doi: /s (03) CLINICAL INVESTIGATION
|
|
- Sarah Beasley
- 6 years ago
- Views:
Transcription
1 doi: /s (03) Int. J. Radiation Oncology Biol. Phys., Vol. 58, No. 4, pp , 2004 Copyright 2004 Elsevier Inc. Printed in the USA. All rights reserved /04/$ see front matter CLINICAL INVESTIGATION Prostate LONG-TERM OUTCOME BY RISK FACTORS USING CONFORMAL HIGH- DOSE-RATE BRACHYTHERAPY (HDR-BT) BOOST WITH OR WITHOUT NEOADJUVANT ANDROGEN SUPPRESSION FOR LOCALIZED PROSTATE CANCER RAZVAN M. GALALAE, M.D.,* ALVARO MARTINEZ, M.D., TIM MATE, M.D., CHRISTINA MITCHELL, R.N., GREGORY EDMUNDSON, M.S., NILS NUERNBERG, M.D.,* STEPHEN EULAU, M.D., GARY GUSTAFSON, M.D., MICHAEL GRIBBLE, M.S., AND GYOERGY KOVÁCS, M.D.* *Clinics for Radiation Therapy and Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Radiation Oncology and Urology Departments, William Beaumont Hospital, Royal Oak, MI; Clinic for Radiation Therapy, Seattle Prostate Institute, Seattle, WA Purpose: The aim of this study is to analyze, during the prostate-specific antigen (PSA) era, the long-term outcome of patients treated with conformal high-dose-rate (HDR) brachytherapy boost to the prostate with or without androgen deprivation therapy (ADT) when patients are stratified by risk factors for failure. Methods and Materials: Between 1986 and 2000, 611 patients were treated for clinically localized prostate cancer in three prospective trials of external beam radiation therapy (EBRT) and dose-escalating HDR brachytherapy (BT) boost. There were 104 patients treated at Seattle, 198 at Kiel University, and 309 at William Beaumont Hospital. Of the 611 patients, 177 received a short course of neoadjuvant/concurrent ADT. The patients were divided into three risk groups. Group I, comprised of 46 patients, had stage <T2a, Gleason score (GS) < 6, and initial PSA (ipsa) < 10 ng/ml. Group II comprised 188 patients with stage >T2b, GS > 7, and ipsa > 10, with any one factor higher. Group III included 359 patients with any two risk factors higher. The American Society for Therapeutic Radiology and Oncology definition for biochemical failure was used. Results: The mean follow-up was 5 years (range, ). For the 611 patients, the 5-year and 10-year biochemical control (BC) rates were 77% and 73%, disease-free survival (DFS) was 67% and 49%, and cause-specific survival (CSS) was 96% and 92%, respectively. BC at 5 years for Group I patients was 96%, for Group II 88%, and for Group III patients 69%. CSS at 5 years was 100% in Group I, 99% in Group II, and 95% in Group III patients. In univariate and multiple regression analyses for BC, risk group, stage, ipsa, and GS were significant in predicting failure. However, age, follow-up interval, and ADT did not. Conclusions: EBRT with HDR-BT produced excellent long-term outcomes in terms of BC, DFS, and CSS in patients with prostate cancer even for those at highest risk. Conformal HDR-BT is both a precise dose delivery system and an effective treatment for both favorable and unfavorable prostate cancer. The addition of a short course of neoadjuvant/concurrent ADT failed to improve outcome. The results were similar at all three institutions, giving credence to the reproducibility of the brachytherapy treatment Elsevier Inc. Conformal HDR brachytherapy, Prostate cancer, Pelvic irradiation, Androgen deprivation, Risk factors. INTRODUCTION Cancer of the prostate (CaP) is one of the most common malignancies in men (1). Standard definitive therapies for CaP, currently, are surgery (radical prostatectomy) or radiation therapy (external beam or brachytherapy). The development of three-dimensional conformal beam techniques has reduced the therapy-related morbidity and improved the efficacy of external beam radiation therapy (EBRT) (2). Brachytherapy (BT) for CaP has evolved into two forms: Reprint requests to: Razvan M. Galalae, M.D., Clinic for Radiation Therapy (Radiooncology), University Hospital, Christian- Albrechts-University of Kiel, Arnold-Heller-Str. 9, Kiel, Germany. Tel: ( 49) ; Fax: ( 49) ; galalae@onco.uni-kiel.de BT with permanent seed (e.g., I 125 or Pd 106 ) implants, and temporary interstitial conformal high-dose-rate brachytherapy (HDR-BT) with a stepping source (e.g., Ir 192 ). For both BT options long-term data have been published in the literature (3 8). Many authors have shown that radiation dose is an important predictor of biochemical no evidence of disease (bned) control rate and that a radiation dose response for patients with clinically localized prostate carcinoma exists Presented at the ASTRO 44th Annual Meeting, October 2002, New Orleans, LA. Oral presentation, Session G, GU.II, No. 57. Received Jan 13, 2003, and in revised form Aug 4, Accepted for publication Aug 5,
2 Long-term outcome using HDR brachytherapy for localized prostate cancer R. M. GALALAE et al (3, 9, 10). A different strategy, the use of adjuvant androgen deprivation therapy (ADT) in addition to standard radiation therapy doses and fields, resulted in a significant improvement in terms of local control, freedom from distant metastasis, and biochemical free survival. However, this advantage was proven for the use of hormonal manipulation following standard EBRT as part of their initial management only, in patients with locally advanced (clinical or pathologic T3; clinical or pathologic node-positive) prostate cancer vs. hormones initiated at relapse (11). Whether this potential advantage is still present with modern local doseescalated techniques is not known. Despite the data in the various studies supporting adjuvant ADT for men with localized CaP, the topic remains controversial. The present study also aims to address the effect of a short course of neoadjuvant/concurrent ADT on the long-term outcome of patients treated with pelvic EBRT and conformal HDR brachytherapy boost to the prostate when patients are stratified by risk factors. METHODS AND MATERIALS The current study includes pooled data of three prospective single-institution trials. Between 1986 and 2000, 611 patients were treated for clinically staged, localized prostate cancer according to the American Joint Committee on Cancer/International Union Against Cancer (12) classification. All patients treated had a histologically proven prostate cancer and a complete clinical staging with chest X-ray, bone scan, and pelvic computed tomography (CT) or magnetic resonance imaging (MRI) scan before treatment. The patients characteristics are detailed in Table 1. Between institutions, differences were noted in the distribution of patient characteristics. There was a trend for more favorable patients treated in Seattle, more unfavorable patients at Kiel University, and in between at William Beaumont Hospital. Of the 611 patients, there were 104 patients treated at Seattle Prostate Institute (Phase II initiated in 1989), 198 at Kiel University (Phase II study