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Moulton CR, House MJ, Lye V, Tang CI, Krawiec M, Joseph DJ, Denham JW, Ebert MA. Spatial features of dose-surface maps from deformably-registered plans correlate with late gastrointestinal complications. Phys Med Biol 2017; 62:4118-4139. [PMID: 28445167 DOI: 10.1088/1361-6560/aa663d] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigates the associations between spatial distribution of dose to the rectal surface and observed gastrointestinal toxicities after deformably registering each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate brachytherapy (HDRBT) prostate cancer treatment. The study contains data for 118 patients where the HDRBT CT was deformably-registered to the EBRT CT. The EBRT and registered HDRBT TG43 dose distributions in a reference 2 Gy/fraction were 3D-summed. Rectum dose-surface maps (DSMs) were obtained by virtually unfolding the rectum surface slice-by-slice. Associations with late peak gastrointestinal toxicities were investigated using voxel-wise DSM analysis as well as parameterised spatial patterns. The latter were obtained by thresholding DSMs from 1-80 Gy (increment = 1) and extracting inferior-superior extent, left-right extent, area, perimeter, compactness, circularity and ellipse fit parameters. Logistic regressions and Mann-Whitney U-tests were used to correlate features with toxicities. Rectal bleeding, stool frequency, diarrhoea and urgency/tenesmus were associated with greater lateral and/or longitudinal spread of the high doses near the anterior rectal surface. Rectal bleeding and stool frequency were also influenced by greater low-intermediate doses to the most inferior 20% of the rectum and greater low-intermediate-high doses to 40-80% of the rectum length respectively. Greater low-intermediate doses to the superior 20% and inferior 20% of the rectum length were associated with anorectal pain and urgency/tenesmus respectively. Diarrhoea, completeness of evacuation and proctitis were also related to greater low doses to the posterior side of the rectum. Spatial features for the intermediate-high dose regions such as area, perimeter, compactness, circularity, ellipse eccentricity and confinement to ellipse fits were strongly associated with toxicities other than anorectal pain. Consequently, toxicity is related to the shape of isodoses as well as dose coverage. The findings indicate spatial constraints on doses to certain sections of the rectum may be important for reducing toxicities and optimising dose.
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Affiliation(s)
- Calyn R Moulton
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia
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Gómez L, Andrés C, Ruiz A. Dosimetric impact in the dose-volume histograms of rectal and vesical wall contouring in prostate cancer IMRT treatments. Rep Pract Oncol Radiother 2017; 22:223-230. [PMID: 28461787 DOI: 10.1016/j.rpor.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/29/2016] [Accepted: 02/26/2017] [Indexed: 12/25/2022] Open
Abstract
AIM The main purpose of this study was to evaluate the differences in dose-volume histograms of IMRT treatments for prostate cancer based on the delineation of the main organs at risk (rectum and bladder) as solid organs or by contouring their wall. BACKGROUND Rectum and bladder have typically been delineated as solid organs, including the waste material, which, in practice, can lead to an erroneous assessment of the risk of adverse effects. MATERIALS AND METHODS A retrospective study was made on 25 patients treated with IMRT radiotherapy for prostate adenocarcinoma. 76.32 Gy in 36 fractions was prescribed to the prostate and seminal vesicles. In addition to the delineation of the rectum and bladder as solid organs (including their content), the rectal and bladder wall were also delineated and the resulting dose-volume histograms were analyzed for the two groups of structures. RESULTS Data analysis shows statistically significant differences in the main parameters used to assess the risk of toxicity of a prostate radiotherapy treatment. Higher doses were received on the rectal and bladder walls compared to doses received on the corresponding solid organs. CONCLUSIONS The observed differences in terms of received doses to the rectum and bladder based on the method of contouring could gain greater importance in inverse planning treatments, where the treatment planning system optimizes the dose in these volumes. So, one should take into account the method of delineating of these structures to make a clinical decision regarding dose limitation and risk assessment of chronic toxicity.
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Affiliation(s)
- Laura Gómez
- Instituto Oncológico, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Carlos Andrés
- Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Antonio Ruiz
- Instituto Oncológico, Hospital Recoletas Campo Grande, Valladolid, Spain
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Chang J, Tian Z, Lu W, Gu X, Chen M, Jiang SB. A novel geometry-dosimetry label fusion method in multi-atlas segmentation for radiotherapy: a proof-of-concept study. Phys Med Biol 2017; 62:3656-3667. [DOI: 10.1088/1361-6560/aa5ed9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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54
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Chemingui FZ, Benrachi F, Bali MS, Ladjal H. Dosimetric comparison between VMAT and RC3D techniques: case of prostate treatment. EPJ WEB OF CONFERENCES 2017. [DOI: 10.1051/epjconf/201715401013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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55
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Nitsche M, Brannath W, Brückner M, Wagner D, Kaltenborn A, Temme N, Hermann RM. Comparison of different contouring definitions of the rectum as organ at risk (OAR) and dose-volume parameters predicting rectal inflammation in radiotherapy of prostate cancer: which definition to use? Br J Radiol 2016; 90:20160370. [PMID: 27936891 DOI: 10.1259/bjr.20160370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this retrospective planning study was to find a contouring definition for the rectum as an organ at risk (OAR) in curative three-dimensional external beam radiotherapy (EBRT) for prostate cancer (PCa) with a predictive correlation between the dose-volume histogram (DVH) and rectal toxicity. METHODS In a pre-study, the planning CT scans of 23 patients with PCa receiving definitive EBRT were analyzed. The rectum was contoured according to 13 different definitions, and the dose distribution was correlated with the respective rectal volumes by generating DVH curves. Three definitions were identified to represent the most distinct differences in the shapes of the DVH curves: one anatomical definition recommended by the Radiation Therapy Oncology Group (RTOG) and two functional definitions based on the target volume. In the main study, the correlation between different relative DVH parameters derived from these three contouring definitions and the occurrence of rectal toxicity during and after EBRT was studied in two consecutive collectives. The first cohort consisted of 97 patients receiving primary curative EBRT and the second cohort consisted of 66 patients treated for biochemical recurrence after prostatectomy. Rectal toxicity was investigated by clinical investigation and scored according to the Common Terminology Criteria for Adverse Events. Candidate parameters were the volume of the rectum, mean dose, maximal dose, volume receiving at least 60 Gy (V60), area under the DVH curve up to 25 Gy and area under the DVH curve up to 75 Gy in dependence of each chosen rectum definition. Multivariable logistic regression considered other clinical factors such as pelvine lymphatics vs local target volume, diabetes, prior rectal surgery, anticoagulation or haemorrhoids too. RESULTS In Cohort 1 (primary EBRT), the mean rectal volumes for definitions "RTOG", planning target volume "(PTV)-based" and "PTV-linked" were 100 cm3 [standard deviation (SD) 43 cm3], 60 cm3 (SD 26 cm3) and 74 cm3 (SD 31 cm3), respectively (p < 0.01; analysis of variance). The mean rectal doses according to these definitions were 35 Gy (SD 8 Gy), 48 Gy (SD 4 Gy) and 44 Gy (SD 5 Gy) (p < 0.01). In Cohort 2 (salvage EBRT), the mean rectal volumes were 114 cm3 (SD 47 cm3), 64 cm3 (SD 26 cm3) and 81 cm3 (SD 30 cm3) (p < 0.01) and the mean doses received by the rectum were 36 Gy (SD 8 Gy), 49 Gy (SD 5 Gy) and 44 Gy (SD 5 Gy) (p < 0.01). Acute or subacute rectal inflammation occurred in 69 (71.9%) patients in Cohort 1 and in 43 (70.5%) in Cohort 2. We did not find a correlation between all investigated DVH parameters and rectal toxicity, irrespective of the investigated definition. By adding additional variables in multivariate analysis, the predictive ability was substantially improved. Still, there was essentially no difference in the probability of predicting rectal inflammation occurrence between the tested contouring definitions. CONCLUSION The RTOG anatomy-based recommendations are questionable in comparison with functional definitions, as they result in higher variances in several relative DVH parameters. Moreover, the anatomy-based definition is no better and no worse in the predictive value concerning clinical end points. Advances in knowledge: Functional definitions for the rectum as OAR are easier to apply, faster to contour, have smaller variances and do not offer less information than the anatomy-based RTOG definition.
