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de Chavez R, Grogan G, Hug B, Howe K, Grigg A, Waterhouse D, Lane J, Glyde A, Brown E, Bydder S, Pryor D, Hargrave C, Charles PH, Hellyer J, Ebert MA. Assessment of HDR brachytherapy-replicating prostate radiotherapy planning for tomotherapy, cyberknife and VMAT. Med Dosim 2021; 47:61-69. [PMID: 34551879 DOI: 10.1016/j.meddos.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
A dosimetric study was undertaken to assess the ability of Cyberknife (CK), Volumetric Modulated Arc Therapy (VMAT), and TomoTherapy (Tomo) to generate treatment plans that mimic the dosimetry of high dose-rate brachytherapy (HDR BT) for prostate cancer. The project aimed to assess the potential of using stereotactic body radiotherapy (SBRT) for boost treatment of high-risk prostate cancer patients where HDR BT in combination with conformal external beam radiotherapy (EBRT) is the standard of care. The datasets of 6 prostate patients previously treated with HDR BT were collated. VMAT, CK, and TomoTherapy treatment plans were generated for each dataset using the target and organ-at-risk structures as defined by the Radiation Oncologist during the HDR BT treatment process. The HDR BT plan isodoses were also converted into planning structures to assist the other modalities to achieve a HDR BT-like dose distribution. CK plans were created using both the iris collimator (IC) and a multileaf collimator (MLC). Comparison of the techniques was made based on dose-volume indices. Each plan was created at centres experienced using the respective treatment planning systems (TPS). Planning target volume (PTV V100%), i.e., the volume of the planning target volume (PTV) receiving 100% of the relative dose, in VMAT and TomoTherapy SBRT plans was higher than HDR BT plans. PTV V150% and V200%, i.e., volume of the PTV receiving 150% and 200% of the relative dose, were approached on all the CK MLC and TomoTherapy SBRT plans. However, it is not presently achievable for "virtual brachytherapy" SBRT to replicate the same high intraprostatic doses as HDR BT while meeting the constraints on the organs-at-risk (OARs). Half of the CK IC plans achieved PTV V150% but this was at the expense of high rectal dose. TomoTherapy and CK MLC plans achieved PTV V150% and V200% but the bladder dose was higher compared to CK IC plans. VMAT exhibited excellent PTV coverage based on V100 and OAR sparing, but without any ability to achieve the high intra-prostatic doses of HDR (V150% and V200%). SBRT techniques can be used to deliver hypofractionated radiotherapy to the PTV V100%. Based on the comparison of "physical" dose distributions, SBRT cannot presently achieve the same high intraprostatic doses as HDR BT while respecting the OAR constraints. SBRT still remains an attractive treatment option for delivering hypofractionated treatments for prostate cancer compared to HDR BT, in particular as it is less invasive and less resource intensive. Long-term outcomes of clinical trials comparing HDR BT and SBRT "prostate boosts" may show whether the high intraprostatic doses are clinically significant and correlate with outcomes.
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Affiliation(s)
- Romena de Chavez
- Princess Alexandra Hospital, Brisbane, Australia; GenesisCare, Australia.
| | - Garry Grogan
- Sir Charles Gairdner Hospital, Perth, Australia.
| | - Ben Hug
- 5D Clinics, Perth, Australia.
| | - Kate Howe
- Princess Alexandra Hospital, Brisbane, Australia.
| | - Alice Grigg
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - David Waterhouse
- Sir Charles Gairdner Hospital, Perth, Australia; GenesisCare, Australia.
| | | | - Alan Glyde
- Princess Alexandra Hospital, Brisbane, Australia.
| | | | - Sean Bydder
- Sir Charles Gairdner Hospital, Perth, Australia; 5D Clinics, Perth, Australia.
| | - David Pryor
- Princess Alexandra Hospital, Brisbane, Australia.
| | - Cathy Hargrave
- Princess Alexandra Hospital, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Paul H Charles
- Princess Alexandra Hospital, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia; Herston Biofabrication Institute, Brisbane, Australia; School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Brisbane, Australia; School of Chemistry and Physics, Queensland University of Technology, Brisbane, Australia.
| | | | - Martin A Ebert
- Sir Charles Gairdner Hospital, Perth, Australia; 5D Clinics, Perth, Australia; University of Western Australia, Perth, Australia.
