Preliminary Toxicity Analysis of 3-Dimensional Conformal Radiation Therapy Versus Intensity Modulated Radiation Therapy on the High-Dose Arm of the Radiation Therapy Oncology Group 0126 Prostate Cancer Trial
Jeff M. Michalski,Y. Yan,Deborah Watkins-Bruner,Walter Bosch,Kathryn Winter,James M. Galvin,Jean-Paul Bahary,Gerard Morton,Matthew Parliament,Howard M. Sandler +9 more
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There is a trend for a clinically meaningful reduction in late G2+ GI toxicity with IMRT, and the occurrence of acute GI toxicity and large (>15%) volumes of rectum >70 Gy are associated with late rectal toxicity.Abstract:
Purpose To give a preliminary report of clinical and treatment factors associated with toxicity in men receiving high-dose radiation therapy (RT) on a phase 3 dose-escalation trial. Methods and Materials The trial was initiated with 3-dimensional conformal RT (3D-CRT) and amended after 1 year to allow intensity modulated RT (IMRT). Patients treated with 3D-CRT received 55.8 Gy to a planning target volume that included the prostate and seminal vesicles, then 23.4 Gy to prostate only. The IMRT patients were treated to the prostate and proximal seminal vesicles to 79.2 Gy. Common Toxicity Criteria, version 2.0, and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late morbidity scores were used for acute and late effects. Results Of 763 patients randomized to the 79.2-Gy arm of Radiation Therapy Oncology Group 0126 protocol, 748 were eligible and evaluable: 491 and 257 were treated with 3D-CRT and IMRT, respectively. For both bladder and rectum, the volumes receiving 65, 70, and 75 Gy were significantly lower with IMRT (all P P =.039). On multivariate analysis, IMRT showed a 26% reduction in G2+ late GI toxicity ( P =.099). Acute G2+ toxicity was associated with late G3+ toxicity ( P =.005). With dose–volume histogram data in the multivariate analysis, RT modality was not significant, whereas white race ( P =.001) and rectal V70 ≥15% were associated with G2+ rectal toxicity ( P =.034). Conclusions Intensity modulated RT is associated with a significant reduction in acute G2+ GI/GU toxicity. There is a trend for a clinically meaningful reduction in late G2+ GI toxicity with IMRT. The occurrence of acute GI toxicity and large (>15%) volumes of rectum >70 Gy are associated with late rectal toxicity.read more
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Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy
Neil Mariados,John Sylvester,Dhiren Shah,Lawrence Karsh,Richard Hudes,David C. Beyer,Steven Kurtzman,Jeffrey A. Bogart,R. Alex Hsi,Michael Kos,Rodney J. Ellis,Mark Logsdon,S.H. Zimberg,Kevin Forsythe,Hong Zhang,Edward Soffen,Patrick Francke,Constantine Mantz,Peter J. Rossi,Theodore L. DeWeese,Daniel A. Hamstra,Walter Bosch,Jeff M. Michalski +22 more
TL;DR: The spacer appears to be an effective tool, potentially enabling advanced prostate RT protocols, and decreased rates of patients experiencing declines in bowel quality of life.
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Recent Developments in Radiotherapy
TL;DR: Advances in sensitizing tumors to and protecting normal tissues from the effects of radiation and in overcoming radiation resistance are improving the outcomes of radiotherapy.
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Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial
Daniel A. Hamstra,Neil Mariados,John Sylvester,Dhiren Shah,Lawrence Karsh,Richard Hudes,David C. Beyer,Steven Kurtzman,Jeffrey A. Bogart,R. Alex Hsi,Michael Kos,Rodney J. Ellis,Mark Logsdon,S.H. Zimberg,Kevin Forsythe,Hong Zhang,Edward Soffen,Patrick Francke,Constantine Mantz,Peter J. Rossi,Theodore L. DeWeese,Stephanie Daignault-Newton,Benjamin W. Fischer-Valuck,Anupama Chundury,Walter Bosch,Jeff M. Michalski +25 more
TL;DR: The benefit of a hydrogel spacer in reducing the rectal dose, toxicity, and QOL declines after image guided intensity modulated radiation therapy for prostate cancer was maintained or increased with a longer follow-up period, providing stronger evidence for the benefit of hydrogels spacer use in prostate radiation therapy.
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Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial.
Jeff M. Michalski,Jennifer Moughan,James A. Purdy,Walter R. Bosch,Deborah Watkins Bruner,Jean-Paul Bahary,Harold Lau,Marie Duclos,Matthew Parliament,Gerard Morton,Daniel A. Hamstra,Daniel A. Hamstra,Michael I. Seider,Michael Lock,Malti Patel,Eric Vigneault,Kathryn Winter,Howard M. Sandler +17 more
TL;DR: Despite improvements in biochemical failure and distant metastases, dose escalation did not improve OS and high doses caused more late toxic effects but lower rates of salvage therapy.
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Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline.
Scott C. Morgan,Karen E. Hoffman,D. Andrew Loblaw,Mark K. Buyyounouski,Caroline Patton,Daniel A. Barocas,Søren M. Bentzen,Michael Chang,Jason A. Efstathiou,Patrick Greany,Per H. Halvorsen,Bridget F. Koontz,Colleen A. Lawton,C. Marc Leyrer,Daniel W. Lin,Michael E. Ray,Howard M. Sandler +16 more
TL;DR: Scott C. Morgan, MD, MSc, FRCPC, a Karen Hoffman,MD, MHSc, MPH,b D. Buyyounouski, MDs, MS,d Caroline Patton, MA,e Daniel Barocas, MD , MPH,f Soren Bentzen, DSc, PhD,g Michael Chang, MD,.
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