Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer
Purpose Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefo...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2016-03, Vol.94 (3), p.605-611 |
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| creator | Lewis, Stephen L., MD Patel, Pretesh, MD Song, Haijun, PhD Freedland, Stephen J., MD Bynum, Sigrun, CMD Oh, Daniel, MD, PhD Palta, Manisha, MD Yoo, David, MD Oleson, James, MD, PhD Salama, Joseph K., MD |
| description | Purpose Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. Methods and Materials From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Results Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA |
| doi_str_mv | 10.1016/j.ijrobp.2015.11.025 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22645111</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0360301615267636</els_id><sourcerecordid>1805500810</sourcerecordid><originalsourceid>FETCH-LOGICAL-c478t-6c16778b5873c8919e55bd08258429ca9213c9faabf018740e103be112c7939c3</originalsourceid><addsrcrecordid>eNqFUsFu1DAUtBAVXRb-AKFIXHpJ8LNjx7kgoRVtVyqigiJxsxzHoQ5JHOwEKX-P02w5cOnFlq2Z997MPITeAM4AA3_fZrb1rhozgoFlABkm7BnagSjKlDL24znaYcpxSiP4HL0MocUYAxT5C3ROuOCFEOUO2WOvfprkara1qZPrZXSNV3qyblBT_Lh1YRp9POJLT65fkuMwmSHYaUk-u3ruHlBfVW3Vyknu7o1X45I0zie3J15yUIM2_hU6a1QXzOvTvUffLz_dHa7Tmy9Xx8PHm1TnhZhSroEXhaiYKKgWJZSGsarGgjCRk1KrkgDVZaNU1eCoNccGMK0MANFFSUtN9-jdVjd2tzJoGye_124YogBJCM8ZAETUxYaK6n7PJkyyt0GbrlODcXOQIDBjGItYfI_yDaqjoOBNI0dve-UXCViuUchWblHINQoJIGMUkfb21GGuelP_Iz16HwEfNoCJbvyxxq_DmmhVbf06a-3sUx3-L6A7O1itul9mMaF1sx-i0xJkIBLLb-s6rNsAjPCCU07_Ara6sUs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1805500810</pqid></control><display><type>article</type><title>Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Lewis, Stephen L., MD ; Patel, Pretesh, MD ; Song, Haijun, PhD ; Freedland, Stephen J., MD ; Bynum, Sigrun, CMD ; Oh, Daniel, MD, PhD ; Palta, Manisha, MD ; Yoo, David, MD ; Oleson, James, MD, PhD ; Salama, Joseph K., MD</creator><creatorcontrib>Lewis, Stephen L., MD ; Patel, Pretesh, MD ; Song, Haijun, PhD ; Freedland, Stephen J., MD ; Bynum, Sigrun, CMD ; Oh, Daniel, MD, PhD ; Palta, Manisha, MD ; Yoo, David, MD ; Oleson, James, MD, PhD ; Salama, Joseph K., MD</creatorcontrib><description>Purpose Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. Methods and Materials From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Results Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%). Conclusions The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2015.11.025</identifier><identifier>PMID: 26867889</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Dose Hypofractionation ; Follow-Up Studies ; GY RANGE 10-100 ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; Middle Aged ; NEOPLASMS ; PATIENTS ; Postoperative Care ; PROSTATE ; Prostate-Specific Antigen - blood ; Prostatectomy ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - radiotherapy ; Prostatic Neoplasms - surgery ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy, Image-Guided - adverse effects ; Radiotherapy, Image-Guided - methods ; Radiotherapy, Intensity-Modulated - adverse effects ; Radiotherapy, Intensity-Modulated - methods ; Time Factors ; TOXICITY</subject><ispartof>International journal of radiation oncology, biology, physics, 2016-03, Vol.94 (3), p.605-611</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-6c16778b5873c8919e55bd08258429ca9213c9faabf018740e103be112c7939c3</citedby><cites>FETCH-LOGICAL-c478t-6c16778b5873c8919e55bd08258429ca9213c9faabf018740e103be112c7939c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2015.11.025$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26867889$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22645111$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Lewis, Stephen L., MD</creatorcontrib><creatorcontrib>Patel, Pretesh, MD</creatorcontrib><creatorcontrib>Song, Haijun, PhD</creatorcontrib><creatorcontrib>Freedland, Stephen J., MD</creatorcontrib><creatorcontrib>Bynum, Sigrun, CMD</creatorcontrib><creatorcontrib>Oh, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Palta, Manisha, MD</creatorcontrib><creatorcontrib>Yoo, David, MD</creatorcontrib><creatorcontrib>Oleson, James, MD, PhD</creatorcontrib><creatorcontrib>Salama, Joseph K., MD</creatorcontrib><title>Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. Methods and Materials From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Results Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%). Conclusions The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.