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Thread: (H) Radiation Treatment

  1. #111
    Basic radiobiology: fractionation, 5 Rs, α/β ratio, QUANTEC
    [2009, Slide Presentation]


    A primer on RT basics flagged by Forum Brother Michael F.

    Radiotherapy (RT) Fractionation
    Aims of RT: the therapeutic ratio
    The 5 Rs of Radiobiology
    Summary: 5 Rs of radiobiology
    Further reading: Potential relationships between the 5Rs of radiobiology and the hallmarks of cancer
    Cell survival and the alpha-beta ratio
    RT Fractionation
    QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic)
    Further Reading

  2. #112
    Analysis of Radiation Dose to Structures Involved in Penile Erections in Men Undergoing MRI-Based Prostate High Dose Rate Brachytherapy


    Erectile Dysfunction after the administration of brachytherapy for treatment for prostate cancer is multifactorial and poorly understood. A component of the dysfunction is potentially due to the amount of radiation received to structures that are hypothesized to be involved in producing penile erections. Currently there is lack of evidence delineating the amount of radiation these structures receive in high dose rate (HDR) brachytherapy. Our objective was to explore the dose to these structures in men undergoing prostate HDR monotherapy.

  3. #113
    Survival Outcomes and Toxicity of Brachytherapy (BT) versus External Beam (EBRT) Boost in the Treatment of Localized Prostate Cancer: A Systematic Review and Meta-Analysis


    High radiation doses may be delivered to the prostate with EBRT or BT. Both low (LDR)- and high dose-rate (HDR) BT have been used as means of dose escalation in randomized controlled trials (RCTs) comparing EBRT to BT boost. These trials have repeatedly demonstrated an improvement in biochemical disease-free survival (bDFS). Yet, the toxicity Results were inconsistent and the trials were underpowered to detect overall survival (OS) differences. Furthermore, to date, there is no randomized data comparing LDR to HDR boost.

  4. #114
    Efficacy Results of a Randomized Trial of Prostate HDR Monotherapy in Either One or Two Fractions for Low and Intermediate Risk Disease


    Evidence supports the use of High Dose-Rate Brachytherapy (HDR) as monotherapy for selected patients with low and intermediate risk prostate cancer when given in schedules of 2 or more fractions. There is limited and conflicting data on the efficacy of HDR monotherapy given as a single fraction. Our Purpose is to report on PSA response and disease-free survival in a randomized trial comparing a single and a 2-fraction regimen.

  5. #115
    Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial



    Hypofractionated radiotherapy for prostate cancer has gained increased attention due to its proposed high radiation-fraction sensitivity. Recent reports from studies comparing moderately hypofractionated and conventionally fractionated radiotherapy support the clinical use of moderate hypofractionation. To date, there are no published randomised studies on ultra-hypofractionated radiotherapy. Here, we report the outcomes of the Scandinavian HYPO-RT-PC phase 3 trial with the aim to show non-inferiority of ultra-hypofractionation compared with conventional fractionation.

    In this open-label, randomised, phase 3 non-inferiority trial done in 12 centres in Sweden and Denmark, we recruited men up to 75 years of age with intermediate-to-high-risk prostate cancer and a WHO performance status between 0 and 2. Patients were randomly assigned to ultra-hypofractionation (427 Gy in seven fractions, 3 days per week for 25 weeks) or conventional fractionated radiotherapy (780 Gy in 39 fractions, 5 days per week for 8 weeks). No androgen deprivation therapy was allowed. The primary endpoint was time to biochemical or clinical failure, analysed in the per-protocol population. The prespecified non-inferiority margin was 4% at 5 years, corresponding to a critical hazard ratio (HR) limit of 1338. Physician-recorded toxicity was measured according to the Radiation Therapy Oncology Group (RTOG) morbidity scale and patient-reported outcome measurements with the Prostate Cancer Symptom Scale (PCSS) questionnaire. This trial is registered with the ISRCTN registry, number ISRCTN45905321.

