PMID- 32900561 OWN - NLM STAT- MEDLINE DCOM- 20210804 LR - 20220910 IS - 1879-355X (Electronic) IS - 0360-3016 (Print) IS - 0360-3016 (Linking) VI - 110 IP - 1 DP - 2021 May 1 TI - Tumor Control Probability Modeling and Systematic Review of the Literature of Stereotactic Body Radiation Therapy for Prostate Cancer. PG - 227-236 LID - S0360-3016(20)34102-X [pii] LID - 10.1016/j.ijrobp.2020.08.014 [doi] AB - PURPOSE: Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation. The evolving treatment approach of ultrahypofractionation with stereotactic body radiation therapy (SBRT) allows possible further biological dose escalation (biologically equivalent dose [BED]) and shortened treatment time. METHODS AND MATERIALS: The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiation Therapy/SBRT included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse. Results were stratified by prostate cancer risk group. RESULTS: Twenty-five published cohorts were identified for inclusion, with a total of 4821 patients (2235 with low-risk, 1894 with intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up of more than 5 years. Dosing regimens ranged from 32 to 50 Gy in 4 to 5 fractions, with total BED (alpha/beta = 1.5 Gy) between 183.1 and 383.3 Gy. At 5 years, we found that in patients with low-intermediate risk disease, an equivalent doses of 2 Gy per fraction (EQD2) of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of 97 Gy (37.6 Gy in 5 fractions) can achieve a TCP of 90% and an EQD2 of 102 Gy (38.7 Gy in 5 fractions) can achieve a TCP of 95%. CONCLUSIONS: We found significant variation in the published literature on target delineation, margins used, dose/fractionation, and treatment schedule. Despite this variation, TCP was excellent. Most prescription doses range from 35 to 40 Gy, delivered in 4 to 5 fractions. The literature did not provide detailed dose-volume data, and our dosimetric analysis was constrained to prescription doses. There are many areas in need of continued research as SBRT continues to evolve as a treatment modality for prostate cancer, including the durability of local control with longer follow-up across risk groups, the efficacy and safety of SBRT as a boost to intensity modulated radiation therapy (IMRT), and the impact of incorporating novel imaging techniques into treatment planning. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Royce, Trevor J AU - Royce TJ AD - Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: trevor_royce@med.unc.edu. FAU - Mavroidis, Panayiotis AU - Mavroidis P AD - Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. FAU - Wang, Kyle AU - Wang K AD - Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. FAU - Falchook, Aaron D AU - Falchook AD AD - Memorial Healthcare System, Pembroke Pines, Florida. FAU - Sheets, Nathan C AU - Sheets NC AD - Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. FAU - Fuller, Donald B AU - Fuller DB AD - Division of Genesis Healthcare Partners Inc, Genesis CyberKnife, San Diego, California. FAU - Collins, Sean P AU - Collins SP AD - Department of Radiation Oncology, Georgetown University, Washington, DC. FAU - El Naqa, Issam AU - El Naqa I AD - Machine Learning Department, Moffitt Cancer Center, Tampa, Florida. FAU - Song, Daniel Y AU - Song DY AD - Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland. FAU - Ding, George X AU - Ding GX AD - Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee. FAU - Nahum, Alan E AU - Nahum AE AD - Department of Physics, University of Liverpool, United Kingdom and Henley-on-Thames, United Kingdom. FAU - Jackson, Andrew AU - Jackson A AD - Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York. FAU - Grimm, Jimm AU - Grimm J AD - Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania. FAU - Yorke, Ellen AU - Yorke E AD - Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York. FAU - Chen, Ronald C AU - Chen RC AD - Department of Radiation Oncology, University of Kansas, Kansas City, Kansas. LA - eng GR - P30 CA008748/CA/NCI NIH HHS/United States GR - R01 CA233487/CA/NCI NIH HHS/United States GR - T32 CA116339/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Systematic Review DEP - 20200906 PL - United States TA - Int J Radiat Oncol Biol Phys JT - International journal of radiation oncology, biology, physics JID - 7603616 SB - IM MH - Dose-Response Relationship, Radiation MH - Humans MH - Linear Models MH - Male MH - Models, Biological MH - Models, Theoretical MH - Probability MH - Prostatic Neoplasms/diagnostic imaging/pathology/*radiotherapy MH - Radiation Dose Hypofractionation MH - Radiosurgery/*methods MH - Relative Biological Effectiveness MH - Risk MH - Time Factors MH - Treatment Outcome MH - Urethra/diagnostic imaging PMC - PMC9445430 MID - NIHMS1832510 EDAT- 2020/09/10 06:00 MHDA- 2021/08/05 06:00 PMCR- 2022/09/06 CRDT- 2020/09/09 05:24 PHST- 2020/07/31 00:00 [received] PHST- 2020/08/02 00:00 [accepted] PHST- 2020/09/10 06:00 [pubmed] PHST- 2021/08/05 06:00 [medline] PHST- 2020/09/09 05:24 [entrez] PHST- 2022/09/06 00:00 [pmc-release] AID - S0360-3016(20)34102-X [pii] AID - 10.1016/j.ijrobp.2020.08.014 [doi] PST - ppublish SO - Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):227-236. doi: 10.1016/j.ijrobp.2020.08.014. Epub 2020 Sep 6.