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SBRT for High-Risk Prostate Cancer

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Stereotactic Radiosurgery for Prostate Cancer

Abstract

SBRT may potentially replace HDR brachytherapy. Theoretical advantages include: (1) a shorter learning curve; (2) similar radiobiological advantages to HDR; (3) the absence of a need for anesthesia; (4) patient convenience. However, there are limited long-term results and there may be subsets of patients for whom SBRT is contraindicated (e.g. men with a prominent median lobe, those with a neurologic movement disorder) and some insurance companies do not coverage for SBRT. Ideally randomized studies are needed to define the role of SBRT in High Risk patients and answer questions concerning the use of ADT and pelvic RT.

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References

  1. Morlacco A, Karnes RJ. High-risk prostate cancer: the role of surgical management. Crit Rev Oncol Hematol. 2016;102:135–43.

    Article  Google Scholar 

  2. National, Comprehensive, Cancer, Network. Prostate cancer (version 2.2017). 2017. Available from https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf

  3. Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet. 2011;378(9809):2104–11.

    Article  Google Scholar 

  4. Widmark A, Klepp O, Solberg A, Damber JE, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373(9660):301–8.

    Article  CAS  Google Scholar 

  5. Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, et al. Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys. 1995;32(1):3–12.

    Article  CAS  Google Scholar 

  6. Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA. 2005;294(10):1233–9.

    Article  CAS  Google Scholar 

  7. Sathya JR, Davis IR, Julian JA, Guo Q, Daya D, Dayes IS, et al. Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol. 2005;23(6):1192–9.

    Article  Google Scholar 

  8. Pollack A, Hanlon AL, Horwitz EM, Feigenberg SJ, Uzzo RG, Hanks GE. Prostate cancer radiotherapy dose response: an update of the fox chase experience. J Urol. 2004;171(3):1132–6.

    Article  Google Scholar 

  9. Heemsbergen WD, Al-Mamgani A, Slot A, Dielwart MF, Lebesque JV. Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol. 2014;110(1):104–9.

    Article  Google Scholar 

  10. Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF, et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24(13):1990–6.

    Article  Google Scholar 

  11. Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(1):67–74.

    Article  Google Scholar 

  12. Dearnaley DP, Sydes MR, Graham JD, Aird EG, Bottomley D, Cowan RA, et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007;8(6):475–87.

    Article  Google Scholar 

  13. Morris WJ, Tyldesley S, Rodda S, Halperin R, Pai H, McKenzie M, et al. Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2017;98(2):275–85.

    Article  Google Scholar 

  14. Spratt DE, Soni PD, McLaughlin PW, Merrick GS, Stock RG, Blasko JC, et al. American Brachytherapy Society Task Group Report: combination of brachytherapy and external beam radiation for high-risk prostate cancer. Brachytherapy. 2017;16(1):1–12.

    Article  Google Scholar 

  15. Horwitz EM, Bae K, Hanks GE, Porter A, Grignon DJ, Brereton HD, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol. 2008;26(15):2497–504.

    Article  CAS  Google Scholar 

  16. Bolla M, de Reijke TM, Van Tienhoven G, Van den Bergh AC, Oddens J, Poortmans PM, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360(24):2516–27.

    Article  CAS  Google Scholar 

  17. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43(5):1095–101.

    CAS  Google Scholar 

  18. Dasu A, Toma-Dasu I. Prostate alpha/beta revisited – an analysis of clinical results from 14 168 patients. Acta Oncol. 2012;51(8):963–74.

    Article  Google Scholar 

  19. Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50(4):1021–31.

    Article  CAS  Google Scholar 

  20. Miralbell R, Roberts SA, Zubizarreta E, Hendry JH. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: alpha/beta = 1.4 (0.9–2.2) Gy. Int J Radiat Oncol Biol Phys. 2012;82(1):e17–24.

    Article  Google Scholar 

  21. Benjamin LC, Tree AC, Dearnaley DP. The role of hypofractionated radiotherapy in prostate cancer. Curr Oncol Rep. 2017;19(4):30.

    Article  Google Scholar 

  22. Fuller DB, Naitoh J, Lee C, Hardy S, Jin H. Virtual HDR CyberKnife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. Int J Radiat Oncol Biol Phys. 2008;70(5):1588–97.