    Between July 1, 2005, and Nov 4, 2015, 1200 patients were randomly assigned to conventional fractionation (n=602) or ultra-hypofractionation (n=598 ), of whom 1180 (591 conventional fractionation and 589 ultra-hypofractionation) constituted the per-protocol population. 1054 (89%) participants were intermediate risk and 126 (11%) were high risk. Median follow-up time was 50 years (IQR 31-70). The estimated failure-free survival at 5 years was 84% (95% CI 80-87) in both treatment groups, with an adjusted HR of 1002 (95% CI 0758-1325; log-rank p=099). There was weak evidence of an increased frequency of acute physician-reported RTOG grade 2 or worse urinary toxicity in the ultra-hypofractionation group at end of radiotherapy (158 [28%] of 569 patients vs 132 [23%] of 578 patients; p=0057). There were no significant differences in grade 2 or worse urinary or bowel late toxicity between the two treatment groups at any point after radiotherapy, except for an increase in urinary toxicity in the ultra-hypofractionation group compared to the conventional fractionation group at 1-year follow-up (32 [6%] of 528 patients vs 13 [2%] of 529 patients; (p=00037). We observed no differences between groups in frequencies at 5 years of RTOG grade 2 or worse urinary toxicity (11 [5%] of 243 patients for the ultra-hypofractionation group vs 12 [5%] of 249 for the conventional fractionation group; p=100) and bowel toxicity (three [1%] of 244 patients vs nine [4%] of 249 patients; p=014). Patient-reported outcomes revealed significantly higher levels of acute urinary and bowel symptoms in the ultra-hypofractionation group compared with the conventional fractionation group but no significant increases in late symptoms were found, except for increased urinary symptoms at 1-year follow-up, consistent with the physician-evaluated toxicity.

    Ultra-hypofractionated radiotherapy is non-inferior to conventionally fractionated radiotherapy for intermediate-to-high risk prostate cancer regarding failure-free survival. Early side-effects are more pronounced with ultra-hypofractionation compared with conventional fractionation whereas late toxicity is similar in both treatment groups. The results support the use of ultra-hypofractionation for radiotherapy of prostate cancer.

  6. #116
    Hypofractionated Intensity-modulated Radiotherapy for Intermediate- and High-risk Prostate Cancer: A Retrospective Study
    [2019, Review, Full Text]



    The aim of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) for intermediate- and high-risk prostate cancer.

    Seventy-five consecutive patients with intermediate- and high-risk prostate cancer treated with IMRT (63 Gy/21 fractions/7 weeks) between 2010 and 2013 were retrospectively analyzed. PSA relapse and adverse events were determined based on the Phoenix criteria and the Common Terminology Criteria for Adverse Events v4.0, respectively.

    The 5-year PSA relapse-free rate, clinical relapse-free rate, and overall survival rate for all patients was 92.1%, 95.1%, and 92.9%, respectively. The incidence of late grade 2 gastrointestinal- and genitourinary-toxicity at 5 years was 1.3% and 17.1%, respectively. No grade 3 or greater toxicities were observed.

    These data indicate that hypofractionated IMRT (63 Gy in a total of 21 fractions with 3 fractions per week) is effective and safe for intermediate- and high-risk prostate cancer.

  7. #117
    Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus
    [2019, Review]



    •SBRT represents a valid treatment option for men with low/intermediate risk PCa.
    •Adding a focal boost to the intraprostatic tumor may improve disease control.
    •A focal boost might have favourable toxicity compared to whole-gland dose-escalation.
    •Currently, SBRT with a focal boost for PCa should be restricted to clinical trials.

    Stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) is gaining interest by the recent publication of the first phase III trials on prostate SBRT and the promising results of many other phase II trials. Before long term results became available, the major concern for implementing SBRT in PCa in daily clinical practice was the potential risk of late genitourinary (GU) and gastrointestinal (GI) toxicity. A number of recently published trials, including late outcome and toxicity data, contributed to the growing evidence for implementation of SBRT for PCa in daily clinical practice. However, there exists substantial variability in delivering SBRT for PCa. The aim of this topical review is to present a number of prospective trials and retrospective analyses of SBRT in the treatment of PCa. We focus on the treatment strategies and techniques used in these trials. In addition, recent literature on a simultaneous integrated boost to the tumor lesion, which could create an additional value in the SBRT treatment of PCa, was described. Furthermore, we discuss the multicenter consensus of the FLAME consortium on SBRT for PCa with a focal boost to the macroscopic intraprostatic tumor nodule(s).

