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Background Dose-escalated hypofractionated radiotherapy (HFRT) using intensity-modulated radiotherapy (IMRT), with inclusion of the pelvic lymph nodes (PLNS), plus androgen suppression therapy (AST) in high-risk prostate cancer patients should improve patient outcomes, but acute toxicity could limit its feasibility. Methods Our single-centre phase II prospective study enrolled 40 high-risk prostate cancer patients. All patients received HFRT using IMRT with daily mega-voltage computed tomography imaging guidance, with 95% of planning target volumes (PTV68 and PTV50) receiving 68 Gy and 50 Gy (respectively) in 25 daily fractions. The boost volume was targeted to the involved PLNS and the prostate (minus the urethra plus 3 mm and minus 3 mm from adjacent rectal wall) and totalled up to 75 Gy in 25 fractions. Acute toxicity scores were recorded weekly during and 3 months after radiotherapy (RT) administration. Results For the 37 patients who completed rt and the 3-month follow-up, median age was 65.5 years (range: 50-76 years). Disease was organ-confined (T1c-T2c) in 23 patients (62.1%), and node-positive in 5 patients (13.5%). All patients received long-term AST. Maximum acute genitourinary (GU) and gastrointestinal (GI) toxicity peaked at grade 2 in 6 of 36 evaluated patients (16.6%) and in 4 of 31 evaluated patients (12.9%) respectively. Diarrhea and urinary frequency were the chief complaints. Dose-volume parameters demonstrated no correlation with toxicity. The PTV treatment objectives were met in 36 of the 37 patients. Conclusions This HFRT dose-escalation trial in high-risk prostate cancer has demonstrated the feasibility of administering 75 Gy in 25 fractions with minimal acute GI and GU toxicities. Further follow-up will report late toxicities and outcomes. [ABSTRACT FROM AUTHOR]

Background Compared with photon therapy, proton-beam therapy (pbt) offers compelling advantages in physical dose distribution. Worldwide, gantry-based proton facilities are increasing in number, but no such facilities exist in Canada. To access pbt, Canadian patients must travel abroad for treatment at high cost. In the face of limited access, this report seeks to provide recommendations for the selection of patients most likely to benefit from pbt and suggests an out-of-country referral process. Methods The medline, embase, PubMed, and Cochrane databases were systematically searched for studies published between January 1990 and May 2014 that evaluated clinical outcomes after pbt. A draft report developed through a review of evidence was externally reviewed and then approved by the Alberta Health Services Cancer Care Proton Therapy Guidelines steering committee. Results Proton therapy is often used to treat tumours close to radiosensitive tissues and to treat children at risk of developing significant late effects of radiation therapy (rt). In uncontrolled and retrospective studies, local control rates with pbt appear similar to, or in some cases higher than, photon rt. Randomized trials comparing equivalent doses of pbt and photon rt are not available. Summary Referral for pbt is recommended for patients who are being treated with curative intent and with an expectation for long-term survival, and who are able and willing to travel abroad to a proton facility Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents who have the greatest risk for long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head-and-neck, breast, lung, gastrointestinal tract, and pelvic cancers, including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases. [ABSTRACT FROM AUTHOR]

Purpose The objective of the present study was to analyze, with relatively high sensitivity and specificity, uptake properties of [11C]-choline in prostate cancer patients by means of positron-emission tomography (PET)/ computed tomography (CT) imaging using objectively defined pet parameters to test for statistically significant changes before, during, and after external-beam radiation therapy (EBRT) and to identify the time points at which the changes occur. Methods The study enrolled 11 patients with intermediate-risk prostate cancer treated with ebrt, who were followed for up to 12 months after EBRT. The [11C]-choline PET scans were performed before treatment (baseline); at weeks 4 and 8 of EBRT; and at 1, 2, 3, 6, and 12 months after EBRT. Results Analysis of [11C]-choline uptake in prostate tissue before treatment resulted in a maximum standardized uptake value (SUVMAX) of 4.0 ± 0.4 (n = 11) at 40 minutes after injection. During week 8 of EBRT, the SUVMAX declined to 2.9 ± 0.1 (n = 10, p < 0.05). At 2 and 12 months after EBRT, SUVMAX values were 2.3 ± 0.3 (n = 10, p < 0.01) and 2.2 ± 0.2 (n = 11, p < 0.001) respectively, indicating that, after EBRT, maximum radiotracer uptake in the prostate was significantly reduced. Similar effects were observed when analyzing the tumour:muscle ratio (TMR). The TMR declined from 7.4 ± 0.6 (n = 11) before EBRT to 6.1 ± 0.4 (n = 11, nonsignificant) during week 8 of EBRT, to 5.6 ± 0.03 (n = 11, p < 0.05) at 2 months after EBRT, and to 4.4 ± 0.4 (n = 11, p < 0.001) at 12 months after EBRT. Conclusions Our study demonstrated that intraprostatic [11C]- choline uptake in the 11 analyzed prostate cancer patients significantly declined during and after EBRT. The PET parameters SUVMAX and TMR also declined significantly. These effects can be detected during radiation therapy and up to 1 year after therapy. The prognostic value of these early and statistically significant changes in intraprostatic [11C]-choline pet avidity during and after EBRT are not yet established. Future studies are indicated to correlate changes in [11C]-choline uptake parameters with long-term biochemical recurrence to further evaluate [11C]-choline pet changes as a possible, but currently unproven, biomarker of response. [ABSTRACT FROM AUTHOR]

