Research: 2018 – Huronia (Hasan)

Project Title:
High Dose Rate (HDR) Brachytherapy Boost and Stereotactic Body Radiation Therapy (SBRT) for Intermediate Risk Prostate Cancer: Phase II Clinical Trial.
Investigators:
Yaser Hasan MD FRCPC, Sunnybrook Odette Cancer Centre, University of Toronto
Gerard Morton
Andrew Loblaw
Hans Chung
Chia-Lin Tseng
Ananth Ravi
Lead Investigator Bio:
I am a current radiation oncology and brachytherapy fellow at the University of Toronto, working under the supervision of Dr Gerard Morton. I am enrolled in the Brachytherapy Area of Focused Competence Diploma Program. Born and raised in Kuwait, I lived most of my school life at home, even during the 8-month invasion of the country in 1990. At the age of 17, I decided to pursue higher education abroad and was accepted to read medicine at Manchester University in England, the United Kingdome. In addition to developing as a big football fan and supporter of Man United, I also developed interest in oncolgy and related research. This resulted in working on a lab-based graduation project investigating tumour suppressor genes in pituitary adenoma cell lines, which was awarded and presented at international meetings. Following graduation, I returned back home and worked within general medicine and oncology for a few years before embarking on radiation oncology as a future career choice. I received a second scholarship to do my residency training in radiation oncology at the University of Toronto, working within Sunnybrook Odette Cancer Centre for a substantial amount of time throughout residency. I found getting accustomed to the cold weather was not an easy task, but could best be achieved through staying indoors doing research! During residency I worked on multple research projects, especially within the central nervous system tumours, which resulted in multiple publications and presentations at international meetings. My interest in practical and procedural skills aspired me to pursue further training in brachytherapy following residency. Since July 2018, I started on the novel 1-year Brachytheapy Diploma program devised and offered for the first time nationwide at Sunnybrook Odette Cancer Centre, working within the genitourinary group under the supervision of Dr Morton. My main focus has been on prostate cancer treatment, utilizing brachytherapy, alongside performing research and fullfilling the requirements set out by the Royal College Brachytherapy Diploma program. I have also been the recepient of the American Brachytherapy Society (ABS) scholarship award participating in the prostate brachytherapy workshop Dec 2018. My research with Dr Morton on HDR brachytherapy has resulted in multiple abstracts submitted for presentations at international meetings, as well as a manuscript for publication. I aspire to continue working on developing clinical trials and engaging in developing creative protocols that utilize cutting-edge technology for the treatment of prostate cancer.
Project Abstract:
The treatment of prostate cancer has evolved significantly over the recent years. Evidence suggests high dose of radiation improves disease control outcomes, and brachytherapy is the most effective way of doing this, providing high doses to the prostate, while minimizing dose to surrounding normal tissues. Previous clinical trials funded by Ride for Dad have helped establish a single high dose-rate (HDR) brachytherapy treatment with 15 external beam treatments over 3 weeks as standard of care. The next question is: can we compress this further? Very short radiation treatments involving just 5 treatments using a technique called stereotactic body radiotherapy (SBRT or SABR) has been shown to be safe and effective. We hope to demonstrate that 5 treatments using SBRT can replace the 15 external beam treatments we currently use. We will test a protocol of single HDR brachytherapy treatment combined with 5 SBRT treatments given over one week, which we hope will be able to replace the current 3-week course of treatment.
Scientific Abstract:
BACKGROUND: Brachytherapy combined with external beam radiotherapy (EBRT) is a safe method of dose escalation for intermediate and high-risk patients and improves disease control outcomes. The current standard of care involves a combination of single HDR brachytherapy to 15Gy followed by mildly hypofractionated EBRT with 37.5 Gy/15 daily fractions. We have evidence to suggest further hypofractionated EBRT, delivered as stereotactic body radiotherapy (SBRT), is safe and effective.
 
HYPOTHESIS: SBRT, delivered as 25Gy/5 fractions in 1 week is radiobiologically equivalent to 37.5Gy/15 fractions over 3 weeks and may be safely combined with single fraction HDR brachytherapy of 15 Gy. OBJECTIVES: To assess toxicity, quality of life, and disease control outcomes for HDR (15 Gy x1) + SBRT (25Gy/5 over 1 week) for intermediate risk prostate cancer.
 
METHODS: Single arm clinical trial of HDR 15 Gy followed by 25 Gy/5 fractions to prostate and proximal seminal vesicles for 30 patients with intermediate risk prostate cancer. Toxicity will be assessed utilizing CTCA v4.0 and quality of life using EPIC questionnaire. Efficacy with PSA.
Impact on prostate cancer patients:
If shown to be safe and effective, this novel protocol would have significant implications on patient well-being, out-of-pocket costs, resource utilization, and socio-economic savings for the healthcare system. While keeping the brachytherapy treatment the same, this will cut patient treatment with external radiation from 3 weeks daily treatments down to 1 week only. Ongoing cancer treatment can be one of the most stressful times in a persons’ life, so being able to shorten this journey while maintaining similarly high cure rates and a low toxicity profile would have substantial impact on patients. This is only feasible due to the availability of advanced technology and skill sets, utilizing MRI-based treatment planning and radiation delivery with the highest levels of precision and accuracy.