American Society For Therapeutic Radiology And Oncology Research Articles

Cryotherapy As Treatment of Curative Intent for Localized Adenocarcinoma of The Prostate Gland with A Focus on Low-risk and Medium – (Intermediate-) Risk Localized Adenocarcinoma of The Prostate Gland: A Review and Update

Cryotherapy As Treatment of Curative Intent for Localized Adenocarcinoma of The Prostate Gland with A Focus on Low-risk and Medium – (Intermediate-) Risk Localized Adenocarcinoma of The Prostate Gland: A Review and Update

Outcomes in ER-negative Breast Cancer Treated with Accelerated Partial Breast Irradiation Using Intracavitary Brachytherapy

The American Brachytherapy Society (ABS), American Society for Therapeutic Radiology and Oncology (ASTRO), and European Society for Therapeutic Radiology and Oncology (ESTRO) have conflicting recommendations regarding the treatment of estrogen receptor (ER)-negative breast tumors with accelerated partial breast irradiation (APBI). The purpose of this study was to evaluate these 3 guidelines using a single institutional experience with treating ER-negative breast cancer with APBI. This is a single institution retrospective review of 76 consecutive patients with biopsy confirmed breast cancer who underwent lumpectomy followed by APBI intracavitary brachytherapy to a dose of 34.0 Gy in 10 fractions from 2003-2018. Patient demographics, tumor/treatment details, and outcomes were abstracted from the electronic medical record. Outcomes, including recurrence-free survival (RFS), ipsilateral breast tumor recurrence (IBTR), contralateral breast tumor recurrence (CBTR), distant metastasis (DM), and overall survival (OS) were estimated with Kaplan-Meier univariate analysis (UVA). Median follow-up time for all patients was 60.2 months (range 0-141 months). The median age at time of treatment was 69 years (range 50-86 years). There were 18 cases of DCIS, 53 cases of IDC, 3 cases of adenoid cystic carcinoma, 1 case of apocrine carcinoma, and 1 case of ILC. There were 56 patients with triple negative breast cancer, 9 patients with PR-positive disease, and 12 patients with HER2-positive disease. There were 8, 16, and 52 cases of grade 1, 2, and 3 disease, respectively. The majority of patients had pN0 disease (63 cases), while the remaining 13 cases, all of which DCIS, did not undergo lymph node evaluation (pNX). Amongst those with DCIS with adequate clinicopathologic data (N = 15), 9 were deemed suitable by ABS criteria, all were deemed cautionary by ASTRO criteria, and all were deemed intermediate risk by ESTRO criteria. Of the evaluable patients with invasive cancer (N = 54), 48 were deemed suitable by ABS criteria, all were deemed cautionary by ASTRO criteria, and 33 were deemed low risk by ESTRO criteria. Twenty-seven patients (35.5%) received adjuvant chemotherapy while 11.8% of patients received endocrine therapy. There was one case of IBTR and no cases of CBTR or DM. Five-year OS, RFS, IBTR, and DM were 88.5%, 98.4%, 1.6%, and 0%, respectively. These results demonstrate the efficacy of intracavitary brachytherapy APBI in patients with early stage, locally controlled ER-negative breast cancer. In light of these results, and given that current guidelines deem ER-negative breast cancer tumors as cautionary or unsuitable for APBI, consideration should be made to expand the current eligibility criteria for treatment of ER-negative breast cancer with APBI using intracavitary brachytherapy.

Bowel and bladder reproducibility in image-guided SBRT prostate: Results of a patterns of practice survey.