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Affiliation(s)
- Mirko Nitsche
- 1 Zentrum für Strahlentherapie und Radioonkologie, Bremen, Germany.,2 Klinik für Strahlentherapie, Karl-Lennert Krebscentrum, Universität Kiel, Kiel, Germany
| | - Werner Brannath
- 3 Abteilung Biometrie, Kompetenzzentrum für Klinische Studien, Universität Bremen, Bremen, Germany
| | - Matthias Brückner
- 3 Abteilung Biometrie, Kompetenzzentrum für Klinische Studien, Universität Bremen, Bremen, Germany
| | - Dirk Wagner
- 1 Zentrum für Strahlentherapie und Radioonkologie, Bremen, Germany
| | - Alexander Kaltenborn
- 4 Abteilung für Unfallchirurgie und Orthopädie, Bundeswehrkrankenhaus Westerstede, Westerstede, Germany.,5 Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Medizinische Hochschule Hannover, Hannover, Germany
| | - Nils Temme
- 1 Zentrum für Strahlentherapie und Radioonkologie, Bremen, Germany
| | - Robert M Hermann
- 1 Zentrum für Strahlentherapie und Radioonkologie, Bremen, Germany.,6 Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
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Moulton CR, House MJ, Lye V, Tang CI, Krawiec M, Joseph DJ, Denham JW, Ebert MA. Prostate external beam radiotherapy combined with high-dose-rate brachytherapy: dose-volume parameters from deformably-registered plans correlate with late gastrointestinal complications. Radiat Oncol 2016; 11:144. [PMID: 27799048 PMCID: PMC5087115 DOI: 10.1186/s13014-016-0719-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Derivation of dose-volume correlated with toxicity for multi-modal treatments can be difficult due to the perceived need for voxel-by-voxel dose accumulation. With data available for a single-institution cohort with long follow-up, an investigation was undertaken into rectal dose-volume effects for gastrointestinal toxicities after deformably-registering each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate (HDR) brachytherapy prostate treatment. METHODS One hundred and eighteen patients received EBRT in 23 fractions of 2 Gy and HDR (TG43 algorithm) in 3 fractions of 6.5 Gy. Results for the Late Effects of Normal Tissues - Subjective, Objective, Management and Analytic toxicity assessments were available with a median follow-up of 72 months. The HDR CT was deformably-registered to the EBRT CT. Doses were corrected for dose fractionation. Rectum dose-volume histogram (DVH) parameters were calculated in two ways. (1) Distribution-adding: parameters were calculated after the EBRT dose distribution was 3D-summed with the registered HDR dose distribution. (2) Parameter-adding: the EBRT DVH parameters were added to HDR DVH parameters. Logistic regressions and Mann-Whitney U-tests were used to correlate parameters with late peak toxicity (dichotomised at grade 1 or 2). RESULTS The 48-80, 40-63 and 49-55 Gy dose regions from distribution-adding were significantly correlated with rectal bleeding, urgency/tenesmus and stool frequency respectively. Additionally, urgency/tenesmus and anorectal pain were associated with the 25-26 Gy and 44-48 Gy dose regions from distribution-adding respectively. Parameter-adding also indicated the low-mid dose region was significantly correlated with stool frequency and proctitis. CONCLUSIONS This study confirms significant dose-histogram effects for gastrointestinal toxicities after including deformable registration to combine phases of EBRT/HDR prostate cancer treatment. The findings from distribution-adding were in most cases consistent with those from parameter-adding. The mid-high dose range and near maximum doses were important for rectal bleeding. The distribution-adding mid-high dose range was also important for stool frequency and urgency/tenesmus. We encourage additional studies in a variety of institutions using a variety of dose accumulation methods with appropriate inter-fraction motion management. TRIAL REGISTRATION NCT NCT00193856 . Retrospectively registered 12 September 2005.
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Affiliation(s)
- Calyn R. Moulton
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Michael J. House
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Victoria Lye
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Colin I. Tang
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Michele Krawiec
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - David J. Joseph
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
- School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - James W. Denham
- School of Medicine and Population Health, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Martin A. Ebert
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
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Whalley D, Hruby G, Alfieri F, Kneebone A, Eade T. SpaceOAR Hydrogel in Dose-escalated Prostate Cancer Radiotherapy: Rectal Dosimetry and Late Toxicity. Clin Oncol (R Coll Radiol) 2016; 28:e148-54. [DOI: 10.1016/j.clon.2016.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
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58
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Viani GA, Rossi BT, Suguikawa E, Zuliani G, Stefano EJ. Treatment outcomes with hypofractionated high-dose radiation therapy for prostate cancer. Rep Pract Oncol Radiother 2016; 21:162-7. [PMID: 27601945 DOI: 10.1016/j.rpor.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 12/01/2015] [Indexed: 11/24/2022] Open
Abstract
AIM To report the treatment results of a retrospective cohort of prostate cancer patients treated with Hypo-RT with a high equivalent biological effective dose (BED). BACKGROUND Hypofractionated radiotherapy (Hypo-RT) has gained popularity and interest in the treatment of prostate cancer. However, there are few experiences with adequate follow-up reporting treatment results using high equivalent dose with Hypo-RT. MATERIALS AND METHODS We assigned 149 men with low-, intermediate- and high-risk prostate cancer to receive Hypo-RT with a total dose of 69 Gy/23 fractions. Late gastrointestinal (GI) and genitourinary (GU) toxicity were prospectively evaluated according to modified RTOG criteria. Biochemical no evidence of disease (bNED) was defined as the nadir prostate-specific antigen level plus 2 ng/mL. RESULTS The median follow-up was 53 months. For the entire cohort, the 5-year bNED rate was 94.6%, and for low-, intermediate- and high-risk patients the 5-year bNED was 100%, 96.4%, and 86% (p = 0.007), respectively. The 5-year overall survival rate was 92%. Only 1 patient died from the disease at 48 months after treatment, giving a 5-year cancer-specific survival of 98%. The worst grade ≥2 rate GI and GU toxicity was 13.4% and 14%, respectively. No grade >3 toxicity was observed. The presence of grade ≥2 GI and GU toxicity at the last follow-up was only 1.3% and 3%, respectively. CONCLUSIONS Hypo-RT (69 Gy/23 fractions) with a high equivalent BED produces excellent rates of biochemical control for low, intermediate and high-risk prostate cancer. The long term GU and GI toxicity rates were considered low and acceptable.
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Affiliation(s)
- Gustavo Arruda Viani
- Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil
| | - Bruno Tiago Rossi
- Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil
| | - Elton Suguikawa
- Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil
| | - Gisele Zuliani
- Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil
| | - Eduardo Jose Stefano
- Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil
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Chen Z, Yang Z, Wang J, Hu W. Dosimetric impact of different bladder and rectum filling during prostate cancer radiotherapy. Radiat Oncol 2016; 11:103. [PMID: 27485637 PMCID: PMC4969718 DOI: 10.1186/s13014-016-0681-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to analyze the influence of volumetric changes of bladder and rectum filling on the 3D dose distribution in prostate cancer radiotherapy. Methods A total of 314 cone-beam CT (CBCT) image data sets from 19 patients were enrolled in this study. For each CBCT, the bladder and rectum were contoured and volume sizes were normalized to those on their original CT. The daily delivered dose was recalculated on the CBCT images and the doses to bladder and rectum were investigated. Linear regression analysis was performed to identify the mean dose change of the volume change using SPSS 19. Results The data show that the variances of the normalized volume of the bladder and the rectum are 0.13–0.58 and 0.12–0.50 respectively. The variances of V70Gy, V60Gy, V50Gy, V40Gy and V30Gy of bladder are bigger than those of rectum for 17 patients. The linear regression analysis indicates a 10 % increase in bladder volume will cause a 5.6 % (±4.9 %) reduction in mean dose (p <0.05). Conclusions The bladder’s volume change is more significant than that of the rectum for the prostate cancer patient. The rectum volume variations are not significant except for air bubbles, which change the shape and the position of the rectum. The bladder volume variations may cause dose changes proportionately. Monitoring the bladder’s volume before fractional treatment delivery will be crucial for accurate dose delivery.
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Affiliation(s)
- Zhi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China.
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Thörnqvist S, Hysing LB, Tuomikoski L, Vestergaard A, Tanderup K, Muren LP, Heijmen BJM. Adaptive radiotherapy strategies for pelvic tumors - a systematic review of clinical implementations. Acta Oncol 2016; 55:943-58. [PMID: 27055486 DOI: 10.3109/0284186x.2016.1156738] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Introdution: Variation in shape, position and treatment response of both tumor and organs at risk are major challenges for accurate dose delivery in radiotherapy. Adaptive radiotherapy (ART) has been proposed to customize the treatment to these motion/response patterns of the individual patients, but increases workload and thereby challenges clinical implementation. This paper reviews strategies and workflows for clinical and in silico implemented ART for prostate, bladder, gynecological (gyne) and ano-rectal cancers. MATERIAL AND METHODS Initial identification of papers was based on searches in PubMed. For each tumor site, the identified papers were screened independently by two researches for selection of studies describing all processes of an ART workflow: treatment monitoring and evaluation, decision and execution of adaptations. Both brachytherapy and external beam studies were eligible for review. RESULTS The review consisted of 43 clinical studies and 51 in silico studies. For prostate, 1219 patients were treated with offline re-planning, mainly to adapt prostate motion relative to bony anatomy. For gyne 1155 patients were treated with online brachytherapy re-planning while 25 ano-rectal cancer patients were treated with offline re-planning, all to account for tumor regression detected by magnetic resonance imaging (MRI)/computed tomography (CT). For bladder and gyne, 161 and 64 patients, respectively, were treated with library-based online plan selection to account for target volume and shape variations. The studies reported sparing of rectum (prostate and bladder cancer), bladder (ano-rectal cancer) and bowel cavity (gyne and bladder cancer) as compared to non-ART. CONCLUSION Implementations of ART were dominated by offline re-planning and online brachytherapy re-planning strategies, although recently online plan selection workflows have increased with the availability of cone-beam CT. Advantageous dosimetric and outcome patterns using ART was documented by the studies of this review. Despite this, clinical implementations were scarce due to challenges in target/organ re-contouring and suboptimal patient selection in the ART workflows.