</description><subject>Adult</subject><subject>Aged</subject><subject>Dose Hypofractionation</subject><subject>Follow-Up Studies</subject><subject>GY RANGE 10-100</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>NEOPLASMS</subject><subject>PATIENTS</subject><subject>Postoperative Care</subject><subject>PROSTATE</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy, Image-Guided - adverse effects</subject><subject>Radiotherapy, Image-Guided - methods</subject><subject>Radiotherapy, Intensity-Modulated - adverse effects</subject><subject>Radiotherapy, Intensity-Modulated - methods</subject><subject>Time Factors</subject><subject>TOXICITY</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsFu1DAUtBAVXRb-AKFIXHpJ8LNjx7kgoRVtVyqigiJxsxzHoQ5JHOwEKX-P02w5cOnFlq2Z997MPITeAM4AA3_fZrb1rhozgoFlABkm7BnagSjKlDL24znaYcpxSiP4HL0MocUYAxT5C3ROuOCFEOUO2WOvfprkara1qZPrZXSNV3qyblBT_Lh1YRp9POJLT65fkuMwmSHYaUk-u3ruHlBfVW3Vyknu7o1X45I0zie3J15yUIM2_hU6a1QXzOvTvUffLz_dHa7Tmy9Xx8PHm1TnhZhSroEXhaiYKKgWJZSGsarGgjCRk1KrkgDVZaNU1eCoNccGMK0MANFFSUtN9-jdVjd2tzJoGye_124YogBJCM8ZAETUxYaK6n7PJkyyt0GbrlODcXOQIDBjGItYfI_yDaqjoOBNI0dve-UXCViuUchWblHINQoJIGMUkfb21GGuelP_Iz16HwEfNoCJbvyxxq_DmmhVbf06a-3sUx3-L6A7O1itul9mMaF1sx-i0xJkIBLLb-s6rNsAjPCCU07_Ara6sUs</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Lewis, Stephen L., MD</creator><creator>Patel, Pretesh, MD</creator><creator>Song, Haijun, PhD</creator><creator>Freedland, Stephen J., MD</creator><creator>Bynum, Sigrun, CMD</creator><creator>Oh, Daniel, MD, PhD</creator><creator>Palta, Manisha, MD</creator><creator>Yoo, David, MD</creator><creator>Oleson, James, MD, PhD</creator><creator>Salama, Joseph K., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>OTOTI</scope></search><sort><creationdate>20160301</creationdate><title>Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer</title><author>Lewis, Stephen L., MD ; Patel, Pretesh, MD ; Song, Haijun, PhD ; Freedland, Stephen J., MD ; Bynum, Sigrun, CMD ; Oh, Daniel, MD, PhD ; Palta, Manisha, MD ; Yoo, David, MD ; Oleson, James, MD, PhD ; Salama, Joseph K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-6c16778b5873c8919e55bd08258429ca9213c9faabf018740e103be112c7939c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Dose Hypofractionation</topic><topic>Follow-Up Studies</topic><topic>GY RANGE 10-100</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>NEOPLASMS</topic><topic>PATIENTS</topic><topic>Postoperative Care</topic><topic>PROSTATE</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy, Image-Guided - adverse effects</topic><topic>Radiotherapy, Image-Guided - methods</topic><topic>Radiotherapy, Intensity-Modulated - adverse effects</topic><topic>Radiotherapy, Intensity-Modulated - methods</topic><topic>Time Factors</topic><topic>TOXICITY</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lewis, Stephen L., MD</creatorcontrib><creatorcontrib>Patel, Pretesh, MD</creatorcontrib><creatorcontrib>Song, Haijun, PhD</creatorcontrib><creatorcontrib>Freedland, Stephen J., MD</creatorcontrib><creatorcontrib>Bynum, Sigrun, CMD</creatorcontrib><creatorcontrib>Oh, Daniel, MD, PhD</creatorcontrib><creatorcontrib>Palta, Manisha, MD</creatorcontrib><creatorcontrib>Yoo, David, MD</creatorcontrib><creatorcontrib>Oleson, James, MD, PhD</creatorcontrib><creatorcontrib>Salama, Joseph K., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lewis, Stephen L., MD</au><au>Patel, Pretesh, MD</au><au>Song, Haijun, PhD</au><au>Freedland, Stephen J., MD</au><au>Bynum, Sigrun, CMD</au><au>Oh, Daniel, MD, PhD</au><au>Palta, Manisha, MD</au><au>Yoo, David, MD</au><au>Oleson, James, MD, PhD</au><au>Salama, Joseph K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>94</volume><issue>3</issue><spage>605</spage><epage>611</epage><pages>605-611</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. Methods and Materials From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Results Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%). Conclusions The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26867889</pmid><doi>10.1016/j.ijrobp.2015.11.025</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Dose Hypofractionation Follow-Up Studies GY RANGE 10-100 Hematology, Oncology and Palliative Medicine Humans Male Middle Aged NEOPLASMS PATIENTS Postoperative Care PROSTATE Prostate-Specific Antigen - blood Prostatectomy Prostatic Neoplasms - blood Prostatic Neoplasms - radiotherapy Prostatic Neoplasms - surgery Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy, Image-Guided - adverse effects Radiotherapy, Image-Guided - methods Radiotherapy, Intensity-Modulated - adverse effects Radiotherapy, Intensity-Modulated - methods Time Factors TOXICITY |
| title | Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer |
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