Cíl práce: Cílem práce je analýza 6letého přežití bez biochemického relapsu (bDFS) a profilu pozdní toxicity u nemocných s karcinomem prostaty léčených ultrahypofrakcionovanou protonovou radioterapií.
Objective: The aim of the paper is an analysis of the six-year biochemical disease-free survival (bDFS) rate and of the late toxicity profile in patients with prostate cancer treated with ultra-hypofractionated proton radiotherapy. Material and methods: Between March 2013 and February 2016, a total of 275 patients were treated with ultra-hypofractionated proton radiotherapy (36.25 GyE/5 fractions). The median follow-up time is 69 months. There were 118 (42.9%) patients with low and 157 (57.1%) patients with intermediate-risk prostate cancer. Fifty (18.2%) patients received neoadjuvant hormone therapy, while none had adjuvant hormone therapy. Results: The estimated six-year bDFS rate was 97.1% (SD 1.7%) and 89.9% (SD 3.0%) for low- and intermediate-risk prostate cancer, respectively. Cumulative late toxicity (CTCAE-v.4) grade ≥ 2 was found for gastrointestinal toxicity (GI) in 17 (6.2%) patients and for genitourinary toxicity (GU) in 11 (4.0%) patients. The estimated cumulative GI toxicity grade ≥ 2 at six years was 6.3% GI and 4.1% for GU toxicity. PSA relapse was observed in 16 (5.8%) patients. During the course of follow-up, 14 (5.1%) patients died. Conclusion: Ultra-hypofractionated proton radiotherapy with the PBS technique is highly effective in treating low- and intermediate-risk prostate cancer with a favourable profile of late gastrointestinal and genitourinary toxicity.
PURPOSE: Hypofractionated radiotherapy for prostate cancer is well established for definitive treatment, but not well defined in the postoperative setting. The purpose of this analysis was to assess oncologic outcomes and toxicity in a large cohort of patients treated with conventionally fractionated three-dimensional (3D) conformal radiotherapy (CF) and hypofractionated volumetric modulated arc therapy (HF) after radical prostatectomy. METHODS: Between 1994 and 2019, a total of 855 patients with prostate carcinoma were treated by postoperative radiotherapy using CF (total dose 65-72 Gy, single fraction 1.8-2 Gy) in 572 patients and HF (total dose 62.5-63.75 Gy, single fraction 2.5-2.55 Gy) in 283 patients. The association of treatment modality with biochemical control, overall survival (OS), and gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using logistic and Cox regression analysis. RESULTS: There was no difference between the two modalities regarding biochemical control rates (77% versus 81%, respectively, for HF and CF at 24 months and 58% and 64% at 60 months; p = 0.20). OS estimates after 5 years: 95% versus 93% (p = 0.72). Patients undergoing HF had less frequent grade 2 or higher acute GI or GU side effects (p = 0.03 and p = 0.005, respectively). There were no differences in late GI side effects between modalities (hazard ratio 0.99). Median follow-up was 23 months for HF and 72 months for CF (p < 0.001). CONCLUSION: For radiation therapy of resected prostate cancer, our analysis of this largest single-centre cohort (n = 283) treated with hypofractionation with advanced treatment techniques compared with conventional fractionation did not yield different outcomes in terms of biochemical control and toxicities. Prospective investigating of HF is merited.
