Rationale for Stereotactic Body Radiation Therapy in Treating Patients with Oligometastatic Hormone-Naïve Prostate Cancer (original) (raw)
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Role of Stereotactic Body Radiation Therapy in Oligometastatic, Hormone Refractory Prostate Cancer
International Journal of Radiation Oncology*Biology*Physics, 2012
Rationale: Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1year overall survival rate does not exceed 25%. Patient concerns: A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response. Interventions: After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day. Outcomes: Patient-reported outcome was characterized by a progression-free survival of approximately 3 years. Lessons: in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment. Abbreviations: DCR = disease control rate, HFS = hand-foot-syndrome, mCRC = metastatic colorectal cancer, OS = overall survival, PFS = progression-free survival, SBRT = stereotactic body radiotherapy, SD = stable disease.
Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Recurrence
2019
Supplemental Digital Content is available in the text. Purpose: The purpose of this study was to evaluate the treatment efficacy of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer recurrence and to assess whether there is any relationship between biologically effective dose (BED) and local control (LC). Materials and Methods: Eligible studies were identified on Medline, Embase, and the Cochrane Library, and the proceedings of annual meetings through May 2019 were also identified. A meta-regression analysis was performed to assess whether there is a relationship between BED and LC. In the univariate analysis, studies were separated by the study design, the number of metastatic sites, the site of metastases, radiotherapy machine, and prostate-specific antigen level at the time of SBRT. A P-value <0.05 was considered significant. Results: Twenty-three observational studies with a total of 1441 lesions treated were included in the meta-analysis. The proportio...
Cancer Treatment Reviews, 2013
Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Stereotactic body radiation therapy (SBRT) is touted as a superior type of external beam radiation therapy (EBRT) for the treatment of various tumors. SBRT developed from the theory that high doses of radiation from brachytherapy implant seeds could be recapitulated from advanced technology of radiation treatment planning and delivery. Moreover, SBRT has been theorized to be advantageous compared to other RT techniques because it has a treatment course shorter than that of conventionally fractionated EBRT (a single session, five days per week, for about two weeks vs. eight weeks), is non-invasive, is more effective at killing tumor cells, and is less likely to cause damage to normal tissue. In areas of the US and Europe where there is limited access to RT centers, SBRT is frequently being used to treat prostate cancer, even though long-term data about its efficacy and safety are not well established. We review the impetus behind SBRT and the current clinical evidence supporting its use for prostate cancer, thus providing oncologists and primary care physicians with an understanding of the continually evolving field of prostate radiation therapy. Studies of SBRT provide encouraging results of biochemical control and late toxicity. However, they are limited by a number of factors, including short follow-up, exclusion of intermediate-and high-risk patients, and relatively small number of patients treated. Currently, SBRT regimens should only be used in the context of clinical trials.
Stereotactic body radiation therapy for the primary treatment of localized prostate cancer
Journal of Radiation Oncology, 2012
Objective The low alpha/beta ratio of prostate cancer suggests that hypofractionated schemes of dose-escalated radiotherapy should be advantageous. We report our experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer to assess efficacy and toxicity. Methods From 2007 to 2010, 70 patients (51 % low risk, 31 % intermediate risk, and 17 % high risk) with localized prostate cancer were treated with SBRT using the Cyber-Knife system. One-third of patients received androgen deprivation therapy. Doses of 37.5 Gy (n 029), 36.25 Gy (n036), and 35 Gy (n05) were administered in five fractions and analyzed as high dose (37.5 Gy) vs. low dose (36.25 and 35 Gy). Results At a median 27 and 37 months follow-up, the low and high dose groups' median PSA nadir to date was 0.3 and 0.2 ng/ml, respectively. The 3-year freedom from biochemical failure (FFBF) was 100 %, 95.0 % and 77.1 % for the low-, intermediate-and high-risk patients. A dose response was observed in intermediate-and high-risk patients with 72 % vs. 100 % 3-year FFBF for the low and high dose groups, respectively (p00.0363). Grade III genitourinary toxicities included 4 % acute and 3 % late (all high dose). Potency was preserved in 83 % of hormone naïve patients. Conclusion CyberKnife dose escalated SBRT for low-, intermediate-and high-risk prostate cancer exhibits favorable efficacy with acceptable toxicity.
Stereotactic body radiation therapy: an emerging technique for prostate cancer treatment
Radiographer, 2011
Purpose: Stereotactic Body Radiation Therapy (SBRT) is treatment using stereotactic techniques outside of the brain. SBRT involves accurate delivery of an extremely hypofractionated treatment which should be beneficial for tumours with a low α/β ratio. The focus of the review is on low risk localised prostate cancer due to the low α/β ratio and lack of research into the region. This will help to determine if further research into SBRT for prostate cancer is warranted. Methods: A review of the literature was performed to discover the history and current use of SBRT for various body sites. Results: SBRT has been investigated for lung and liver cancers with studies finding toxicity and survival outcomes equivalent to conventional radiation therapy. Research into the use of SBRT in other body sites has also been conducted. However, short follow up times, small patient populations and lack of randomised trials mean the results are not of the highest reliability. The same limitations are ...
Cureus, 2020
Introduction: Stereotactic body radiation therapy (SBRT) is increasingly being utilized to deliver escalated radiation doses for improving outcomes in various malignancies. We analyzed our cohort of locally advanced, node-positive, and bone oligometastatic prostate cancer patients, that were treated with a combination of pelvic RT using conventional fractionation (CF) and SBRT boost to prostate using extreme hypofractionation (EH), along with hormone therapy (HT). Materials and Methods: Outcomes of 44 prospectively treated patients were analyzed. Volumetric modulated arc therapy (VMAT) was utilized to deliver a dose of 45 Gy to pelvic nodal region, 50 Gy to prostate, and 54-56 Gy to gross nodes in 25 fractions. EH boost 18 Gy in three fractions was delivered to the prostate using CyberKnife (Accuray, Sunnyvale, CA, USA) SBRT. Bone oligometastasis, if any, were treated to a dose of 16 Gy in two fractions, delivered on weekends. Serum prostate-specific antigen (PSA), multi-parametric magnetic resonance imaging (MRI) of pelvis, and prostate-specific membrane antigen-positron emission tomography (PSMA-PET) were used for response assessment during follow-up. HT was given as per standard guidelines. Results: There were 33 (75%) locally advanced, nine (20.5%) node-positive, and two (4.5%) oligometastatic cases. At a median follow-up of 63.5 months, the five-year progression-free survival (PFS) was 88.2%, biochemical PFS (bPFS) was 91.4% and overall survival (OS) was 96.9%. Grade III or greater acute genitourinary and gastrointestinal toxicity was 2.3% each, and late toxicity was 4.5% and 0%, respectively. Conclusion: Excellent five-year outcomes can be attained even for locally advanced, node-positive and bone oligometastatic prostate cancer, by means of dose-escalation using EH-SBRT boost to the prostate.