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Affiliation(s)
- Sara Thörnqvist
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Liv B. Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Laura Tuomikoski
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne Vestergaard
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Kari Tanderup
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ben J. M. Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Steineck G, Schmidt H, Alevronta E, Sjöberg F, Bull CM, Vordermark D. Toward Restored Bowel Health in Rectal Cancer Survivors. Semin Radiat Oncol 2016; 26:236-50. [DOI: 10.1016/j.semradonc.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Musunuru HB, Davidson M, Cheung P, Vesprini D, Liu S, Chung H, Chu W, Mamedov A, Ravi A, D'Alimonte L, Commisso K, Helou J, Deabreu A, Zhang L, Loblaw A. Predictive Parameters of Symptomatic Hematochezia Following 5-Fraction Gantry-Based SABR in Prostate Cancer. Int J Radiat Oncol Biol Phys 2016; 94:1043-51. [DOI: 10.1016/j.ijrobp.2015.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023]
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Abstract
Objective Radiation is an integral part of the treatment of many pelvic tumors. The cellular death induced by radiotherapy (RT) benefits cancer control but can also result in adverse effects (AEs) on the organ being treated or those adjacent to it. RT for cancers of the pelvis (bladder, prostate, rectum, uterus or cervix) can result in AEs in the urinary tract. While the acute urinary AEs of pelvic RT are well described, late AEs are less well characterized. The burden of treatment for late AEs may be large given the prevalence of tumors in the pelvis and the high utilization of RT to treat them. Review For prostate cancer, grade 1 and 2 urinary AEs following external beam radiation therapy (EBRT) are reported to occur in 20-43% and 7-19%, respectively, with a follow up of 10 years. Three-year cumulative risk for grade ≥2 urinary AEs is 28-30%. Following brachytherapy (BT), rates of urinary AEs at 5 years are reported to be 36%, 24%, 6.2% and 0.1% for Radiation Therapy Oncology Group (RTOG) grade 1, 2, 3, and 4, respectively. For bladder cancer, with a median follow-up of 5 years, 7-12% of patients who receive RT experience urinary AEs of grade 3 or more. For cervical cancer, there remains a 0.25% per year risk of severe AEs for at least 25 years following RT, and ureteral stricture is a well-described AE. For endometrial cancer, severe urinary AEs are rare, but at 13 years of follow up, patients report a significantly worse quality of life with respect to urinary function. In rectal cancer, preoperative RT has a lower risk of AEs than postoperative RT, and few urinary AEs are reported in the literature. Conclusions Urinary AEs can manifest long after RT, and there is a paucity of studies describing rates of these long-term AEs. It is important that the possible complications of RT are recognized by providers and properly communicated to patients so that they are able to make informed decisions about their cancer treatment.
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Affiliation(s)
- Daniel Liberman
- Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Brian Mehus
- Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Kusumoto C, Ohira S, Miyazaki M, Ueda Y, Isono M, Teshima T. Effect of various methods for rectum delineation on relative and absolute dose-volume histograms for prostate IMRT treatment planning. Med Dosim 2016; 41:136-41. [DOI: 10.1016/j.meddos.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/11/2015] [Accepted: 11/29/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Chiaki Kusumoto
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
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Sundar S, Walker G, Pascoe A. Should Elderly Prostate Cancer Patients with Comorbidity be Spared from Prostate Radiation Dose Escalation? Clin Oncol (R Coll Radiol) 2015; 28:227-8. [PMID: 26482454 DOI: 10.1016/j.clon.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
Affiliation(s)
- S Sundar
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - G Walker
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Pascoe
- Nottingham University Hospital NHS Trust, Nottingham, UK
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Yartsev S, Chen J. Separating the dosimetric consequences of changing tumor anatomy from positional uncertainty for conventional fractionated lung cancer patients. Pract Radiat Oncol 2015; 5:e553-e554. [DOI: 10.1016/j.prro.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/07/2015] [Indexed: 10/23/2022]
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Hamlett LJ, McPartlin AJ, Maile EJ, Webster G, Swindell R, Rowbottom CG, Choudhury A, Aitkenhead AH. Parametrized rectal dose and associations with late toxicity in prostate cancer radiotherapy. Br J Radiol 2015; 88:20150110. [PMID: 26246172 DOI: 10.1259/bjr.20150110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated possible associations between planned dose-volume parameters and rectal late toxicity in 170 patients having radical prostate cancer radiotherapy. METHODS For each patient, the rectum was outlined from anorectal junction to sigmoid colon, and rectal dose was parametrized using dose-volume (DVH), dose-surface (DSH) and dose-line (DLH) histograms. Generation of DLHs differed from previous studies in that the rectal dose was parametrized without first unwrapping onto 2-dimensional dose-surface maps. Patient-reported outcomes were collected using a validated Later Effects in Normal Tissues Subjective, Objective, Management and Analytic questionnaire. Associations between dose and toxicity were assessed using a one-sided Mann-Whitney U test. RESULTS Associations (p < 0.05) were found between equieffective dose (EQD23) and late toxicity as follows: overall toxicity with DVH and DSH at 13-24 Gy; proctitis with DVH and DSH at 25-36 Gy and with DVH, DSH and DLH at 61-67 Gy; bowel urgency with DVH and DSH at 10-20 Gy. None of these associations met statistical significance following the application of a Bonferroni correction. CONCLUSION Independently confirmed associations between rectal dose and late toxicity remain elusive. Future work to increase the accuracy of the knowledge of the rectal dose, either by accounting for interfraction and intrafraction rectal motion or via stabilization of the rectum during treatment, may be necessary to allow for improved dose-toxicity comparisons. ADVANCES IN KNOWLEDGE This study is the first to use parametrized DLHs to study associations with patient-reported toxicity for prostate radiotherapy showing that it is feasible to model rectal dose mapping in three dimensions.
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Affiliation(s)
- Lynsey J Hamlett
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,2 Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew J McPartlin
- 3 Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Edward J Maile
- 4 Oxford University Clinical Academic Graduate School, Medical Sciences Division, John Radcliffe Hospital, Oxford, UK
| | - Gareth Webster
- 5 Hall-Edwards Radiotherapy Research Group, Medical Physics, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ric Swindell
- 6 The Christie NHS Foundation Trust, Manchester, UK
| | - Carl G Rowbottom
- 7 Department of Medical Physics, Clatterbridge Cancer Centre, Liverpool, UK
| | - Ananya Choudhury
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,3 Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Adam H Aitkenhead
- 1 Manchester Academic Health Science Centre (MAHSC), Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,2 Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
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68
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Scaife JE, Thomas SJ, Harrison K, Romanchikova M, Sutcliffe MPF, Forman JR, Bates AM, Jena R, Parker MA, Burnet NG. Accumulated dose to the rectum, measured using dose-volume histograms and dose-surface maps, is different from planned dose in all patients treated with radiotherapy for prostate cancer. Br J Radiol 2015. [PMID: 26204919 PMCID: PMC4730972 DOI: 10.1259/bjr.20150243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to calculate accumulated dose (DA) to the rectum in patients treated with radiotherapy for prostate cancer. We were particularly interested in whether dose-surface maps (DSMs) provide additional information to dose-volume histograms (DVHs). METHODS Manual rectal contours were obtained for kilovoltage and daily megavoltage CT scans for 10 participants from the VoxTox study (380 scans). Daily delivered dose recalculation was performed using a ray-tracing algorithm. Delivered DVHs were summated to create accumulated DVHs. The rectum was considered as a cylinder, cut and unfolded to produce daily delivered DSMs; these were summated to produce accumulated DSMs. RESULTS Accumulated dose-volumes were different from planned in all participants. For one participant, all DA levels were higher and all volumes were larger than planned. For four participants, all DA levels were lower and all volumes were smaller than planned. For each of these four participants, ≥1% of pixels on the accumulated DSM received ≥5 Gy more than had been planned. CONCLUSION Differences between accumulated and planned dose-volumes were seen in all participants. DSMs were able to identify differences between DA and planned dose that could not be appreciated from the DVHs. Further work is needed to extract the dose data embedded in the DSMs. These will be correlated with toxicity as part of the VoxTox Programme. ADVANCES IN KNOWLEDGE DSMs are able to identify differences between DA and planned dose that cannot be appreciated from DVHs alone and should be incorporated into future studies investigating links between DA and toxicity.
