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Dose-response with stereotactic body radiotherapy for prostate cancer: A multi-institutional analysis of prostate-specific antigen kinetics and biochemical control.
Levin-Epstein, Rebecca G; Jiang, Naomi Y; Wang, Xiaoyan; Upadhyaya, Shrinivasa K; Collins, Sean P; Suy, Simeng; Aghdam, Nima; Mantz, Constantine; Katz, Alan J; Miszczyk, Leszek; Napieralska, Aleksandra; Namysl-Kaletka, Agnieszka; Prionas, Nicholas; Bagshaw, Hilary; Buyyounouski, Mark K; Cao, Minsong; Agazaryan, Nzhde; Dang, Audrey; Yuan, Ye; Kupelian, Patrick A; Zaorsky, Nicholas G; Spratt, Daniel E; Mohamad, Osama; Feng, Felix Y; Mahal, Brandon A; Boutros, Paul C; Kishan, Arun U; Juarez, Jesus; Shabsovich, David; Jiang, Tommy; Kahlon, Sartajdeep; Patel, Ankur; Patel, Jay; Nickols, Nicholas G; Steinberg, Michael L; Fuller, Donald B; Kishan, Amar U.
Afiliación
  • Levin-Epstein RG; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Jiang NY; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Wang X; UCLA Division of General Internal Medicine and Health Services Research, USA.
  • Upadhyaya SK; Department of Biological and Agricultural Engineering, University of California, Davis, USA.
  • Collins SP; Department of Radiation Medicine, Georgetown University Hospital, USA.
  • Suy S; Department of Radiation Medicine, Georgetown University Hospital, USA.
  • Aghdam N; Department of Radiation Medicine, Georgetown University Hospital, USA.
  • Mantz C; 21st Century Oncology, Inc., Fort Myers, USA.
  • Katz AJ; FROS Radiation Oncology and CyberKnife Center, Flushing, USA.
  • Miszczyk L; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland.
  • Napieralska A; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland.
  • Namysl-Kaletka A; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland.
  • Prionas N; Department of Radiation Oncology, Stanford University Medical Center, USA.
  • Bagshaw H; Department of Radiation Oncology, Stanford University Medical Center, USA.
  • Buyyounouski MK; Department of Radiation Oncology, Stanford University Medical Center, USA.
  • Cao M; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Agazaryan N; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Dang A; Department of Radiation Oncology, Tulane Medical Center, New Orleans, USA.
  • Yuan Y; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Kupelian PA; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Zaorsky NG; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
  • Spratt DE; Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
  • Mohamad O; Department of Radiation Oncology, University of California San Francisco, USA.
  • Feng FY; Department of Radiation Oncology, University of California San Francisco, USA.
  • Mahal BA; Department of Radiation Oncology, University of Miami, USA.
  • Boutros PC; Department of Human Genetics, University of California, Los Angeles, USA; Department of Urology, University of California, Los Angeles, USA.
  • Kishan AU; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Juarez J; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Shabsovich D; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Jiang T; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Kahlon S; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Patel A; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Patel J; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Nickols NG; Department of Radiation Oncology, University of California, Los Angeles, USA; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, USA.
  • Steinberg ML; Department of Radiation Oncology, University of California, Los Angeles, USA.
  • Fuller DB; Department of Radiation Oncology, Genesis Healthcare, USA.
  • Kishan AU; Department of Radiation Oncology, University of California, Los Angeles, USA; Department of Urology, University of California, Los Angeles, USA. Electronic address: aukishan@mednet.ucla.edu.
Radiother Oncol ; 154: 207-213, 2021 01.
Article en En | MEDLINE | ID: mdl-33035622
ABSTRACT
BACKGROUND AND

PURPOSE:

The optimal dose for prostate stereotactic body radiotherapy (SBRT) is still unknown. This study evaluated the dose-response relationships for prostate-specific antigen (PSA) decay and biochemical recurrence (BCR) among 4 SBRT dose regimens. MATERIALS AND

METHODS:

In 1908 men with low-risk (50.0%), favorable intermediate-risk (30.9%), and unfavorable intermediate-risk (19.1%) prostate cancer treated with prostate SBRT across 8 institutions from 2003 to 2018, we examined 4 regimens (35 Gy/5 fractions [35/5, n = 265, 13.4%], 36.25 Gy/5 fractions [36.25/5, n = 711, 37.3%], 40 Gy/5 fractions [40/5, n = 684, 35.8%], and 38 Gy/4 fractions [38/4, n = 257, 13.5%]). Between dose groups, we compared PSA decay slope, nadir PSA (nPSA), achievement of nPSA ≤0.2 and ≤0.5 ng/mL, and BCR-free survival (BCRFS).

RESULTS:

Median follow-up was 72.3 months. Median nPSA was 0.01 ng/mL for 38/4, and 0.17-0.20 ng/mL for 5-fraction regimens (p < 0.0001). The 38/4 cohort demonstrated the steepest PSA decay slope and greater odds of nPSA ≤0.2 ng/mL (both p < 0.0001 vs. all other regimens). BCR occurred in 6.25%, 6.75%, 3.95%, and 8.95% of men treated with 35/5, 36.25/5, 40/5, and 38/4, respectively (p = 0.12), with the highest BCRFS after 40/5 (vs. 35/5 hazard ratio [HR] 0.49, p = 0.026; vs. 36.25/5 HR 0.42, p = 0.0005; vs. 38/4 HR 0.55, p = 0.037) including the entirety of follow-up, but not for 5-year BCRFS (≥93% for all regimens, p ≥ 0.21).

CONCLUSION:

Dose-escalation was associated with greater prostate ablation and PSA decay. Dose-escalation to 40/5, but not beyond, was associated with improved BCRFS. Biochemical control remains excellent, and prospective studies will provide clarity on the benefit of dose-escalation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Radiocirugia Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: Radiother Oncol Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Radiocirugia Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: Radiother Oncol Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos