MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer
Background and purposeLocally recurrent prostate cancer after radiotherapy merits an effective salvage strategy that mitigates the risk of adverse events. We report outcomes of a cohort enrolled across two institutions investigating MRI-guided tumor-targeted salvage high dose rate brachytherapy (HDR...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.971344/full |
| _version_ | 1828128752401383424 |
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| author | Cynthia Ménard Inmaculada Navarro-Domenech Zhihu (Amy) Liu Lisa Joseph Maroie Barkati Alejandro Berlin Guila Delouya Daniel Taussky Marie-Claude Beauchemin Benedicte Nicolas Samuel Kadoury Alexandra Rink Srinivas Raman Aravindhan Sundaramurthy Robert Weersink Dominic Beliveau-Nadeau Joelle Helou Peter Chung |
| author_facet | Cynthia Ménard Inmaculada Navarro-Domenech Zhihu (Amy) Liu Lisa Joseph Maroie Barkati Alejandro Berlin Guila Delouya Daniel Taussky Marie-Claude Beauchemin Benedicte Nicolas Samuel Kadoury Alexandra Rink Srinivas Raman Aravindhan Sundaramurthy Robert Weersink Dominic Beliveau-Nadeau Joelle Helou Peter Chung |
| author_sort | Cynthia Ménard |
| collection | DOAJ |
| description | Background and purposeLocally recurrent prostate cancer after radiotherapy merits an effective salvage strategy that mitigates the risk of adverse events. We report outcomes of a cohort enrolled across two institutions investigating MRI-guided tumor-targeted salvage high dose rate brachytherapy (HDR-BT).Materials and methodsAnalysis of a prospective cohort of 88 patients treated across two institutions with MRI-guided salvage HDR-BT to visible local recurrence after radiotherapy (RT). Tumor target dose ranged from 22-26 Gy, using either an integrated boost (ibBT) or focal technique (fBT), delivered in two implants over a median of 7 days. Outcome metrics included cancer control and toxicity (CTCAE). Quality of life (QoL-EPIC) was analyzed in a subset.ResultsAt a median follow-up of 35 months (6 -134), 3 and 5-year failure-free survival (FFS) outcomes were 67% and 49%, respectively. At 5 years, fBT was associated with a 17% cumulative incidence of local failure (LF) outside the GTV (vs. 7.8% ibBT, p=0.14), while LF within the GTV occurred in 13% (vs. 16% ibBT, p=0.81). Predictors of LF outside fBT volumes included pre-salvage PSA>7 ng/mL (p=0.03) and interval since RT less than 5 years (p=0.04). No attributable grade 3 events occurred, and ibBT was associated with a higher rate of grade 2 toxicity (p<0.001), and trend towards a larger reduction in QoL sexual domain score (p=0.07), compared to fBT.ConclusionA tumor-targeted HDR-BT salvage approach achieved favorable cancer control outcomes. While a fBT was associated with less toxicity, it may be best suited to a subgroup with lower PSA at later recurrence. Tumor targeted dose escalation may be warranted. |
| first_indexed | 2024-04-11T16:10:17Z |
| format | Article |
| id | doaj.art-fb4ebd5427f24fa58d553b0cc2684064 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-11T16:10:17Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-fb4ebd5427f24fa58d553b0cc26840642022-12-22T04:14:44ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.971344971344MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancerCynthia Ménard0Inmaculada Navarro-Domenech1Zhihu (Amy) Liu2Lisa Joseph3Maroie Barkati4Alejandro Berlin5Guila Delouya6Daniel Taussky7Marie-Claude Beauchemin8Benedicte Nicolas9Samuel Kadoury10Alexandra Rink11Srinivas Raman12Aravindhan Sundaramurthy13Robert Weersink14Dominic Beliveau-Nadeau15Joelle Helou16Peter Chung17Radiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaRadiation Oncology, Polytechnique Montreal, Montreal, QC, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaRadiation Oncology, Centre Hospitaliser de l’Université de Montréal (CHUM), Montreal, QC, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, CanadaBackground and purposeLocally recurrent prostate cancer after radiotherapy merits an effective salvage strategy that mitigates the risk of adverse events. We report outcomes of a cohort enrolled across two institutions investigating MRI-guided tumor-targeted salvage high dose rate brachytherapy (HDR-BT).Materials and methodsAnalysis of a prospective cohort of 88 patients treated across two institutions with MRI-guided salvage HDR-BT to visible local recurrence after radiotherapy (RT). Tumor target dose ranged from 22-26 Gy, using either an integrated boost (ibBT) or focal technique (fBT), delivered in two implants over a median of 7 days. Outcome metrics included cancer control and toxicity (CTCAE). Quality of life (QoL-EPIC) was analyzed in a subset.ResultsAt a median follow-up of 35 months (6 -134), 3 and 5-year failure-free survival (FFS) outcomes were 67% and 49%, respectively. At 5 years, fBT was associated with a 17% cumulative incidence of local failure (LF) outside the GTV (vs. 7.8% ibBT, p=0.14), while LF within the GTV occurred in 13% (vs. 16% ibBT, p=0.81). Predictors of LF outside fBT volumes included pre-salvage PSA>7 ng/mL (p=0.03) and interval since RT less than 5 years (p=0.04). No attributable grade 3 events occurred, and ibBT was associated with a higher rate of grade 2 toxicity (p<0.001), and trend towards a larger reduction in QoL sexual domain score (p=0.07), compared to fBT.ConclusionA tumor-targeted HDR-BT salvage approach achieved favorable cancer control outcomes. While a fBT was associated with less toxicity, it may be best suited to a subgroup with lower PSA at later recurrence. Tumor targeted dose escalation may be warranted.https://www.frontiersin.org/articles/10.3389/fonc.2022.971344/fullprostate cancerbrachytherapysalvageradiotherapymagnetic resonance imaging |
| spellingShingle | Cynthia Ménard Inmaculada Navarro-Domenech Zhihu (Amy) Liu Lisa Joseph Maroie Barkati Alejandro Berlin Guila Delouya Daniel Taussky Marie-Claude Beauchemin Benedicte Nicolas Samuel Kadoury Alexandra Rink Srinivas Raman Aravindhan Sundaramurthy Robert Weersink Dominic Beliveau-Nadeau Joelle Helou Peter Chung MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer Frontiers in Oncology prostate cancer brachytherapy salvage radiotherapy magnetic resonance imaging |
| title | MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| title_full | MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| title_fullStr | MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| title_full_unstemmed | MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| title_short | MRI-guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| title_sort | mri guided focal or integrated boost high dose rate brachytherapy for recurrent prostate cancer |
| topic | prostate cancer brachytherapy salvage radiotherapy magnetic resonance imaging |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.971344/full |
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