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Affiliation(s)
- Jessica E Scaife
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Simon J Thomas
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Medical Physics Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karl Harrison
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,4 Department of Physics, University of Cambridge, Cavendish Laboratory, Cambridge, UK
| | - Marina Romanchikova
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Medical Physics Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael P F Sutcliffe
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,5 Department of Engineering, University of Cambridge, Cambridge, UK
| | - Julia R Forman
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,6 Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy M Bates
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Raj Jena
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M Andrew Parker
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,4 Department of Physics, University of Cambridge, Cavendish Laboratory, Cambridge, UK
| | - Neil G Burnet
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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Wortel RC, Incrocci L, Pos FJ, Lebesque JV, Witte MG, van der Heide UA, van Herk M, Heemsbergen WD. Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2015; 91:737-44. [PMID: 25752386 DOI: 10.1016/j.ijrobp.2014.12.017] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Image-guided intensity modulated radiation therapy (IG-IMRT) allows significant dose reductions to organs at risk in prostate cancer patients. However, clinical data identifying the benefits of IG-IMRT in daily practice are scarce. The purpose of this study was to compare dose distributions to organs at risk and acute gastrointestinal (GI) and genitourinary (GU) toxicity levels of patients treated to 78 Gy with either IG-IMRT or 3D-CRT. METHODS AND MATERIALS Patients treated with 3D-CRT (n=215) and IG-IMRT (n=260) receiving 78 Gy in 39 fractions within 2 randomized trials were selected. Dose surface histograms of anorectum, anal canal, and bladder were calculated. Identical toxicity questionnaires were distributed at baseline, prior to fraction 20 and 30 and at 90 days after treatment. Radiation Therapy Oncology Group (RTOG) grade ≥1, ≥2, and ≥3 endpoints were derived directly from questionnaires. Univariate and multivariate binary logistic regression analyses were applied. RESULTS The median volumes receiving 5 to 75 Gy were significantly lower (all P<.001) with IG-IMRT for anorectum, anal canal, and bladder. The mean dose to the anorectum was 34.4 Gy versus 47.3 Gy (P<.001), 23.6 Gy versus 44.6 Gy for the anal canal (P<.001), and 33.1 Gy versus 43.2 Gy for the bladder (P<.001). Significantly lower grade ≥2 toxicity was observed for proctitis, stool frequency ≥6/day, and urinary frequency ≥12/day. IG-IMRT resulted in significantly lower overall RTOG grade ≥2 GI toxicity (29% vs 49%, respectively, P=.002) and overall GU grade ≥2 toxicity (38% vs 48%, respectively, P=.009). CONCLUSIONS A clinically meaningful reduction in dose to organs at risk and acute toxicity levels was observed in IG-IMRT patients, as a result of improved technique and tighter margins. Therefore reduced late toxicity levels can be expected as well; additional research is needed to quantify such reductions.
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Affiliation(s)
- Ruud C Wortel
- Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joos V Lebesque
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marnix G Witte
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel van Herk
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilma D Heemsbergen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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70
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Ebert MA, Foo K, Haworth A, Gulliford SL, Kennedy A, Joseph DJ, Denham JW. Gastrointestinal dose-histogram effects in the context of dose-volume-constrained prostate radiation therapy: analysis of data from the RADAR prostate radiation therapy trial. Int J Radiat Oncol Biol Phys 2015; 91:595-603. [PMID: 25596108 DOI: 10.1016/j.ijrobp.2014.11.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To use a high-quality multicenter trial dataset to determine dose-volume effects for gastrointestinal (GI) toxicity following radiation therapy for prostate carcinoma. Influential dose-volume histogram regions were to be determined as functions of dose, anatomical location, toxicity, and clinical endpoint. METHODS AND MATERIALS Planning datasets for 754 participants in the TROG 03.04 RADAR trial were available, with Late Effects of Normal Tissues (LENT) Subjective, Objective, Management, and Analytic (SOMA) toxicity assessment to a median of 72 months. A rank sum method was used to define dose-volume cut-points as near-continuous functions of dose to 3 GI anatomical regions, together with a comprehensive assessment of significance. Univariate and multivariate ordinal regression was used to assess the importance of cut-points at each dose. RESULTS Dose ranges providing significant cut-points tended to be consistent with those showing significant univariate regression odds-ratios (representing the probability of a unitary increase in toxicity grade per percent relative volume). Ranges of significant cut-points for rectal bleeding validated previously published results. Separation of the lower GI anatomy into complete anorectum, rectum, and anal canal showed the impact of mid-low doses to the anal canal on urgency and tenesmus, completeness of evacuation and stool frequency, and mid-high doses to the anorectum on bleeding and stool frequency. Derived multivariate models emphasized the importance of the high-dose region of the anorectum and rectum for rectal bleeding and mid- to low-dose regions for diarrhea and urgency and tenesmus, and low-to-mid doses to the anal canal for stool frequency, diarrhea, evacuation, and bleeding. CONCLUSIONS Results confirm anatomical dependence of specific GI toxicities. They provide an atlas summarizing dose-histogram effects and derived constraints as functions of anatomical region, dose, toxicity, and endpoint for informing future radiation therapy planning.
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Affiliation(s)
- Martin A Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Physics, University of Western Australia, Perth, Western Australia, Australia.
| | - Kerwyn Foo
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Annette Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah L Gulliford
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, United Kingdom
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Ishii K, Ogino R, Hosokawa Y, Fujioka C, Okada W, Nakahara R, Kawamorita R, Tada T, Hayashi Y, Nakajima T. Whole-pelvic volumetric-modulated arc therapy for high-risk prostate cancer: treatment planning and acute toxicity. JOURNAL OF RADIATION RESEARCH 2015; 56:141-150. [PMID: 25304328 PMCID: PMC4572588 DOI: 10.1093/jrr/rru086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023]
Abstract
The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy (VMAT) and daily image guidance in high-risk prostate cancer patients. A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy (WPRT) were enrolled. All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume (PTV), while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions, followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions. Image-guided RT was performed with daily cone-beam computed tomography. Dose-volume parameters for the PTV and the organs at risk (OARs), total number of monitor units (MUs) and treatment time were evaluated. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events, version 4.0. All dosimetric parameters met the present plan acceptance criteria. Mean MU and treatment time were 471 and 146 s for double-arc VMAT, respectively, and were 520 and 76 s for single-arc VMAT, respectively. No Grade 3 or higher acute toxicity was reported. Acute Grade 2 proctitis, diarrhea, and genitourinary toxicity occurred in 12 patients (12%), 6 patients (6%) and 13 patients (13%), respectively. The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity. These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients.
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Affiliation(s)
- Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Yukinari Hosokawa
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Chiaki Fujioka
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Wataru Okada
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryota Nakahara
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, 4-10-10 Futyu-cho, Izumi, 594-0071, Japan
| | - Yoshiki Hayashi
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Toshifumi Nakajima
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
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Hegemann NS, Guckenberger M, Belka C, Ganswindt U, Manapov F, Li M. Hypofractionated radiotherapy for prostate cancer. Radiat Oncol 2014; 9:275. [PMID: 25480014 PMCID: PMC4273481 DOI: 10.1186/s13014-014-0275-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 12/01/2022] Open
Abstract
In the last few years, hypofractionated external beam radiotherapy has gained increasing popularity for prostate cancer treatment, since sufficient evidence exists that prostate cancer has a low α/β ratio, lower than the one of the surrounding organs at risk and thus there is a potential therapeutic benefit of using larger fractionated single doses. Apart from the therapeutic rationale there are advantages such as saving treatment time and medical resources and thereby improving patient’s convenience. While older trials showed unsatisfactory results in both standard and hypofractionated arm due to insufficient radiation doses and non-standard contouring of target volumes, contemporary randomized studies have reported on encouraging results of tumor control mostly without an increase of relevant side effects, especially late toxicity. Aim of this review is to give a detailed analysis of relevant, recently published clinical trials with special focus on rationale for hypofractionation and different therapy settings.
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Affiliation(s)
- Nina-Sophie Hegemann
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital Munich, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
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73
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Fonteyne V, Ost P, Vanpachtenbeke F, Colman R, Sadeghi S, Villeirs G, Decaestecker K, De Meerleer G. Rectal toxicity after intensity modulated radiotherapy for prostate cancer: which rectal dose volume constraints should we use? Radiother Oncol 2014; 113:398-403. [PMID: 25441610 DOI: 10.1016/j.radonc.2014.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/19/2014] [Accepted: 10/31/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND To define rectal dose volume constraints (DVC) to prevent ⩾grade2 late rectal toxicity (LRT) after intensity modulated radiotherapy (IMRT) for prostate cancer (PC). MATERIAL AND METHODS Six hundred thirty-seven PC patients were treated with primary (prostate median dose: 78Gy) or postoperative (prostatic bed median dose: 74Gy (adjuvant)-76Gy (salvage)) IMRTwhile restricting the rectal dose to 76Gy, 72Gy and 74Gy respectively. The impact of patient characteristics and rectal volume parameters on ⩾grade2 LRT was determined. DVC were defined to estimate the 5% and 10% risk of developing ⩾grade2 LRT. RESULTS The 5-year probability of being free from ⩾grade2 LRT, non-rectal blood loss and persisting symptoms is 88.8% (95% CI: 85.8-91.1%), 93.4% (95% CI: 91.0-95.1%) and 94.3% (95% CI: 92.0-95.9%) respectively. There was no correlation with patient characteristics. All volume parameters, except rectal volume receiving ⩾70Gy (R70), were significantly correlated with ⩾grade2 LRT. To avoid 10% and 5% risk of ⩾grade2 LRT following DVC were derived: R40, R50, R60 and R65 <64-35%, 52-22%, 38-14% and 5% respectively. CONCLUSION Applying existing rectal volume constraints resulted in a 5-year estimated risk of developing late ⩾grade2 LRT of 11.2%. New rectal DVC for primary and postoperative IMRT planning of PC patients are proposed. A prospective evaluation is needed.