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Pokhrel D, Tackett T, Stephen J, Visak J, Amin-Zimmerman F, McGregor A, Strup SE, St Clair W. Prostate SBRT using O-Ring Halcyon Linac - Plan quality, delivery efficiency, and accuracy. J Appl Clin Med Phys 2020; 22:68-75. [PMID: 33340388 PMCID: PMC7856496 DOI: 10.1002/acm2.13105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 12/31/2022] Open
Abstract
Cone beam CT‐guided prostate stereotactic body radiotherapy (SBRT) treatment on the recently installed novel O‐ring coplanar geometry Halcyon Linac with a single energy 6MV‐flattening filter free (FFF) beam and volumetric modulated arc therapy (VMAT) is a fast, safe, and feasible treatment modality for early stage low‐ and intermediate‐risk prostate cancer patients. Following the RTOG‐0938 compliance criteria and utilizing two‐full arc geometry, VMAT prostate SBRT plans were generated for ten consecutive patients using advanced Acuros‐based algorithm for heterogeneity corrections with Halcyon couch insert. Halcyon VMAT plans with the stacked and staggered multileaf collimators (MLC) produced highly conformal SBRT dose distributions to the prostate, lower intermediate dose spillage and similar dose to adjacent organs‐at‐risks (OARs) compared to SBRT‐dedicated Truebeam VMAT plans. Due to lower monitor units per fraction and less MLC modulation through the target, the Halcyon VMAT plan can deliver prostate SBRT fractions in and overall treatment time of less than 10 minutes (for 36.25 Gy in five fractions), significantly improving patient compliance and clinic workflow. Pretreatment quality assurance results were similar to Truebeam VMAT plans. We have implemented Halcyon Linac for prostate SBRT treatment in our institution. We recommend that others use Halcyon for prostate SBRT treatments to expand the access of curative hypofractionated treatments to other clinics only equipped with a Halcyon Linac. Clinical follow‐up results for patients who underwent prostate SBRT treatment on our Halcyon Linac is underway.
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Affiliation(s)
- Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
| | - Tanner Tackett
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
| | - Joseph Stephen
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
| | - Justin Visak
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Andrew McGregor
- Lexington Clinic, University of Kentucky, Lexington, KY, USA
| | - Stephen E Strup
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - William St Clair
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
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Lapierre A, Horn S, Créhange G, Enachescu C, Latorzeff I, Supiot S, Sargos P, Hennequin C, Chapet O. Radiothérapie stéréotaxique extracrânienne : quelle machine pour quelle indication ? Stéréotaxie prostatique. Cancer Radiother 2019; 23:651-657. [DOI: 10.1016/j.canrad.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
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Kishan AU, King CR. Stereotactic Body Radiotherapy for Low- and Intermediate-Risk Prostate Cancer. Semin Radiat Oncol 2017; 27:268-278. [PMID: 28577834 DOI: 10.1016/j.semradonc.2017.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With over a decade׳s worth of clinical experience to guide stereotactic body radiotherapy (SBRT) for the treatment of clinically localized prostate cancer (PCa), sufficient data exist for robust conclusions to be made regarding its efficacy and the toxicities associated with this treatment. We briefly review the fundamental radiobiological basis of SBRT for PCa and provide a comprehensive synthesis of the medical literature to date, focusing on clinical outcomes and toxicities. When possible, we draw comparisons to comparable data for conventionally fractionated radiotherapy. Finally, a brief overview of technical considerations is presented. Although randomized clinical trials comparing SBRT with conventionally fractionated radiotherapy are underway, the current body of evidence supports the efficacy and safety of SBRT for PCa.
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Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
| | - Christopher R King
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
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Avkshtol V, Dong Y, Hayes SB, Hallman MA, Price RA, Sobczak ML, Horwitz EM, Zaorsky NG. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer. Res Rep Urol 2016; 8:145-58. [PMID: 27574585 PMCID: PMC4993397 DOI: 10.2147/rru.s58262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years) and acute and late toxicity (<6% grade 3–4 late toxicities). Other outcomes (eg, overall and cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.