initiated in 1986), and 309 at William Beaumont Hospital (Phase II dose escalating trial initiated in 1991). The treatment strategies and techniques were quite similar. The pelvic EBRT was CT-based planned and applied using a beam from a MV linear accelerator. The clinical target volume (CTV) of the EBRT included the prostate, the seminal vesicles, and the pelvic lymph nodes and was not significantly different between the institutions. The total EBRT dose ranged from 45.6 to 50 Gy in 1.8 to 2 Gy daily fractions, 5 times per week. Characteristic Table 1. Patients characteristics All n 611 (%) Pretreatment PSA (9%) (41%) (26%) (20%) Not known 27 (4%) Age (25%) (62%) (13%) Stage UICC 1992 T1a T1c 102 (17%) T2a T2b 276 (45%) T2c 121 (20%) T3a T3c 112 (18%) Gleason score (76%) (24%) Abbreviations: PSA prostate-specific antigen; UICC International Union Against Cancer. HDR brachytherapy techniques The conformal interstitial HDR-BT was planned on the base of a complete prostate volumetric study by transrectal ultrasound, which was also used to visualize the normal prostate and the organs at risk (e.g., urethra, rectum, and bladder) during the implantation procedure. To shorten the overall treatment time (8 weeks down to 5 6 weeks), 2 to 4 fractions of conformal HDR brachytherapy were performed during the course of EBRT treatment. Initially on the trial, three implants were performed at William Beaumont Hospital (Weeks 1, 2, and 3), while in Seattle four fractions were applied. In Kiel (Weeks 3 and 5) the conformal BT was given in 2 fractions only. In October 1995, the BT fraction frequency at William Beaumont Hospital was reduced to 2 (Weeks 1 and 3). An iridium-192 stepping source from an afterloader with an initial activity of 370 GBq was used in all institutions. The treatment planning was performed according to the International Commission on Radiation Units and Measurements (ICRU) Report 58 (13). At the Seattle Prostate Institute, increasing boost doses from 3 to 4 Gy were applied. At Kiel University, the CTV for brachytherapy was differentiated in two levels. The CTV 1 was defined in the peripheral zone of McNeal (14), whereas the CTV 2 included the entire prostate. The planning target volume (PTV) encompassed the corresponding CTV with a small margin (1 3 mm) especially in high-risk tumors to address extracapsular disease. The minimum target dose (MTD) at the periphery of the PTV 1 according to the ICRU Report 58 was defined as reference dose and was equal to 15 Gy per fraction. The MTD corresponding to PTV 2 was 8 to 9 Gy per fraction. Two HDR fractions were performed. At William Beaumont Hospital, the HDR BT boost doses were escalated prospectively from 5.5 up to 11.5 Gy. Total combined biologically effective doses ranged from 79.6 Gy to 123 Gy if a value of 1.5 is assumed for / ratio, or up to 82.9 if 10 is assumed for /. However, many recent publications provided supporting evidence that alpha/ beta values for prostate tumor control are low (15, 16). Details of the techniques have been published (3 5, 17, 18).
3 1050 I. J. Radiation Oncology Biology Physics Volume 58, Number 4, 2004 Androgen deprivation therapy (ADT) There were 177 patients who received a short-term course of neoadjuvant/concurrent ADT as part of their initial management: 75 patients at Kiel University, and 102 at William Beaumont Hospital. A total of 434 patients were hormonenaïve and treated by radiotherapy only: 104 patients at Seattle Prostate Institute, 123 patients at Kiel University, and 207 at William Beaumont Hospital. The ADT therapy was performed specially in cases with an enlarged prostate volume for downsizing. It was initiated as neoadjuvant treatment, before the start of radiotherapy, and was terminated shortly before, during, or shortly after the radiotherapy. The median duration of ADT was 4 months. There were no significant institutional differences in the management of the ADT. Definition of risk factor groups Of the 611 patients, there were 593 eligible for the risk factor selection analysis. The pretreatment prostate-specific antigen (PSA) of 27 patients was not known. Nine of these patients had a Gleason score 8 and were included in the risk group 3 as defined below. Eighteen of the 27 patients were dropped from the analysis. The 593 remaining patients were divided into three risk groups. Group I comprised 46 patients who had stage T2a, Gleason score 6, and PSA 10. Group II comprised 188 patients with stage T2b, Gleason score 7, and PSA 10, with any one factor defined higher, and Group III comprised 359 patients with any two risk factors higher. Statistical analysis Times to events were measured from the start of radiotherapy to death, to failure, or to the most recent follow-up examination for evaluation of overall survival (OS), causespecific survival (CSS), and disease-free survival (DFS), whereas for biochemical control (BC) it was the date of the last post-treatment PSA testing. The American Society for Therapeutic Radiology and Oncology definition was used to define biochemical control. Digital examination and/or transrectal ultrasound was utilized to assess local control. The estimation of actuarial survival rates defined above was performed using Kaplan-Meier product limit methodology (19). Univariate analyses using the log rank test compared Kaplan-Meier rates. Cox regression models (20) were used to examine the effect of clinical and treatment variables in order to determine independent prognostic factors. Fig. 1. Actuarial analysis of long-term outcomes of conformal HDR brachytherapy boost. revealed no statistical difference at 5 and 10 years between institutions (p 0.276). In addition, in the three series the biochemical failures appear to plateau after 5 years. The actuarial analysis of biochemical control stratified by ADT for all 611 patients showed no statistically significant benefit (p 0.159) for the ADT group vs. no ADT group (Fig. 3). The actuarial 5-year survival analysis and local recurrence rates by risk factor groups are detailed in Table 2. A remarkably high biochemical control was observed even for the high-risk patient Group III. A small but gradual decrease in outcome was seen as risk factors increased. Also a higher local recurrence rate of 10% was seen in the high-risk group when compared with 0% for the low-risk group (mean RESULTS The mean follow-up time for the entire cohort of 611 patients was 5 years: for Group I 6.2 years (range, ), for Group II 4.4 years (range, ), and for Group III 5.3 years (range, ). For the 611 patients, the 5-year and 10-year BC rates were 77% and 73%, for OS they were 85% and 65%, and for CSS they were 96% and 92%, respectively (Fig. 1). The actuarial analysis of biochemical control stratified by institution depicted in Fig. 2 Fig. 2. Actuarial analysis of biochemical control stratified by institution.
