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Journal articles on the topic 'NTCP; second cancer; prostate radiotherapy'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Sukhikh, E. S., I. N. Sheyno, L. G. Sukhikh, A. V. Taletskiy, A. V. Vertinskiy, and P. V. Izhevskiy. "Radiobiological Evaluation of Dosimetric Plans for Stereotactic Radiotherapy for Prostate Cancer According to Fractionation Regimen." Journal of radiology and nuclear medicine 100, no. 5 (November 4, 2019): 263–69. http://dx.doi.org/10.20862/0042-4676-2019-100-5-263-269.

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Objective. To determine the most effective irradiation regimen (total dose and dose per fraction) for hypofractionated treatment for prostate carcinomas according the TCP/NTCP radiobiological criteria.Material and methods. Using the tomographic information of five patients with low-risk prostate adenocarcinoma as an example, the authors devised dosimetric radiation therapy plans using the volumetric modulated arc therapy (VMAT) procedure. They considered the range of total doses of 33.5 to 38 Gy administered in 4 and 5 fractions. Based on the equivalent uniform dose concept proposed by A. Niemierko and on the computed differential dose volume histograms, the investigators modeled local tumor control probability (TCP) values, by taking into account the uncertainties of main radiobiological parameters, and estimated normal tissue complication probabilities (NTCP) for the anterior rectal wall as the organ most at risk of irradiation. An effective dosimetric plan was selected according to the UTCP criterion and the probability of complication-free tumor control, i.e. TCP (1 – NTCP).Results. The results of modeling the UTCP criterion show that with a higher total dose, the TCP value increases and so does the NTCP value, therefore the optimal radiation therapy plans are to irradiate with a total dose of 34 Gy over 4 fractions or with a dose of 36–37 Gy over 5 fractions. The difference between the fractionation regimens is that the UTCP value is achieved with a higher TCP value over 4 fractions and with a lower load on the rectal wall over 5 fractions.Conclusion. The choice of a specific fractionation regimen should be determined from the calculated values of differential dose volume histograms for each patient, as well as from radiobiological criteria, such as TCP, NTCP and UTCP.

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Fellin, G., C. Fiorino, T. Rancati, V. Vavassori, S. Barra, E. Cagna, P. Franzone, P. Gabriele, F. Mauro, and R. Valdagni. "Late Rectal Bleeding after Conformal Radiotherapy for Prostate Cancer: NTCP Modeling." International Journal of Radiation Oncology*Biology*Physics 72, no. 1 (September 2008): S332. http://dx.doi.org/10.1016/j.ijrobp.2008.06.1128.

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3

Zhu, J., A. Simon, J. Ospina, A. Bossi, C. Chira, K. Gnep, V. Beckendorf, and R. De Crevoisier. "EP-2005: NTCP model to predict late urinary toxicity after prostate cancer radiotherapy." Radiotherapy and Oncology 127 (April 2018): S1092. http://dx.doi.org/10.1016/s0167-8140(18)32314-4.

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4

Syndikus, Isabel, Eva Onjukka, Julien Uzan, and Alan Nahum. "Outcome of hypofractionated biological optimized dose-painting radiotherapy for high-risk prostate cancer." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 107. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.107.

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107 Background: Prostate dose-painting radiotherapy and hypo-fractionation both can improve biochemical contol in localised disease. We report toxicity and outcome for a cohort of high risk patients. Methods: We selected 28 patients with high-risk localised prostate cancer and 2 or 3 risk factors. Functional MRI’s were used to define boost volumes with a margin of 5 mm PTV. Neo-adjuvant hormone therapy was given for 3 months. Dose volume constraints, TCP and NTCP parameters were used for optimization of rotational IMRT treatment plans. We used fiducial markers, bowel and bladder preparation and daily IGRT. Results: Mean age was 66 years, mean PSA was 17.4 ng/ml (range 4.6-59.1), 20 patients had T3a and 10 had Gleason score ≥ 8. The mean dose to the prostate excluding the boost volume was 61.4 Gy (range 60.6-62.3) and the boost PTV 66.1 Gy (range 60.9-72.5). Mean NTCP for rectal bleeding was 4.7% (range 3.4-5.8), for faecal incontinence 3.5% (range 2.3-5) and mean TCP 75% (range 71-79) assuming a 71% biochemical control at 5 years for a standard plan. All patients completed radiotherapy, 16/28 patients had acute bladder toxicity grade 2 (RTOG score), but no grade 3 toxicity was observed. Worst acute bowel toxicity was grade 1 (4/28). Mean follow up was 15 months (range 8-25). For the 20 patients who had neo-adjuvant hormone therapy beyond 6months, the mean PSA was 0.33 ng/ml (range 0.2-0.8), 2 patients had relapsed at 12 month, 6 patients are still on hormone therapy. 4 patients had Grade 2 urinary late toxicities (CTCv4). Two patients developed grade 1 diarrhoea. Patient reported outcomes >6 month after completion of radiotherapy (EPIC QOL questionnaire) demonstrated similar scores to controls without prostate cancer for the bowel domains; reduction in the urinary domains was similar to other cohorts treated with external beam radiotherapy and hormone therapy. Conclusions: In this high risk group, dose escalation with hypo-fractionated dose painting radiotherapy achieved good biochemical control and urinary and bowel toxicity similar to standard dose radiotherapy during follow up.

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Fischer-Valuck, Benjamin Walker, Lindsey Olsen, Thomas Mazur, Michael Altman, Beth Bottani, Hiram Alberto Gay, and Jeff M. Michalski. "A treatment planning comparison of proton therapy and intensity-modulated radiotherapy (IMRT) for prostate cancer using the normal tissue complication probability (NTCP)." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 153. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.153.

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153 Background: The volume of rectum receiving high-dose (i.e. > or = 60 Gy) is consistently associated with the risk of Grade > or = 2 rectal toxicity or rectal bleeding based on common terminology criteria for adverse events (CTCAE). Our goal was to compare intensity-modulated photon radiotherapy (IMRT) with proton radiotherapy in regard to the rectal dose using the normal tissue complication probability (NTCP). Methods: Between July 2014 and September 2015 the first 10 consecutive low or intermediate risk prostate cancer patients were treated with proton therapy at our institution. All 10 patients were planned with three-dimensional conformal proton therapy (3D-CPT) using two parallel opposed fields as well as comparison IMRT plans. A rectal balloon filled with water was used in all patients treated. Prescribed dose to the prostate was 79.2 Gy or cobalt Gy equivalent (CBE) for protons. Dose-volume histograms were compared. The Lyman-Kutcher-Burman model (n = 0.09, m = 0.13, and TD50 = 76.9 Gy) was used to generate NTCP estimates for both IMRT and proton plans. Results: At least 95% of the planning target volume received the prescription dose for both proton and IMRT plans. Dose constraints placed on the rectum included volume receiving 65 Gy (V65) less than 17% and V40 less than 35%. The mean dose to the rectum was 24.5 Gy (range, 19.5-30.1 Gy) and 31.7 Gy (range, 23.7-39.4 Gy) for the proton and IMRT plans, respectively. The V65 constraint was unachievable in 3 of the proton plans and 3 of the IMRT plans. The mean V70 and V75 for proton plans was 8.4% and 5.4% compared to 7.5% and 4.8% for the IMRT plans. The mean NTCP for proton treatment plans was 7.72% (range, 2.7-11.7%) and 7.92% (range, 1.7-15.3%) for IMRT (P = 0.45). After median follow-up of 6 months, no grade 2 or higher toxicity has been reported. Conclusions: Utilizing NTCP estimations, proton therapy and IMRT have similar predicted rates of rectal toxicity. Currently, a Phase III randomized clinical trial is underway comparing proton therapy and IMRT with regards to rectal toxicity and quality of life.

