Tumor Control Probability Modeling and Systematic Review of the Literature of Stereotactic Body Radiation Therapy for Prostate Cancer
| Autor: | Danny Y. Song, Alan E. Nahum, Sean P. Collins, Aaron D. Falchook, Jimm Grimm, Ronald C. Chen, Ellen Yorke, Issam El Naqa, Trevor J. Royce, Andrew Jackson, Nathan C. Sheets, George X. Ding, Donald B. Fuller, Kyle Wang, Panayiotis Mavroidis |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Risk Cancer Research medicine.medical_specialty Hypofractionated Radiation Therapy Time Factors Stereotactic body radiation therapy Radiosurgery Models Biological Article 030218 nuclear medicine & medical imaging 03 medical and health sciences Prostate cancer 0302 clinical medicine Urethra Prostate medicine Humans Radiology Nuclear Medicine and imaging Dosing Radiation treatment planning Probability Radiation business.industry Equivalent dose Prostatic Neoplasms Dose-Response Relationship Radiation Models Theoretical Tumor control medicine.disease medicine.anatomical_structure Treatment Outcome Oncology 030220 oncology & carcinogenesis Linear Models Radiation Dose Hypofractionation Radiology business Relative Biological Effectiveness |
| Zdroj: | Int J Radiat Oncol Biol Phys |
| ISSN: | 1879-355X |
| Popis: | Purpose Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation. The evolving treatment approach of ultrahypofractionation with stereotactic body radiation therapy (SBRT) allows possible further biological dose escalation (biologically equivalent dose [BED]) and shortened treatment time. Methods and Materials The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiation Therapy/SBRT included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse. Results were stratified by prostate cancer risk group. Results Twenty-five published cohorts were identified for inclusion, with a total of 4821 patients (2235 with low-risk, 1894 with intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up of more than 5 years. Dosing regimens ranged from 32 to 50 Gy in 4 to 5 fractions, with total BED (α/β = 1.5 Gy) between 183.1 and 383.3 Gy. At 5 years, we found that in patients with low-intermediate risk disease, an equivalent doses of 2 Gy per fraction (EQD2) of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of 97 Gy (37.6 Gy in 5 fractions) can achieve a TCP of 90% and an EQD2 of 102 Gy (38.7 Gy in 5 fractions) can achieve a TCP of 95%. Conclusions We found significant variation in the published literature on target delineation, margins used, dose/fractionation, and treatment schedule. Despite this variation, TCP was excellent. Most prescription doses range from 35 to 40 Gy, delivered in 4 to 5 fractions. The literature did not provide detailed dose-volume data, and our dosimetric analysis was constrained to prescription doses. There are many areas in need of continued research as SBRT continues to evolve as a treatment modality for prostate cancer, including the durability of local control with longer follow-up across risk groups, the efficacy and safety of SBRT as a boost to intensity modulated radiation therapy (IMRT), and the impact of incorporating novel imaging techniques into treatment planning. |
| Databáze: | OpenAIRE |
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