  8. #118
    Particle therapy for prostate cancer: The past, present and future [2019, Review, Full Text]


    Although prostate cancer control using radiotherapy is dose‐dependent, dose–volume effects on late toxicities in organs at risk, such as the rectum and bladder, have been observed. Both protons and carbon ions offer advantageous physical properties for radiotherapy, and create favorable dose distributions using fewer portals compared with photon‐based radiotherapy. Thus, particle beam therapy using protons and carbon ions theoretically seems suitable for dose escalation and reduced risk of toxicity. However, it is difficult to evaluate the superiority of particle beam radiotherapy over photon beam radiotherapy for prostate cancer, as no clinical trials have directly compared the outcomes between the two types of therapy due to the limited number of facilities using particle beam therapy. The Japanese Society for Radiation Oncology organized a joint effort among research groups to establish standardized treatment policies and indications for particle beam therapy according to disease, and multicenter prospective studies have been planned for several common cancers. Clinical trials of proton beam therapy for intermediate‐risk prostate cancer and carbon‐ion therapy for high‐risk prostate cancer have already begun. As particle beam therapy for prostate cancer is covered by the Japanese national health insurance system as of April 2018, and the number of facilities practicing particle beam therapy has increased recently, the number of prostate cancer patients treated with particle beam therapy in Japan is expected to increase drastically. Here, we review the results from studies of particle beam therapy for prostate cancer and discuss future developments in this field.
    [Emphasis mine]

    A nice major review with good illustrations.

  9. #119
    Sexual Function in Patients Treated With Stereotactic Radiotherapy For Prostate Cancer: A Systematic Review of the Current Evidence



    Sexual function can be impaired by all prostate cancer treatment modalities, but studies specifically addressing the impact of stereotactic body radiotherapy (SBRT) on sexual function are scarce.

    To systematically evaluate sexual outcomes in patients treated by SBRT for prostate cancer and determine clinical factors associated with erectile dysfunction (ED).

    A systematic review of the available literature was performed on PubMed/Medline, Scopus, and Cochrane Library databases in June 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Only articles providing data on baseline and post-treatment sexual function after SBRT (≥5 Gy/fraction) were included in this analysis (n = 12).

    Sexual function deteriorates after SBRT of the prostate.

    Deterioration of sexual health was found, with Expanded Prostate Cancer Index Composite-26 sexual domain scores showing a median decrease of 9.2 at 12 months and a median decrease of the Sexual Health Inventory for Men subdomain score by 2.7 at 12 months (from baseline median value of 56.3 and 16, respectively). At 60 months, ED was reported by 26-55% of previously sexually functioning patients in 5 of the 12 studies.

    ED affects ≤55% of previously sexually functioning patients at 5 years, as reported for other non-surgical treatment modalities.

    This study enforced strict inclusion criteria of selected studies and exclusion of patients receiving concurrent androgen deprivation therapy. However, inconsistencies in the choice of assessment tool and definition of ED hamper a robust meta-analysis of pooled data.

    Sexual function decline after SBRT for prostate cancer appears to be similar to other modalities and should be specifically addressed in future studies.
    Last edited by DjinTonic; 07-16-2019 at 01:33 PM.

  10. #120
    High-dose-rate prostate brachytherapy appears safe in patients with high baseline International Prostate Symptom Scores [2019]



    The purpose of the study was to report our institutional quality of life data for those undergoing high-dose-rate brachytherapy with an International Prostate Symptom Score (IPSS) ≥15 compared with those with an IPSS <15.

    Methods and Materials
    The charts of 95 patients with localized adenocarcinoma of the prostate treated with high-dose-rate as monotherapy or as a boost after external beam radiation therapy at a single institution between 2012 and 2015 were reviewed. All patients completed the IPSS and Expanded Prostate Index for Prostate Cancer–Clinical Practice quality of life assessments before treatment and at least one followup survey. Linear mixed models were performed to test for significant changes and differences in each outcome over time.

    Median followup in the IPSS <15 group was 23 months and 16 months in the IPSS ≥15 group. Median prostate volume was 46.3 cc and 45.4 cc, respectively (p = 0.901). IPSS, incontinence, and urinary irritation/obstruction scores were significantly higher in the IPSS ≥15 group compared with the IPSS <15 group at baseline (all p ≤ 0.05). By the >24 months time point, these scores had decreased below baseline and were not significantly different from those with a baseline IPSS <15 (all p > 0.1). 12.5% in the IPSS ≥15 group developed a new Grade 2 genitourinary toxicity requiring an alpha blocker compared with 26.5% in the IPSS <15 group (p = 0.34). No patients required emergency placement of a foley catheter within 30 days of treatment.

    Given the low rates of genitourinary toxicity, this technique appears appropriate even for those with high baseline urinary symptoms.


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