4 Long-term outcome using HDR brachytherapy for localized prostate cancer R. M. GALALAE et al Fig. 3. Actuarial analysis of biochemical control of all patients stratified by ADT. Table 2. Actuarial analysis at 5 years by risk factors groups Endpoint All (n 593) Group I (n 46) Group II (n 188) Group III (n 359) OS 85% 88% 86% 85% CSS 96% 100% 99% 95% BC 77% 96% 88% 69% DFS 67% 83% 75% 61% LR 7.4% 0% 3.5% 10% Abbreviations: BC biochemical control; CSS cause-specific survival; DFS disease-free survival; LR local recurrence; OS overall survival. follow-up of 6.2 years). The survival analyses stratified by ADT are shown in Table 3. No evidence of any type of survival advantage was demonstrated by the addition of a short course of neoadjuvant/concurrent ADT. The biochemical control at 5 years for Group I patients was 96%, for Group II 88% (87% with no ADT and 91% with ADT), and for Group III patients 69% (69% with no ADT and 68% with ADT). Figure 4 shows the biochemical control curves stratified by risk group. It revealed worsening of BC in Group III with a significant p value of The cancer death cause-specific survival at 5 years is depicted in Fig. 5 Fig. 4. Actuarial analysis of biochemical control stratified by risk groups. and was 100% in Group I, 99% in Group II (100% with no ADT and 97% with ADT), and 95% in Group III patients (97% with no ADT and 90% with ADT). A more detailed survival analysis at 5 years comparing Groups II and III and stratified by ADT is presented in Table 3. The differences were not statistically significant with the exception of CSS in Group III, where the no ADT group showed a better survival when compared with the ADT group (p 0.002). To analyze in more detail the worse subgroup within Groups II and III, Fig. 6a depicts the actuarial analysis for patients with only one of the following poor factors: stage T2b, PSA 20, and Gleason score 8. This group comprises 265 patients, of whom 117 (44.2%) have a follow-up longer than 5 years. No benefit can be seen for those patients receiving ADT. Figure 6b depicts patients with any combination of two of the three above-mentioned poor factors. More than 50% of the 123 patients were followed for greater than 5 years. Once again, no benefit can be observed from a short course of neoadjuvant/concurrent ADT. In addition, univariate analyses for biochemical control at Table 3. Survival analysis at 5 years of risk factors groups stratified by ADT Group II Group III Endpoint No ADT (n 137) ADT (n 51) p values No ADT (n 240) ADT (n 119) p values OS 86% 90% % 80% CSS 100% 97% % 90% BC 87% 91% % 68% DFS 73% 85% % 61% Abbreviations: ADT androgen deprivation therapy. Other abbreviations as in Table 2.
5 1052 I. J. Radiation Oncology Biology Physics Volume 58, Number 4, 2004 Table 4. Univariate and multivariate analysis for biochemical control at 5 years Variable Univariate p values Multivariate p values Risk group Stage Pretreatment PSA Gleason group 7 vs Age Hormones Follow-up interval Cox proportional hazards regression. Fig. 5. Actuarial analysis of cause-specific survival stratified by risk groups. 5 years (chi-square/logistical regression) and multivariate analyses (Cox proportional hazards regression) for the entire cohort were performed. Risk group, stage, pretreatment PSA, and Gleason score were significant in predicting failure. However, age (p 0.332), follow-up interval (p 0.244), and the use of hormones (p 0.123) did not. These data are detailed in Table 4. DISCUSSION Radical prostatectomy is one standard local therapy modality for CaP. Radical prostatectomy may lead to cure as long as the cancer is confined to the prostate and all malignant cells are removed. Neoadjuvant hormone therapy (NHT) is one option being used to increase the likelihood of cure after radical prostatectomy. Fair and Betancourt (21) reported the results of radical prostatectomy at Memorial Sloan-Kettering Cancer Center in 520 patients with clinically localized CaP who received preoperative NHT for 3 to 11 (or more) months. The results in the NHT patients were compared with those in 1413 men having surgery without NHT at the same institution during the same time period. The overall DFS rate was defined according to serum PSA concentration 0.2 ng/ml, and it was 75% at 5 years and 50% at 10 years. NHT did not improve DFS. The presence of positive surgical margins was a negative prognostic factor (p 0.001). Men who received NHT had a statistically lower positive margin rate (p 0.001). However, NHT did not increase the likelihood of a durable DFS (p 0.175). The duration of NHT did not affect DFS (p for 3 vs. 3 months). The authors concluded that there appeared to be no subset of men undergoing radical prostatectomy in which the routine administration of NHT is beneficial. A Fig. 6. (a) Actuarial analysis of BC for patients with only one of the following factors: Stage T2b, PSA 20, or Gleason score 8(n 265). (b) Actuarial analysis of BC for patients with any two of the following factors: Stage T2b, PSA 20, or Gleason score 8(n 123).