- MeSH
- hypofrakcionace při ozařování MeSH
- lidé MeSH
- nádory prostaty * patologie radioterapie chirurgie MeSH
- prospektivní studie MeSH
- prostata patologie MeSH
- prostatektomie MeSH
- radioterapie s modulovanou intenzitou * metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: To report prostate deformation during treatment, based on an analysis of fiducial marker positional differences in a large sample. MATERIAL AND METHODS: This study included 144 patients treated with prostate stereotactic body radiation therapy after implantation in each of 4 gold fiducial markers (FMs), which were located and numbered consistently. The center of mass of the FMs was recorded for every pair of X-ray images taken during treatment. The distance between each pair of fiducials in the live X-ray images is calculated and compared with the respective distances as determined in the CT volume. The RBE is the difference between these distances. Mean RBE and intrafraction and interfraction RBE were evaluated. The intrafraction and intefraction RBE variability were defined as the standard deviation, respectively, of all RBE during 1 treatment fraction and of the mean daily RBE over the whole treatment course. RESULTS: We analyzed 720 treatment fractions comprising 24,453 orthogonal X-ray image acquisitions. We observed a trend to higher RBE related to FM4 (apex) during treatment. The fiducial marker in the prostate apex could not be used in 16% of observations, in which RBE was > 2.5 mm. The mean RBEavg was 0.93 ± 0.39 mm (range 0.32-1.79 mm) over the 5 fractions. The RBEavg was significantly lower for the first and second fraction compared with the others (P < .001). The interfraction variability of RBEavg was 0.26 ± 0.16 mm (range 0.04-0.74 mm). The mean intrafraction variability of all FMs was 0.45 ± 0.25 mm. The highest Pearson correlation coefficient was observed between FM2 and FM3 (middle left and right prostate) (R = 0.78; P < .001). Every combination with FM4 yielded lower coefficients (range 0.66-0.71; P < .001), indicating different deformation of the prostate apex. CONCLUSIONS: Ideally, prostate deformation is generally small, but it is very sensitive to rectal and bladder filling. We observed RBE up to 11.3 mm. The overall correlation between FMs was affected by shifts of individual fiducials, indicating that the prostate is not a "rigid" organ. Systematic change of RBE average between subsequent fractions indicates a systematic change in prostate shape.
- MeSH
- celková dávka radioterapie MeSH
- hypofrakcionace při ozařování MeSH
- lidé MeSH
- nádory prostaty diagnostické zobrazování patologie radioterapie MeSH
- plánování radioterapie pomocí počítače metody MeSH
- počítačová rentgenová tomografie metody MeSH
- počítačové zpracování obrazu metody MeSH
- pohyb MeSH
- protézy a implantáty * MeSH
- radioterapie řízená obrazem metody MeSH
- radioterapie s modulovanou intenzitou metody MeSH
- zaměřovací značky pro radioterapii statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To analyze the 5-year biochemical disease-free survival (bDFS) and late toxicity profile in patients with prostate cancer treated with pencil beam scanning (PBS) proton radiation therapy. METHODS AND MATERIALS: Between January 2013 and March 2016, 284 patients with prostate cancer were treated using intensity modulated proton therapy (IMPT), with an ultrahypofractionated schedule (36.25 GyE in 5 fractions). Five patients were immediately lost from follow-up and thus were excluded from analysis. Data for 279 patients were prospectively collected and analyzed with a median follow-up time of 56.5 (range, 3.4-87.5) months. The mean age at time of treatment was 64.5 (40.1-85.7) years, and the median prostate-specific antigen (PSA) value was 6.35 μg/L (0.67-17.3 μg/L). A total of 121 (43.4%) patients had low-risk, 125 patients (44.8%) had favorable, and 33 (11.8%) unfavorable intermediate-risk cancer. In addition, 49 (17.6%) patients underwent neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. bDFS and late toxicity profiles were evaluated. RESULTS: The median treatment time was 9 days (range, 7-18 days). The 5-year bDFS was 96.9%, 91.7%, and 83.5% for the low-, favorable, and unfavorable intermediate-risk group, respectively. Late toxicity (Common Terminology Criteria for Adverse Events v.4) was as follows: gastrointestinal: grade 1, 62 patients (22%), grade 2, 20 patients (7.2%), and grade 3, 1 patient (0.36%); genitourinary: grade 1, 80 patients (28.7%), grade 2, 14 patients (5%), and grade 3, 0 patients. PSA relapse was observed in 17 patients (6.1%), and lymph node or bone recurrence was detected in 11 patients. Four (1.4%) local recurrences were detected. Nine patients (3.2%) died of causes unrelated to prostate cancer. No deaths related to prostate cancer were reported. CONCLUSION: Ultrahypofractionated proton beam radiation therapy for prostate cancer is effective with long-term bDFS comparable with other fractionation schedules and with minimal serious long-term GI and GU toxicity.
