104 (NQF 0390): Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High Risk Prostate Cancer National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS
More informationPORT after RP. Adjuvant. Salvage
PORT after RP Adjuvant Or Salvage RT after RP 40-50% PSA relapse after RP in HR Definition: PSA should be undetectable within 6 weeks of RP Initial PSA is measured 6-12 weeks after RP AUA defines biochemical
More informationBIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY
BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY AZHAN BIN YUSOFF AZHAN BIN YUSOFF 2013 SCENARIO A 66 year old man underwent Robotic Radical Prostatectomy for a T1c Gleason 4+4, PSA 15 ng/ml prostate
More informationOpen clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD
Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED
More informationPROSTATE CANCER TREATMENT
PROSTATE CANCER TREATMENT INFORMATION GUIDE Several effective treatment options exist today for men diagnosed with prostate cancer. Each man s particular cancer, overall health, age, and lifestyle will
More informationRadiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008
Radiation Therapy for Prostate Cancer Amy Hou,, MD Resident Dept of Urology General Surgery Grand Round November 24, 2008 External Beam Radiation Advances Improving Therapy Generation of linear accelerators
More informationOpen clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD
CLINICAL TRIALS Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS
More informationCurrent Clinical Practice. MR Imaging Evaluations. MRI Anatomic Review. Imaging to Address Clinical Challenges. Prostate MR
BETH ISRAEL DEACONESS MEDICAL CENTER Prostate MR Neil M. Rofsky, MD Harvard Medical School Current Clinical Practice DIGITAL RECTAL EXAMINATION PSA ( ~ 20% False negative) BIOPSY (18-25% False negative)
More informationStereotactic Ablative Radiotherapy for Prostate Cancer
Stereotactic Ablative Radiotherapy for Prostate Cancer Laurie Cuttino, MD Associate Professor of Radiation Oncology VCU Massey Cancer Center Director of Radiation Oncology Sarah Cannon Cancer Center at
More informationThe Evolution of SBRT and Hypofractionation in Thoracic Radiation Oncology
The Evolution of SBRT and Hypofractionation in Thoracic Radiation Oncology (specifically, lung cancer) 2/10/18 Jeffrey Kittel, MD Radiation Oncology, Aurora St. Luke s Medical Center Outline The history
More informationWhere are we with radiotherapy for biliary tract cancers?
Where are we with radiotherapy for biliary tract cancers? Professor Maria A. Hawkins Associate Professor in Clinical Oncology MRC Group Leader/Honorary Consultant Clinical Oncologist CRUK MRC Oxford Institute
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #102 (NQF 0389): Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS
More informationClinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults)
Clinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults) Reference: NHS England: 170021/P Standard NHS England INFORMATION READER
More informationStereotactic radiotherapy
Stereotactic radiotherapy Influence of patient positioning and fixation on treatment planning - clinical results Frank Zimmermann Institut für Radioonkologie Universitätsspital Basel Petersgraben 4 CH
More informationBest Papers. F. Fusco
Best Papers UROLOGY F. Fusco Best papers - 2015 RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND This cohort reflects the current clinical
More informationThe Rise, Fall, and Rise Again of Proton Therapy or Never count out a well-financed therapy
The Rise, Fall, and Rise Again of Proton Therapy or Never count out a well-financed therapy Anthony Zietman MD Shipley Professor of Radiation Oncology Massachusetts General Hospital Harvard Medical School
More informationSBRT in early stage NSCLC
SBRT in early stage NSCLC Optimal technique and tumor dose Frank Zimmermann Clinic of Radiotherapy and Radiation Oncology University Hospital Basel Petersgraben 4 CH 4031 Basel radioonkologiebasel.ch Techniques
More informationDemands and Perspectives of Hadron Therapy
Demands and Perspectives of Hadron Therapy Alexander Lin, M.D. Assistant Professor University of Pennsylvania Direction of Operations Roberts Proton Therapy Center Disclosures Teva Pharmaceuticals: Advisory
More informationSRO Tutorial: Prostate Cancer Clinics
SRO Tutorial: Prostate Cancer Clinics May 7th, 2010 Daniel M. Aebersold Klinik und Poliklinik für Radio-Onkologie Universität Bern, Inselspital Is cure necessary in those in whom it may be possible, and
More informationThe clinical and cost effectiveness of the use of brachytherapy to treat localised prostate cancer Health technology description
In response to an enquiry from the Scottish Radiotherapy Advisory Group Number 37 June 2011 The clinical and cost effectiveness of the use of brachytherapy to treat localised prostate cancer Health technology
More informationNational Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design:
Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A PHASE III STUDY OF IRESSA
More informationBRACHYTHERAPY FOR PROSTATE CANCER. Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital
BRACHYTHERAPY FOR PROSTATE CANCER Dr Brandon Nguyen MBBS(Hons), FRANZCR Radiation Oncologist, The Canberra Hospital PROSTATE BRACHYTHERAPY Why brachytherapy? How do we do it? What are the results? Questions?
