000			04542nam a22003857a 4500
008			240807s20242024 xxu||||| |||| 00| 0 eng d
022			_a2168-8184
024			_aPMC11214744 [pmc]
040			_aOvid MEDLINE(R)
099			_a38947568
245			_aStereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Men With Hip Prostheses: A Cautionary Note.
251			_aCureus. 16(5):e61432, 2024 May.
252			_aCureus. 16(5):e61432, 2024 May.
253			_aCureus
260			_c2024
260			_fFY2025
260			_p2024 May
265			_sepublish
265			_tPubMed-not-MEDLINE
266			_d2024-08-07
266			_z2024/07/01 05:45
520			_aCONCLUSIONS: In the general population, high-grade toxicities and local recurrences are uncommon following prostate SBRT. However, in this cohort of patients with prior hip replacements, prostate SBRT had higher than expected rates of late toxicity and local recurrence. In the opinion of the authors, such patients should be counseled regarding an elevated risk of late toxicity and local recurrence with prostate SBRT. With its ultrasound guidance, brachytherapy would have the advantage of circumventing the need for MRI/CT-based imaging and thus may represent a preferable radiation alternative in this patient population. If these patients are treated with SBRT, they should be monitored closely for local recurrence so early salvage can be performed. We hope that recent advances in metal artifact reduction techniques and dose-calculation algorithms will improve future outcomes. Copyright © 2024, Shah et al.
520			_aMETHODS: 23 patients treated with localized prostate cancer and a history of pre-treatment hip replacement, treated with SBRT from 2007 to 2017 at MedStar Georgetown University Hospital were included in this retrospective analysis. Treatment was administered with the CyberKnife R (Accuray Incorporated, Sunnyvale, CA) at doses of 35 Gy or 36.25 Gy in 5 fractions. The targets and OARs were identified and contoured by a single experienced Radiation Oncologist (SPC). The adequacy of the CT and T2W MRI images for treatment planning was assessed with a three-point scale (good, adequate, or suboptimal). During treatment planning, care was taken to avoid treatment beams that directly traversed the hip prosthesis. Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). Local recurrence was confirmed by magnetic resonance imaging and/or prostate biopsy.
520			_aPURPOSE: Stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. SBRT requires high accuracy to reduce treatment margins. Metal hip prostheses create artifacts that distort pelvic imaging and potentially decrease the accuracy of target/organ at risk (OAR) identification and radiation dose calculations. Data on the safety and efficacy of SBRT after hip replacement is limited. This single-institution study sought to evaluate the safety and local control following SBRT for prostate cancer in men with hip replacements.
520			_aRESULTS: The median follow-up was seven years. The patients were elderly (median age = 71 years) with a high rate of comorbidities (Charlson Comorbidity Index > 2 in 25%). Four patients had bilateral hip replacements. The majority of patients were low to intermediate risk per the D'Amico classification. Around 13% received upfront ADT. In total, 13 patients were treated with 35 Gy, and 10 were treated with 36.25 Gy. The rates of late > Grade 3 GU toxicity and > Grade 2 GI toxicity were 8.6% and 4.3%, respectively. There were no Grade 4 or 5 toxicities. Six patients (26%) developed a local recurrence at a median time of 7.5 years. Of these six patients, four had unilateral hip replacements and two had bilateral. Three underwent salvage cryotherapy and three received salvage ADT.
546			_aEnglish
650			_zAutomated
656			_aMedStar Georgetown University Hospital/MedStar Washington Hospital Center
656			_aRadiation Oncology Residency
657			_aJournal Article
700			_aConroy, Dylan _bMGUH _cRadiation Oncology Residency _dMD
790			_aShah S, Saravanakumar S, Conroy D, Sowmiyanarayanan S, Singh R, Pepin A, Rashid H, Danner MT, Krishnan P, Lei S, Rashid A, Suy S, Kataria S, Aghdam N, Collins S
856			_uhttps://dx.doi.org/10.7759/cureus.61432 _zhttps://dx.doi.org/10.7759/cureus.61432
942			_cART _dArticle
999			_c14469 _d14469