6 Long-term outcome using HDR brachytherapy for localized prostate cancer R. M. GALALAE et al Table 5. Literature comparison by risk factors groups Author All Biochemical control at 5 years Group I Group II Group III Zelefsky et al. (25) % 65% 35% Current study % 87% 69% decrease in the number of positive surgical margins was found also by other authors in clinically staged T1 and T2 prostate cancer patients receiving NHT before surgery (22), with a further decrease in those receiving treatment over longer periods of time (3 vs. 8 months; the positive margin rates were 17% and 5%, p 0.01) (23). In ct3 prostate cancer patients equivocal results have been obtained (22). However, none of the studies reported a positive impact of neoadjuvant hormonal ablative treatment before radical prostatectomy on survival. The positive effect on surgical margins by NHT did not translate into improved survival outcomes. Radiotherapy is another potentially curative treatment modality for localized CaP. Many studies have clearly shown that total radiotherapy dose is a strong predictor of outcome, using three-dimensional conformal radiotherapy (3D-CRT) (24, 25), intensity-modulated radiotherapy (26, 27), or conformal brachytherapy (3). Zelefsky et al. (25) reported a significantly improved PSA relapse-free survival in patients with intermediate and unfavorable prognosis receiving 75.6 Gy (p 0.05). The 5-year actuarial biochemical control rate for patients with favorable prognostic indicators (stage T1 2, pretreatment PSA 10.0 ng/ml, and Gleason score 6) was 85%, compared with 65% for those with intermediate prognosis (one of the prognostic indicators with a higher value) and 35% for the group with unfavorable prognosis (two or more indicators with higher values) (p 0.001). However, no dose response was observed for patients with pretreatment PSA 10 ng/ml (24). Compared with the outcome after 3D-CRT, our results in terms of biochemical control in 434 hormone-naïve patients were excellent (for Risk Group I patients it was 96%, for Group II 87%, and for Group III patients 69%). This literature comparison is detailed in Table 5. Adjuvant ADT has been used to increase the likelihood of cure as adjunct to radiotherapy also. Three large prospective Phase III trials addressed the potential advantage of adjuvant ADT in addition to standard radiotherapy in year The Radiation Therapy Oncology Group (RTOG) trial tested from 1987 to 1991 the hypothesis whether androgen ablation before and during conventional radiotherapy for locally advanced carcinoma of the prostate may, by reducing tumor bulk and enhancing tumor cell kill, improve locoregional control and ultimately survival. The study randomized 226 patients to receive a short course of androgen ablation administered before and during radiotherapy, or 230 patients to receive radiation therapy alone. RTOG trial evaluated the potential benefit of long-term adjuvant androgen suppression following standard radiation therapy for unfavorable-prognosis carcinoma of the prostate in 945 men from 1987 to In both trials, the radiotherapy total dose was 65 to 70 Gy. In 2001, Horwitz et al. reported the updated pooled results of the RTOG and trials (28). Based on this analysis, adjuvant long-term hormones compared with short-term hormones and by today s standards, suboptimal radiotherapy resulted in statistically significant improvements in biochemical control, distant metastases failure, and cause-specific failure rates for patients with locally advanced nonmetastatic prostate cancer. However, a benefit in overall survival could not be detected at 8 years with rates of 50%, 51%, and 44%, respectively (p 0.2). Both studies have also clearly shown that conventional definitive radiotherapy alone cannot be considered an effective curative modality in men with locally advanced CaP. The 8-year biochemical control rate was only 14%. This could be improved by short-term hormones to 27% and by long-term hormones to 52% (p ). The comparison with our excellent results of 69% biochemical control in Group III patients with unfavorable prognosis highlights the low probability of conventional radiotherapy to cure locally advanced prostate cancer and the necessity to use modern techniques with capabilities for dose escalation. The third prospective trial addressing this specific question, the European Organization for Research and Treatment of Cancer trial 22863, included from 1987 to patients with locally advanced prostate cancer. They were randomly assigned to receive conventional radiotherapy alone or radiotherapy plus immediate treatment with goserelin a luteinizing hormone releasing hormone analog for 3 years (29). Long-term adjuvant treatment with goserelin improved local control (p 0.001) and overall survival (p 0.001). Taking into account all three randomized Phase III trials, the results suggest that androgen suppression before and during standard conventional radiation according to (technique and doses) improves disease-free survival; and administration of long-term hormones during and after conventional radiation improves overall survival. Whether this is true for adjuvant ADT as an adjunct to dose-escalated radiotherapy using modern state-of-the-art irradiation techniques is not known. The RTOG study determined the effect on toxicity by the addition of induction hormonal therapy (HT) to 3D-CRT in 547 men treated at dose level I (68.4 Gy), level II (73.8 Gy), or level III (79.2 Gy) (30). Induction HT did not have an independent effect on the risk of side effects after 3D-CRT. However, induction HT combined with 3D-CRT significantly increased the risk of acute genitourinary effects compared with 3D-CRT alone in men with poor baseline urinary function. Longterm effects of induction HT on survival from this study are not published yet. Further randomized Phase III trials specifically addressing this question have not been published. Velasco et al. reported the data of 105 patients with locally advanced prostate cancer who had received radiotherapy in two dose-escalation studies (31). The total dose ranged from
7 1054 I. J. Radiation Oncology Biology Physics Volume 58, Number 4, to 87 Gy in 2 Gy per fraction. Sixty-seven of those patients received additionally neoadjuvant hormonal therapy. The median duration of the treatment was 4 months. However, the patients were not randomized. The post-radiation PSA nadir was shown to be a predictor of outcome. After radiation, the actuarial 3-year bned rate for patients achieving a PSA nadir value less than 1 ng/ml was 63% vs. 22% for those with a nadir of 1 ng/ml or greater (p 0.001). Neoadjuvant hormonal therapy allowed patients to achieve the nadir after radiation more quickly (p ) and to a lower value (p ). However, there was no impact on the bned results. The 3-year actuarial bned rate for patients receiving neoadjuvant hormonal therapy was not different from those who did not receive hormonal therapy (p 0.3). Their preliminary findings support our results of failing to detect an effect of short-term neoadjuvant/concurrent ADT with dose-escalated radiotherapy on survival. Our results are the first published addressing this question and reporting long-term outcome. However, we recognize the limitations of our study, which did not randomize ADT and no ADT treatment. Whether long-term hormonal exposure provides a survival benefit to patients when both precise and very high biologic doses are delivered, such as is the case with HDR prostate brachytherapy, is not known. There are no data published addressing this question at the present time. So far, there is no evidence of survival benefit of neoadjuvant/concurrent ADT as adjunct to