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Murray, Julia, Clare Griffin, Emma Hall, Jamie Dean, Isabel Syndikus, John Staffurth, Helen Mayles, Sarah Gulliford, and David P. Dearnaley. "Normal Tissue Complication Probability (NTCP) model for erectile dysfunction (ED) following external beam radiotherapy (RT) for prostate cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 135. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.135.

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135 Background: ED remains a common toxicity of prostate RT despite technological advances. Penile bulb (PB) dose has been proposed as a predictor of ED post RT. The main objective of this study was to develop NTCP models for ED. Methods: 162 men treated within the CHHiP IGRT substudy (CRUK/06/16) had baseline clinical data, PB dosimetric data & evaluation of ED using EPIC-26 at least 3 years post RT. Planning CT and reference dose distributions were imported into analysis software (VODCA, MSS GmbH) and PB retrospectively contoured by one clinician. The defined endpoint (severe ED) was a standardised average value of 0-33 for EPIC-26 sexual domain. Predictive models of ED were generated using PB dose in EQD2 (α/β ratio = 3Gy) & clinical data (age, diabetes, hypertension, NCCN risk group, baseline PSA, hormone therapy, IGRT, margin size, PB volume). Multivariate logistic regression method using resampling methods was applied to select model order and parameters. Models were fitted using logistic regression of the form Probability = eA(x)/1+eA(x), where A(x) = constant + sum of (variables * associated regression coefficients). Model performance was evaluated through area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow (HL) goodness-of-fit test. Results: 101/162 (62%) men had severe ED with statistically significant difference in PB max and mean dose between those patients with or without severe ED (max: 61.8Gy vs 43Gy & mean: 27.4Gy vs 14Gy respectively; p = 0.001). In the univariate analyses, age, diabetes, risk group, PB mean and max doses were significantly associated with EPIC calculated severe ED. The optimal NTCP model (AUC 0.78; CI 0.71-0.86: p for HL = 0.75) for EPIC calculated severe ED included age, PB mean dose and diabetes where A(x) = -10.13+(0.14*age)+(0.03*PB mean dose)+(2.88 if diabetic). A comparable model using clinician completed outcomes will be reported. Conclusions: This study provides the first known clinical prediction model for ED including PB dose, with good model performance. The determined predictors for the NTCP model of severe ED in this cohort were PB mean dose, age & diabetes. External validation of this model is desirable. Clinical trial information: 97182923.

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Van Vreeswijk, N. L., C. Hammer, A. C. M. Van den Bergh, H. A. M. Vanhauten, S. Bijmolt, J. A. Langendijk, and S. Aluwini. "PV-0626: Long term toxicity after radiotherapy for prostate cancer: NTCP models for rectal toxicity." Radiotherapy and Oncology 127 (April 2018): S332. http://dx.doi.org/10.1016/s0167-8140(18)30936-8.

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Charas, Tomer, Amandeep Taggar, and Michael J. Zelefsky. "Second malignancy risk in prostate cancer and radiotherapy." Future Oncology 13, no. 5 (February 2017): 385–89. http://dx.doi.org/10.2217/fon-2016-0503.

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Reddy, Chandana A., Jay P. Ciezki, and Eric A. Klein. "Second Malignancies after Definitive Radiotherapy for Prostate Cancer." Brachytherapy 9 (April 2010): S78. http://dx.doi.org/10.1016/j.brachy.2010.02.131.

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Christiansen, R. L., L. Dysager, C. R. Hansen, T. Schytte, A. S. Bertelsen, H. R. Jensen, F. Mahmood, et al. "PO-1689 Potential NTCP reductions for high-risk prostate cancer patients by MR-guided adaptive radiotherapy." Radiotherapy and Oncology 170 (May 2022): S1488—S1489. http://dx.doi.org/10.1016/s0167-8140(22)03653-2.

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Alicikus, Z. A., B. Aydin, D. Akcay, N. Akturk, and I. B. Gorken. "EP-2299: Correlation Of Tcp And Ntcp In Prostate Cancer Patients Treated With High-Dose Radiotherapy." Radiotherapy and Oncology 127 (April 2018): S1268—S1269. http://dx.doi.org/10.1016/s0167-8140(18)32608-2.

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Barbosa, B., and I. Bravo. "NTCP AND TCP COMPARISON OF 3DCRT AND IMRT+3DCRT PLANS IN RADIOTHERAPY TREATMENT OF PROSTATE CANCER." Radiotherapy and Oncology 98 (March 2011): S32. http://dx.doi.org/10.1016/s0167-8140(11)71779-0.

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13

Tang, Du, Zhan Liang, Fada Guan, and Zhen Yang. "Dosimetric and Radiobiological Comparison of Five Techniques for Postmastectomy Radiotherapy with Simultaneous Integrated Boost." BioMed Research International 2020 (July 21, 2020): 1–9. http://dx.doi.org/10.1155/2020/9097352.