    Article  Google Scholar 

  23. Kishan AU, King CR. Stereotactic body radiotherapy for low- and intermediate-risk prostate cancer. Semin Radiat Oncol. 2017;27(3):268–78.

    Article  Google Scholar 

  24. Gonzalez-Motta A, Roach M 3rd. Stereotactic body radiotherapy (SBRT) for high-risk prostate cancer: where are we now? Pract Radiat Oncol. 2018;8(3):185–202.

    Article  Google Scholar 

  25. Bolzicco G, Favretto MS, Satariano N, Scremin E, Tambone C, Tasca A. A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy. BMC Urol. 2013;13:49.

    Article  Google Scholar 

  26. Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, et al. Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol. 2013;8:58.

    Article  Google Scholar 

  27. Davis J, Sharma S, Shumway R, Perry D, Bydder S, Simpson CK, et al. Stereotactic body radiotherapy for clinically localized prostate cancer: toxicity and biochemical disease-free outcomes from a multi-institutional patient registry. Cureus. 2015;7(12):e395.

    PubMed  PubMed Central  Google Scholar 

  28. Janowski E, Chen LN, Kim JS, Lei S, Suy S, Collins B, et al. Stereotactic body radiation therapy (SBRT) for prostate cancer in men with large prostates (>/=50 cm3). Radiat Oncol. 2014;9:241.

    Article  Google Scholar 

  29. Kang JK, Cho CK, Choi CW, Yoo S, Kim MS, Yang K, et al. Image-guided stereotactic body radiation therapy for localized prostate cancer. Tumori. 2011;97(1):43–8.

    Article  Google Scholar 

  30. Katz A, Formenti SC, Kang J. Predicting biochemical disease-free survival after prostate stereotactic body radiotherapy: risk-stratification and patterns of failure. Front Oncol. 2016;6:168.

    PubMed  PubMed Central  Google Scholar 

  31. King CR, Freeman D, Kaplan I, Fuller D, Bolzicco G, Collins S, et al. Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials. Radiother Oncol. 2013;109(2):217–21.

    Article  Google Scholar 

  32. Koskela K, Palmgren JE, Heikkila J, Virsunen H, Sailas L, Auvinen P, et al. Hypofractionated stereotactic body radiotherapy for localized prostate cancer – first Nordic clinical experience. Acta Oncol. 2017;56(7):978–83.

    Article  Google Scholar 

  33. Kotecha R, Djemil T, Tendulkar RD, Reddy CA, Thousand RA, Vassil A, et al. Dose-escalated stereotactic body radiation therapy for patients with intermediate- and high-risk prostate cancer: initial dosimetry analysis and patient outcomes. Int J Radiat Oncol Biol Phys. 2016;95(3):960–4.

    Article  Google Scholar 

  34. Lee SW, Jang HS, Lee JH, Kim SH, Yoon SC. Stereotactic body radiation therapy for prostate cancer patients with old age or medical comorbidity: a 5-year follow-up of an investigational study. Medicine. 2014;93(28):e290.

    Article  Google Scholar 

  35. Ricco A, Manahan G, Lanciano R, Hanlon A, Yang J, Arrigo S, et al. The comparison of stereotactic body radiation therapy and intensity-modulated radiation therapy for prostate cancer by NCCN risk groups. Front Oncol. 2016;6:184.

    Article  Google Scholar 

  36. Fan CY, Chao HL, Huang WY, Lin CS, Chen CM, Lo CH. Stereotactic ablative radiotherapy with CyberKnife in the treatment of locally advanced prostate cancer: preliminary results. Tumori. 2015;101(6):684–91.

    Article  CAS  Google Scholar 

  37. Rana Z, Hong RL, Abugideiri M, McRae D, Cernica G, Mordkin R, et al. Sexual, irritative, and voiding outcomes, following stereotactic body radiation therapy for prostate cancer. Radiat Oncol. 2015;10:182.

    Article  Google Scholar 

  38. Miralbell R, Molla M, Rouzaud M, Hidalgo A, Toscas JI, Lozano J, et al. Hypofractionated boost to the dominant tumor region with intensity modulated stereotactic radiotherapy for prostate cancer: a sequential dose escalation pilot study. Int J Radiat Oncol Biol Phys. 2010;78(1):50–7.

    Article  Google Scholar 

  39. Anwar M, Weinberg V, Seymour Z, Hsu IJ, Roach M 3rd, Gottschalk AR. Outcomes of hypofractionated stereotactic body radiotherapy boost for intermediate and high-risk prostate cancer. Radiat Oncol. 2016;11:8.