dose-escalated radiotherapy. Timing and sequence of neoadjuvant androgen suppression and radiation might be important, with radiation being most effective if given at the point of maximal tumor regression (32). However, many murine adenocarcinomas respond to androgen deprivation by a reduction in the proliferation rate and arrest in cell cycle phase G(0), and in vitro data suggest that this arrest may interfere with radiation-induced cell killing (32). Furthermore, the effect on cell killing after EBRT (2 Gy per fraction) is different than for hypofractionated HDR brachytherapy, giving HDR a clear advantage (16). Clinical trials seem to support a positive interaction of androgen deprivation with conventional EBRT only. However, from today s perspective it has been also long established that conventional/standard EBRT characterized by old techniques and suboptimal doses represents an insufficient therapy and should be replaced by modern techniques and strategies with the ability to deliver much higher doses of radiation. It cannot be assumed that the same advantage of adjuvant androgen deprivation will hold with dose-escalated radiotherapy, e.g., by HDR brachytherapy or high-dose 3D-CRT. In the meantime, patients must be informed of the advantages and disadvantages of adjuvant hormonal treatment to allow them to make informed treatment decisions. CONCLUSION Pelvic EBRT with conformal HDR boost produced excellent long-term outcomes in terms of BC, DFS, and CSS in patients with prostate cancer, even for patients in Group III with a biochemical control rate of 69%, which represents the best result ever published for this unfavorable-prognosis group of patients. Conformal HDR prostate brachytherapy is a precise dose delivery system and a very effective treatment for both favorable and unfavorable prostate cancer. The results were similar at all three institutions, giving credence to the reproducibility of the brachytherapy treatment. The presented data suggest that when the prostate is treated to a significantly higher BED, compared with conventional EBRT, the addition of a short course 6 months of neoadjuvant/concurrent ADT appears to be unnecessary. REFERENCES 1. Jemal A, Thomas A, Murray T, et al. Cancer statistics, CA Cancer J Clin 2002;52: Zelefsky MJ, Fuks Z, Hunt M, et al. High-dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002;53: Martinez AA, Gustafson G, Gonzalez J, et al. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer. Int J Radiat Oncol Biol Phys 2002;53: Galalae R, Kovács G, Schultze J, et al. Long-term outcome following high dose rate brachytherapy and external-beam radiotherapy in men with advanced local prostate cancer: Does elective irradiation of the pelvic lymphatics compromise the feasibility of local dose escalation? Int J Radiat Oncol Biol Phys 2002;52: Mate TP, Gottesman JE, Hatton J, et al. High dose-rate afterloading 192Iridium prostate brachytherapy: Feasibility report. Int J Radiat Oncol Biol Phys 1998;41: Grado GL, Larson TR, Balch CS, et al. Actuarial diseasefree survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys 1998;42: Blasko JC, Mate T, Sylvester JE, Grimm PD, Cavanagh W. Brachytherapy for carcinoma of the prostate: Techniques, patient selection, and clinical outcomes. Semin Radiat Oncol 2002;12: Blasko JC, Grimm PD, Sylvester JE, Cavanagh W. The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 2000;57: Hanks GE, Hanlon AL, Pinover WH, et al. Survival advantage for prostate cancer patients treated with high-dose three-dimensional conformal radiotherapy. Cancer J Sci Am 1999;5: Horwitz EM, Hanlon AL, Pinover WH, et al. Defining the optimal radiation dose with three-dimensional conformal radiation therapy for patients with nonmetastatic prostate carcinoma by using recursive partitioning techniques. Cancer 2001;92: Lawton CA, Winter K, Murray K, et al. Updated results of the phase III Radiation Therapy Oncology Group (RTOG) trial evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable progno-
8 Long-term outcome using HDR brachytherapy for localized prostate cancer R. M. GALALAE et al sis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001;49: Union International Contre le Cancer (UICC). Illustrated guide to TNM/pTNM classification of malignant tumors. 3rd ed., 2nd rev. Spiessl B, Bears OH, Hermanek P, et al., editors. New York: Springer; Chassagne D, Dutreix A, Ash D, et al. ICRU Report No 58: Dose and volume specification for reporting interstitial therapy. Washington, DC: International Commission on Radiation Units and Measurements; McNeal JE. Zonal anatomy of the prostate. Prostate 1981;2: Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys 2001;50: Brenner DJ, Martinez AA, Edmundson GK, et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys 2002;52: Stromberg J, Martinez A, Gonzalez J, et al. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a dose escalating clinical trial. Int J Radiat Oncol Biol Phys 1995;33: Bertermann H, Brix F. Ultrasonically guided interstitial high dose brachytherapy with iridium 192: Technique and preliminary results in locally confined prostate cancer. In: Martinez A, Orton C, Mould RF, editors. Brachytherapy HDR and LDR. Columbia, MD: Nucletron Corp.; p Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53: Cox DR. Regression models and life table. J Royal Stat Soc 1971;34: Fair WR, Betancourt JE. Update on Memorial Sloan-Kettering Cancer Center studies of neoadjuvant hormonal therapy for prostate cancer. Mol Urol 2000;4: Schulman CC, Debruyne FM, Forster G, et al. 4-Year follow-up results of a European prospective randomized study on neoadjuvant hormonal therapy prior to radical prostatectomy in T2-3N0M0 prostate cancer. European Study Group on Neoadjuvant Treatment of Prostate Cancer. Europ Urol 2000; 38: Klotz L, Gleave M, Goldenberg SL. Neoadjuvant hormone therapy: The Canadian trials. Mol Urol 2000;4: Hanks GE, Hanlon AL, Schultheiss TE, et al. Dose escalation with 3-D conformal treatment: Five-year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys 1998;41: Zelefsky MJ, Leibel SA, Gaudin PB, et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998;41: Martinez AA, Yan D, Lockman D, et al. Improvement in dose escalation using the process of adaptive radiotherapy combined with three-dimensional conformal or intensity-modulated beams for prostate cancer. Int J Radiat Oncol Biol Phys 2001;50: Kupelian PA, Reddy CA, Carlson TP, et al. Preliminary observations on biochemical relapse-free survival rates after short-course intensity-modulated radiotherapy (70 Gy at 2.5 Gy/fraction) for localized prostate cancer. Int J Radiat Oncol Biol Phys 2002;53: Horwitz EM, Winter K, Hanks GE, et al. Subset analysis of RTOG and indicates an advantage for long-term vs. short-term adjuvant hormones for patients with locally advanced nonmetastatic prostate cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys 2001;49: Bolla M, Gonzalez D, Warde P, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997;337: Valicenti RK, Winter K, Cox JD, et al. The effect on toxicity of induction hormonal therapy in prostate cancer patients receiving dose escalated 3D conformal radiation therapy on RTOG Int J Radiat Oncol Biol Phys 2002;54(Suppl. 2): Velasco J, Tekyi-Mensah S, Bolton S, et al. Postneoadjuvant hormone PSA levels and prognosis in locally advanced prostate cancer. Urology 1999;54: Zietman AL. The case for neoadjuvant androgen suppression before radiation therapy. Mol Urol 2000;4:
SRO 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 informationSupported by M. D. Anderson Cancer Center physician investigator funds. We thank Gerald E. Hanks, MD, for help and guidance with this project.