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Purpose. To compare five techniques for the postmastectomy radiotherapy (PMRT) with simultaneous integrated boost (SIB). Materials and Methods. Twenty patients with left-sided breast cancer were retrospectively selected. Five treatment plans were created for each patient: TomoDirect (TD), unblocked helical TomoTherapy (unb-HT), blocked HT (b-HT), hybrid intensity-modulated radiotherapy (hy-IMRT), and fixed-field IMRT (ff-IMRT). A dose of 50.4 Gy in 28 fractions to PTVtotal and 60.2 Gy in 28 fractions to PTVboost were prescribed. The dosimetric parameters for targets and organs at risk (OARs), the normal tissue complication probability (NTCP), the second cancer complication probability (SCCP) for OARs, and the treatment efficiency were assessed and compared. Results. TD plans and hy-IMRT plans had similar good dose coverage and homogeneity for both PTVboost and PTVtotal and superior dose sparing for the lungs and heart. The ff-IMRT plans had similar dosimetric results for the target volumes compared with the TD and hy-IMRT plans, but gave a relatively higher NTCP and SCCP for the lungs. The unb-HT plans exhibited the highest OAR mean dose, highest NTCP for the lungs (0.97±1.25‰) and heart (4.58±3.62%), and highest SCCP for the lungs (3.57±0.05%) and contralateral breast (2.75±0.29%) among all techniques. The b-HT plans significantly outperformed unb-HT plans with respect to the sparing of the lungs and heart. This technique also showed the best conformity index (0.73±0.08) for PTVboost and the optimal NTCP for the lungs (0.03±0.03‰) and heart (0.61±0.73%). Concerning the delivery efficiency, the hy-IMRT and ff-IMRT achieved much higher delivery efficiency compared with TomoTherapy plans. Conclusion. Of the five techniques studied, TD and hy-IMRT are considered the preferable options for PMRT with SIB for left-sided breast cancer treatment and can be routinely applied in clinical practice.

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Sukhikh, E., L. Sukhikh, A. Vertinsky, P. Izhevsky, I. Sheino, and V. Vertoukhova. "Analysis of the Physical and Radiobiological Equivalence of the Calculated and Measured Dose Distributions for Prostate Stereotactic Radiotherapy." Medical Radiology and radiation safety 66, no. 3 (July 20, 2021): 68–75. http://dx.doi.org/10.12737/1024-6177-2021-66-3-68-75.

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Purpose: Carrying out the analysis of the physical and radiobiological equivalence of dose distributions obtained during the planning of hypofractionated stereotactic radiation therapy of the prostate cancer and verification using a three-dimensional cylindrical dosimeter. Material and Methods: Based on the anatomical data of twelve patients diagnosed with prostate carcinoma, stage T2N0M0 with low risk, plans were developed for stereotactic radiation therapy with volumetric modulates arc therapy (VMAT). The dose per fraction was 7,25 Gy for 5 fractions (total dose 36,25 Gy) with a normal photon energy of 10 MV. The developed plans were verified using a three-dimensional cylindrical ArcCHECK phantom. During the verification process, the three-dimensional dose distribution in the phantom was measured, based on which the values of the three-dimensional gamma index and the dose–volume histogram within each contoured anatomical structures were calculated with 3DVH software. The gamma index value γ (3 %, 2 mm, GN) at a threshold equal to 20 % of the dose maximum of the plan and the percentage of coincidence of points at least 95 % was chosen as a criterion of physical convergence of the calculated and measured dose distribution according to the recommendations of AAPM TG-218. To analyze the radiobiological equivalence of the calculated and measured dose distribution, the local control probability (TCP) and normal tissue complication probability (NTCP) criteria were used based on the calculated and measured dose–volume histograms. Contours of the target (PTV) and the anterior wall of the rectum were used for the analysis. The approach based on the concept of equivalent uniform dose (EUD) by A. Niemierko was used to calculate the values of TCP/NTCP criteria. Results: The results of physical convergence of plans for all patients on the contour of the whole body were higher than 95 % for the criteria γ (3 %, 2 mm, GN). The convergence along the PTV contour is in the range (75.5–95.2)%. The TCP and NTCP values obtained from the measured dose-volume histograms were higher than the planned values for all patients. It was found that the accelerator delivered a slightly higher dose to the PTV and the anterior wall of the rectum than originally planned. Conclusion: The capabilities of modern dosimetric equipment allow us move to the verification of treatment plans based on the analysis of TCP / NTCP radiobiological equivalence, taking into account the individual characteristics of the patient and the capabilities of radiation therapy equipment.

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Oh, Kevin S., and Howard M. Sandler. "Second Malignancies After Radiotherapy for Prostate Cancer: Keeping Perspective." Urology 72, no. 5 (November 2008): 971–73. http://dx.doi.org/10.1016/j.urology.2008.07.016.

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Numata, Kousaku, Koji Azuma, Katsuyoshi Hashine, and Yoshiteru Sumiyoshi. "TWO CASES OF SECOND BLADDER CANCER AFTER RADIOTHERAPY FOR PROSTATE CANCER." Japanese Journal of Urology 96, no. 3 (2005): 466–69. http://dx.doi.org/10.5980/jpnjurol1989.96.466.

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Aksnessaether, Bjorg Y., Arne Solberg, Tor Åge Myklebust, Solveig Roth Hoff, Eva Skovlund, Olbjørn Klepp, and Jo-Åsmund Lund. "Second cancer following radical prostate cancer treatment." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 16. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.16.

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16 Background: We estimated second cancer (SC) risk following radical prostate cancer (PC) treatment and evaluated if the risk was influenced by treatment. Methods: We analyzed data from the Cancer Registry of Norway on all patients with PC (first cancer diagnosis) from 1997-2014. Standardized incidence ratios (SIRs) for SC were calculated. Subdistribution hazard ratios (SHRs) were estimated in treatment groups (prostatectomy (RP) reference). Results: Median follow-up in 24155 radically treated patients was 6 and 4 years in the external beam radiotherapy (EBRT) and RP-groups, respectively. SC-incidence was indifferent from that of the reference population in 24155 radically treated patients, higher following EBRT, SIR 1.06(1.01-1.12), and lower following RP, SIR 0.91(0.84-0.98). EBRT-patients had higher rectal and urinary bladder cancer incidences. Compared to RP, the EBRT-patients had a 38 % higher risk of any SC. Respective figures for rectal, urinary bladder and lung cancer: 72, 38, and 113%. Conclusions: EBRT-patients had a slightly higher SC-incidence than the general population. The rectal and urinary bladder cancer risk should be taken into account in follow-up after EBRT.[Table: see text]

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Parikh, Neil R., and Amar U. Kishan. "Stereotactic Body Radiotherapy for Prostate Cancer." American Journal of Men's Health 14, no. 3 (May 2020): 155798832092724. http://dx.doi.org/10.1177/1557988320927241.

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Prostate cancer remains the most common and second most deadly cancer diagnosed amongst U.S. men. External beam radiotherapy is a standard-of-care definitive treatment option for localized prostate cancer and historically constituted an 8–9-week treatment course comprised of 39–45 doses of 1.8–2.0 Gy each (conventional fractionation, CF). Based on the notion that prostate cancer may respond favorably to a higher dose per day, considerable research efforts have been focused on characterizing the safety and efficacy profile of shorter and shorter radiation courses. Ultrahypofractionation (UHF) involves condensing the radiation course into just 5–7 treatments of 6–8 Gy each. When utilizing modern techniques that allow the precise sculpting of a dose distribution that delivers high doses to the prostate and lower doses to surrounding normal tissues over five or fewer treatments, this treatment is called stereotactic body radiotherapy (SBRT). Two randomized trials (HYPO-RT-PC and PACE-B) have compared UHF to longer radiation courses. The former demonstrated that UHF and CF have similar long-term toxicity and efficacy, while the latter demonstrated that modern SBRT has equivalent short-term toxicity as well. A separate report from a consortium of studies data provides prospective, albeit nonrandomized, data supporting the longer-term safety and efficacy of SBRT specifically. Thus, mounting high-level evidence suggests that SBRT is an acceptable standard care of option for men with localized prostate cancer.