76 Background: Use of prostate stereotactic body radiotherapy (SBRT) as treatment for localized prostate cancer (PCa) is increasing. Given the high dose (>5Gy) per fraction (Fx) being delivered, SBRT requires careful preparation and delivery to ensure accuracy and precision. Guidelines and data on best practice for bowel and bladder preparation are lacking. Therefore, we surveyed practicing radiation oncologists (RO) to document practice patterns for prostate SBRT. Methods: From June to October 2018 we completed a nationwide survey of 1395 American Society for Therapeutic Radiology and Oncology (ASTRO) members who self-identified as managing PCa. A SurveyMonkey link was sent via email, and analysis included practicing RO who treat PCa with SBRT. Results: 204 responses were received with 32% (64/204) using SBRT. 80% (51/64) provided the fractionation used: 33% (17/51) use 35Gy to 36.25Gy, and 17.6% (9/51) use >40Gy in 5 Fx, and 1 used >9Gy Fx. 94% use implantable devices for localization (83% fiducial markers, 17% radiofrequency transponders). 65% (42/64) use a hydrogel spacer. 75% (48/64) use daily cone beam CT (CBCT) for image guidance. The majority use a 5 mm PTV, with 3 mm posteriorly. For bladder and bowel preparation 97% (62/64) provided preferences. For bladder, 90.3% (56/62) required a comfortably full bladder for both simulation and treatment. For simulation, 92% (57/62) have a bowel protocol (BP) to optimize rectal reproducibility. 51.6% (31/62) have patients empty their bowels prior, and 51.6% (31/62) prescribe a BP. Diet alteration was recommended by 77% (48/62). 86% (53/62) used a BP during SBRT treatment. Of those using a BP, 67% (43/64) continued it throughout SBRT with 30% (19/64) continuing BP unless symptoms change management. Only 3% (2/64) stop BP after simulation. Conclusions: The variability of data in the literature on effective BP for treatment reproducibility for PCa is reflected in the varied patterns of practice seen in our survey. Consensus on bladder preparation is seen for a majority of practitioners. A variety of BP regimens are employed.

Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer

Optimizing radiation therapy techniques for localized prostate cancer can affect patient outcomes. Dose escalation improves biochemical control, but no prior trials were powered to detect overall survival (OS) differences. To determine whether radiation dose escalation to 79.2 Gy compared with 70.2 Gy would improve OS and other outcomes in prostate cancer. The NRG Oncology/RTOG 0126 randomized clinical trial randomized 1532 patients from 104 North American Radiation Therapy Oncology Group institutions March 2002 through August 2008. Men with stage cT1b to T2b, Gleason score 2 to 6, and prostate-specific antigen (PSA) level of 10 or greater and less than 20 or Gleason score of 7 and PSA less than 15 received 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy to 79.2 Gy in 44 fractions or 70.2 Gy in 39 fractions. Time to OS measured from randomization to death due to any cause. American Society for Therapeutic Radiology and Oncology (ASTRO)/Phoenix definitions were used for biochemical failure. Acute (≤90 days of treatment start) and late radiation therapy toxic effects (>90 days) were graded using the National Cancer Institute Common Toxicity Criteria, version 2.0, and the RTOG/European Organisation for the Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme, respectively. With a median follow-up of 8.4 (range, 0.02-13.0) years in 1499 patients (median [range] age, 71 [33-87] years; 70% had PSA <10 ng/mL, 84% Gleason score of 7, 57% T1 disease), there was no difference in OS between the 751 men in the 79.2-Gy arm and the 748 men in the 70.2-Gy arm. The 8-year rates of OS were 76% with 79.2 Gy and 75% with 70.2 Gy (hazard ratio [HR], 1.00; 95% CI, 0.83-1.20; P = .98). The 8-year cumulative rates of distant metastases were 4% for the 79.2-Gy arm and 6% for the 70.2-Gy arm (HR, 0.65; 95% CI, 0.42-1.01; P = .05). The ASTRO and Phoenix biochemical failure rates at 5 and 8 years were 31% and 20% with 79.2 Gy and 47% and 35% with 70.2 Gy, respectively (both P < .001; ASTRO: HR, 0.59; 95% CI, 0.50-0.70; Phoenix: HR, 0.54; 95% CI, 0.44-0.65). The high-dose arm had a lower rate of salvage therapy use. The 5-year rates of late grade 2 or greater gastrointestinal and/or genitourinary toxic effects were 21% and 12% with 79.2 Gy and 15% and 7% with 70.2 Gy (P = .006 [HR, 1.39; 95% CI, 1.10-1.77] and P = .003 [HR, 1.59; 95% CI, 1.17-2.16], respectively). Despite improvements in biochemical failure and distant metastases, dose escalation did not improve OS. High doses caused more late toxic effects but lower rates of salvage therapy. clinicaltrials.gov Identifier: NCT00033631.