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Affiliation(s)
- Valérie Fonteyne
- Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium.
| | - Piet Ost
- Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium
| | - Frank Vanpachtenbeke
- Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium
| | - Roos Colman
- Ghent University, Biostatistics Unit, Department of Public Health, Faculty of Medicine and Health Sciences, Belgium
| | - Simin Sadeghi
- Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium
| | - Geert Villeirs
- Ghent University Hospital, Department of Radiology, Belgium
| | | | - Gert De Meerleer
- Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Belgium
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Li H, Yu L, Anastasio MA, Chen HC, Tan J, Gay H, Michalski JM, Low DA, Mutic S. Automatic CT simulation optimization for radiation therapy: A general strategy. Med Phys 2014; 41:031913. [PMID: 24593731 DOI: 10.1118/1.4866377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE In radiation therapy, x-ray computed tomography (CT) simulation protocol specifications should be driven by the treatment planning requirements in lieu of duplicating diagnostic CT screening protocols. The purpose of this study was to develop a general strategy that allows for automatically, prospectively, and objectively determining the optimal patient-specific CT simulation protocols based on radiation-therapy goals, namely, maintenance of contouring quality and integrity while minimizing patient CT simulation dose. METHODS The authors proposed a general prediction strategy that provides automatic optimal CT simulation protocol selection as a function of patient size and treatment planning task. The optimal protocol is the one that delivers the minimum dose required to provide a CT simulation scan that yields accurate contours. Accurate treatment plans depend on accurate contours in order to conform the dose to actual tumor and normal organ positions. An image quality index, defined to characterize how simulation scan quality affects contour delineation, was developed and used to benchmark the contouring accuracy and treatment plan quality within the predication strategy. A clinical workflow was developed to select the optimal CT simulation protocols incorporating patient size, target delineation, and radiation dose efficiency. An experimental study using an anthropomorphic pelvis phantom with added-bolus layers was used to demonstrate how the proposed prediction strategy could be implemented and how the optimal CT simulation protocols could be selected for prostate cancer patients based on patient size and treatment planning task. Clinical IMRT prostate treatment plans for seven CT scans with varied image quality indices were separately optimized and compared to verify the trace of target and organ dosimetry coverage. RESULTS Based on the phantom study, the optimal image quality index for accurate manual prostate contouring was 4.4. The optimal tube potentials for patient sizes of 38, 43, 48, 53, and 58 cm were 120, 140, 140, 140, and 140 kVp, respectively, and the corresponding minimum CTDIvol for achieving the optimal image quality index 4.4 were 9.8, 32.2, 100.9, 241.4, and 274.1 mGy, respectively. For patients with lateral sizes of 43-58 cm, 120-kVp scan protocols yielded up to 165% greater radiation dose relative to 140-kVp protocols, and 140-kVp protocols always yielded a greater image quality index compared to the same dose-level 120-kVp protocols. The trace of target and organ dosimetry coverage and the γ passing rates of seven IMRT dose distribution pairs indicated the feasibility of the proposed image quality index for the predication strategy. CONCLUSIONS A general strategy to predict the optimal CT simulation protocols in a flexible and quantitative way was developed that takes into account patient size, treatment planning task, and radiation dose. The experimental study indicated that the optimal CT simulation protocol and the corresponding radiation dose varied significantly for different patient sizes, contouring accuracy, and radiation treatment planning tasks.
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Affiliation(s)
- Hua Li
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905
| | - Mark A Anastasio
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri 63110
| | - Hsin-Chen Chen
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
| | - Jun Tan
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
| | - Hiram Gay
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
| | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110
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A method for generating large datasets of organ geometries for radiotherapy treatment planning studies. Radiol Oncol 2014; 48:408-15. [PMID: 25435856 PMCID: PMC4230563 DOI: 10.2478/raon-2014-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/11/2013] [Indexed: 11/25/2022] Open
Abstract
Background With the rapidly increasing application of adaptive radiotherapy, large datasets of organ geometries based on the patient’s anatomy are desired to support clinical application or research work, such as image segmentation, re-planning, and organ deformation analysis. Sometimes only limited datasets are available in clinical practice. In this study, we propose a new method to generate large datasets of organ geometries to be utilized in adaptive radiotherapy. Methods Given a training dataset of organ shapes derived from daily cone-beam CT, we align them into a common coordinate frame and select one of the training surfaces as reference surface. A statistical shape model of organs was constructed, based on the establishment of point correspondence between surfaces and non-uniform rational B-spline (NURBS) representation. A principal component analysis is performed on the sampled surface points to capture the major variation modes of each organ. Results A set of principal components and their respective coefficients, which represent organ surface deformation, were obtained, and a statistical analysis of the coefficients was performed. New sets of statistically equivalent coefficients can be constructed and assigned to the principal components, resulting in a larger geometry dataset for the patient’s organs. Conclusions These generated organ geometries are realistic and statistically representative.
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Yamazaki H, Nakamura S, Nishimura T, Yoshida K, Yoshioka Y, Koizumi M, Ogawa K. Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis. JOURNAL OF RADIATION RESEARCH 2014; 55:1033-1047. [PMID: 25204643 PMCID: PMC4229926 DOI: 10.1093/jrr/rru061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/27/2014] [Accepted: 06/09/2014] [Indexed: 06/02/2023]
Abstract
With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoaki Nakamura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takuya Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ken Yoshida
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-City, Osaka, 569-8686, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
| | - Masahiko Koizumi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
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Ingrosso G, Carosi A, Ponti E, Murgia A, di Cristino D, Barbarino R, Benassi M, Di Murro L, Giudice E, Bove P, Santoni R. Acute and Late Toxicity after Three-Dimensional Conformal Image-Guided Radiotherapy for Localized Prostate Cancer. Cancer Invest 2014; 32:526-32. [DOI: 10.3109/07357907.2014.970193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Luo HC, Cheng HH, Lin GS, Fu ZC, Li DS. Intensity-modulated radiotherapy combined with endocrine therapy for intermediate and advanced prostate cancer: long-term outcome of Chinese patients. Asian Pac J Cancer Prev 2014; 14:4711-5. [PMID: 24083731 DOI: 10.7314/apjcp.2013.14.8.4711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of this study was to evaluate acute adverse events and efficacy of three-dimensional intensity- modulated radiotherapy (IMRT) combined with endocrine therapy for intermediate and advanced prostate cancer. METHODS Sixty-seven patients were treated with three-dimensional IMRT combined with maximum androgen blockade. The correlation between radiation-induced rectal injury and clinical factors was further analyzed. RESULTS After treatment, 21 patients had complete remission (CR), 37 had partial remission (PR), and nine had stable disease (SD), with an overall response rate of 86.5%. The follow-up period ranged from 12.5 to 99.6 months. Thirty-nine patients had a follow-up time of ≥ five years. In this group, three-year and five-year overall survival rates were 89% and 89.5%, respectively; three-year and five-year progression-free survival rates were 72% and 63%. In univariate analyses, gross tumor volume was found to be prognostic for survival (χ2 = 5.70, P = 0.037). Rates of leucopenia and anemia were 91.1% and 89.5%, respectively. Two patients developed acute liver injury, and a majority of patients developed acute radiation proctitis and cystitis, mainly grade 1/2. Tumor volume before treatment was the only prognostic factor influencing the severity of acute radiation proctitis (P < 0.05). CONCLUSIONS IMRT combined with endocrine therapy demonstrated promising efficacy and was well tolerated in patients with intermediate and advanced prostate cancer.
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Affiliation(s)
- Hua-Chun Luo
- Department of Radiation Oncology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, China E-mail :
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Phase I/II trial of definitive carbon ion radiotherapy for prostate cancer: evaluation of shortening of treatment period to 3 weeks. Br J Cancer 2014; 110:2389-95. [PMID: 24722181 PMCID: PMC4021525 DOI: 10.1038/bjc.2014.191] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/04/2014] [Accepted: 03/15/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility of a new shortened 3-week treatment schedule of carbon ion radiotherapy (CIRT) for prostate cancer. METHODS Beginning in May 2010, patients with T1b-T3bN0M0, histologically proven prostate adenocarcinoma were enrolled in the phase II trial of CIRT. Patients received 51.6 GyE in 12 fractions over 3 weeks (protocol 1002). The primary end point was defined as the incidence of late adverse events that were evaluated based on the Common Terminology Criteria for Adverse Events version 4.0. Biochemical failure was determined using the Phoenix definition (nadir +2.0 ng ml(-1)). RESULTS Forty-six patients were enrolled, and all patients were included in the analysis. The number of low-, intermediate-, and high-risk patients was 12 (26%), 9 (20%), and 25 (54%), respectively. The median follow-up period of surviving patients was 32.3 months. Two patients had intercurrent death without recurrence, and the remaining 44 patients were alive at the time of this analysis. In the analysis of late toxicities, grade 1 (G1) rectal haemorrhage was observed in 3 (7%) patients. The incidence of G1 haematuria was observed in 6 (13%) patients, and G1 urinary frequency was observed in 17 (37%) patients. No ⩾G2 late toxicities were observed. In the analysis of acute toxicities, 2 (4%) patients showed G2 urinary frequency, and no other G2 acute toxicities were observed. CONCLUSIONS The new shortened CIRT schedule over 3 weeks was considered as feasible. The analysis of long-term outcome is warranted.