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Liu, Mitchell, Vitali Moiseenko, Alexander Agranovich, Anand Karvat, Winkle Kwan, Ziad H. Saleh, Aditya A. Apte, and Joseph O. Deasy. "Normal Tissue Complication Probability (NTCP) modeling of late rectal bleeding following external beam radiotherapy for prostate cancer: A Test of the QUANTEC-recommended NTCP model." Acta Oncologica 49, no. 7 (September 13, 2010): 1040–44. http://dx.doi.org/10.3109/0284186x.2010.509736.

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Singh, Gaganpreet, Rose Kamal, Deepak Thaper, Arun Singh Oinam, Bhumika Handa, Vivek Kumar, and Narendra Kumar. "Voxel based evaluation of sequential radiotherapy treatment plans with different dose fractionation schemes." British Journal of Radiology 93, no. 1112 (August 2020): 20200197. http://dx.doi.org/10.1259/bjr.20200197.

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Objective: This study presents a methodology for voxel-based evaluation of two phase sequential radiotherapy treatment plans having conventional dose scheme in the first phase and subsequent hypofractionation dose scheme in the second phase based upon different priority [planning target volume (PTV), clinical target volume (CTV) and organs at risk (OAR)] of display modes. Methods: A case of carcinoma prostate was selected for demonstration. Varian Eclipse treatment planning system (TPS) was used for contouring and planning. In the first phase, a dose of 52 Gy in 26 fractions to the PTV and in the second phase, a dose of 19.5 Gy in 3 fractions to the PTV Boost was planned on the same CT data set. Both the plans (Phase 1 and Phase 2) were exported and processed using “Voxel-based radiobiology display (VRb) tool”. Plan Sum for Biologically effective dose (BED)-Cube and equivalent dose of 2Gy (EQD2)-Cube was reconstructed using a combination of linear quadratic (LQ) and linear quadratic-linear (LQ-L) radiobiological models. Tumor control probability (TCP) and normal tissue complication probability (NTCP) for different target volumes and organs were also calculated using EQD2-volume histograms of the Plan Sum. Results: An in-house graphical user interface (GUI) is developed to present the qualitative and quantitative evaluation of the multiphase treatment plans with different display modes and dose regimens. The voxel based TCP obtained for the combined target volume was 90.56%. NTCP for the bladder and rectum was calculated from the Plan Sum histograms and found to be 0.33% and ~0.0% respectively. Conclusion: The proposed methodology using the VRb tool offers superior plan evaluation for multiphase sequential radiotherapy treatment plans over the existing methods. Advances in knowledge: PTV, CTV and OAR priority based display modes in VRb tool offers better understanding of radiobiological evaluation of sequential radiotherapy treatment plans.

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King, Liam, Nijole Bernaitis, David Christie, Russ Chess-Williams, Donna Sellers, Catherine McDermott, Wendy Dare, and Shailendra Anoopkumar-Dukie. "Drivers of Radioresistance in Prostate Cancer." Journal of Clinical Medicine 11, no. 19 (September 24, 2022): 5637. http://dx.doi.org/10.3390/jcm11195637.

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Prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide. Radiotherapy remains one of the first-line treatments in localised disease and may be used as monotherapy or in combination with other treatments such as androgen deprivation therapy or radical prostatectomy. Despite advancements in delivery methods and techniques, radiotherapy has been unable to totally overcome radioresistance resulting in treatment failure or recurrence of previously treated PCa. Various factors have been linked to the development of tumour radioresistance including abnormal tumour vasculature, oxygen depletion, glucose and energy deprivation, changes in gene expression and proteome alterations. Understanding the biological mechanisms behind radioresistance is essential in the development of therapies that are able to produce both initial and sustained response to radiotherapy. This review will investigate the different biological mechanisms utilised by PCa tumours to drive radioresistance.

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Rancati, Tiziana, Claudio Fiorino, Gianni Fellin, Vittorio Vavassori, Emanuela Cagna, Valeria Casanova Borca, Giuseppe Girelli, et al. "Inclusion of clinical risk factors into NTCP modelling of late rectal toxicity after high dose radiotherapy for prostate cancer." Radiotherapy and Oncology 100, no. 1 (July 2011): 124–30. http://dx.doi.org/10.1016/j.radonc.2011.06.032.

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Li, Yongqiang, Ping Li, Wenchien Hsi, Zhengshan Hong, Shen Fu, and Qing Zhang. "Normal tissue complication probability (NTCP) models of acute urinary toxicity (AUT) following carbon ion radiotherapy (CIRT) for prostate cancer." Radiotherapy and Oncology 156 (March 2021): 69–79. http://dx.doi.org/10.1016/j.radonc.2020.12.009.

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Rancati, T., C. Fiorino, V. Vavassori, G. Fellin, F. Mauro, E. Cagna, G. Girelli, and R. Valdagni. "Inclusion of Clinical Risk Factors into NTCP Modeling of Late Rectal Toxicity after High Dose Radiotherapy for Prostate Cancer." International Journal of Radiation Oncology*Biology*Physics 81, no. 2 (October 2011): S440. http://dx.doi.org/10.1016/j.ijrobp.2011.06.729.

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Abdel-Wahab, May, Isildinha M. Reis, and Kara Hamilton. "Second Primary Cancer After Radiotherapy for Prostate Cancer—A SEER Analysis of Brachytherapy Versus External Beam Radiotherapy." International Journal of Radiation Oncology*Biology*Physics 72, no. 1 (September 2008): 58–68. http://dx.doi.org/10.1016/j.ijrobp.2007.12.043.

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Cicchetti, Alessandro, Barbara Avuzzi, Federica Palorini, Tiziana Rancati, Claudio Stucchi, Giovanni Fellin, Pietro Gabriele, et al. "Predicting late fecal incontinence risk after RT for prostate cancer: External independent validation." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 116. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.116.