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Affiliation(s)
- Vladimir Avkshtol
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Yanqun Dong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark L Sobczak
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Mancosu P, Clemente S, Landoni V, Ruggieri R, Alongi F, Scorsetti M, Stasi M. SBRT for prostate cancer: Challenges and features from a physicist prospective. Phys Med 2016; 32:479-84. [PMID: 27061869 DOI: 10.1016/j.ejmp.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/26/2023] Open
Abstract
Emerging data are showing the safety and the efficacy of Stereotactic Body Radiation Therapy (SBRT) in prostate cancer management. In this context, the medical physicists are regularly involved to review the appropriateness of the adopted technology and to proactively study new solutions. From the physics point of view there are two major challenges in prostate SBRT: (1) mitigation of geometrical uncertainty and (2) generation of highly conformal dose distributions that maximally spare the OARs. Geometrical uncertainties have to be limited as much as possible in order to avoid the use of large PTV margins. Furthermore, advanced planning and delivery techniques are needed to generate maximally conformal dose distributions. In this non-systematic review the technology and the physics aspects of SBRT for prostate cancer were analyzed. In details, the aims were: (i) to describe the rationale of reducing the number of fractions (i.e. increasing the dose per fraction), (ii) to analyze the features to be accounted for performing an extreme hypo-fractionation scheme (>6-7Gy), and (iii) to describe technological solutions for treating in a safe way. The analysis of outcomes, toxicities, and other clinical aspects are not object of the present evaluation.
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Affiliation(s)
- Pietro Mancosu
- Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.
| | | | | | | | - Filippo Alongi
- Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Michele Stasi
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
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Musunuru HB, Loblaw A. Clinical trials of stereotactic ablative radiotherapy for prostate cancer: updates and future direction. Future Oncol 2015; 11:819-31. [PMID: 25757684 DOI: 10.2217/fon.15.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Stereotactic body radiotherapy, also known as stereotactic ablative body radiotherapy (SABR), is an emerging treatment option for lung, prostate, liver and other tumors. Key factors in SABR are delivery of a high-dose radiation per fraction, proper patient positioning and target localization. Our review details the various radiotherapy techniques, dose fractionation schedules and toxicities for prostate SABR. Ongoing Phase II/III SABR studies across various risk groups have been included. It also discusses the role of conscientious focal dose escalation of the dominant intraprostatic nodule, integrating multiparametric MRI into radiotherapy protocols and finally cost-effectiveness of SABR.
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Affiliation(s)
- H Bindu Musunuru
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Macias VA, Blanco ML, Barrera I, Garcia R. A Phase II Study of Stereotactic Body Radiation Therapy for Low-Intermediate-High-Risk Prostate Cancer Using Helical Tomotherapy: Dose-Volumetric Parameters Predicting Early Toxicity. Front Oncol 2014; 4:336. [PMID: 25505734 PMCID: PMC4244529 DOI: 10.3389/fonc.2014.00336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
Endpoint: To assess early urinary (GU) and rectal (GI) toxicities after helical tomotherapy Stereotactic body radiation therapy (SBRT), and to determine their predictive factors. Methods: Since May 2012, 45 prostate cancer patients were treated with eight fractions of 5.48 (low risk, 29%) or 5.65 Gy (intermediate-high risk, 71%) on alternative days over 2.5 weeks. The exclusion criteria were Gleason score 9–10, PSA >40 ng/mL, cT3b-4, IPSS ≥20, and history of acute urinary retention. During the follow-up, a set of potential prognostic factors was correlated with urinary or rectal toxicity. Results: The median follow-up was 13.8 months (2–25 months). There were no grade ≥3 toxicities. Acute grade 2 GU complications were found in a 22.7% of men, but in 2.3% of patients at 1 month, 0% at 6 months, and 0% at 12 months. The correspondent figures for grade 2 GI toxicities were 20.4% (acute), 2.3% (1 month), 3.6% (6 months), and 5% (12 months). Acute GI toxicity was significantly correlated with the rectal volume (>15 cm3) receiving 28 Gy, only when expressed as absolute volume. The age (>72 years old) was a predictor of GI toxicity after 1 month of treatment. No correlation was found, however, between urinary toxicity and the other analyzed variables. IPSS increased significantly at the time of the last fraction and within the first month, returning to the baseline at sixth month. Urinary-related quality of life (IPSS question 8 score), it was not significantly worsen during radiotherapy returning to the baseline levels 1 month after the treatment. At 12 months follow-up patient’s perception of their urinary function improved significantly in comparison with the baseline. Conclusion: Our scheme of eight fractions on alternative days delivered using helical tomotherapy is well tolerated. We recommend using actual volume instead of percentual volume in the treatment planning, and not to exceed 15 cm3 of rectal volume receiving ≥25 Gy in order to diminish acute GI toxicity.