1496 Biochemical and Clinical Significance of the Posttreatment Prostate-Specific Antigen Bounce for Prostate Cancer Patients Treated With External Beam Radiation Therapy Alone A Multiinstitutional Pooled
More informationOutcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer
Clinical Urology Post-radiotherapy Prostate Biopsy for Recurrent Disease International Braz J Urol Vol. 36 (1): 44-48, January - February, 2010 doi: 10.1590/S1677-55382010000100007 Outcomes Following Negative
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 informationVol. 36, pp , 2008 T1-3N0M0 : T1-3. prostate-specific antigen PSA. 68 Gy National Institutes of Health 10
25 Vol. 36, pp. 25 32, 2008 T1-3N0M0 : 20 2 18 T1-3 N0M0 1990 2006 16 113 59.4-70 Gy 68 Gy 24 prostate-specific antigen PSA 1.2 17.2 6.5 5 91 95 5 100 93 p 0.04 T3 PSA60 ng ml 68 Gy p 0.0008 0.03 0.04
More information20 Prostate Cancer Dan Ash
20 Prostate Cancer Dan Ash 1 Introduction Prostate cancer is a disease of ageing men for which the aetiology remains unknown. The incidence rises up to 30 to 40% in men over 80. The symptoms of localised
More informationDOSE ESCALATION USING CONFORMAL HIGH-DOSE-RATE BRACHYTHERAPY IMPROVES OUTCOME IN UNFAVORABLE PROSTATE CANCER
PII S0360-3016(02)02733-5 Int. J. Radiation Oncology Biol. Phys., Vol. 53, No. 2, pp. 316 327, 2002 Copyright 2002 Elsevier Science Inc. Printed in the USA. All rights reserved 0360-3016/02/$ see front
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 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 informationPSA bouncing after brachytherapy HDR and external beam radiation therapy: a study of 121 patients with minimum 5-years follow-up
Original article Original articles PSA bouncing after brachytherapy HDR and external beam radiation therapy: a study of 121 patients with minimum 5-years follow-up Roman Makarewicz, MD, PhD, Prof., Andrzej
More informationHIGH DOSE RADIATION DELIVERED BY INTENSITY MODULATED CONFORMAL RADIOTHERAPY IMPROVES THE OUTCOME OF LOCALIZED PROSTATE CANCER
0022-5347/01/1663-0876/0 THE JOURNAL OF UROLOGY Vol. 166, 876 881, September 2001 Copyright 2001 by AMERICAN UROLOGICAL ASSOCIATION, INC. Printed in U.S.A. HIGH DOSE RADIATION DELIVERED BY INTENSITY MODULATED
More informationThe Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients With Prostate Cancer
55 The Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients With Prostate Cancer Matthew C. Abramowitz, MD 1 Tiaynu Li, MA 2 Mark K. Buyyounouski, MD 1 Eric Ross, PhD 2 Robert
More informationProject approved by the Fondo de investigaciones Socio Sanitarias (FISS). Resolution dated June 8, Official State Gazette: June 17, 2004.
Edition No. 01 Phase III randomized and multicenter trial of adjuvant androgen deprivation combined with high-dose 3-dimensional conformal radiotherapy in intermediate- or high-risk localized prostate
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 informationRadiation dose has been reported to be an important determinant
538 The Relationship of Increasing Radiotherapy Dose to Reduced Distant Metastases and Mortality in Men with Prostate Cancer Rojymon Jacob, M.D. 1 Alexandra L. Hanlon, Ph.D. 2 Eric M. Horwitz, M.D. 1 Benjamin
More information2015 myresearch Science Internship Program: Applied Medicine. Civic Education Office of Government and Community Relations
2015 myresearch Science Internship Program: Applied Medicine Civic Education Office of Government and Community Relations Harguneet Singh Science Internship Program: Applied Medicine Comparisons of Outcomes
More informationSubject Index. Androgen antiandrogen therapy, see Hormone ablation therapy, prostate cancer synthesis and metabolism 49
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Subject Index Androgen antiandrogen therapy, see Hormone ablation therapy, synthesis and metabolism 49 Bacillus Calmette-Guérin adjunct therapy with transurethral resection
More informationHigh-Dose Rate Temporary Prostate Brachytherapy. Original Policy Date
MP 8.01.15 High-Dose Rate Temporary Prostate Brachytherapy Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return
More informationHeterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy
Cagney et al. BMC Urology (2017) 17:60 DOI 10.1186/s12894-017-0250-2 RESEARCH ARTICLE Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy
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 informationRadical Prostatectomy versus Intensity Modulated Radiation Therapy in the Management of Localized Prostate Cancer
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 10-19-2009 Radical Prostatectomy versus Intensity Modulated Radiation
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. 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 informationWhen radical prostatectomy is not enough: The evolving role of postoperative
When radical prostatectomy is not enough: The evolving role of postoperative radiation therapy Dr Tom Pickles Clinical Associate Professor, UBC. Chair, Provincial Genito-Urinary Tumour Group BC Cancer
More informationHormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice
european urology supplements 5 (2006) 362 368 available at www.sciencedirect.com journal homepage: www.europeanurology.com Hormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice Antonio
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 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 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 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 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 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 informationComparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients
Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients R Kuefer 1, BG Volkmer 1, M Loeffler 1, RL Shen 2, L Kempf 3, AS Merseburger 4, JE Gschwend
More informationBiochemical progression-free survival in localized prostate cancer patients treated with definitive external beam radiotherapy
Electronic Physician (ISSN: 2008-5842) http://www.ephysician.ir October 2015, Volume: 7, Issue: 6, Pages: 1330-1335, DOI: 10.14661/1330 Biochemical progression-free survival in localized prostate cancer
More informationSalvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes
ORIGINAL RESEARCH Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes Michael J. Metcalfe, MD ; Patricia Troncoso, MD 2 ; Charles C. Guo,
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 informationMEDICAL POLICY. SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER POLICY NUMBER: CATEGORY: Technology Assessment
MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy
More informationRadiation treatment in prostate cancer : balancing between tumor control and toxicity Heemsbergen, W.D.