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116 Background: To validating a predictive model for late fecal incontinence (FI) on a recent population (pop) of prostate cancer patients (pts) treated with radical radiotherapy. NTCP model was derived from literature. Methods: Pop included 267 pts treated with IMRT in 2010-2014. Prescribed dose was between 68 and 80 Gy with conventional and hypo-fractionated (HF, from 2.2 to 2.8 Gy) treatment. Rectal toxicity was scored using the LENT/SOMA. Follow-up (FU) was considered up to 2 years. We chose to validate a model for prediction of chronic FI through multiple measures during FU. Mean FI was defined as the average score during the FU period after RT (Mean incontinence > 1). Literature based multivariate model included: mean rectal dose (Dmean), previous diseases of colon (COLO) and previous abdominal surgery (SURG). Dose distributions were corrected EQD in 2 Gy fractions. Results: 186 pts were available. Mean grade > 1 FI was scored in 18 patients (〜10%). Univariate logistic analysis confirmed the risk factors reported in literature. Similar Odds Ratios (OR) were found for Dmean (1.04vs1.05) and SURG (1.90vs1.50). COLO was not a risk factor for this pop. As consequence, NTCP models including Dmean and Dmean+SURG were evaluated through calibration plot. The models showed a clear trend (increasing observed toxicity rates with predicted risk), but the observed toxicity rates were underestimated (slope〜3, R2〜0.7). Including HF (OR = 2.20, 8.6% vs 17.6%) as a variable into the previous model the calibrations improved significantly (slope〜1, R2〜0.9). Conclusions: The study confirms formerly published results on effect of abdominal surgery and dose to large rectal volumes as potential risk factors for late FI. The overfitting in calibrations could be due to an effect of HF, not included in previous models developed on normofractionated treatments. This effect goes beyond the applied standard correction using LQ model for late effects and also beyond the time recovery correction (slope〜2, R^2〜0.8). Probably we should found a more suitable alpha/beta value for the longitudinal definition (toxicity starting in acute phase and persisting during follow-up) instead of using the assumption settled on incidence of late peak events.

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Brenner, David J. "Induced second cancers after prostate-cancer radiotherapy: No cause for concern?" International Journal of Radiation Oncology*Biology*Physics 65, no. 3 (July 2006): 637–39. http://dx.doi.org/10.1016/j.ijrobp.2006.02.044.

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Wang, Rong, Amer M. Zeidan, Pamela R. Soulos, James B. Yu, Amy J. Davidoff, Steven D. Gore, Cary P. Gross, and Xiaomei Ma. "Myelodysplastic Syndromes and Acute Myeloid Leukemia in Prostate Cancer Patients after Radiotherapy, a Population-Based Study." Blood 126, no. 23 (December 3, 2015): 3295. http://dx.doi.org/10.1182/blood.v126.23.3295.3295.

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Abstract Background: Radiation is a known risk factor for myeloid malignancies. Approximately 1.4% of prostate cancer patients who undergo radiotherapy and survive >10 years will develop a secondary cancer. However, the impact of radiotherapy on the development of second myeloid malignancies among prostate cancer patients is unclear. Methods: We performed a retrospective cohort study of elderly prostate cancer patients (diagnosed with clinical stages T1-T3 at the age of 66-99 years during 1999-2009) using the linked Surveillance, Epidemiology and End Results (SEER) - Medicare database. Patients who received chemotherapy after prostate cancer diagnosis or had radiotherapy for prostate cancer recurrence were excluded. We searched Medicare claims and SEER records to identify incident myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) diagnoses after prostate cancer diagnosis. Patients were followed from the diagnosis of prostate cancer through the diagnosis of a second malignancy, death or end of study (12/31/2010 for prostate cancer patients diagnosed in 1999-2003, and 12/31/2012 for those diagnosed in 2004-2011), whichever came first. Competing risk analysis was conducted to assess the impact of radiotherapy on the development of second MDS/AML, compared with surgery. Death and developing a second malignancy other than MDS/AML were considered competing events. Competing risks regression models were performed using the Fine and Gray method to provide estimates of hazard ratios (HRs). Age at prostate diagnosis, race, Elixhauser comorbidity score excluding anemia, history of anemia, disability function score (in quartiles), stage of prostate cancer, and year of prostate cancer diagnosis were adjusted for in the multivariate model. Results: A total of 32,212 prostate cancer patients were included, with a median follow-up of 4.91 years. Patients who received surgery (n = 17,503) were younger than those who underwent radiotherapy (n = 14,709). Intensity-modulated radiotherapy (IMRT) was the most common type of radiotherapy received (n = 8,813, 59.9%; median follow-up: 3.91 years), followed by brachytherapy (n = 3,201, 21.8%; median follow-up: 5.67 years) and external beam radiotherapy (EBRT, n = 2,695, 18.3%; median follow-up: 7.84 years). We observed 158 incident cases of MDS/AML (123 MDS cases and 35 AML cases) after the diagnosis of prostate cancer. The median time to develop MDS/AML was 3.30 (range: 0.20-9.77) years. In the multivariate model, compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing second MDS/AML (HR = 1.54, 95% confidence interval [CI]: 1.09-2.11). When the analysis was stratified by specific radiation modality, increased risk of second MDS/AML was observed in each group, but the increase only reached statistical significance in the IMRT group (HR = 1.66, 95% CI: 1.09-2.52) (Table). We also conducted a separate analysis of the 123 patients who developed MDS. In the unadjusted model, compared with prostate cancer patients who received surgery only, patients who underwent any type of radiotherapy, EBRT, or IMRT had significantly increased risk of MDS. However, after adjusting for other factors, the magnitude of the effect diminished, and the effect was no longer statistically significant (Table). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by radiation modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. Table 1. Risk of Second MDS/AML after Radiotherapy among Prostate Cancer Patients Second cancerof interest Unadjusted Adjusted n (%) HR (95% CI) p HR (95% CI) p MDS/AML (n=158) Surgery 60 (0.34) 1.00 1.00 Radiotherapy 98 (0.67) 1.94 (1.41-2.68) <.01 1.54 (1.09-2.17) 0.01 Brachytherapy 19 (0.59) 1.58 (0.94-2.64) 0.08 1.35 (0.80-2.27) 0.26 EBRT 29 (1.08) 2.13 (1.36-3.34) <.01 1.51 (0.91-2.50) 0.11 IMRT 50 (0.57) 2.02 (1.39-2.93) <.01 1.66 (1.09-2.52) 0.02 MDS (n=123) Surgery 49 (0.28) 1.00 1.00 Radiotherapy 74 (0.50) 1.80 (1.25-2.58) <.01 1.43 (0.97-2.12) 0.07 Brachytherapy 15 (0.47) 1.53 (0.86-2.73) 0.20 1.32 (0.74-2.35) 0.35 EBRT 24 (0.89) 2.17 (1.33-3.54) <.01 1.53 (0.87-2.70) 0.14 IMRT 35 (0.40) 1.72 (1.11-2.65) 0.01 1.43 (0.88-2.33) 0.15 Disclosures Yu: 21st-Century Oncology LLC: Research Funding. Davidoff:Celgene: Consultancy, Research Funding. Gore:Celgene: Consultancy, Research Funding. Gross:21st-Century Oncology LLC: Research Funding; Medtronic: Research Funding; Johnson and Johnson: Research Funding. Ma:Incyte Corp: Consultancy; Celgene Corp: Consultancy.

