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Ma TM, Ladbury C, Tran M, Keiper TD, Andraos T, Gogineni E, Mohideen N, Siva S, Loblaw A, Tree AC, Cheung P, Kresl J, Collins S, Cao M, Kishan AU. Stereotactic Body Radiation Therapy: A Radiosurgery Society Guide to the Treatment of Localized Prostate Cancer Illustrated by Challenging Cases. Pract Radiat Oncol 2024; 14:e117-e131. [PMID: 37661040 DOI: 10.1016/j.prro.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
Traditionally, external beam radiotherapy (EBRT) for localized prostate cancer (PCa) involved lengthy courses with low daily doses. However, advancements in radiation delivery and a better understanding of prostate radiobiology have enabled the development of shorter courses of EBRT. Ultrahypofractionated radiotherapy, administering doses greater than 5 Gy per fraction, is now considered a standard of care regimen for localized PCa, particularly for intermediate-risk disease. Stereotactic body radiotherapy (SBRT), a specific type of ultrahypofractionated radiotherapy employing advanced planning, imaging, and treatment technology to deliver in five or fewer fractions, is gaining prominence as a cost-effective, convenient, and safe alternative to longer radiotherapy courses. It is crucial to address practical considerations related to patient selection, fractionation scheme, target delineation, and planning objectives. This is especially important in challenging clinical situations where clear evidence for guidance may be lacking. The Radiosurgery Society endorses this case-based guide with the aim of providing a practical framework for delivering SBRT to the intact prostate, exemplified by two case studies. The article will explore common SBRT dose/fractionation schemes and dose constraints for organs-at-risk. Additionally, it will review existing evidence and expert opinions on topics such as SBRT dose escalation, the use of rectal spacers, the role of androgen deprivation therapy in the context of SBRT, SBRT in special patient populations (e.g., high-risk disease, large prostate, high baseline urinary symptom burdens, and inflammatory bowel disease), as well as new imaging-guidance techniques like Magnetic Resonance Imaging for SBRT delivery.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Maxwell Tran
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Timothy D Keiper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Therese Andraos
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Najeeb Mohideen
- Department of Radiation Oncology, Northwest Community Hospital, Arlington Heights, Illinois
| | - Shankar Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Patrick Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Kresl
- Phoenix CyberKnife and Radiation Oncology Center, Phoenix, Arizona
| | - Sean Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, D.C
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; Department of Urology, University of California Los Angeles, Los Angeles, California.
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Sturt P, Suh YE, Khoo V. The dosimetric advantages of perirectal hydrogel spacer in men with localized prostate cancer undergoing stereotactic ablative radiotherapy (SABR). Med Dosim 2022; 47:173-176. [PMID: 35277316 DOI: 10.1016/j.meddos.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/04/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
To evaluate the dosimetric differences for patients receiving a perirectal hydrogel spacer (PR-HS) using SpaceOAR undergoing stereotactic ablative radiotherapy (SABR) for localized prostate cancer with the CyberKnife VSI system. Gold fiducial markers and a PR-HS was inserted in 22 consecutive patients with histologically confirmed localized prostate cancer. For planning comparison, dosimetry from the clinical plans was compared against replans based on a simulated rectum volume designed to recreate a clinically appropriate spacer-less anatomy for each patient. Both sets were planned to 36.25 Gy in 5 fractions using the treatment planning system associated with the CyberKnife VSI system. The aim was to ensure equivalent target coverage for both plans and to evaluate doses to the organs-at-risk (OARs): rectum, bladder and penile bulb. The median PR-HS implant volume was 11.2 cc (range 8.8 to 14.9 cc). The maximal median perirectal separation was 15.5 mm (10.5 to 20.7 mm). Statistically significant reductions were noted for the 3 OARs, with no statistically significant difference in planning target volumes or clinical target volume coverage. All rectal dose constraints were significantly improved in the PR-HS plans with a percentage dose difference of at least 24% (rectum V18.1Gy (%)) to 60.5% (rectum V36Gy (cc)). The bladder and penile bulb dose constraints parameters were also significantly improved: the bladder V37Gy was reduced by 17.1%, V18.1Gy was reduced by 4.2%; the penile bulb D50% was reduced by 7.7%. The use of PR-HS was able to significantly reduce planned dose to the rectum, bladder and penile bulb with SABR techniques associated with the CyberKnife VSI system.
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Affiliation(s)
- Philippa Sturt
- Department of Physics, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Yae-Eun Suh
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
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Manabe Y, Hashimoto S, Mukouyama H, Shibamoto Y. Stereotactic body radiotherapy using a hydrogel spacer for localized prostate cancer: A dosimetric comparison between tomotherapy with the newly-developed tumor-tracking system and cyberknife. J Appl Clin Med Phys 2021; 22:66-72. [PMID: 34415658 PMCID: PMC8504610 DOI: 10.1002/acm2.13395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose With a new tumor‐tracking system (Synchrony®) for tomotherapy (Radixact®), the internal and set‐up margins can be tightened, like cyberknife (CyberKnife®), in the planning of stereotactic body radiotherapy (SBRT) for prostate cancer. Recently, the usefulness of placing a hydrogel spacer between the prostate and rectum has been established in prostate radiotherapy. We evaluated the characteristics of tomotherapy plans with the tumor‐tracking system and compared them with cyberknife SBRT plans for localized prostate cancer using a hydrogel spacer. Methods In 20 patients, two plans were created and compared using tomotherapy and cyberknife. All patients underwent hydrogel spacer injection behind the prostate before simulation CT and MRI for fusion. For all plans, 36.25 Gy in 7.25‐Gy fractions for a minimum coverage dose of 95% of planning target volume (PTV) (D95%) was prescribed. The D99% of PTV and D0.1 ml of the PTV, urethra, bladder, and rectum were intended to be > 90%, 110–130%, 100–110%, <110%, and <100%, respectively, of the prescribed doses. Results All plans using tomotherapy and cyberknife achieved the intended dose constraints. The cyberknife plans yielded better median PTV‐V110% (volume of PTV covered by 110% isodose line, 54.8%), maintaining lower median D0.1 ml of the urethra (37.5 Gy) and V80% of the bladder (11.0 ml) compared to the tomotherapy plans (39.0%; p < 0.0001, 38.2 Gy; p < 0.0001, and 18.3 ml; p < 0.0001, respectively). The tomotherapy plans were superior to the cyberknife plans for the rectum (V80% = 0.4 vs. 1.0 ml, p < 0.001; D1ml = 26.4 vs. 29.0 Gy, p = 0.013). Conclusions Our results suggested that tomotherapy with the tumor‐tracking system has reasonable potential for SBRT for localized prostate cancer using a hydrogel spacer.
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Affiliation(s)
- Yoshihiko Manabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.,Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Seiji Hashimoto
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Hideki Mukouyama
- Department of Urology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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