Purpose We examined the impact of hypofractionated radiation therapy and androgen suppression therapy (AST) on quality of life (QOL) in high-risk prostate cancer patients. Methods Between March 2005 and March 2007, 60 patients with high-risk prostate cancer were enrolled in a prospective phase II study. All patients received 68 Gy (2.72 Gy per fraction) to the prostate gland and 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes in 25 fractions over 5 weeks. Of the 60 patients, 58 received AST. The University of California- Los Angeles Prostate Cancer Index questionnaire was used to prospectively measure QOL at baseline (month 0) and at 1, 6, 12, 18, 24, 30, and 36 months after radiation treatment. The generalized estimating equation approach was used to compare the QOL scores at 1, 6, 12, 18, 24, 30, and 36 months with those at baseline. Results We observed a significant decrease in QOL items related to bowel and sexual function. Several QOL items related to bowel function were significantly adversely affected at both 1 and 6 months, with improvement toward 6 months. Although decreased QOL scores persisted beyond the 6-month mark, they began to re-approach baseline at the 18- to 24-month mark. Most sexual function items were significantly adversely affected at both 1 and 6 months, but the effects were not considered to be a problem by most patients. A complete return to baseline was not observed for either bowel or sexual function. Urinary function items remained largely unaffected, with overall urinary function being the only item adversely affected at 6 months, but not at 1 month. Urinary function returned to baseline and remained unimpaired from 18 months onwards. Conclusions In our study population, who received hypofractionated radiation delivered using dynamic intensitymodulated radiotherapy with inclusion of the pelvic lymph nodes, and 2-3 years of AST prescription, QOL with respect to bowel and sexual function was significantly affected; QOL with respect to urinary function was largely unaffected. Our results are comparable to those in other published studies. [ABSTRACT FROM AUTHOR]

Background Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO2) may be an effective option for some patients. Methods In a systematic review of the literature, the Ovid medline, embase, Cochrane Library, National Guidelines Clearinghouse, and Canadian Medical Association Infobase databases were searched to June 2009 for clinical practice guidelines, systematic reviews, randomized controlled trials, or other relevant evidence. Studies that did not evaluate soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications were excluded. Results Two randomized trials, eleven nonrandomized studies, and five supporting documents comprise the evidence base. In addition, information on the harms and safety of treatment with HBO2 were reported in three additional sources. There is modest direct evidence and emerging indirect evidence that the use of HBO2 is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies. Conclusions Based on the evidence and expert consensus opinion, • HBO2 is likely effective for late radiation tissue injury of the pelvis, with demonstrated efficacy • the main indication for HBO2 therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury; • HBO2 may provide symptomatic benefit in certain clinical settings (for example, cystitis, soft-tissue necrosis, and osteonecrosis); and • HBO2 may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis. [ABSTRACT FROM AUTHOR]

Purpose: The objective of the present study was to analyze, with relatively high sensitivity and specificity, uptake properties of [(11)C]-choline in prostate cancer patients by means of positron-emission tomography (pet)/computed tomography (ct) imaging using objectively defined pet parameters to test for statistically significant changes before, during, and after external-beam radiation therapy (ebrt) and to identify the time points at which the changes occur., Methods: The study enrolled 11 patients with intermediate-risk prostate cancer treated with ebrt, who were followed for up to 12 months after ebrt. The [(11)C]-choline pet scans were performed before treatment (baseline); at weeks 4 and 8 of ebrt; and at 1, 2, 3, 6, and 12 months after ebrt., Results: Analysis of [(11)C]-choline uptake in prostate tissue before treatment resulted in a maximum standardized uptake value (suvmax) of 4.0 ± 0.4 (n = 11) at 40 minutes after injection. During week 8 of ebrt, the suvmax declined to 2.9 ± 0.1 (n = 10, p < 0.05). At 2 and 12 months after ebrt, suvmax values were 2.3 ± 0.3 (n = 10, p < 0.01) and 2.2 ± 0.2 (n = 11, p < 0.001) respectively, indicating that, after ebrt, maximum radiotracer uptake in the prostate was significantly reduced. Similar effects were observed when analyzing the tumour:muscle ratio (tmr). The tmr declined from 7.4 ± 0.6 (n = 11) before ebrt to 6.1 ± 0.4 (n = 11, nonsignificant) during week 8 of ebrt, to 5.6 ± 0.03 (n = 11, p < 0.05) at 2 months after ebrt, and to 4.4 ± 0.4 (n = 11, p < 0.001) at 12 months after ebrt., Conclusions: Our study demonstrated that intraprostatic [(11)C]-choline uptake in the 11 analyzed prostate cancer patients significantly declined during and after ebrt. The pet parameters SUVmax and tmr also declined significantly. These effects can be detected during radiation therapy and up to 1 year after therapy. The prognostic value of these early and statistically significant changes in intraprostatic [(11)C]-choline pet avidity during and after ebrt are not yet established. Future studies are indicated to correlate changes in [(11)C]-choline uptake parameters with long-term biochemical recurrence to further evaluate [(11)C]-choline pet changes as a possible, but currently unproven, biomarker of response.