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Brenner, David J., Rochelle E. Curtis, Eric J. Hall, and Elaine Ron. "Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery." Cancer 88, no. 2 (January 15, 2000): 398–406. http://dx.doi.org/10.1002/(sici)1097-0142(20000115)88:2<398::aid-cncr22>3.0.co;2-v.

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Neugut, Alfred I., Habibul Ahsan, Eliezer Robinson, and Ronald D. Ennis. "Bladder carcinoma and other second malignancies after radiotherapy for prostate carcinoma." Cancer 79, no. 8 (April 15, 1997): 1600–1604. http://dx.doi.org/10.1002/(sici)1097-0142(19970415)79:8<1600::aid-cncr24>3.0.co;2-0.

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Hegemann, N. S., U. Ganswindt, J. Engel, and C. Belka. "OC-0344: Risk of second primary cancers after radiotherapy for prostate cancer." Radiotherapy and Oncology 119 (April 2016): S158. http://dx.doi.org/10.1016/s0167-8140(16)31593-6.

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Wang, Tonghe, Jun Zhou, Sibo Tian, Yinan Wang, Pretesh Patel, Ashesh B. Jani, Katja M. Langen, Walter J. Curran, Tian Liu, and Xiaofeng Yang. "A planning study of focal dose escalations to multiparametric MRI-defined dominant intraprostatic lesions in prostate proton radiation therapy." British Journal of Radiology 93, no. 1107 (March 2020): 20190845. http://dx.doi.org/10.1259/bjr.20190845.

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Objectives: The purpose of this study is to investigate the dosimetric effect and clinical impact of delivering a focal radiotherapy boost dose to multiparametric MRI (mp-MRI)-defined dominant intraprostatic lesions (DILs) in prostate cancer using proton therapy. Methods: We retrospectively investigated 36 patients with pre-treatment mp-MRI and CT images who were treated using pencil beam scanning (PBS) proton radiation therapy to the whole prostate. DILs were contoured on co-registered mp-MRIs. Simultaneous integrated boost (SIB) plans using intensity-modulated proton therapy (IMPT) were created based on conventional whole-prostate-irradiation for each patient and optimized with additional DIL coverage goals and urethral constraints. DIL dose coverage and organ-at-risk (OAR) sparing were compared between conventional and SIB plans. Tumor control probability (TCP) and normal tissue complication probability (NTCP) were estimated to evaluate the clinical impact of the SIB plans. Results: Optimized SIB plans significantly escalated the dose to DILs while meeting OAR constraints. SIB plans were able to achieve 125, 150 and 175% of prescription dose coverage in 74, 54 and 17% of 36 patients, respectively. This was modeled to result in an increase in DIL TCP by 7.3–13.3% depending on [Formula: see text] and DIL risk level. Conclusion: The proposed mp-MRI-guided DIL boost using proton radiation therapy is feasible without violating OAR constraints and demonstrates a potential clinical benefit by improving DIL TCP. This retrospective study suggested the use of IMPT-based DIL SIB may represent a strategy to improve tumor control. Advances in knowledge: This study investigated the planning of mp-MRI-guided DIL boost in prostate proton radiation therapy and estimated its clinical impact with respect to TCP and NTCP.

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Schaake, Wouter, Arjen van der Schaaf, Lisanne V. van Dijk, Alfons H. H. Bongaerts, Alfons C. M. van den Bergh, and Johannes A. Langendijk. "Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients." Radiotherapy and Oncology 119, no. 3 (June 2016): 381–87. http://dx.doi.org/10.1016/j.radonc.2016.04.005.

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Venkitaraman, Ramachandran, Lakshmi Harihar, Muhammad Sabar, and Christopher D. Scrase. "Sequential or concomitant radiotherapy treatment for patients with localized prostate cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e17610-e17610. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e17610.

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e17610 Background: External Beam radiotherapy is a standard treatment for patients with intermediate risk localised prostate cancer. Commonly the radiotherapy plan is delivered in two phases with adequate margins, the first phase to the prostate and seminal vesicles and the second phase to the prostate alone. The two phases can be delivered by intensity modulated radiotherapy as a sequential or concomitant treatment. We compared the toxicities and clinical outcomes of patients who received radiotherapy either as sequential or as concomitant treatment. Methods: Two hundred and twenty five consecutive patients with intermediate risk prostate cancer were included in the study. The patients who had sequential treatment received 60 Gy in 30 fractions to the prostate and seminal vesicles,, while patients who had concomitant treatment received 60 Gy in 37 fractions. All patients received 74 Gy in 37 fractions to the prostate. The Genitourinary (GU) and Gastrointestinal (GI) toxicity data and outcomes in terms of biochemical progression free survival were compared. Results: One hundred eighty patients received sequential radiotherapy, while forty five patients received concomitant radiotherapy. Acute GI toxicity was significantly less in the patients who received concomitant radiotherapy, during weeks four(p = 0.03), six(p = 0.03) and eight(p = 0.06) of treatment, compared to patients who receive sequential radiotherapy. Acute GU toxicities were similar in both groups of patients during treatment. Late GU and GI toxicity at 1 year and 2 years were similar. 3 year biochemical Progression free survival was 90 % for patients who received either sequential compared to 75 % for patients who received concomitant radiotherapy, though not statistically significant (log rank p value = 0.173). Conclusions: Concomitant radiotherapy to prostate and seminal vesicles resulted in lower acute gastrointestinal toxicity compared to sequential radiotherapy to the prostate and seminal vesicles as two phases. The genitourinary and late toxicities were similar. Biochemical progression free survival for patients who received concomitant radiotherapy treatment, could however be inferior to sequential treatment, probably due to the lower dose per fraction to the seminal vesicles and margins.

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Yamazaki, Hideya, Gen Suzuki, Norihiro Aibe, Daisuke Shimizu, Takuya Kimoto, Koji Masui, Ken Yoshida, Satoaki Nakamura, Yasutoshi Hashimoto, and Haruumi Okabe. "Ultrahypofractionated Radiotherapy versus Conventional to Moderate Hypofractionated Radiotherapy for Clinically Localized Prostate Cancer." Cancers 14, no. 1 (December 31, 2021): 195. http://dx.doi.org/10.3390/cancers14010195.