More informationCauses of Raised PSA A very large prostate Gland Infection of urine or Prostate Gland Possibility of prostate Cancer
Causes of Raised PSA A very large prostate Gland Infection of urine or Prostate Gland Possibility of prostate Cancer Gleason score Gleason score 2-4: well differentiated (seldom reported now): Low risk
More informationRALP Registration Form (new registration)
RALP Registration Form (new registration) RALP registration form new registration v2.0 1 RALP registration form new registration All fields are required, except those marked with an asterisk (*) Variables
More informationPROSTATE CANCER Amit Gupta MD MPH
PROSTATE CANCER Amit Gupta MD MPH Depts. of Urology and Epidemiology Amit-Gupta-1@uiowa.edu dramitgupta@gmail.com Tel: 319-384-5251 OUTLINE PSA screening controversy How to use PSA more effectively Treatment
More informationPROSTATE CANCER, Radiotherapy ADVANCES in RADIOTHERAPY for PROSTATE CANCER
PROSTATE CANCER, Radiotherapy ADVANCES in RADIOTHERAPY for PROSTATE CANCER Alberto Bossi Radiotherapy and Oncology Gustave Roussy, Villejuif, France PROSTATE CANCER, Radiotherapy IGRT RT + ADT: short vs
More informationCLINICAL WORKSHOP IMAGE-GUIDED HDR BRACHYTHERAPY OF PROSTATE CANCER
CLINICAL WORKSHOP IMAGE-GUIDED HDR BRACHYTHERAPY OF PROSTATE CANCER Klinikum Offenbach Nucletron April 27 th 28 th, 2014 History HDR Protocols for Boost and Monotherapy, Results, Logistics and Practical
More informationEmbracing Technology & Timing of Salvage Hormones
Embracing Technology & Timing of Salvage Hormones Andrew Loblaw BSc, MD, MSc, FRCPC, CIP Department of Radiation Oncology Sunnybrook Health Sciences Centre University of Toronto Us Too, Brampton October
More informationHypofractionated RT in Cervix Cancer. Anuja Jhingran, MD
Hypofractionated RT in Cervix Cancer Anuja Jhingran, MD Hypofractionated RT in Cervix Cancer: Clinicaltrials.gov 919 cervix trials 134 hypofractionated RT trials Prostate, breast, NSCLC, GBM 0 cervix trials
More informationGuidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer
Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group
More informationIMRT RTOG Definitive IMRT for Low Risk Prostate Cancer. All about dose and dose matters, probably Although hormones may matter
Definitive for Low Risk Prostate Cancer Howard Sandler, MD, MS Bloom Family Chair in Cancer Therapeutics Cedar-Sinai Medical Center All about dose and dose matters, probably Although hormones may matter
More informationDescription. Section: Therapy Effective Date: October 15, 2015 Subsection: Therapy Original Policy Date: December 7, 2011 Subject:
Last Review Status/Date: September 2015 Page: 1 of 14 Description High-dose rate (HDR) temporary prostate brachytherapy is a technique of delivering a high-intensity radiation source directly to the prostate
More informationLDR Monotherapy vs. HDR Monotherapy
Abstract No. 1234 LDR Monotherapy vs. HDR Monotherapy Is it time for LDR to retire? Gerard Morton 2 LDR Seed Brachytherapy First 2000 LDR patients from BCCA Low and Intermediate Risk LDR Implant Morris
More informationPSA is rising: What to do? After curative intended radiotherapy: More local options?
