0000000000225689
AUTHOR
Etienne Martin
Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: Who, when, where and how?
Even in the current era of dose-escalated radiotherapy for prostate cancer, biochemical recurrence is not uncommon. Furthermore, biochemical failure is not specific to the site of recurrence. One of the major challenges in the management of prostate cancer patients with biochemical failure after radiotherapy is the early discrimination between those with locoregional recurrence only and those with metastatic disease. While the latter are generally considered incurable, patients with locoregional disease may benefit from emerging treatment options. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and t…
Prostate Metabolism After the Completion of Exclusive Radiation Is More Depleted After Seeds Brachytherapy Compared to External Beam Radiation Therapy for Prostate Cancer Patients
International audience; Biochemical outcome after radiation therapy requires a protracted time. PSA decreases slowly over time so that it is difficult to differentiate immediately after the completion of radiation the impact of radiation in the prostate using brachytherapy or external radiotherapy. At 3 months, the mean PSA values were similar between the 2 groups: 2.54 ng/mL (±1.59) in the EBRT group and 1.88 ng/mL (±1.14) in the PPI group (p=0.23). For Choline levels, 3-months Choline / Baseline Choline ratios were 1.13 (±0.60) after EBRT vs. 0.45 (±0.23) in the PPI group (p=0.003). Similar results were observed for Citrate levels: 3-months Citrate level / Baseline Citrate level ratios we…
Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma.
International audience; Purpose. - Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. Patients and methods. - Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy …
Absolute volume of the rectum and AUC from rectal DVH between 25Gy and 50Gy predict acute gastrointestinal toxicity with IG-IMRT in prostate cancer
International audience; Background: To determine whether dose/volume specific endpoints (DVSE) or Area under the rectal DVH curve (rAUC) better predict acute gastrointestinal (GI) toxicity in prostate cancer patients treated with IMRT in the era of daily image guidance (IG-IMRT). Methods: A set of DVSE was recorded from V25 to V75 (increments of 5Gy) (both in % and in cc) for 180 men. The rAUC was calculated for doses ranging between 25Gy and 50Gy (rAUC(25-50)). Univariate and multivariate logistic regressions were performed to determine the relationship between DVSE or rAUC(25-50) and the appearance of any acute GI toxicity. Results: The rates of acute grade 1 (G1), G2 and G3 GI toxicities…
Multiparametric MRI and post implant CT-based dosimetry after prostate brachytherapy with iodine seeds: The higher the dose to the dominant index lesion, the lower the PSA bounce
Abstract Purpose To determine whether post-implant MRI-based dosimetry of the Dominant Intra-prostatic Lesion (DIL) could best predict the occurrence of PSA bounce after prostate brachytherapy. Methods and materials We selected 66 patients with a low risk prostate cancer treated with 125 I prostate brachytherapy as monotherapy. Post-implant dosimetry based on day 30 CT-scan and multiparametric MRI co-registration was generated: planned D 90, D 95, V 100, V 150 values were calculated for each DIL. Bounce was defined as a PSA elevation ⩾0.2ng/mL from the previous baseline value followed by a decrease to or below the prior nadir with no additional treatment. Results After a median follow-up of…
Focal or whole-gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for postradiotherapy local failure: How best to spare the rectum?