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The purpose of this study was to compare the toxicity (first endpoint) and efficacy (second endpoint) of ultrahypofractionated radiotherapy (UHF) and dose-escalated conventional to moderate hypofractionated radiotherapy (DeRT) for clinically localized prostate cancer. We compared 253 patients treated with UHF and 499 patients treated with DeRT using multi-institutional retrospective data. To analyze toxicity, we divided UHF into High-dose UHF (H-UHF; equivalent doses of 2 Gy per fraction: EQD2 > 100 Gy1.5) and low-dose UHF (L-UHF; EQD2 ≤ 100 Gy1.5). In toxicity, H-UHF elevated for 3 years accumulated late gastrointestinal and genitourinary toxicity grade ≥ 2 (11.1% and 9.3%) more than L-UHF (3% and 1.2%) and DeRT (3.1% and 4.8%, p = 0.00126 and p = 0.00549). With median follow-up periods of 32.0 and 61.7 months, the actuarial 3-year biochemical failure-free survival rates were 100% (100% and 100% in the L-UHF and H-UHF) and 96.3% in the low-risk group, 96.5% (97.1% and 95.6%) and 94.9% in the intermediate-risk group, and 93.7% (100% and 94.6%) and 91.7% in the high-risk group in the UHF and DeRT groups, respectively. UHF showed equivocal efficacy, although not conclusive but suggestive due to a short follow-up period of UHF. L-UHF using EQD2 ≤ 100 Gy1.5 is a feasible UHF schedule with a good balance between toxicity and efficacy.

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Stolyarova, O. Y., M. I. Paliy, Y. V. Dumansky, O. V. Synyachenko, and M. V. Yermolayeva. "Factors determining the efficacy of radiotherapy for prostate cancer." Український радіологічний та онкологічний журнал 29, no. 1 (March 29, 2021): 32–44. http://dx.doi.org/10.46879/ukroj.1.2021.32-44.

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Background. Prostate cancer (PC) ranks first in the structure of oncological pathology in men, being the second leading cause of cancer death and having 30 % as the five-year survival rate. Radiation therapy (RT) for prostate cancer has great potential for enhancement. Purpose – to evaluate the efficacy of RT in patients with prostate cancer and highlight the clinical and laboratory factors determining it. Materials and methods. The study enrolled 195 men with prostate cancer aged 52 to 82 years. The duration from the moment of diagnosis of the disease averaged 3 years. The Gleason score parameters were 6 points on average, the ratio of peripheral to central tumor form was 3:1, adenocarcinoma was diagnosed in 94 % of cases, giant cell carcinoma – in 6 %. Results. On average, recurring neoplasm is observed in 40 % of the patients with prostate cancer 2.5 years after radical prostatectomy combined with different methods of radiation therapy, which is associated with the initial indicators of the Gleason score, shape, localization and expansion of the tumor process, the presence of comorbid papillary carcinoma of the urinary bladder, metastases in the lymph nodes, distant viscera and the skeleton, while the power and direction of radiation exposure influence such radiotherapy complications as dermatitis, polyneuropathy, acute vascular insufficiency and tubulointerstitial nephritis. Conclusions. Developing the medical technology for RT in patients with prostate cancer to reduce the effect of prognostically unfavorable treatment factors is essential.

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Radosevic-Jelic, Ljiljana, V. Stankovic, T. Josifovski, M. Dozic, N. Borojevic, and C. Tulic. "Combined hormono-radiotherapy in treatment of locally advanced prostate cancer." Acta chirurgica Iugoslavica 56, no. 4 (2009): 174–81. http://dx.doi.org/10.2298/aci0904174r.

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Numerous questions regarding combined hormono-radiotherapy in the treatment of locally advanced prostate cancer still remain open. We present results of combined treatment in 133 our patients with locally advanced prostate cancer. All patients received hormonotherapy as neoadjuvant, concomitant with radiotherapy (tumor dose range 65-72Gy), and adjuvant. In six months follow-up time, complete regression (CR) was noted in 120 patients (90%), partial regression (PR) in 6 (4,5%), stabile disease (SD) in 2 (1,5%) and progression of disease (PD) in 5 patients (4%). In mean follow up time of 17 months (6-77), 13 patients relapsed. Five-year time to progression was 70%. Five-year disease-free interval for CR patients was 70%. At the date of last control CR was noted in 116 patients (87%), PR in 2 patients (2%), SD in 7 patients (5%), and 8 patients (6%) had progressive disease. Second malignancy was noted in 4 patients. Multidisciplinary studies directed towards the optimisation of combined treatment are ongoing. There are no definitive conclusions.

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GOLDSTRAW, MILES A., HEATHER PAYNE, and ROGER S. KIRBY. "WHAT ARE THE RISKS OF SECOND CANCER FORMATION AFTER RADIOTHERAPY TO THE PROSTATE?" BJU International 98, no. 3 (September 2006): 489–91. http://dx.doi.org/10.1111/j.1464-410x.2006.06288.x.

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Hellawell, Giles O., and Janet C. Dearden. "WHAT ARE THE RISKS OF SECOND CANCER FORMATION AFTER RADIOTHERAPY TO THE PROSTATE?" BJU International 99, no. 3 (March 2007): 698. http://dx.doi.org/10.1111/j.1464-410x.2007.06779_1.x.

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Huang, Jiayi, Larry L. Kestin, Hong Ye, Michelle Wallace, Alvaro A. Martinez, and Frank A. Vicini. "Analysis of second malignancies after modern radiotherapy versus prostatectomy for localized prostate cancer." Radiotherapy and Oncology 98, no. 1 (January 2011): 81–86. http://dx.doi.org/10.1016/j.radonc.2010.09.012.

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Pithadia, K., P. G. Advani, S. Schonfeld, D. Withrow, J. E. Bekelman, D. E. Citrin, A. Berrington de Gonza, and L. Morton. "Risk for Second Primary Hematologic Malignancies by Radiotherapy Technique in Prostate Cancer Survivors." International Journal of Radiation Oncology*Biology*Physics 114, no. 3 (November 2022): e240. http://dx.doi.org/10.1016/j.ijrobp.2022.07.1209.

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42

Wu, Yijun, Yunlong Li, Chang Han, Yuming Chong, Kai Kang, Zhikai Liu, and Fuquan Zhang. "Risk of second primary malignancies associated with radiotherapy in prostate cancer patients: competing risk analysis." Future Oncology 18, no. 4 (February 2022): 445–55. http://dx.doi.org/10.2217/fon-2021-0332.

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Background: The effect of radiotherapy (RT) for second primary malignancies (SPMs) among prostate cancer survivors is controversial. Methods: Applying logistic regression, competing risk analysis and propensity score matching method, this study analyzed clinical data from the Surveillance, Epidemiology, and End Results program to compare the risk for SPMs between patients receiving RT and non-RT. Results: In this study, prostate cancer patients treated with RT developed more SPMs in the anus, bladder, rectum, liver, lung and bronchus and lymphoma than non-RT groups. Conclusion: More intensive surveillance should be adopted for these cancers among prostate cancer survivors.