UvA-DARE (Digital Academic Repository) Radiation treatment in prostate cancer : balancing between tumor control and toxicity Heemsbergen, W.D. Link to publication Citation for published version (APA):
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 informationDebate: Whole pelvic RT for high risk prostate cancer??
Debate: Whole pelvic RT for high risk prostate cancer?? WPRT well, at least it ll get the job done.or will it? Andrew K. Lee, MD, MPH Associate Professor Department of Radiation Oncology Using T-stage,
More informationJure Murgic 1, Matthew H Stenmark 1, Schuyler Halverson 1, Kevin Blas 1, Felix Y Feng 1,2 and Daniel A Hamstra 1,3*
Murgic et al. Radiation Oncology 2012, 7:127 RESEARCH Open Access The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for
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 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 informationPost Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series
Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,
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 informationQ&A. Overview. Collecting Cancer Data: Prostate. Collecting Cancer Data: Prostate 5/5/2011. NAACCR Webinar Series 1
Collecting Cancer Data: Prostate NAACCR 2010-2011 Webinar Series May 5, 2011 Q&A Please submit all questions concerning webinar content through the Q&A panel Overview NAACCR 2010-2011 Webinar Series 1
More informationMEDICAL POLICY SUBJECT: BRACHYTHERAPY OR RADIOACTIVE SEED IMPLANTATION FOR PROSTATE CANCER
MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy
More informationResearch Article Implant R100 Predicts Rectal Bleeding in Prostate Cancer Patients Treated with IG-IMRT to 45 Gy and Pd-103 Implant
Radiotherapy, Article ID 130652, 6 pages http://dx.doi.org/10.1155/2014/130652 Research Article Implant R100 Predicts Rectal Bleeding in Prostate Cancer Patients Treated with IG-IMRT to 45 Gy and Pd-103
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 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 informationCyberKnife 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 informationin 32%, T2c in 16% and T3 in 2% of patients.
BJUI Gleason 7 prostate cancer treated with lowdose-rate brachytherapy: lack of impact of primary Gleason pattern on biochemical failure Richard G. Stock, Joshua Berkowitz, Seth R. Blacksburg and Nelson
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 informationBRACHYTHERAPY FOR PATIENTS WITH PROSTATE CANCER: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update
BRACHYTHERAPY FOR PATIENTS WITH PROSTATE CANCER: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update Table of Contents Data Supplement 1: Additional Evidence Table(s) Table
More informationCyberKnife Radiotherapy For Localized Prostate Cancer: Rationale And Technical Feasibility
Open Access Article The authors, the publisher, and the right holders grant the right to use, reproduce, and disseminate the work in digital form to all users. Technology in Cancer Research & Treatment
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 informationUpdated Results of High-Dose Rate Brachytherapy and External Beam Radiotherapy for Locally and Locally Advanced
Clinical Urology High-Dose Rate Brachytherapy for Prostate Cancer International Braz J Urol Vol. 34 (3): 293-301, May - June, 2008 Updated Results of High-Dose Rate Brachytherapy and External Beam Radiotherapy
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 informationDepartment of Radiotherapy & Nuclear Medicine, National Cancer Institute, Cairo University, Cairo, Egypt.
Original article Res. Oncol. Vol. 12, No. 1, Jun. 2016:10-14 Dosimetric comparison of 3D conformal conventional radiotherapy versus intensity-modulated radiation therapy both in conventional and high dose
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 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 informationName of Policy: High-Dose Rate Temporary Prostate Brachytherapy
Name of Policy: High-Dose Rate Temporary Prostate Brachytherapy Policy #: 024 Latest Review Date: June 2014 Category: Therapy Policy Grade: C Background/Definitions: As a general rule, benefits are payable
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 informationThe Spa Hotel, Tunbridge Wells Friday 23 rd March Platinum sponsor
The Spa Hotel, Tunbridge Wells Friday 23 rd March 2018 Platinum sponsor ADT in brachytherapy Adding efficacy or just toxicity C. Salembier Department of Radiotherapy-Oncology Europe Hospitals Brussels
More informationHow to deal with patients who fail intracavitary treatment
How to deal with patients who fail intracavitary treatment A. Heidenreich Department of Urology Non-surgical therapy of PCA IMRT SEEDS IGRT HDR-BRACHY HIFU CRYO LDR - Brachytherapy Author Follow-up bned
More informationAdvances in Treatment of Cancer by Brachytherapy in Kenya, in Particular, Prostate Cancer
Research Article imedpub Journals www.imedpub.com Journal Of Medical Physics And Applied Sciences ISSN 2574-285X DOI: 1.21767/2574-285X.12 Advances in Treatment of Cancer by Brachytherapy in Kenya, in
More informationRadiation Dose Escalation for Localized Prostate Cancer
Radiation Dose Escalation for Localized Prostate Cancer Intensity-Modulated Radiotherapy Versus Permanent Transperineal Brachytherapy William W. Wong, MD 1 ; Sujay A. Vora, MD 1 ; Steven E. Schild, MD
More informationTrina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April
Trina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April 17, 2016 Discuss permanent prostate brachytherapy and
More informationTRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY
TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY 1 TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY BRENDAN CAREY, MD TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BRACHYTHERAPY 2 TRANSRECTAL ULTRASOUND-GUIDED
More informationManaging Prostate Cancer After Initital Treatment Fails: Are There Good Next Steps?
