Search

Background Evidence supporting the efficacy of stereotactic body radiotherapy (SBRT) for localized prostate cancer is accumulating, but comparative studies of patient-reported quality of life (QOL) following SBRT versus conventionally fractionated external beam radiotherapy (EBRT) or active surveillance (AS) are limited. Objective To compare QOL of patients pursuing SBRT and EBRT versus AS. Design, setting, and participants A population-based cohort of 680 men with newly diagnosed localized prostate cancer was prospectively enrolled from 2011 to 2013. Intervention SBRT, EBRT without androgen deprivation therapy, or AS. Outcome measurements and statistical analysis QOL was prospectively assessed before treatment (baseline), and at 3, 12, and 24 mo after treatment using the validated Prostate Cancer Symptom Indices, which contain four domains: sexual dysfunction, urinary obstruction/irritation, urinary incontinence, and bowel problems. Propensity weighting via logistic regression models was used to balance baseline characteristics, and the mean QOL scores of EBRT and SBRT patients were compared against AS patients as the control group. Results and limitations Compared with AS patients, EBRT patients had worse urinary obstructive/irritative symptoms and sexual dysfunction at 3 mo, and worse bowel symptoms at 3 and 24 mo. SBRT patients had similar scores as AS patients in all domains and across all time points; however, due to small sample size, worse sexual function and urinary incontinence in SBRT patients cannot be ruled out. Further research is needed to assess long-term outcomes. Conclusions In a nonrandomized cohort of men with localized prostate cancer, SBRT appeared to result in favorable QOL results through 2 yr of follow-up, but worse sexual function and urinary incontinence compared with AS cannot be ruled out completely. Larger studies with longer follow-up are needed to confirm these findings. Patient summary Stereotactic body radiotherapy (SBRT) and active surveillance appear to have similar quality of life outcomes through 2 yr, although worse sexual function and urinary incontinence from SBRT cannot be ruled out completely.

Purpose/objective(s) Stereotactic body radiation therapy (SBRT) is increasingly utilized for treatment of patients with recurrent and metastatic tumors. Considering the relative radioresistance of some sarcoma histologies, SBRT may allow for higher biological effectiveness compared to conventional radiotherapy. We report local control outcomes after SBRT based on radiation dose and histology. Materials/methods From our IRB-approved single-institution registry, all patients treated with SBRT for metastatic sarcoma between 2014 and 2020 were identified. Kaplan-Meier analysis was used to estimate local control and overall survival at 1 year. Univariate and multivariable Cox proportional hazard model analyses were performed to determine association between SBRT dose, histology, and local control. Small round blue cell sarcomas were classified as more radiosensitive and others as radioresistant histologies. A receiver operating characteristic (ROC) curve was generated to determine optimal biologically effective dose (BED) using a/β of 3 Gy. Local control was compared by SBRT dose using the BED cut point and histology. Results Forty-two patients with a total of 138 lesions met inclusion criteria. Median follow up was 9.7 months (range 0.5-34.5). Patients were heavily pre-treated with systemic therapy. Median SBRT prescription was 30 Gy (range 15-60) in 4 fractions (range 1-5). Sixty-two lesions met criteria for radiosensitive histology while 75 lesions were considered radioresistant. Local control for all lesions was 66.7% (95% CI, 56.6-78.5) at 1 year and 50.2% (95% CI, 38.2-66.1) at 2 years. Stratifying by histology, 1-year local control was 65.3% for radiosensitive and 68.6% for radioresistant histologies (P = 0.49). The ROC cut point for BED was 95 Gy. Local control at 1-year was 75% for lesions receiving ≥ 95 Gy BED, and 46.2% for lesions receiving Conclusion For patients undergoing stereotactic body radiotherapy for metastatic sarcoma, local control was significantly improved when BED was ≥ 95 Gy for radiosensitive histologies, but was not significant for radioresistant histologies. Further investigation into the dose-response relationship is warranted to maximize the therapeutic index.

Historically, stage IV prostate cancer was considered incurable. Although node-positive and oligometastatic prostate cancers are both classified as stage IV, these likely represent distinct clinical groups, and some patients may be curable with aggressive multimodality treatments. There is a lack of randomized evidence, but retrospective studies suggest that radical prostatectomy or radiotherapy may improve survival in these patients. This is an area of great current research interest and prospective randomized trials are needed to help define the optimal treatments for these patients.

We appreciate the opportunity to respond to Drs. Safer and Binay Saferregarding ourrecentstudy which utilizedcomputed tomography (CT) imaging to determine the prevalence of sarcopenia in older adults with colorectal cancer. The authors inquired about the usage of single-slice CT imaging to determine total body muscle mass and our functioning definition of sarcopenia.