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Nakamura, Yuki, Takahiko Soma, Keita Izumi, Yasuyuki Sakai, Hiroki Ushijima, Shigehiro Kudo, Yoshihiro Saito, and Yukio Kageyama. "Screening of chronic radiation proctitis and colorectal cancer using periodic total colonoscopy after external beam radiation therapy for prostate cancer." Japanese Journal of Clinical Oncology 51, no. 8 (April 23, 2021): 1298–302. http://dx.doi.org/10.1093/jjco/hyab056.

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Abstract Objective To investigate the incidence of colorectal cancer and chronic radiation proctitis after prostate radiotherapy using periodic total colonoscopy screening. Methods From February 2013 to January 2018, 270 patients who underwent external beam radiation therapy for prostate cancer were advised to receive periodic total colonoscopy screening annually. We evaluated the incidence and characteristics of colorectal cancer and chronic radiation proctitis. Results First, second, third, fourth and fifth total colonoscopy were performed in 256 (95%), 151 (56%), 60 (22%), 23 (8.5%) and 7 (2.6%) patients at a median of 14, 31, 42, 54 and 72 months after radiotherapy, respectively. The prevalence proportion of colorectal cancer in the first colonoscopy since radiotherapy was 3.9%. Twelve (4.4%) patients were diagnosed with colorectal cancer, including four invasive cancers, during a follow-up period. Eight of these 12 patients had not experienced rectal bleeding. The median time to diagnosis of colorectal cancer was 21 months. Chronic radiation proctitis was observed in 136 (50%) patients, including 67 (25%) patients with symptomatic bleeding. Conclusions The high detection rate of asymptomatic radiation proctitis suggests the utility of total colonoscopy to screen for early-stage colorectal cancer prior to or following radiotherapy for prostate cancer. Considering the longevity after localized prostate cancer treatment, the awareness of chronic radiation-induced proctitis and the risk of colorectal cancer masked by bleeding is needed in treatment decision -making.

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Jahreiβ, M., K. K. Aben, M. S. Hoogeman, M. L. Dirkx, H. Reuvekamp, M. Ahmadi, K. C. De Vries, L. Incrocci, and W. D. Heemsbergen. "OC-0101: Second primary cancer risks among prostate cancer radiotherapy survivors: effect of smoking and IMRT." Radiotherapy and Oncology 152 (November 2020): S48. http://dx.doi.org/10.1016/s0167-8140(21)00127-4.

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Takam, R., E. Bezak, and E. E. Yeoh. "Risk of second primary cancer following prostate cancer radiotherapy: DVH analysis using the competitive risk model." Physics in Medicine and Biology 54, no. 3 (January 6, 2009): 611–25. http://dx.doi.org/10.1088/0031-9155/54/3/009.

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Potapova, A. V., I. A. Gladilina, A. V. Petrovsky, V. A. Chernyaev, V. N. Sholokhov, B. V. Bukharkin, M. I. Nechushkin, et al. "Outcomes of combined radiotherapy in high-risk prostate cancer." Malignant tumours 9, no. 4 (April 11, 2020): 32–40. http://dx.doi.org/10.18027/2224-5057-2019-9-4-32-40.

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Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques.Purpose. The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them.Materials and methods. 53 patients with PC received 125I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied.Results. Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps.Conclusion. EBT using 125I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.

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Berthold, Dominik R., Cora N. Sternberg, and Ian F. Tannock. "Management of Advanced Prostate Cancer After First-Line Chemotherapy." Journal of Clinical Oncology 23, no. 32 (November 10, 2005): 8247–52. http://dx.doi.org/10.1200/jco.2005.03.1435.

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Hormone refractory prostate cancer (HRPC) causes substantial morbidity and mortality. There are increasing options for both first- and second-line therapy in the palliative treatment of patients with HRPC. Medications to control symptoms should first be optimized in patients with late-stage disease, and radiotherapy applied to dominant painful bone lesions. Docetaxel, mitoxantrone, satraplatin, and ixabepilone are active chemotherapeutic agents in the first- and/or second-line setting for patients with HRPC, and this may be true also of older drugs such as oral cyclophosphamide and vinorelbine. Radioisotopes such as strontium and samarium are useful for treatment of more generalized bone pain. Third-line hormonal maneuvers including glucocorticoids, ketoconazole, and estrogens can lead to further palliation in some patients, and there are provocative data that chemotherapy might restore hormonal sensitivity in a subset of patients.

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Miles, Edward F., Laura L. Jacimore, and John W. Nelson. "Metachronous Anal Canal and Prostate Cancers with Simultaneous Definitive Therapy: A Case Report and Review of the Literature." Case Reports in Oncological Medicine 2011 (2011): 1–4. http://dx.doi.org/10.1155/2011/864371.

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Anal canal cancer is rare, accounting for only 1.3% of all gastrointestinal tract malignancies. Prostate cancer incidence is much higher and accounts for 27.6% of all malignancies in men. Treatment guidelines for anal cancer involve radiotherapy to the primary site and draining lymphatics while treatment for prostate cancer can also include pelvic radiotherapy. The literature is silent on the optimum course of action when these two malignancies are found synchronously or metachronously. Herein, we report a case of a patient diagnosed with intermediate risk prostate cancer who, prior to definitive therapy for this first malignancy, was also diagnosed with anal canal cancer. We conclude that a simultaneous approach with radiation therapy and chemotherapy with subsequent boost to the prostate is recommended. Screening for synchronous prostate cancer in male anal canal cancer patients is probably indicated and may preclude suboptimal treatment for a second occult primary.

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Olvera, Marlene, Miriam Delgado, Melchor Vázquez, José Zavala, Verónica Macedo, and Martha Puentes. "Unusual Presentation of Prostate Cancer Metastatic to the Cricoid Cartilage and Oral Cavity." Case Reports in Medicine 2018 (2018): 1–3. http://dx.doi.org/10.1155/2018/5207204.

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In Mexico, prostate cancer is the second leading cause of death in men. Prostate cancer usually presents metastasis to the regional lymph nodes and bone. Hereby, we present an unusual case of metastatic prostate cancer, with affectation to the cricoid cartilage and oral cavity, being the first case to have ever been reported in Mexico. A 68-year-old Mexican man was diagnosed with prostate cancer and cribriform architecture histology with low serum level of prostate-specific antigen, debuting with laryngeal stridor. The biopsy came back positive for metastatic prostate carcinoma. During treatment with radiotherapy, metastasis developed to the oral cavity.

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Jahreiß, M.-C., W. D. Heemsbergen, B. Van Santvoort, I. Van Oort, M. S. Hoogeman, L. Incrocci, and K. K. H. Aben. "Impact of modern radiotherapy on second primary cancer risk in prostate cancer survivors: A nationwide cohort study." European Urology 79 (June 2021): S1701. http://dx.doi.org/10.1016/s0302-2838(21)01573-6.

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