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Old 01-12-2011, 11:41 AM   #1
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Post CyberKnife - 5 year results

Drs. King and Freeman just published the five year results for CyberKnife:

http://www.ncbi.nlm.nih.gov/pubmed/21219625

Quote:
At a median follow-up of 5 years the biochemical progression-free survival was 93% . Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation.
Dr. King told me that there was no ED due to radiation in 80% of those patients, even without PDE5 Inhibitors (Cialis, Viagra, Levitra).

They compare this favorably to studies that show 5-year progression-free survival for prostatectomy (93%, 76%-92%), IMRT>72Gy (85%), IMRT<72Gy (69%-89%), Seed Brachy (83%-88%, 90%), HDR Brachy (90%), and other studies show cure rates in the 92-95% range for surgery, high-dose and hypofractionated EBRT, and seed brachytherapy for low-risk patients.

 
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Old 01-12-2011, 03:15 PM   #2
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Smile Re: CyberKnife - 5 year results

Allen and board colleagues,

Thank you so much Allen for calling attention to this new, long-awaited study and for providing additional detail!

The results pretty well nail down the low side effect likelihood, perhaps the main question mark about SBRT. As I understand it, what you see at five years for radiation is a very good indicator of long-term results (for both control of the prostate cancer and side effects).

This looks like a game changing, very high impact study to me. While there were relatively few patients in the study, just 41, that's enough to provide some solid safety data at the five year point for median (meaning average) follow-up. This is what we were waiting for and hoping for, and the results at least met expectations as I see it.

The key significance for us patients is that the radiation medial world now knows that SBRT radiation (higher doses delivered in far fewer sessions) for prostate cancer can be delivered with impressive low results for side effects. While Dr. King had earlier switched to every-other-day treatment with his early patients when he saw some side effects with consecutive day treatment, all but three of the patients in this study were treated on five consecutive days. In other words, instead of spending eight weeks going to the radiation treatment center, patients can now be treated in just one week with SBRT. There are some issues yet to be resolved, and the track record is still short and based on relatively few patients, so other forms of radiation delivery will still have large and legitimate followings for years. However, for external beam radiation, I think we will see a growing trend favoring SBRT treatment.

I'll insert some other comments in green.


Quote:
Originally Posted by Tall Allen View Post
Drs. King and Freeman just published the five year results for CyberKnife:

http://www.ncbi.nlm.nih.gov/pubmed/21219625
A copy of the full manuscript is also available and it is easy to read for laymen patients like us.

Quote:
Dr. King told me that there was no ED due to radiation in 80% of those patients, even without PDE5 Inhibitors (Cialis, Viagra, Levitra).
It's very helpful that you added this key fact. Surprisingly, ED was not specifically addressed in the paper. Do you have any idea why it was omitted? Wow: 80% with no ED at five years is awesome! Needless to say, that is going to get patients' attention!

Quote:
They compare this favorably to studies that show 5-year progression-free survival for prostatectomy (93%, 76%-92%), IMRT>72Gy (85%), IMRT<72Gy (69%-89%), Seed Brachy (83%-88%, 90%), HDR Brachy (90%), and other studies show cure rates in the 92-95% range for surgery, high-dose and hypofractionated EBRT, and seed brachytherapy for low-risk patients.
That rate of 93% is promising, but it will be helpful when additional and larger SBRT studies report. The authors highlight a number of such current studies, and at least one should report this year. The problem is that just 41 patients are involved here, and there is some chance that an unusual high proportion had the kind of low-risk prostate cancer that will never be a problem. While not likely, if so, results from this study would look better than reality. We know from research on active surveillance that about 70% of low-risk patients would also show no progression in their cancer at the five yuear point (from my recollection, but should be close to 70%), so you can see where random chance could skew results for a study with just 41 patients. At least the result gives us an emerging therapy to feel good about, contrasting sharply to so many HIFU studies that are reporting disappointing results at the five year mark for median follow-up.

While that 93% cancer control (or possible cure) success (assuming it stands up as more results come in from other studies) is impressive, it is a few percentage points lower than the results from some of the brachytherapy (seeds) studies done by leading experts, especially those from Dattoli and Grimm/Blasko and Sylvester (Seattle); the study cites at least one of these studies. It is possible that the Freeman/King group of patients had an unusually large proportion of stealthy higher risk patients who appeared to be low-risk; if so, that would have tended to lead to lower success at five years than SBRT could actually produce over a large number of patients; in other words, it's possible that true success is even higher than around 93%. This is the flip side of the point I made earlier. At this juncture, we just don't have enough information to know. We can say that compared to other forms of external beam radiation, that 93% at five years is a very impressive result.

Thanks again for this wonderful news!

Jim

 
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