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80
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van Gysen K, Kneebone A, Alfieri F, Guo L, Eade T. Feasibility of and rectal dosimetry improvement with the use of SpaceOAR® hydrogel for dose-escalated prostate cancer radiotherapy. J Med Imaging Radiat Oncol 2014; 58:511-6. [PMID: 24580893 DOI: 10.1111/1754-9485.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the feasibility of injecting a temporary spacer between the rectum and the prostate and to quantify the degree of rectal dosimetric improvement that might result. METHODS Ten patients underwent CT and MRI before and after injection of 10 cc of hydrogel and at completion of radiotherapy. Hydrogel was injected under general anaesthetic using a transperineal approach. The primary endpoints were perioperative toxicity and rectal dosimetry (V80, V75, V70, V65, V40 and V30). Secondary endpoints were acute gastrointestinal toxicity during and 3 months following radiotherapy and the stability of the hydrogel. Treatment for all patients was planned incorporating volumetric modulated arc therapy with a D95 of 80 Gy in 40 fractions to the prostate and proximal seminal vesicles on both the pre- and post-hydrogel scans. Toxicity was scored with the Common Terminology Criteria, v. 3.0. RESULTS In the first 24 h, two patients described an increase in bowel movement frequency. The comparison plans had identical prescription doses. Rectal doses were significantly lower for all hydrogel patients for all dose endpoints (V80 = 7% vs. 0.1%, V75 = 10.3% vs. 1.1%, V70 = 13.2% vs. 2.7%, V65 = 15.8% vs. 4.6%, V40 = 35.2% vs. 23.3%, V30 = 52.6% vs. 38.5%; P < 0.001). Post-treatment MRI showed gel stability. Grade 1 bowel toxicity was reported in six patients during radiotherapy and two patients at 3 months' follow-up. No Grade 2 or Grade 3 acute bowel toxicity was reported. CONCLUSION SpaceOAR hydrogel was successfully injected in 10 patients with minimal side effects. Rectal dosimetry was significantly improved in all patients. This study has been extended to 30 patients with longer follow-up planned.
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Affiliation(s)
- Kirsten van Gysen
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
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81
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Ng M, Brown E, Williams A, Chao M, Lawrentschuk N, Chee R. Fiducial markers and spacers in prostate radiotherapy: current applications. BJU Int 2014; 113 Suppl 2:13-20. [DOI: 10.1111/bju.12624] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Ng
- Radiation Oncology Victoria; Melbourne VIC Australia
| | - Elizabeth Brown
- Department of Radiation Oncology; Princess Alexandra Hospital; Brisbane QLD Australia
| | - Andrew Williams
- Department of Urology; Auckland City Hospital; Auckland New Zealand
| | - Michael Chao
- Radiation Oncology Victoria; Melbourne VIC Australia
| | - Nathan Lawrentschuk
- Department of Surgery and Ludwig Institute for Cancer Research; Austin Hospital; University of Melbourne; Melbourne VIC Australia
| | - Raphael Chee
- Genesis Cancer Care Western Australia; Joondalup WA Australia
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Schaake W, Wiegman EM, de Groot M, van der Laan HP, van der Schans CP, van den Bergh AC, Langendijk JA. The impact of gastrointestinal and genitourinary toxicity on health related quality of life among irradiated prostate cancer patients. Radiother Oncol 2014; 110:284-90. [DOI: 10.1016/j.radonc.2013.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 06/18/2013] [Accepted: 11/10/2013] [Indexed: 11/12/2022]
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83
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Stenmark MH, Conlon AS, Johnson S, Daignault S, Litzenberg D, Marsh R, Ritter T, Vance S, Kazzi N, Feng FY, Sandler H, Sanda MG, Hamstra DA. Dose to the inferior rectum is strongly associated with patient reported bowel quality of life after radiation therapy for prostate cancer. Radiother Oncol 2014; 110:291-7. [DOI: 10.1016/j.radonc.2014.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 11/24/2022]
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84
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Prabhakar R, Oates R, Jones D, Kron T, Cramb J, Foroudi F, Geso M, Gill S. A study on planning organ at risk volume for the rectum using cone beam computed tomography in the treatment of prostate cancer. Med Dosim 2014; 39:38-43. [PMID: 24412028 DOI: 10.1016/j.meddos.2013.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 09/18/2013] [Accepted: 09/27/2013] [Indexed: 10/25/2022]
Abstract
In this study, we analyzed planning organ at risk volume (PRV) for the rectum using a series of cone beam computed tomographies (CBCTs) acquired during the treatment of prostate cancer and evaluated the dosimetric effect of different PRV definitions. Overall, 21 patients with prostate cancer were treated radically with 78Gy in 39 fractions had in total 418 CBCTs, each acquired at the end of the first 5 fractions and then every alternate fraction. The PRV was generated from the Boolean sum volume of the rectum obtained from first 5 fractions (PRV-CBCT-5) and from all CBCTs (PRV-CBCT-All). The PRV margin was compared at the superior, middle, and inferior slices of the contoured rectum to compare PRV-CBCT-5 and PRV-CBCT-All. We also compared the dose received by the planned rectum (Rectum-computed tomography [CT]), PRV-CBCT-5, PRV-CBCT-All, and average rectum (CBCT-AV-dose-volume histogram [DVH]) at critical dose levels. The average measured rectal volume for all 21 patients for Rectum-CT, PRV-CBCT-5, and PRV-CBCT-All was 44.3 ± 15.0, 92.8 ± 40.40, and 121.5 ± 36.7cm(3), respectively. For PRV-CBCT-All, the mean ± standard deviation displacement in the anterior, posterior, right, and left lateral directions in centimeters was 2.1 ± 1.1, 0.9 ± 0.5, 0.9 ± 0.8, and 1.1 ± 0.7 for the superior rectum; 0.8 ± 0.5, 1.1 ± 0.5, 1.0 ± 0.5, and 1.0 ± 0.5 for the middle rectum; and 0.3 ± 0.3; 0.9 ± 0.5; 0.4 ± 0.2, and 0.5 ± 0.3 for the inferior rectum, respectively. The first 5 CBCTs did not predict the PRV for individual patients. Our study shows that the PRV margin is different for superior, middle, and the inferior parts of the rectum, it is wider superiorly and narrower inferiorly. A uniform PRV margin does not represent the actual rectal variations during treatment for all treatment fractions. The large variation in interpatient rectal size implies a potential role for adaptive radiotherapy for prostate cancer.
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Affiliation(s)
- Ramachandran Prabhakar
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; RMIT University, Melbourne, Australia.
| | - Richard Oates
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daryl Jones
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; RMIT University, Melbourne, Australia
| | - Jim Cramb
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Suki Gill
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
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85
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Image-guided intensity-modulated radiotherapy for prostate cancer: Dose constraints for the anterior rectal wall to minimize rectal toxicity. Med Dosim 2014; 39:12-7. [DOI: 10.1016/j.meddos.2013.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/10/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022]
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86
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Michalski JM, Yan Y, Watkins-Bruner D, Bosch WR, Winter K, Galvin JM, Bahary JP, Morton GC, Parliament MB, Sandler HM. Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the Radiation Therapy Oncology Group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys 2013; 87:932-8. [PMID: 24113055 PMCID: PMC3840044 DOI: 10.1016/j.ijrobp.2013.07.041] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE To give a preliminary report of clinical and treatment factors associated with toxicity in men receiving high-dose radiation therapy (RT) on a phase 3 dose-escalation trial. METHODS AND MATERIALS The trial was initiated with 3-dimensional conformal RT (3D-CRT) and amended after 1 year to allow intensity modulated RT (IMRT). Patients treated with 3D-CRT received 55.8 Gy to a planning target volume that included the prostate and seminal vesicles, then 23.4 Gy to prostate only. The IMRT patients were treated to the prostate and proximal seminal vesicles to 79.2 Gy. Common Toxicity Criteria, version 2.0, and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late morbidity scores were used for acute and late effects. RESULTS Of 763 patients randomized to the 79.2-Gy arm of Radiation Therapy Oncology Group 0126 protocol, 748 were eligible and evaluable: 491 and 257 were treated with 3D-CRT and IMRT, respectively. For both bladder and rectum, the volumes receiving 65, 70, and 75 Gy were significantly lower with IMRT (all P<.0001). For grade (G) 2+ acute gastrointestinal/genitourinary (GI/GU) toxicity, both univariate and multivariate analyses showed a statistically significant decrease in G2+ acute collective GI/GU toxicity for IMRT. There were no significant differences with 3D-CRT or IMRT for acute or late G2+ or 3+ GU toxicities. Univariate analysis showed a statistically significant decrease in late G2+ GI toxicity for IMRT (P=.039). On multivariate analysis, IMRT showed a 26% reduction in G2+ late GI toxicity (P=.099). Acute G2+ toxicity was associated with late G3+ toxicity (P=.005). With dose-volume histogram data in the multivariate analysis, RT modality was not significant, whereas white race (P=.001) and rectal V70 ≥15% were associated with G2+ rectal toxicity (P=.034). CONCLUSIONS Intensity modulated RT is associated with a significant reduction in acute G2+ GI/GU toxicity. There is a trend for a clinically meaningful reduction in late G2+ GI toxicity with IMRT. The occurrence of acute GI toxicity and large (>15%) volumes of rectum >70 Gy are associated with late rectal toxicity.
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Affiliation(s)
- Jeff M Michalski
- Department of Radiation Oncology Washington University Medical Center, St. Louis, Missouri.