    Article  Google Scholar 

  40. Kim HJ, Phak JH, Kim WC. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy boost and whole pelvic radiotherapy for intermediate- and high-risk prostate cancer. Asia Pac J Clin Oncol. 2017;13(1):21–7.

    Article  Google Scholar 

  41. Lin YW, Lin LC, Lin KL. The early result of whole pelvic radiotherapy and stereotactic body radiotherapy boost for high-risk localized prostate cancer. Front Oncol. 2014;4:278.

    Article  Google Scholar 

  42. Mercado C, Kress MA, Cyr RA, Chen LN, Yung TM, Bullock EG, et al. Intensity-modulated radiation therapy with stereotactic body radiation therapy boost for unfavorable prostate cancer: the Georgetown University experience. Front Oncol. 2016;6:114.

    Article  Google Scholar 

  43. Katz A, Kang J. Stereotactic body radiotherapy with or without external beam radiation as treatment for organ confined high-risk prostate carcinoma: a six year study. Radiat Oncol. 2014;9:1.

    Article  Google Scholar 

  44. Freeman D, Dickerson G, Perman M. Multi-institutional registry for prostate cancer radiosurgery: a prospective observational clinical trial. Front Oncol. 2015;4:369.

    Article  Google Scholar 

  45. Zapatero A, Guerrero A, Maldonado X, Alvarez A, Gonzalez San Segundo C, Cabeza Rodriguez MA, et al. High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial. Lancet Oncol. 2015;16(3):320–7.

    Article  CAS  Google Scholar 

  46. Zelefsky MJ, Pei X, Chou JF, Schechter M, Kollmeier M, Cox B, et al. Dose escalation for prostate cancer radiotherapy: predictors of long-term biochemical tumor control and distant metastases-free survival outcomes. Eur Urol. 2011;60(6):1133–9.

    Article  Google Scholar 

  47. Nguyen QN, Levy LB, Lee AK, Choi SS, Frank SJ, Pugh TJ, et al. Long-term outcomes for men with high-risk prostate cancer treated definitively with external beam radiotherapy with or without androgen deprivation. Cancer. 2013;119(18):3265–71.

    Article  CAS  Google Scholar 

  48. Ko EC, Stone NN, Stock RG. PSA nadir of <0.5 ng/mL following brachytherapy for early-stage prostate adenocarcinoma is associated with freedom from prostate-specific antigen failure. Int J Radiat Oncol Biol Phys. 2012;83(2):600–7.

    Article  Google Scholar 

  49. Lee WR, Hanlon AL, Hanks GE. Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: the relationship between nadir level and disease-free survival. J Urol. 1996;156(2 Pt 1):450–3.

    CAS  PubMed  Google Scholar 

  50. Ray ME, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. 2006;64(4):1140–50.

    Article  Google Scholar 

  51. Zietman AL, Tibbs MK, Dallow KC, Smith CT, Althausen AF, Zlotecki RA, et al. Use of PSA nadir to predict subsequent biochemical outcome following external beam radiation therapy for T1-2 adenocarcinoma of the prostate. Radiother Oncol. 1996;40(2):159–62.

    Article  CAS  Google Scholar 

  52. Kishan AU, Wang PC, Upadhyaya SK, Hauswald H, Demanes DJ, Nickols NG, et al. SBRT and HDR brachytherapy produce lower PSA nadirs and different PSA decay patterns than conventionally fractionated IMRT in patients with low- or intermediate-risk prostate cancer. Pract Radiat Oncol. 2016;6(4):268–75.

    Article  Google Scholar 

  53. Martinez AA, Gonzalez J, Ye H, Ghilezan M, Shetty S, Kernen K, et al. Dose escalation improves cancer-related events at 10 years for intermediate- and high-risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2011;79(2):363–70.

    Article  Google Scholar 

  54. Boreta L, Ronan Raleigh D, Roach M. Palliation of urinary obstruction from advanced prostate cancer with SBRT. J Clin Oncol. 2017;35:246.

    Article  Google Scholar 

  55. Forman JD, Yudelev M, Bolton S, Tekyi-Mensah S, Maughan R. Fast neutron irradiation for prostate cancer. Cancer Metastasis Rev. 2002;21(2):131–5.