MP74-09 P2PSA AND DERIVATIVES (%P2PSA AND PHI) ACCURATELY PREDICT PROSTATE CANCER IN OBESE MEN FROM A MULTICENTER PROSPECTIVE EUROPEAN STUDY

be a more robust determinant of patient outcome compared with the American Society for Therapeutic Radiology and Oncology (ASTRO) definition (three consecutive increases of PSA). However, the Phoenix definition is not suitable for comparing BF of BT and that of radical prostatectomy (RP) because BF after RP is diagnosed when PSA >0.2ng/mL and a large portion of the patients undergo salvage therapy before PSA reaches 2.0 ng/mL. The objective of this study is to compare a new definition of BF, PSA>0.2ng/mL with three consecutive increases (NTMC definition), with the Phoenix definition and the ASTRO definition. METHODS: A total of 1442 patients with clinically localized PCa were treated with BT between September 2003 and October 2010 at our institution, and followed at least 36 months (22 to 118, median 70.0 months). The patients were treated with seed implantation using I-125 with or without EBRT combination. The patients may have neoadjuvant androgen deprivation therapy (ADT), but ADT after BT was not performed in any of the cases before the diagnosis of disease recurrence. Sesitivity and specificity of each definition are calculated and compared. True failure is confirmed by clinical failure. Possible failure (PF) is defined as rising PSA toward the end of observation without clear evidence of clinical recurrence. There were 46 PF cases and they were excluded from the study. RESULTS: Sensitivity and specificity of the Phoenix, the ASTRO, and our definition are shown in a table. NTMC definition showed much higher sensitivity and slightly lower specificity compared to the Phoenix definition. NTMC definition had similar sensitivity and higher specificity to the ASTRO definition. Neoadjuvant ADT lowered sensitivity of the Phoenix definition, and raised specificity of the Phoenix and our definition. CONCLUSIONS: NTMC definition of BF after BT such as PSA>0.2ng/mL with three consecutive increases showed sufficiently high sensitivity and specificity. The definition is useful especially the cases with neoadjuvant ADT, or when comparing therapeutic effect of BT and RP.

Cryotherapy for primary treatment of prostate cancer: intermediate term results of a prospective study from a single institution.

Purpose. Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution. Material and Methods. Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported. Results. The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%. Conclusions. Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.

Long-term results of the Dutch randomized prostate cancer trial: Impact of dose-escalation on local, biochemical, clinical failure, and survival

PurposeNowadays, advanced irradiation techniques make it possible to escalate safely the dose in prostate cancer. We studied the effect of a higher dose on tumor control in a randomized trial with a median follow-up of 110months. Patients and methodsPatients with T1b-T4N0 prostate cancer (n=664) were randomized between 78Gy and 68Gy. Primary endpoint was biochemical and/or clinical failure (BCF) according to the American Society for Therapeutic Radiology and Oncology (ASTRO) guidelines (3 consecutive rises), and to Phoenix (nadir plus 2μg/L). Secondary endpoints were clinical failure (CF), local failure (LF), prostate cancer death (PCD), and overall survival (OS). Explorative subgroup analyses were performed. ResultsBCF rate (HR=0.8; 20% less events) and LF rate (HR=0.5; 50% less events) were significantly lower in the 78Gy arm (p<0.05). CF, PCD and OS were similar in both arms. A significant heterogeneity of treatment effect was found for PSA cutoffs between 7 and 10μg/L. ConclusionWe observed significantly less BCF and LF in the high-dose arm. This suggests improvement of the therapeutic ratio. However, we observed similar rates of CF and PCD at the current update. More follow-up is needed to investigate which patients benefit in terms of prolonged OS.