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87
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Management of high-risk prostate cancer: Radiation therapy and hormonal therapy. Cancer Treat Rev 2013; 39:872-8. [DOI: 10.1016/j.ctrv.2013.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/20/2022]
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88
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Doi H, Ishimaru F, Tanooka M, Inoue H, Odawara S, Takada Y, Niwa Y, Fujiwara M, Kamikonya N, Yamamoto S, Hirota S. Body mass index can affect gastrointestinal and genitourinary toxicity in patients with prostate cancer treated with external beam radiation therapy. Oncol Lett 2013; 7:209-214. [PMID: 24348850 PMCID: PMC3861581 DOI: 10.3892/ol.2013.1658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/25/2013] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to determine the impact of obesity on radiation-induced gastrointestinal (GI) and genitourinary (GU) toxicity. The cases of 54 patients with prostate cancer, treated with three-dimensional conformal radiation therapy (RT), were reviewed. For each patient, the body mass index (BMI), distance between the prostate and rectum (D) on a computerised tomography scan and the dosimetric parameters of the rectum and bladder in the planning data of RT, were analyzed. GI and GU toxicity was assessed during and following RT. The results of the patients with a BMI of <25 (lower BMI) were compared with those of the patients with a BMI of ≥25 (higher BMI). The higher BMI group exhibited significantly lower doses of V60 and V65 in the rectum than the lower BMI group. No significant differences were found in D and bladder doses between the two groups. The incidence of acute GI and GU toxicity and late GI and GU toxicity were 41.7, 19.4, 35.3 and 5.7% in the lower BMI group, respectively, and 27.8, 27.8, 5.9 and 35.3% in the higher BMI group, respectively. In addition, a significant difference was found in the incidence of late GU toxicity between the two groups. Among patients who underwent RT for prostate cancer, those with higher BMIs had a tendency to show lower incidences of GI toxicity and higher incidences of GU toxicity than patients with lower BMIs. To conclude, an increased effort must be made to reduce rectal doses in patients with lower BMIs. Conversely, increased care for GU toxicity must be provided for overweight patients.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Fumiko Ishimaru
- Department of Clinical Radiology, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Masao Tanooka
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroyuki Inoue
- Department of Clinical Radiology, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Soichi Odawara
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yasuhiro Takada
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yasue Niwa
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Masayuki Fujiwara
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Norihiko Kamikonya
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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Pearlstein KA, Chen RC. Comparing Dosimetric, Morbidity, Quality of Life, and Cancer Control Outcomes After 3D Conformal, Intensity-Modulated, and Proton Radiation Therapy for Prostate Cancer. Semin Radiat Oncol 2013; 23:182-90. [DOI: 10.1016/j.semradonc.2013.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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90
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Valdagni R, Rancati T. Reducing rectal injury during external beam radiotherapy for prostate cancer. Nat Rev Urol 2013; 10:345-57. [PMID: 23670182 DOI: 10.1038/nrurol.2013.96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rectal bleeding and faecal incontinence are serious injuries that men with prostate cancer who receive radiotherapy can experience. Although technical advances--including the use of intensity-modulated radiotherapy coupled with image-guided radiotherapy--have enabled the delivery of dose distributions that conform to the shape of the tumour target with steep dose gradients that reduce the dose given to surrounding tissues, radiotherapy-associated toxicity can not be avoided completely. Many large-scale prospective studies have analysed the correlations of patient-related and treatment-related parameters with acute and late toxicity to optimize patient selection and treatment planning. The careful application of dose-volume constraints and the tuning of these constraints to the individual patient's characteristics are now considered the most effective ways of reducing rectal morbidity. Additionally, the use of endorectal balloons (to reduce the margins between the clinical target volume and planning target volume) and the insertion of tissue spacers into the region between the prostate and anterior rectal wall have been investigated as means to further reduce late rectal injury. Finally, some drugs and other compounds are also being considered to help protect healthy tissue. Overall, a number of approaches exist that must be fully explored in large prospective trials to address the important issue of rectal toxicity in prostate cancer radiotherapy.
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Affiliation(s)
- Riccardo Valdagni
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan 20133, Italy
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91
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Song DY, Herfarth KK, Uhl M, Eble MJ, Pinkawa M, van Triest B, Kalisvaart R, Weber DC, Miralbell R, Deweese TL, Ford EC. A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: analysis of dosimetric outcomes. Int J Radiat Oncol Biol Phys 2013; 87:81-7. [PMID: 23414766 DOI: 10.1016/j.ijrobp.2012.12.019] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To characterize the effect of a prostate-rectum spacer on dose to rectum during external beam radiation therapy for prostate cancer and to assess for factors correlated with rectal dose reduction. METHODS AND MATERIALS Fifty-two patients at 4 institutions were enrolled into a prospective pilot clinical trial. Patients underwent baseline scans and then were injected with perirectal spacing hydrogel and rescanned. Intensity modulated radiation therapy plans were created on both scans for comparison. The objectives were to establish rates of creation of ≥ 7.5 mm of prostate-rectal separation, and decrease in rectal V70 of ≥ 25%. Multiple regression analysis was performed to evaluate the associations between preinjection and postinjection changes in rectal V70 and changes in plan conformity, rectal volume, bladder volume, bladder V70, planning target volume (PTV), and postinjection midgland separation, gel volume, gel thickness, length of PTV/gel contact, and gel left-to-right symmetry. RESULTS Hydrogel resulted in ≥7.5-mm prostate-rectal separation in 95.8% of patients; 95.7% had decreased rectal V70 of ≥ 25%, with a mean reduction of 8.0 Gy. There were no significant differences in preinjection and postinjection prostate, PTV, rectal, and bladder volumes. Plan conformities were significantly different before versus after injection (P=.02); plans with worse conformity indexes after injection compared with before injection (n=13) still had improvements in rectal V70. In multiple regression analysis, greater postinjection reduction in V70 was associated with decreased relative postinjection plan conformity (P=.01). Reductions in V70 did not significantly vary by institution, despite significant interinstitutional variations in plan conformity. There were no significant relationships between reduction in V70 and the other characteristics analyzed. CONCLUSIONS Injection of hydrogel into the prostate-rectal interface resulted in dose reductions to rectum for >90% of patients treated. Rectal sparing was statistically significant across a range of 10 to 75 Gy and was demonstrated within the presence of significant interinstitutional variability in plan conformity, target definitions, and injection results.
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Affiliation(s)
- Danny Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
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Gloi AM, Buchanan R. Dosimetric assessment of prostate cancer patients through principal component analysis (PCA). J Appl Clin Med Phys 2013; 14:3882. [PMID: 23318379 PMCID: PMC5713663 DOI: 10.1120/jacmp.v14i1.3882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 08/23/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022] Open
Abstract
The aims of this study were twofold: first, to determine the impact of variance in dose-volume histograms (DVH) on patient-specific toxicity after 2 high-dose fractions in a sample of 22 men with prostate cancer; and second, to compare the effectiveness of traditional DVH analysis and principal component analysis (PCA) in predicting rectum and urethra toxicity. A series of 22 patients diagnosed with prostate adenocarcinoma was treated with 45 Gy external beam and 20 Gy dose rate brachytherapy. Principal component analysis was applied to model the shapes of the rectum and urethra dose-volume histograms. We used logistic regression to measure the correlations between the principal components and the incidence of rectal bleeding and urethra stricture. We also calculated the equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) for the urethra and rectum, and tumor control probability (TCP) for the prostate using BioSuite software. We evaluated their correlations with rectal and urethra toxicity. The rectum DVHs are well described by one principal component (PC1), which accounts for 93.5% of the variance in their shapes. The urethra DVHs are described by two principal components, PC1 and PC2, which account for 94.98% and 3.15% of the variance, respectively. Multivariate exact logistic regression suggests that urethra PC2 is a good predictor of stricture, with Nagelkerke's R2 estimated at 0.798 and a Wald criterion of 5.421 (p < 0.021). The average NTCPs were 0.06% ± 0.04% and 1.25% ± 0.22% for the rectum and urethra, respectively. The average TCP was 85.29% ± 2.28%. This study suggests that principal component analysis can be used to identify the shape variation in dose-volume histograms, and that the principal components can be correlated with the toxicity of a treatment plan based on multivariate analysis. The principal components are also correlated with traditional dosimetric parameters.
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Affiliation(s)
- Aime M Gloi
- Department of Radiation Oncology, St Vincent Hospital, Green Bay, WI 54307, USA.
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93
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Lee R, Chan EK, Kosztyla R, Liu M, Moiseenko V. Dose-distance metric that predicts late rectal bleeding in patients receiving radical prostate external-beam radiotherapy. Phys Med Biol 2012. [PMID: 23190583 DOI: 10.1088/0031-9155/57/24/8297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The relationship between rectal dose distribution and the incidence of late rectal complications following external-beam radiotherapy has been previously studied using dose-volume histograms or dose-surface histograms. However, they do not account for the spatial dose distribution. This study proposes a metric based on both surface dose and distance that can predict the incidence of rectal bleeding in prostate cancer patients treated with radical radiotherapy. One hundred and forty-four patients treated with radical radiotherapy for prostate cancer were prospectively followed to record the incidence of grade ≥2 rectal bleeding. Radiotherapy plans were used to evaluate a dose-distance metric that accounts for the dose and its spatial distribution on the rectal surface, characterized by a logistic weighting function with slope a and inflection point d₀. This was compared to the effective dose obtained from dose-surface histograms, characterized by the parameter n which describes sensitivity to hot spots. The log-rank test was used to determine statistically significant (p < 0.05) cut-off values for the dose-distance metric and effective dose that predict for the occurrence of rectal bleeding. For the dose-distance metric, only d₀ = 25 and 30 mm combined with a > 5 led to statistical significant cut-offs. For the effective dose metric, only values of n in the range 0.07-0.35 led to statistically significant cut-offs. The proposed dose-distance metric is a predictor of rectal bleeding in prostate cancer patients treated with radiotherapy. Both the dose-distance metric and the effective dose metric indicate that the incidence of grade ≥2 rectal bleeding is sensitive to localized damage to the rectal surface.