    Article  CAS  Google Scholar 

  56. Lawton CA, DeSilvio M, Roach M 3rd, Uhl V, Kirsch R, Seider M, et al. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys. 2007;69(3):646–55.

    Article  Google Scholar 

  57. Pommier P, Chabaud S, Lagrange JL, Richaud P, Le Prise E, Wagner JP, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Update of the long-term survival results of the GETUG-01 randomized study. Int J Radiat Oncol Biol Phys. 2016;96(4):759–69.

    Article  Google Scholar 

  58. Kaidar-Person O, Roach M 3rd, Crehange G. Whole-pelvic nodal radiation therapy in the context of hypofractionation for high-risk prostate cancer patients: a step forward. Int J Radiat Oncol Biol Phys. 2013;86(4):600–5.

    Article  Google Scholar 

  59. Demanes DJ, Brandt D, Schour L, Hill DR. Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by androgen deprivation. Am J Clin Oncol. 2009;32(4):342–7.

    Article  Google Scholar 

  60. Keyes M, Merrick G, Frank SJ, Grimm P, Zelefsky MJ. American Brachytherapy Society Task Group Report: use of androgen deprivation therapy with prostate brachytherapy-A systematic literature review. Brachytherapy. 2017;16(2):245–65.

    Article  CAS  Google Scholar 

  61. Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P, De Santis M, Henry A, Joniau S, Lam T, Mason MD, Van den Poel H, Van den Kwast TH, Rouvière O, Wiegel T, Members of the EAU – ESTRO – ESUR –SIOG Prostate Cancer Guidelines Panel. EAU – ESTRO – ESUR – SIOG Guidelines on prostate cancer. Edn. Presented at the EAU Annual Congress London 2017. 978-90-79754-91-5. EAU Guidelines Office, Arnhem. 2017.

    Google Scholar 

  62. Kim DW, Cho LC, Straka C, Christie A, Lotan Y, Pistenmaa D, et al. Predictors of rectal tolerance observed in a dose-escalated phase 1-2 trial of stereotactic body radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2014;89(3):509–17.

    Article  Google Scholar 

  63. Zaorsky NG, Palmer JD, Hurwitz MD, Keith SW, Dicker AP, Den RB. What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiother Oncol. 2015;115(3):295–300.

    Article  Google Scholar 

  64. Roach M, Fahim N, Wahl M, Ahmed SA, Descovich M. Stereotactic body radiotherapy (SBRT) in the management of clinically localized prostate cancer: where are we now? Curr Cancer Ther Rev. 2018;14:1–15.

    Article  Google Scholar 

  65. Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010;37(8):4078–101.

    Article  Google Scholar 

  66. Hanna GG, Murray L, Patel R, Jain S, Aitken KL, Franks KN, et al. UK consensus on normal tissue dose constraints for stereotactic radiotherapy. Clin Oncol. 2018;30(1):5–14.

    Article  CAS  Google Scholar 

  67. Descovich M, Carrara M, Morlino S, Pinnaduwage DS, Saltiel D, Pouliot J, et al. Improving plan quality and consistency by standardization of dose constraints in prostate cancer patients treated with CyberKnife. J Appl Clin Med Phys. 2013;14(5):162–72.

    Article  Google Scholar 

  68. Xie Y, Djajaputra D, King CR, Hossain S, Ma L, Xing L. Intrafractional motion of the prostate during hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(1):236–46.

    Article  Google Scholar 

  69. Seymour ZA, Chang AJ, Zhang L, Kirby N, Descovich M, Roach M 3rd, et al. Dose-volume analysis and the temporal nature of toxicity with stereotactic body radiation therapy for prostate cancer. Pract Radiat Oncol. 2015;5(5):e465–72.

    Article  Google Scholar 

  70. Wahl M, Chang AJ, Gottschalk AR, Roach M III. Genitourinary sites. In: Sethi RA, Barani IJ, Larson DA, Roach III M, editors. Handbook of evidence-based stereotactic radiosurgery and stereotactic body radiotherapy. Cham: Springer; 2016. p. 245.

    Google Scholar 

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González-Motta, A., Anwar, M., Gottschalk, A., Descovich, M., Roach, M. (2019). SBRT for High-Risk Prostate Cancer. In: Zelefsky, M. (eds) Stereotactic Radiosurgery for Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-92453-3_11

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