Post-mastectomy radiotherapy for one to three axillary node positive early breast cancer: To radiate or not to radiate?

Post-mastectomy radiotherapy (PMRT) in early breast cancer has long been a matter of debate among oncologists. The American Society of Clinical Oncology (ASCO) and the American Society for Therapeutic Radiology and Oncology (ASTRO) recommend the use of PMRT for patients, whose primary tumor is larger than 5 cm and/or patients who have four or more involved axillary lymph nodes (ALNs). Recently, few trials have been published showing the positive impact of PMRT on overall survival (OS) even in patients having 1-3 positive ALNs with T1-T2 primary disease or early breast cancer (EBC). So, it has become a matter of controversy whether to radiate or not to radiate? We have made an extensive search in the internet in Pubmed and other sites of medical publication mentioning our topic of discussion and reviewed the relevant articles. We nearly got 3,220 articles. After reviewing the available publications in the internet, we blended the elixir with our experience and tried to find an answer of our question. In conclusion, PMRT significantly and substantially improved loco-regional control and overall survival in patients with 1-3 positive nodes as in patients with 4 or more positive nodes, and nearly the same number of patients is needed to treat to avoid a loco-regional recurrence and/or death in both groups. We should reconsider the current guidelines for the indication for PMRT.

Compte rendu de la 54e réunion de l’American Society for Therapeutic Radiology and Oncology (Astro), Boston (états-Unis), 28-31 octobre 2012

Compte rendu de la 54e réunion de l’American Society for Therapeutic Radiology and Oncology (Astro), Boston (états-Unis), 28-31 octobre 2012

Quality of Life in Neuro-oncology: Presence at National Meetings

The quality of life (QOL) is of growing importance in our healthcare system with increasing cost expenditures and increased survival times with advanced treatments. Many brain tumors carry poor prognosis, and QOL issues is paramount in neuro-oncology, given the unique features of neurologic disease, its sequelae, and treatment. Neuro-oncologic disease on its own can cause devastating effects on QOL, which must be weighed against the effects of its treatment. Our aim is to determine whether there is adequate focus on QOL in neuro-oncologic disease at national conferences. All abstracts presented at major neuro-oncology conferences in the last five years (2007-2011) were reviewed for topics on QOL. The conferences included were the annual meetings of American Society of Clinical Oncology (ASCO), American Society for Therapeutic Radiology and Oncology (ASTRO) and Society of Neuro-Oncology (SNO). The abstract databases were searched for the terms “quality of life” and “neuro”, “brain”, “spine”, or “CNS” in the title or body of the abstract. The selected abstracts were then carefully read to determine those that specifically dealt with QOL issues in central nervous system disease only. The number of QOL abstracts and number of neuro-oncology abstracts were collected for each year and are reported as a percentage. There were total of 15 meetings in the last five years, with each society holding a meeting annually. The median number of accepted neuro-oncology abstracts at ASCO, ASTRO, and SNO were 122 (111-160); 183 (141-233) 588 (493-727) respectively.Poster Viewing Abstract 3153; Table20072008200920102011TotalASCO0% (0/122)4.5% (5/111)4.2% (5/118)6.3% (10/160)4.8% (6/126)4.1% (26/638)ASTRO0.7% (1/141)1.2% (2/163)1.6% (3/183)0.5% (1/212)1.3% (3/233)1.1% (10/932)SNO6.7% (33/492)5.0% (28/564)5.7% (34/598)4.4% (26/588)3.3% (24/727)4.9% (145/2970)Total4.5% (34/755)4.2% (35/838)4.7% (42/899)3.9% (37/960)3.0% (33/1086)3.3% (181/4540) Open table in a new tab Proper functioning of the CNS provides patients with the necessary motor and cognitive skills to perform activities of daily living, which are generally equated with QOL. QOL should therefore be of central concern in neuroscience and neuro-oncology research. Our analysis shows, however, that less than 5% of the neuro-oncological abstracts addressed QOL issues at the major oncology national conferences. As national meetings are the premier forum for sharing the most current and pressing topics in oncology, it is our responsibility to increase the study of QOL issues and their presence at these meetings. This will allow the study of QOL issues to become more rigorous and scientific, giving clinicians an evidence-based foundation on which to make better treatment decisions and therefore provide our patients with a better QOL.