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Affiliation(s)
- Richard Lee
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, 600 West 10th Ave, Vancouver, BC V5Z 4E6, Canada
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94
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Yang B, Zhu L, Cheng H, Li Q, Zhang Y, Zhao Y. Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis. Radiat Oncol 2012; 7:197. [PMID: 23176540 PMCID: PMC3539899 DOI: 10.1186/1748-717x-7-197] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 09/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose-volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis. METHODS Relevant articles were retrieved from the PubMed, Embase, and Cochrane Library databases up to August 2011. Two independent reviewers assessed the included studies and extracted data. Pooled average percent irradiated volumes of adjacent non-cancerous tissues were calculated and compared between IMRT and 3D-CRT for a range of common radiation doses (5-45 Gy). RESULTS In total, 13 articles comprised of 222 IMRT-treated and 233 3D-CRT-treated patients were included. For rectum receiving doses ≥30 Gy, the IMRT pooled average irradiated volumes were less than those from 3D-CRT by 26.40% (30 Gy, p = 0.004), 27.00% (35 Gy, p = 0.040), 37.30% (40 Gy, p = 0.006), and 39.50% (45 Gy, p = 0.002). Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT. However, there were no significant differences in the IMRT and 3D-CRT pooled average percent volumes of irradiated small bowel or rectum from lower doses, or in the bladder or bone marrow from any of the doses. IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients. CONCLUSIONS IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.
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Affiliation(s)
- Baojuan Yang
- Department of Gynecologic Oncology, Cancer Hospital of Harbin Medical University, 150 Haping Street, Nangang District, Harbin, Heilongjiang Province, PR China
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95
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Role of early proctoscopy in predicting late symptomatic proctitis after external radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 2012; 85:1031-7. [PMID: 22975612 DOI: 10.1016/j.ijrobp.2012.07.2373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/27/2012] [Accepted: 07/28/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine whether acute radiation-proctitis, diagnosed by proctoscopy after radiation therapy for prostate cancer, can predict late clinical proctitis. METHODS AND MATERIALS A prospective study of 130 patients who underwent external radiation therapy (RT) for stage T1 to T4 prostate cancer between 1997 and 2008 was performed. Treatments were conventional (2-dimensional [2D]) in 61 patients and 3D conformal in 69, with a median target dose of 72 Gy (70-74 Gy). Within 1 week after RT, proctoscopy was performed to detect possible acute endoscopic proctitis (AEP). Acute clinical proctitis (ACP) and late clinical proctitis (LCP) were also evaluated. The median follow-up was 84 months (20-180 months). The influence of AEP and ACP on LCP occurrence was studied using the Cox model controlling for age, dose, prostatectomy, RT technique (2D vs 3D), and hormone therapy. RESULTS AEP was detected in 15 patients (11.5%) and ACP in 67 (51.5%); in 13 cases (10%) AEP and ACP occurred simultaneously. Thirty-five cases of LCP were recorded. The 5-year probability of developing LCP was highest in patients with AEP and ACP (77%, 95% confidence interval [CI] 53%-94%) and lowest in asymptomatic patients (14%, 95% CI 7%-26%; P<.001). Compared to asymptomatic patients, the 5-year probability also was slightly increased in patients with ACP only (26%, 95% CI 16%-40%; P=.052). In multivariable analysis, the combination of AEP and ACP was the main predictor of LCP: compared to asymptomatic patients, the hazard ratio was 5.6 (2.1-15.2) in patients with AEP plus ACP (P=.001) and 2.1 (0.9-4.9) in those with ACP only (P=.103). CONCLUSIONS In patients with AEP and ACP, the risk of LCP was more than 5-fold increased compared to those who were asymptomatic, while a much smaller increase in risk occurred in patients with ACP only. Early proctoscopy can provide valuable information regarding the likelihood of late proctitis.
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96
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Murthy V, Shukla P, Adurkar P, Master Z, Mahantshetty U, Shrivastava S. Predicting Rectal and Bladder Overdose During the Course of Prostate Radiotherapy Using Dose-Volume Data From Initial Treatment Fractions. Int J Radiat Oncol Biol Phys 2012; 84:119-24. [DOI: 10.1016/j.ijrobp.2011.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 10/30/2011] [Accepted: 11/01/2011] [Indexed: 11/26/2022]
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97
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Buettner F, Gulliford SL, Webb S, Sydes MR, Dearnaley DP, Partridge M. The dose-response of the anal sphincter region--an analysis of data from the MRC RT01 trial. Radiother Oncol 2012; 103:347-52. [PMID: 22520267 DOI: 10.1016/j.radonc.2012.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 02/15/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE Most studies investigating the dose-response of the rectum focus on rectal bleeding. However, it has been reported that other symptoms such as urgency or sphincter control have a large impact on quality-of-life and that different symptoms are related to the dose to different parts of the anorectal wall. In this study correlations between the 3D dose distribution to the anal-sphincter region and radiation-induced side-effects were quantified. MATERIALS AND METHODS Dose-surface maps of the anal canal were generated. Next, longitudinal and lateral extent and eccentricity were calculated at different dose levels; DSHs and DVHs were also determined. Correlations between these dosimetric measures and seven clinically relevant endpoints were determined by assessing dosimetric constraints. Furthermore, an LKB model was generated. The study was performed using the data of 388 prostate patients from the RT01 trial (ISRCTN 47772397). RESULTS Subjective sphincter control was significantly correlated with the dose to the anal surface. The strongest correlations were found for lateral extent at 53 Gy (p=0.01). Outcome was also significantly correlated with the DSH and the mean dose to the anal surface. CONCLUSIONS The dose to the anal sphincter region should be taken into account when generating treatment-plans. This could be done using shape-based tools, DSH/DVH-based tools or an NTCP model.
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Affiliation(s)
- Florian Buettner
- Joint Department of Physics, Institute of Cancer Research, Surrey, UK.
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98
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Bujold A, Craig T, Jaffray D, Dawson LA. Image-guided radiotherapy: has it influenced patient outcomes? Semin Radiat Oncol 2012; 22:50-61. [PMID: 22177878 DOI: 10.1016/j.semradonc.2011.09.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cancer control and toxicity outcomes are the mainstay of evidence-based medicine in radiation oncology. However, radiotherapy is an intricate therapy involving numerous processes that need to be executed appropriately in order for the therapy to be delivered successfully. The use of image-guided radiation therapy (IGRT), referring to imaging occurring in the radiation therapy room with per-patient adjustments, can increase the agreement between the planned and the actual dose delivered. However, the absence of direct evidence regarding the clinical benefit of IGRT has been a criticism. Here, we dissect the role of IGRT in the radiotherapy (RT) process and emphasize its role in improving the quality of the intervention. The literature is reviewed to collect evidence that supports that higher-quality dose delivery enabled by IGRT results in higher clinical control rates, reduced toxicity, and new treatment options for patients that previously were without viable options.
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Affiliation(s)
- Alexis Bujold
- Département de Radio-Oncologie Clinique-Enseignement-Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
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99
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Krol R, Hopman WPM, Smeenk RJ, Van Lin ENJT. Increased rectal wall stiffness after prostate radiotherapy: relation with fecal urgency. Neurogastroenterol Motil 2012; 24:339-e166. [PMID: 22235913 DOI: 10.1111/j.1365-2982.2011.01858.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Late anorectal toxicity is a frequent adverse event of external beam radiotherapy (EBRT) for prostate cancer. The pathophysiology of anorectal toxicity remains unknown, but we speculate that rectal distensibility is impaired due to fibrosis. Our goal was to determine whether EBRT induces changes of rectal distensibility as measured by an electronic barostat and to explore whether anorectal complaints are related to specific changes of anorectal function. METHODS Thirty-two men, irradiated for localized prostate carcinoma, underwent barostat measurements, anorectal manometry, and completed a questionnaire prior to and 1 year after radiotherapy. The primary outcome measure was rectal distensibility in response to stepwise isobaric distensions. In addition, we assessed sensory thresholds, anal pressures, and anorectal complaints. KEY RESULTS External beam radiotherapy reduced maximal rectal capacity (227 ± 14 mL vs 277 ± 15 mL; P < 0.001), area under the pressure-volume curve (3212 ± 352 mL mmHg vs 3969 ± 413 mL mmHg; P < 0.005), and rectal compliance (15.7 ± 1.2 mL mmHg(-1) vs 17.6 ± 0.9 mL mmHg(-1) ; P = 0.12). Sensory pressure thresholds did not significantly change. Sixteen of the 32 patients (50%) had one or more anorectal complaints. Patients with urgency (n = 10) had a more reduced anal squeeze and maximum pressure (decrease 29 ± 11 mmHg vs 1 ± 7 mmHg; P < 0.05 and 31 ± 12 mmHg vs 2 ± 8 mmHg; P < 0.05 respectively) compared with patients without complaints, indicating a deteriorated external anal sphincter function. CONCLUSIONS & INFERENCES Irradiation for prostate cancer leads to reduced rectal distensibility. In patients with urgency symptoms, anal sphincter function was also impaired.
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Affiliation(s)
- R Krol
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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100
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Leborgne F, Fowler J, Leborgne JH, Mezzera J. Later Outcomes and Alpha/Beta Estimate From Hypofractionated Conformal Three-Dimensional Radiotherapy Versus Standard Fractionation for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2012; 82:1200-7. [DOI: 10.1016/j.ijrobp.2010.12.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/26/2022]
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