Journal ArticleDOI
Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: First clinical trial results
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In this paper, the feasibility and toxicity of stereotactic hypofractionated accurate radiotherapy (SHARP) for localized prostate cancer were evaluated in a Phase I/II trial with 40 patients.Abstract:
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 (α/β 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.read more
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Clinical practice guidelines in oncology
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Journal ArticleDOI
Stereotactic body radiotherapy for localized prostate cancer: Pooled analysis from a multi-institutional consortium of prospective phase II trials
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Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer.
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References
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Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: A multi- institutional update
Alan W. Partin,Michael W. Kattan,Eric N.P. Subong,Patrick C. Walsh,Kirk J. Wojno,Joseph E. Oesterling,Peter T. Scardino,Jay D. Pearson +7 more
TL;DR: In this paper, a multinomial log-linear regression was performed for the simultaneous prediction of organ-confined disease, isolated capsular penetration, seminal vesicle involvement, or pelvic lymph node involvement.
Journal ArticleDOI
Fractionation and protraction for radiotherapy of prostate carcinoma
David J. Brenner,Eric J. Hall +1 more
TL;DR: High dose rate (HDR) brachytherapy would be a highly appropriate modality for treating prostate cancer because of the documented relationship between cellular proliferative status and sensitivity to changes in fractionation, and prostatic tumors contain exceptionally low proportions of proliferating cells.
Journal ArticleDOI
Is α/β for prostate tumors really low?
TL;DR: All the estimates point toward low values of α/β, at least as low as the estimates of Brenner and Hall, and possibly lower than the expected values of about 3 Gy for late complications.
Journal ArticleDOI
The radiobiology of prostate cancer including new aspects of fractionated radiotherapy
TL;DR: Theoretical modeling shows a stronger enhancement of tumor effect than of late complications for larger (and fewer) fractions, in prostate tumors uniquely, and Combination treatments of external beam (EBRT) and brachytherapy boost doses can give higher biological tumor effects than any EBRT using daily 2 Gy doses, and with acceptable late complications.
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