MO-F-BRCD-02: SBRT (Part 2): Physics and Quality Assurance Updates.

The technical advantage of stereotactic body radiation therapy (SBRT) is based upon the ability to deliver a hypofractionated course of heterogeneous dose to a well-defined volume with a rapid fall-off of dose outside the treatment volume. The overall goal is to deliver an ablative dose to the target while minimizing the effects of radiation on the surrounding normal tissue. The major advantage of SBRT is the greater biologically effective dose to the target than that permitted by less conformal, fractionated techniques. In this presentation the established recommendations for quality assurance and safety of SBRT from ACR, ASTRO, and AAPM will be reviewed. The recommendations include establishing an SBRT clinic, equipment and imaging considerations, overview of staffing and personnel qualifications, treatment planning considerations, training, acceptance and commissioning practices, and use of safety checklists. Additionally, a Failure Mode and Effect Analysis (FMEA) for Stereotactic Body Radiation Therapy Delivery is presented.

Addition of Radiotherapy to Long-Term Androgen Deprivation in Locally Advanced Prostate Cancer: An Open Randomised Phase 3 Trial

BackgroundRadiotherapy combined with androgen-deprivation therapy (ADT) is superior to radiotherapy alone in localised prostate cancer; however, data comparing ADT alone are somewhat limited. ObjectiveTo compare 3-yr ADT plus radiotherapy with ADT alone in locally advanced prostate cancer patients. Design, setting, and participantsA multicentre randomised open controlled phase 3 trial in 264 histologically confirmed T3–4 or pT3N0M0 prostate cancer patients randomised from March 2000 to December 2003. InterventionADT (11.25mg subcutaneous depot injection of leuprorelin every 3 mo for 3 yr) plus external-beam radiotherapy or ADT alone. Flutamide (750g/d) was administered for 1 mo. Outcome measurements and statistical analysisThe primary objective was 5 yr progression-free survival (PFS) according to clinical or biologic criteria, using the American Society for Therapeutic Radiology and Oncology (ASTRO) and the newer (Phoenix) definition (nadir plus 2 ng/ml), by intention to treat. Secondary objectives included time to locoregional recurrence and distant metastases, and overall and disease-specific survival. Our Analyses: intent-to-treat analysis, multivariate analyses using a Cox model with a 5% threshold from univariate analysis, and Kaplan-Meier estimates. Results and limitationsADT alone was administered to 130 patients and combined therapy to 133. With a median follow-up of 67 mo, 5-yr PFS was 60.9% for combined therapy versus 8.5% with ADT alone (ASTRO; p<0.0001), and 64.7% versus 15.4%, respectively, for Phoenix (p<0.0011). Locoregional progression was reported in 9.8% of combined-therapy patients versus 29.2% with ADT alone (p<0.0001) and metastatic progression in 3.0% versus 10.8%, respectively (p<0.018). Overall survival was 71.4% with combined therapy versus 71.5% with ADT alone; disease-specific survival was 93.2% versus 86.2%. Limitations included the relatively small population and a relatively short follow-up period. ConclusionsCombined therapy strongly favoured improved PFS, locoregional control, and metastasis-free survival. Longer follow-up is needed to assess the potential survival impact.

Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America

Gastric cancer is a global health problem accounting for 10% of all new cancer cases and 12% of all cancer deaths worldwide. Many clinical trials and meta-analyses have explored the value of neoadjuvant or adjuvant chemotherapy and radiation therapy in gastric cancer; however, these studies have produced conflicting results. The purpose of this guidance document was to determine whether patients with resectable gastric cancer should receive neoadjuvant or adjuvant therapy in addition to surgery. Outcomes of interest were overall survival, disease-free survival, and adverse events. A systematic review was undertaken to inform recommendations regarding neoadjuvant and adjuvant therapy in resectable gastric cancer in Ontario, Canada. MEDLINE and EMBASE databases, as well as American Society of Clinical Oncology (ASCO) annual meeting proceedings and American Society for Therapeutic Radiology and Oncology (ASTRO) proceedings were systematically searched from 2002 to 2010. Oral fluoropyrimidine trials were excluded owing to the unavailability of these agents in North America. Overall, 22 randomized controlled trials (RCTs), 13 meta-analyses, and two secondary analyses were included. The systematic review informed the development of a clinical practice guideline with the following recommendations. Postoperative 5-fluorouracil-based chemoradiotherapy based on the Macdonald approach or perioperative ECF (epirubicin, cisplatin, fluorouracil) chemotherapy based on the Cunningham/MAGIC (Medical Research Council Adjuvant Gastric Infusional Chemotherapy) approach are both acceptable standards of care in North America. Choice of treatment should be made on a case-by-case basis. Adjuvant chemotherapy is a reasonable option for those patients for whom the Macdonald and MAGIC protocols are contraindicated. All patients with resectable gastric cancer should undergo a pretreatment multidisciplinary assessment to determine the best plan of care. Overall survival in patients with resectable gastric cancer is significantly improved with the use of either postoperative chemoradiation (Macdonald approach) or perioperative ECF (MAGIC protocol).

Long-Term Results of an RTOG Phase II Trial (00-19) of External-Beam Radiation Therapy Combined With Permanent Source Brachytherapy for Intermediate-Risk Clinically Localized Adenocarcinoma of the Prostate

External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques.

Combination external beam radiation and brachytherapy boost with androgen deprivation for treatment of intermediate-risk prostate cancer: long-term results of CALGB 99809.

Combined transperineal prostate brachytherapy and external beam radiation therapy (EBRT) is widely used for treatment of prostate cancer. Long-term efficacy and toxicity results of a multicenter phase 2 trial assessing combination of EBRT and transperineal prostate brachytherapy boost with androgen deprivation therapy (ADT) for intermediate-risk prostate cancer are presented. Intermediate-risk patients per Memorial Sloan-Kettering Cancer Center/National Comprehensive Cancer Network criteria received 6 months of ADT, and 45 grays (Gy) EBRT to the prostate and seminal vesicles, followed by transperineal prostate brachytherapy with I125 (100 Gy) or Pd103 (90 Gy). Toxicity was graded using the National Cancer Institute Common Toxicity Criteria version 2 and Radiation Therapy Oncology Group late radiation morbidity scoring systems. Disease-free survival (DFS) was defined as time from enrollment to progression (biochemical, local, distant, or prostate cancer death). In addition to the protocol definition of biochemical failure (3 consecutive prostate-specific antigen rises>1.0 ng/mL after 18 months from treatment start), the 1997 American Society for Therapeutic Radiology and Oncology (ASTRO) consensus and Phoenix definitions were also assessed in defining DFS. The Kaplan-Meier method was used to estimate DFS and overall survival. Sixty-one of 63 enrolled patients were eligible. Median follow-up was 73 months. Late grade 2 and 3 toxicity, excluding sexual dysfunction, occurred in 20% and 3% of patients. Six-year DFS applying the protocol definition, 1997 ASTRO consensus, and Phoenix definitions was 87.1%, 75.1%, and 84.9%. Six deaths occurred; only 1 was attributed to prostate cancer. Six-year overall survival was 96.1%. In a cooperative setting, combination of EBRT and transperineal prostate brachytherapy boost plus ADT resulted in excellent DFS with acceptable late toxicity for patients with intermediate-risk prostate cancer.