Managing Prostate Cancer After Initital Treatment Fails: Are There Good Next Steps? Michael J Zelefsky, M.D. Professor of Radiation Oncology Chief Brachytherapy Service Department of Radiation Oncology
More informationWhen PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy
When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA
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 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 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 informationReceived June 2, 2006
NEOPLASMA 54, 1, 2007 7 Radiotherapy combined with hormonal therapy (RT-HT) in prostate cancer patients with low, intermediate, and high risk of biochemical recurrence: perspective and therapeutic gain
More informationPost Radical Prostatectomy Adjuvant Radiation in Patients with Seminal Vesicle Invasion - A Historical Series
Post Radical Prostatectomy Adjuvant Radiation in Patients with Seminal Vesicle Invasion - A Historical Series E. Z. Neulander 1, K. Rubinov 2, W. Mermershtain 2, Z. Wajsman 3 1 Department of Urology, Soroka
More informationThe benefit of a preplanning procedure - view from oncologist. Dorota Kazberuk November, 2014 Otwock
The benefit of a preplanning procedure - view from oncologist Dorota Kazberuk 21-22 November, 2014 Otwock Brachytherapy is supreme tool in prostate cancer management with a wide range of options in every
More informationGUIDELINES ON PROSTATE CANCER
10 G. Aus (chairman), C. Abbou, M. Bolla, A. Heidenreich, H-P. Schmid, H. van Poppel, J. Wolff, F. Zattoni Eur Urol 2001;40:97-101 Introduction Cancer of the prostate is now recognized as one of the principal
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 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 informationIntensity Modulated Radiotherapy (IMRT) of the Prostate
Medical Policy Manual Medicine, Policy No. 137 Intensity Modulated Radiotherapy (IMRT) of the Prostate Next Review: August 2018 Last Review: November 2017 Effective: December 1, 2017 IMPORTANT REMINDER
More informationOriginal articles. Abstract. Purpose
Original article Original articles Correlation between treatment plan parameters and particular prognostic factors in prostate cancer treated with high-dose-rate brachytherapy (HDR-BT) as a boost Adam
More informationconcordance indices were calculated for the entire model and subsequently for each risk group.
; 2010 Urological Oncology ACCURACY OF KATTAN NOMOGRAM KORETS ET AL. BJUI Accuracy of the Kattan nomogram across prostate cancer risk-groups Ruslan Korets, Piruz Motamedinia, Olga Yeshchina, Manisha Desai
More informationPSA nadir post LDR Brachytherapy and early Salvage Therapy. Dr Duncan McLaren UK & Ireland Users Group Meeting 2016
PSA nadir post LDR Brachytherapy and early Salvage Therapy Dr Duncan McLaren UK & Ireland Users Group Meeting 2016 Differences in PSA relapse rates based on definition used PSA ng/ml Recurrence ASTRO Recurrence
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 informationIntraoperative Radiation Therapy for
Frontiers ofradiation Therapy and Oncology Reprint Editors: J.M. Vaeth, J.L. Meyer, San Francisco, Calif. ~' Publishers: S.Karger, Basel Printed in Switzerland Vaeth JM, Meyer JL (eds): The Role of High
More informationTiming of Androgen Deprivation: The Modern Debate Must be conducted in the following Contexts: 1. Clinical States Model
Timing and Type of Androgen Deprivation Charles J. Ryan MD Associate Professor of Clinical Medicine UCSF Comprehensive Cancer Center Timing of Androgen Deprivation: The Modern Debate Must be conducted
More informationPET imaging of cancer metabolism is commonly performed with F18
PCRI Insights, August 2012, Vol. 15: No. 3 Carbon-11-Acetate PET/CT Imaging in Prostate Cancer Fabio Almeida, M.D. Medical Director, Arizona Molecular Imaging Center - Phoenix PET imaging of cancer metabolism
More informationGUIDELINEs ON PROSTATE CANCER
GUIDELINEs ON PROSTATE CANCER (Text update March 2005: an update is foreseen for publication in 2010. Readers are kindly advised to consult the 2009 full text print of the PCa guidelines for the most recent
More informationVital role of volume and number of needles in HDR brachytherapy (HDR-BT) of prostate cancer
Original article Clinical Investigations Vital role of volume and number of needles in HDR brachytherapy (HDR-BT) of prostate cancer Adam Chichel/, MD, Marek Kanikowski, MD, Janusz Skowronek, MD, PhD,
More informationVALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE
Session 3 Advanced prostate cancer VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE 1 PSA is a serine protease and the physiological role is believed to be liquefying the seminal fluid PSA
More informationClinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer
Original Article Radiat Oncol J 205;33():2-28 http://dx.doi.org/0.3857/roj.205.33..2 pissn 2234-900 eissn 2234-356 Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation
More informationOver the last decade, prostate brachytherapy a radiation treatment
135 Modern Prostate Brachytherapy Prostate Specific Antigen Results in 219 Patients with up to 12 Years of Observed Follow-Up Haakon Ragde, M.D. 1 Leroy J. Korb, M.D. 1 Abdel-Aziz Elgamal, M.D. 2 Gordon
More informationRadiotherapy for Localized Hormone-refractory Prostate Cancer in Japan
Radiotherapy for Localized Hormone-refractory Prostate Cancer in Japan KATSUMASA NAKAMURA 1, TERUKI TESHIMA 2, YUTAKA TAKAHASHI 2, ATSUSHI IMAI 3, MASAHIKO KOIZUMI 4, NORIO MITSUHASHI 5, YOSHIYUKI SHIOYAMA
More informationfailure (FBF) rates were calculated using the Phoenix definition.
. JOURNAL COMPILATION 2009 BJU INTERNATIONAL Urological Oncology GLEASON SCORES 8 10 PROSTATE CANCER TREATED WITH TRIMODAL THERAPY STOCK et al. BJUI BJU INTERNATIONAL Outcomes for patients with high-grade
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 informationThe Use of Conformal Radiotherapy and the Selection of Radiation Dose in T1 or T2 Prostate Cancer
Evidence-based Series 3-11 EDUCATION AND INFORMATION 2011 The Use of Conformal Radiotherapy and the Selection of Radiation Dose in T1 or T2 Prostate Cancer Members of the Genitourinary Cancer Disease Site
More informationTanaka et al. BMC Cancer (2017) 17:573 DOI /s
Tanaka et al. BMC Cancer (2017) 17:573 DOI 10.1186/s12885-017-3565-1 RESEARCH ARTICLE Comparison of PSA value at last follow-up of patients who underwent low-dose rate brachytherapy and intensity-modulated
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 informationHigh dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients
High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients Tselis et al. Tselis et al. Radiation Oncology 213, 8:115
More informationJ Clin Oncol 26: by American Society of Clinical Oncology INTRODUCTION
VOLUME 26 NUMBER 4 FEBRUARY 1 28 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Short-Term Neoadjuvant Androgen Deprivation Therapy and External-Beam Radiotherapy for Locally Advanced Prostate
More information