International audience; PURPOSE: Salvage prostate permanent implant (sPPI) for postradiation local failure provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum is still unknown. METHODS AND MATERIALS: We reviewed the postimplant CT-based dosimetry of 18 selected patients who underwent sPPI with I-125 seeds for isolated biopsy-proven local failure several years after external beam radiation therapy. Ten patients had whole-prostate sPPI, and 8 patients had multiparametric MRI-based focal sPPI. In 8 patients, hyaluronic acid (HA) gel was injected into the prostate rectum space. RESULTS: The median cumulative biological effective dose after EB…
Radiothérapie guidée par l’image des cancers prostatiques : concepts et implications
Resume La radiotherapie conformationnelle avec modulation d’intensite (RCMI) et la radiotherapie guidee par l’image sont deux evolutions technologiques qui, appliquees au modele des cancers prostatiques, ont permis de voir diminuer significativement la toxicite et les sequelles digestives et urinaires de la radiotherapie conformationnelle tridimensionnelle. Le benefice clinique majeur de ces techniques sur la diminution de la toxicite digestive et urinaire est indiscutable puisque les sequelles observees a dix ans sont devenues rares avec ces techniques (2 % de cas de toxicite digestive de grade 2 et 1 % de grade 3, 11 % de cas de toxicite urinaire de grade 2 et 5 % de grade 3). Si ces deux…
Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy
Abstract Introduction The purpose of this study was to describe the pattern of nodal relapse with 18 F-fluoro-choline (FCH) Positron Emission Tomography/Computerized Tomography (PET/CT) in prostate cancer patients after radiotherapy. Materials and methods Eighty-three patients had a FCH PET/CT at time of biochemical failure. Of 65 patients with positive findings, 33 had positive nodes. This analysis included 31 patients who had undergone prior prostate-only radiotherapy with or without a prior radical prostatectomy. Each FCH positive node was assigned to a lymph node station with respect to the CTV defined by the RTOG guidelines (CTV RTOG ). 3D mapping was performed after each node was manu…
Multiparametric MRI-based Dosimetric Parameters Best Predict Short-term Time Course of PSA After Iodine 125 Permanent Prostate Implantation for Localized Prostate Cancer
International audience; D90% and V150% of the entire prostate are recognized as the best dosimetric predictors of outcome after 125 I permanent prostate implantation (PPI). The purpose of this study was 2-fold: 1) to determine the relationship between dose-volume parameters of the Dominant Intraprostatic Lesion (DIL) when compared to the prostate and early biochemical outcome after PPI; 2) to define if dose-volume parameters of the central gland (CG), the peripheral zone (PZ) and the DIL could best predict PSA bounce occurrence. The time course of PSA and mechanisms of bounces still remain unclear after PPI. Patients who had a higher dose in the DIL had a worse PSA level at 1 year which is …
Metronomic oral cyclophosphamide prednisolone chemotherapy is an effective treatment for metastatic hormone-refractory prostate cancer after docetaxel failure.
There is currently no standard of treatment for patients with hormone refractory prostate cancer (HRPC) after failure of docetaxel-based chemotherapy. The purpose of this study was to assess the anticancer activity and tolerance of metronomic cyclophosphamide prednisolone combination in this setting.From 2005 to 2010, patients with HRPC who failed at least docetaxel-based chemotherapy were proposed metronomic cyclophosphamide-prednisolone regimen, and were prospectively registered. Twenty-three patients received 50 mg cyclophosphamide and 10 mg prednisolone per os daily until disease progression. Treatment tolerance and efficacy on PSA decrease and pain were studied.Metronomic cyclophospham…
Impact of rectal distension on prostate CBCT-based positioning assessed with 6 degrees-of-freedom couch
International audience; Introduction: Prostate requires a daily correction of its 3-dimensional position in relation with rectal distension. In this study, we sought to determine whether rectal distension with respect to the rectal behavior might have an impact on prostate translations and/or rotations during prostate image guided radiation therapy using a 6 degrees-of-freedom (DOF) couch.Methods and materials: We reviewed the data from 39 patients with localized prostate cancer treated with protracted external radiation therapy using a 6 DOF couch. Before each fraction, a kilovoltage cone beam computed tomography (kV-CBCT) scan was performed. The automatic fusion algorithm was set to fuse …
Inferring postimplant dose distribution of salvage permanent prostate implant (PPI) after primary PPI on CT images
International audience; PURPOSE:To evaluate the dose distribution of additional radioactive seeds implanted during salvage permanent prostate implant (sPPI) after a primary permanent prostate implant (pPPI).METHODS AND MATERIALS:Patients with localized prostate cancer were primarily implanted with iodine-125 seeds and had a dosimetric assessment based on day 30 postimplant CT (CT1). After an average of 6 years, these patients underwent sPPI followed by the same CT-based evaluation of dosimetry (CT2). Radioactive seeds on each CT were detected. The detected primary seeds on CT1 and CT2 were registered and then removed from CT2 referred as a modified CT2 (mCT2). Dosimetry evaluations (D90 and…