Klinik und Poliklinik für Urologie und Kinderurologie Direktor: Prof. Dr. H. Riedmiller PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinische und molekulare Charakterisierung
More informationProstate cancer: intervention comparisons
National Institute for Health and Care Excellence Guideline version (Draft) Prostate cancer: intervention comparisons [G] Evidence reviews for active surveillance, radical prostatectomy or radical radiotherapy
More informationAcute toxicity profile in prostate cancer with conventional and hypofractionated treatment
Viani et al. Radiation Oncology 2013, 8:94 RESEARCH Acute toxicity profile in prostate cancer with conventional and hypofractionated treatment Open Access Gustavo Arruda Viani 1,3*, Lucas Bernardes Godoy
More informationNew Radiation Treatment Modalities in the Treatment of Lung Cancer
New Radiation Treatment Modalities in the Treatment of Lung Cancer David Perry, M.D. Chief, Radiation Oncology Medical Director, CyberKnife Radiosurgery Center Medstar Franklin Square Medical Center Definitions
More informationVALUE IN HEALTH REGIONAL ISSUES 10C (2016) Available online at journal homepage:
VALUE IN HEALTH REGIONAL ISSUES 10C (2016) 91 99 Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/vhri Conventionally Fractionationed Volumetric Arc Therapy versus Hypofractionated
More informationMeasuring the value of healthcare activities. Susan Rollason, Director of Finance and Strategy
Measuring the value of healthcare activities Susan Rollason, Director of Finance and Strategy Items covered What are we doing and why? What have we done so far? What challenges have we faced? What are
More informationPROSTATE CANCER BRACHYTHERAPY. Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College
PROSTATE CANCER BRACHYTHERAPY Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College Risk categorization Very Low Risk Low Risk Intermediate Risk High Risk
More informationProstate and Lymph Node VMAT Treatment Planning
Prostate and Lymph Node VMAT Treatment Planning Jess France, Alison McVey, Graham McVey, Jaap Vaarkamp 1 Presentation Outline Old planning method multi-phase New planning method single-phase Comparison
More informationCase Discussions: Prostate Cancer
Case Discussions: Prostate Cancer Andrew J. Stephenson, MD FRCSC FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Elevated PSA 1 54 yo, healthy male, family Hx of
More informationDepartment of Urology, Cochin hospital Paris Descartes University
Technical advances in the treatment of localized prostate cancer Pr Michaël Peyromaure Department of Urology, Cochin hospital Paris Descartes University Introduction Curative treatments of localized prostate
More informationA phase III trial of prostate alone vs. pelvic lymph node IMRT with or
in partnership with A phase III trial of prostate alone vs. pelvic lymph node IMRT with or without prostate boost for intermediate and high risk localised prostate cancer Dr A Ibrahim Chief Investigator
More informationProstatectomy as salvage therapy. Cases. Paul Cathcart - Guy s & St Thomas NHS Trust, London
Prostatectomy as salvage therapy Cases Paul Cathcart - Guy s & St Thomas NHS Trust, London Attributes of brachytherapy appeal to young men who place high utility on genitourinary function At risk of
More informationHDR vs. LDR Is One Better Than The Other?
HDR vs. LDR Is One Better Than The Other? Daniel Fernandez, MD, PhD 11/3/2017 New Frontiers in Urologic Oncology Learning Objectives Indications for prostate brachytherapy Identify pros/cons of HDR vs
More informationRadiation with oral hormonal manipulation for non-metastatic, intermediate or high risk prostate cancer in men 70 and older or with comorbidities
Radiation with oral hormonal manipulation for non-metastatic, intermediate or high risk prostate cancer in men 70 and older or with comorbidities Prostate cancer is predominately a disease of older men,
More information2/14/09. Why Discuss this topic? Managing Local Recurrences after Radiation Failure. PROSTATE CANCER Second Treatment
Why Discuss this topic? Mack Roach III, MD Professor and Chair Radiation Oncology UCSF Managing Local Recurrences after Radiation Failure 1. ~15 to 75% of CaP pts recur after definitive RT. 2. Heterogeneous
More information