NYPI JOURNAL CLUB
STEREOTACTIC HYPOFRACTIONATED ACCURATE RADIOTHERAPY OF
- Berit L. Madsen, M.D.,* R. Alex Hsi, M.D.,* Huong T. Pham, M.D.,* Jack F. Fowler, D.Sc., Ph.D., Laura Esagui, C.M.D.,* And John Corman, M.D.! *Sections of Radiation Oncology and !Urology, Virginia Mason Medical Center, Seattle, WA; Emeritus, Department of Human Oncology, Medical School, University of Wisconsin, Madison, WI
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A comparison of overall survival between patients with low- and intermediate-risk prostate cancer treated with brachytherapy, external beam radiotherapy, or radical prostatectomy.
- J. P. Ciezki, C. A. Reddy, P. A. Kupelian, E. A. Klein, C. Robinson, N. Chehade, K. Angermeier, A. Altman, J. Ulchaker
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Prostate Cancer in Fathers With Fewer Male Offspring: the Jerusalem Perinatal Study Cohort
- Susan Harlap, Ora Paltiel, Yehiel Friedlander, Ronit Calderon-Margalit, Lisa Deutsch, Karinne R. Kleinhaus, Orly Manor, Alfred I. Neugut, Mark Opler, Mary C. Perrin, Mary B. Terry, Efrat Tiram, Rivka Yanetz
Affliliations of authors: Department of Epidemiology, Mailman School of Public Health (SH, AIN, MO, MCP, MBT), and Department of Psychiatry (KRK), Columbia University, New York, NY; Epidemiology Unit, Braun School of Public Health, Hebrew University-Hadassah School of Public Health, Jerusalem, Israel (OP, YF, RCM, LD, OM, ET, RY)
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Effect of once-weekly oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer: a randomized trial.
- Greenspan SL, Nelson JB, Trump DL, Resnick NM.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Prostate Specific Antigen Density Correlates
- Shilajit D. Kundu, Kim Yu, Jo Ann V. Antenor, Brian K. Suarez and William J. Catalona, Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (SDK, XY, WJC), and the Departments of Psychiatry (KAR, BKS) and Neurology (JVA), Washington University, School of Medicine, St. Louis, Missouri
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May 18, 2007 - Comments: This is the first publication on hypofracionation for prostate cancer, a regimen typically used by Cyberknife users. It is most interesting that their results, meaning their preliminary success rates are so poor. And to further bolster these results, the authors suggest that it appears to be safe to test higher radiation doses. It is ironic then that this therapy is advertised as accepted and safe therapy when the current doses used offer poor outcomes and that more study is required to test higher doses. May the buyer beware. LP
Purpose: To evaluate the feasibility and toxicity of stereotactic hypofractionated accurate radiotherapy (SHARP) for localized prostate cancer.
Methods and Materials: A Phase I/II trial of SHARP performed for localized prostate cancer using 33.5 Gy in 5 fractions, calculated to be biologically equivalent to 78 Gy in 2 Gy fractions (+/- ratio of 1.5 Gy). Noncoplanar conformal fields and daily stereotactic localization of implanted fiducials were used for treatment. Genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated by American Urologic Association (AUA) score and Common Toxicity Criteria (CTC). Prostate-specific antigen (PSA) values and self-reported sexual function were recorded at specified follow-up intervals.
Results: The study includes 40 patients. The median follow-up is 41 months (range, 21-60 months). Acute toxicity Grade 1-2 was 48.5% (GU) and 39% (GI); 1 acute Grade 3 GU toxicity. Late Grade 1-2 toxicity was 45% (GU) and 37% (GI). No late Grade 3 or higher toxicity was reported. Twenty-six patients reported potency before therapy; 6 (23%) have developed impotence. Median time to PSA nadir was 18 months with the majority of nadirs less than 1.0 ng/mL. The actuarial 48-month biochemical freedom from relapse is 70% for the American Society for Therapeutic Radiology and Oncology definition and 90% by the alternative nadir _ 2 ng/mL failure definition.
Conclusions: SHARP for localized prostate cancer is feasible with minimal acute or late toxicity. Dose escalation should be possible.
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