- MeSH
- hypofrakcionace při ozařování * MeSH
- lidé středního věku MeSH
- lidé MeSH
- membránové proteiny MeSH
- nádorové supresorové proteiny MeSH
- nádory prostaty radioterapie MeSH
- přežití po terapii bez příznaků nemoci MeSH
- protonová terapie * MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Východiska: Radioterapie karcinomu prostaty patří při použití konvenční frakcionace k nejdelším radioterapeutickým sériím. Snaha o zkrácení celkové doby ozařování přináší benefit nejen pacientům, ale také snižuje zátěž radioterapeutických pracovišť. Materiál a metody: Bylo ozařováno 205 pacientů s karcinomem prostaty, a to dávkou 20 × 3,0 Gy na oblast prostaty, 4 frakce týdně (nízké riziko) nebo dávkou 21 × 3,0/2,1 Gy na oblast prostaty / 2/3 semenných váčků (střední a vysoké riziko), střídavě 4 a 3 dny v týdnu. Výsledky: Akutní toxicita podle Radiation Therapy Oncology Group / European Organisation for Research and Therapy of Cancer (RTOG/EORTC): Genitourinární trakt: G0 49 %, G1 32 %, G2 16 %, G3 1 % a G4 2 %. Gastrointestinální trakt: G0 79 %, G1 19 % a G2 2 %. Chronická toxicita podle Radiation Therapy Oncology Group // stupnice Fox Chase Cancer Center (ROTG/FC-LENT): Medián sledování je 5,1 roku. Pacienti s dobou sledování < 1 rok byly z hodnocení vyřazeni. Genitourinární trakt: G0 71 %, G1 21 %, G2 5 %, G3 1 % a G4 2 %. Gastrointestinální trakt: G0 83 %, G1 13 %, G2 11 % a G3 1%. Závěr: Frakcionace 20–21 × 3,0 Gy 3–4× týdně se jeví z hlediska toxicity jako bezpečná metoda. Ke zhodnocení biochemické kontroly je třeba delší sledování.
Background: Conventionally fractionated radiotherapy for prostate cancer belongs to the longest radiotherapy courses. Shortening of the overall duration of the course not only brings a benefit to the patients, but also decreases the workload of radiation oncology departments. Material and methods: A total of 205 patients with prostate cancer were irradiated with the dose of 20 x 3.0 Gy to the prostate, 4 fractions a week (low risk) or 21 × 3.0/2.1 Gy to the prostate / 2/3 of seminal vesicles, 3 and 4 fractions a week alternately (intermediate and high risk). Results: Early toxicity by Radiation Therapy Oncology Group / European Organisation for Research and Therapy of Cancer (RTOG/EORTC): Genitourinary tract: G0 49%, G1 32%, G2 16%, G3 1% and G4 2%. Gastrointestinal tract: G0 79%, G1 19% and G2 2%. Late toxicity by Radiation Therapy Oncology Group / Fox Chase Cancer Center (RTOG/FC-LENT): The median follow-up is 5,1 years. Patients with the follow-up < 1 year were excluded. Genitourinary tract: G0 71%, G1 21%, G2 5%, G3 1% and G4 2%. Gastrointestinal tract: G0 83%, G1 13%, G2 11% and G3 1%. Conclusion: The fractionation scheme 20–21 × 3.0 Gy, 3–4-times a week seems to be a safe method according to the toxicity. For biochemical control evaluation, longer follow-up is needed.
- MeSH
- dospělí MeSH
- hypofrakcionace při ozařování * MeSH
- klinická studie jako téma MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prostaty * radioterapie MeSH
- radioterapie metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
INTRODUCTION: Extreme hypofractionated radiotherapy for prostate cancer is a common modality in photon therapy. Pencil beam scanning (PBS) in similar fractionation allows better dose distribution and makes proton therapy more available for such patients. The purpose of this study is the feasibility of extreme proton hypofractionated radiotherapy and publication of early clinical results. METHODS: Two hundred patients with early-stage prostate cancer were treated with IMPT (intensity-modulated proton therapy), extreme hypofractionated schedule (36.25 GyE in five fractions) between February 2013 and December 2015. Mean age of the patients was 64.3 years, and the mean value of prostate-specific antigen (PSA) before treatment was 6.83 μg/L (0.6-17.3 μg/L). Ninety-three patients (46.5%) were in the low-risk group. One hundred and seven patients (53.5%) were in the intermediate-risk group. Twenty-nine patients (14.5%) had neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. Acute toxicity, late toxicity and short-term results were evaluated. RESULTS: All patients finished radiotherapy without interruptions. The median follow-up time was 36 months. The mean treatment time was 9.5 days (median 9 days). Acute toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0 was (gastrointestinal toxicity) GI (grade) G1-17%, G2-3.5%; (genitourinary toxicity) GU G1-40%, G2-19%; and no G3 toxicity was observed. Late toxicity was GI G1-19%, G2-5.5%; GU G1-17%, G2-4%; and no G3 toxicity was observed. PSA relapse was observed in one patient (1.08%) in the low-risk group (pelvic lymph node involvement was detected) and in seven patients (6.5%) in the intermediate-risk group (three lymph node metastases, two lymph node and bone metastases, two PSA relapses). No patient died of prostate cancer, and three patients died from other reasons. No local recurrence of cancer in the prostate was observed. CONCLUSIONS: Proton beam radiotherapy for prostate cancer is feasible with a low rate of acute toxicity and promising late toxicity and effectivity.