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Affiliation(s)
- Victor A Macias
- Radiation Oncology Department, Salamanca University Hospital , Salamanca , Spain
| | - Manuel L Blanco
- Radiation Oncology Department, Salamanca University Hospital , Salamanca , Spain
| | | | - Rafael Garcia
- Radiation Oncology Department, CyberKnife Unit, IMO Group , Madrid , Spain
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Lee HC, Kim SH, Suh YJ, Chung MJ, Kang DG, Choi HJ, Lee JH. A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer. Radiat Oncol 2014; 9:244. [PMID: 25410791 PMCID: PMC4244044 DOI: 10.1186/s13014-014-0244-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/30/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the technical feasibility and toxicity of TomoDirect in breast cancer patients who received radiotherapy after breast-conserving surgery. METHODS 155 consecutive patients with breast carcinoma in situ or T1-2 breast cancer with negative lymph node received breast irradiation with TomoDirect using simultaneous integrated boost technique in the prospective cohort study. A radiation dose of 50.4 Gy and 57.4 Gy in 28 fractions was prescribed to the ipsilateral breast and tumor bed, respectively. Dosimetric parameters of target and organ at risk and acute complication were assessed prospectively. RESULTS The mean dose for the tumor bed is 58.90 Gy. The mean values of V54.53Gy (95% of the prescribed dose), V63.14Gy (110% of the prescribed dose), and V66.01Gy (115% of the prescribed dose) were 99.97%, 1.26%, and 0%, respectively. The mean value of radiation conformality index was 1.01. The mean value of radical dose homogeneity index was 0.89. The average dose irradiated to the ipsilateral lung, heart, and contralateral breast was 4.72 Gy, 1.09 Gy, and 0.19 Gy, respectively. The most common toxicity was dermatitis. During breast irradiation, grade 2 and 3 dermatitis occurred in 41 (26.5%) and 6 (3.9%) of the 155 patients, respectively. Two patients had arm lymphedema during breast irradiation. Two patients had grade 2 pneumonitis 1 month after breast irradiation. CONCLUSIONS Radiotherapy using TomoDirect in early breast cancer patients showed acceptable toxicities and optimal results in terms of target coverage and organ at risk sparing.
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Affiliation(s)
- Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Young Jin Suh
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Mi Joo Chung
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Dae Gyu Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Hyun Joo Choi
- Department of Hospital Pathology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
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Musunuru HB, Cheung P, Loblaw A. Evolution of hypofractionated accelerated radiotherapy for prostate cancer - the sunnybrook experience. Front Oncol 2014; 4:313. [PMID: 25452934 PMCID: PMC4231839 DOI: 10.3389/fonc.2014.00313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/20/2014] [Indexed: 11/13/2022] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) is a newer method of ultra hypo fractionated radiotherapy that uses combination of image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT), to deliver high doses of radiation in a few fractions to a target, at the same time sparing the surrounding organs at risk (OAR). SABR is ideal for treating small volumes of disease and has been introduced in a number of disease sites including brain, lung, liver, spine, and prostate. Given the radiobiological advantages of treating prostate cancer with high doses per fraction, SABR is becoming a standard of care for low and intermediate-risk prostate cancer patients based upon the results from Sunnybrook and also the US-based prostate SABR consortium. This review examines the development of moderate and ultra hypo-fractionation schedules at the Odette Cancer centre, Sunnybrook Health Sciences. Moderate hypo-fractionation protocol was first developed in 2001 for intermediate-risk prostate cancer and from there on different treatment schedules including SABR evolved for all risk groups.
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Affiliation(s)
- Hima Bindu Musunuru
- Odette Cancer Centre, Sunnybrook Health Sciences Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada ; Department of Health Policy, Measurement and Evaluation, University of Toronto , Toronto, ON , Canada
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