Advances in uro-oncology “OncoForum”: The best of 2010

ObjectiveTo highlight the most important issues of the 2010 annual meetings of the European Association of Urology (EAU), the American Urological Association (AUA), the American Society of Clinical Oncology (ASCO), and the American Society for Therapeutic Radiology and Oncology (ASTRO). MethodsA group of experts in oncological urology selected the most important summaries of the four congresses. Subsequently, the revisers assessed the findings in relation to their present and future impacts on clinical practice. This document includes the summaries with the highest points. ResultsThe following messages were considered important. In pT3 prostate cancer, postoperative radiotherapy (RT) improves local control and biochemical progression-free survival, with no significant impact on distant metastasis and overall survival. In patients with bladder cancer without muscle invasion and with the risk of intermediate recurrence, maintenance chemotherapy does not increase recurrence-free survival after transurethral resection. There is no evidence of a synergist effect of the combination of Temsirolimus/Bevacizumab in patients with metastatic kidney cell carcinoma without prior treatment. In the SWENOTECA V protocol for the treatment of seminomatous germ-cell testicular cancer, the adjuvant RT was interrupted because the concern regarding the induction of secondary cancers was greater than the reduction of relapses. ConclusionsIn 2010, new data were produced on the diagnosis and treatment in oncological urology, thanks to the interesting work of different trials.

Reply

We agree with the editor's response. Treatment of PSA recurrence after radiation therapy for prostate cancer is one of the major dilemmas facing urologists. Many would treat these patients with hormonal therapy, which can be premature. However, these cases mandate a team approach that is crucial to providing more clinical information to render the most appropriate care. Editorial CommentUrologyVol. 76Issue 5PreviewThe current study1 has attempted to use an algorithm, based on both prostate biopsy and capromab pendetide scanning (CPS), to enhance clinical decision making for patients with PSA relapse after radiation therapy. Assuming that approximately 30% of radiation therapy candidates for presumed localized disease will ultimately develop biochemical relapse, regardless of the most current American Society for Therapeutic Radiology and Oncology (ASTRO) definition, the clinician must assist the patient in deciding upon available options. Full-Text PDF

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee Report on Electronic Brachytherapy

The development of novel technologies for the safe and effective delivery of radiation is critical to advancing the field of radiation oncology. The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for, or are already in, clinical use. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft, Inc. (Fremont, CA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany). These devices are designed to deliver electronically generated radiation, and because of their relatively low energy output, they do not fall under existing regulatory scrutiny of radioactive sources that are used for conventional radioisotope brachytherapy. This report provides a descriptive overview of the technologies, current and future projected applications, comparison of competing technologies, potential impact, and potential safety issues. The full Emerging Technology Committee report is available on the American Society for Therapeutic Radiology and Oncology Web site.

American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guidelines for Image-Guided Radiation Therapy (IGRT)

*Department of Radiation Medicine, Long Island Jewish Medical Center, New Hyde Park, New York; yDepartment of Radiation Oncology, University of Colorado, Denver, Colorado; zDepartment of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania; xSection of Radiation Oncology, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; {CyberKnife Center of Miami, Miami, Florida **Department of Radiation Oncology, MD Anderson Cancer CenterOrlando, Orlando, Florida; yyDepartment of Radiation Oncology, Northwest Community Hospital, Arlington Heights, Illinois; zzDepartment of Radiation Oncology, Mt. Sinai Medical Center, Miami, Florida; xxDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; {{Department of Radiation Oncology, Scripps Clinic, La Jolla, California; ***Department of Radiation Oncology, Wayne State University, Detroit, Michigan; yyyDepartment of Radiation Oncology, Stanford University, Stanford, California; and zzzRadiation Oncology Center, Radiological Associates of Sacramento, Sacramento, California

American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of Stereotactic Body Radiation Therapy

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the developers of this guideline cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, an approach that differs from the