- MeSH
- celková dávka radioterapie MeSH
- hypofrakcionace při ozařování * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prostaty radioterapie MeSH
- prostata účinky záření MeSH
- protonová terapie škodlivé účinky metody MeSH
- radiační poranění prevence a kontrola MeSH
- studie proveditelnosti MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Karcinom prsu je celosvětově nejčastějším zhoubným nádorem u žen. V posledních letech se zvyšuje počet žen, které onemocní v mladém věku. V r. 2016 onemocnělo v České republice zhoubným nádorem prsu 7 220 žen, ve věkové skupině do 35 let to bylo 139 žen, ve věkové skupině 35–39 bylo hlášeno 221 případů (1). Jedná se o nevelkou skupinu – do 35 let jsou to necelé 2 %, pod 40 let věku je to 5 % z celkového počtu. Nádory u těchto žen jsou agresivnější, často jsou spojené s genetickou mutací. Nezřídka je diagnóza stanovena v těhotenství nebo v době kojení. Nejlepší léčebné výsledky jsou dosaženy při multidisciplinárním přístupu, jehož je radioterapie nedílnou součástí. Tato práce vznikla jako reakce na nová doporučení v radioterapii karcinomu prsu publikovaná Americkou společností radiační onkologie (ASTRO) na jaře r. 2018.
Breast carcinoma is the most commonly diagnosed malignancy in women globally. Recently the number of women with the disease developing in young age has been increasing. In 2016 7,220 women were diagnosed with breast carcinoma, with 139 women under-35 and with 221 cases being reported in the 35–39 age groups. It is quite a small group – less than 2 % in under-35 age group, 5 % out of the total in under-40 age group. Carcinomas in these women are more aggressive, commonly accompanied by genetic mutation. Quite frequently the diagnosis is made during pregnancy or in the period of breastfeeding. The best medical outcomes occur when adopting the multidisciplinary approach, with radiotherapy being its integral part. This work was created as a response to new guidelines on breast carcinoma radiation therapy published by the American Society for Radiation Oncology (ASTRO) in spring 2018.
- MeSH
- adjuvantní radioterapie metody MeSH
- hypofrakcionace při ozařování MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory prsu * radioterapie MeSH
- protokoly protinádorové léčby MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- adjuvantní radioterapie * metody trendy využití MeSH
- hodnocení biomedicínských technologií metody trendy využití MeSH
- hypofrakcionace při ozařování normy MeSH
- karcinom farmakoterapie chirurgie radioterapie MeSH
- kardiotoxicita prevence a kontrola MeSH
- klinické zkoušky jako téma MeSH
- konformní radioterapie metody trendy využití MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- nádory prsu * chirurgie radioterapie MeSH
- protonová terapie * metody trendy využití MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
x
x
- MeSH
- adjuvantní radioterapie * metody normy využití MeSH
- celková dávka radioterapie * normy MeSH
- frakcionace dávky záření MeSH
- hypofrakcionace při ozařování normy MeSH
- kardiotoxicita diagnóza komplikace prevence a kontrola MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- nádory prsu * farmakoterapie radioterapie terapie MeSH
- receptor erbB-2 antagonisté a inhibitory terapeutické užití účinky záření MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- společnosti lékařské MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
