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Cellini F, Tagliaferri L, Frascino V, Alitto AR, Fionda B, Boldrini L, Romano A, Casà C, Catucci F, Mattiucci GC, Valentini V. Radiation therapy for prostate cancer: What's the best in 2021. Urologia 2022; 89:5-15. [PMID: 34496707 DOI: 10.1177/03915603211042335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Radiotherapy is highly involved in the management of prostate cancer. Its features and potential applications experienced a radical evolution over last decades, as they are associated to the continuous evolution of available technology and current oncological innovations. Some application of radiotherapy like brachytherapy have been recently enriched by innovative features and multidisciplinary dedications. In this report we aim to put some questions regarding the following issues regarding multiple aspects of modern application of radiation oncology: the current application of radiation oncology; the modern role of stereotactic body radiotherapy (SBRT) for both the management of primary lesions and for lymph-nodal recurrence; the management of the oligometastatic presentations; the role of brachytherapy; the aid played by the application of the organ at risk spacer (spacer OAR), fiducial markers, electromagnetic tracking systems and on-line Magnetic Resonance guided radiotherapy (MRgRT), and the role of the new opportunity represented by radiomic analysis.
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Affiliation(s)
- Francesco Cellini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Anna Rita Alitto
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Fionda
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Angela Romano
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Calogero Casà
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Gian Carlo Mattiucci
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
- Radiation Oncology, Mater Olbia Hospital, Olbia, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
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Ghaffari H, Navaser M, Mofid B, Mahdavi SR, Mohammadi R, Tavakol A. Fiducial markers in prostate cancer image-guided radiotherapy. Med J Islam Repub Iran 2019; 33:15. [PMID: 31086794 PMCID: PMC6504932 DOI: 10.34171/mjiri.33.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Image-guided radiotherapy (IGRT) is recommended to reduce the risk of geometrical miss when modern radiotherapy technologies with high grades of conformity are used. The purpose of this study was to evaluate the efficacy of fiducial markers (FMs) for electronic portal imaging in prostate cancer radiotherapy in term of evaluating the complications associated with FMs implantation, quantifying inter-fraction prostate motion, and determination of optimal planning target volume (PTV) margins.
Methods: In this single institution, prospective, consecutive study, 27 patients underwent implantation of three-gold seed FMs into the prostate gland before prostate radiotherapy. Prior to computed tomography planning, all patients were asked to report any complication associated with FMs implantation that have experienced to date. Daily pre-treatment electronic portal images were captured, and prostate position errors were corrected if they were greater than 2 mm along three translational directions. Optimal PTV expansions were computed using van Herk formula [PTV-margin= 2.5Σ + 0.7σ].
Results: FMs implantation was successful with an acceptable toxicity profile in all patients. Without IGRT, margins of 5.4 mm, 5.8 mm and 5.5 mm, in vertical, longitudinal and lateral directions, respectively, are needed for a 95% confidence level of complete clinical target volume (CTV) coverage in each treatment session. The PTV margins of 3.0 mm, 3.3 mm and 4.0 mm in corresponding directions were calculated when FMs based electronic portal imaging was applied.
Conclusion: FMs based electronic portal imaging is an effective tool for prostate cancer IGRT.
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Affiliation(s)
- Hamed Ghaffari
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Navaser
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mohammadi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Asieh Tavakol
- Department of Medical Physics, Roshana Radiotherapy Cancer Center, Tehran, Iran
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White P, Yee CK, Shan LC, Chung LW, Man NH, Cheung YS. A comparison of two systems of patient immobilization for prostate radiotherapy. Radiat Oncol 2014; 9:29. [PMID: 24447702 PMCID: PMC3905910 DOI: 10.1186/1748-717x-9-29] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproducibility of different immobilization systems, which may affect set-up errors, remains uncertain. Immobilization systems and their corresponding set-up errors influence the clinical target volume to planning target volume (CTV-PTV) margins and thus may result in undesirable treatment outcomes. This study compared the reproducibility of patient positioning with Hipfix system and whole body alpha cradle with respect to localized prostate cancer and investigated the existing CTV-PTV margins in the clinical oncology departments of two hospitals. METHODS Forty sets of data of patients with localized T1-T3 prostate cancer were randomly selected from two regional hospitals, with 20 patients immobilized by a whole-body alpha cradle system and 20 by a thermoplastic Hipfix system. Seven sets of the anterior-posterior (AP), cranial-caudal (CC) and medial-lateral (ML) deviations were collected from each patient. The reproducibility of patient positioning within the two hospitals was compared using a total vector error (TVE) parameter. In addition, CTV-PTV margins were computed using van Herk's formula. The resulting values were compared to the current CTV-PTV margins in both hospitals. RESULTS The TVE values were 5.1 and 2.8 mm for the Hipfix and the whole-body alpha cradle systems respectively. TVE associated with the whole-body alpha cradle system was found to be significantly less than the Hipfix system (p < 0.05). The CC axis in the Hipfix system attained the highest frequency of large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3 mm for the Hipfix system, and 2.1, 3.4 and 1.8 mm for the whole body alpha cradle in CC, ML and AP axes respectively. All but one (CC axis using Hipfix) margin calculated did not exceed the corresponding hospital protocol. The whole body alpha cradle system was found to be significantly better than the Hipfix system in terms of reproducibility (p < 0.05), especially in the CC axis. CONCLUSIONS The whole body alpha cradle system was more reproducible than the Hipfix system. In particular, the difference in CC axis contributed most to the results and the current CC margin for the Hipfix system might be considered as inadequate.
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Affiliation(s)
- Peter White
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Chui Ka Yee
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lee Chi Shan
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lee Wai Chung
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ng Ho Man
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yik Shing Cheung
- The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Ibbott GS, Haworth A, Followill DS. Quality assurance for clinical trials. Front Oncol 2013; 3:311. [PMID: 24392352 PMCID: PMC3867736 DOI: 10.3389/fonc.2013.00311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/05/2013] [Indexed: 11/13/2022] Open
Abstract
Cooperative groups, of which the Radiation Therapy Oncology Group is one example, conduct national clinical trials that often involve the use of radiation therapy. In preparation for such a trial, the cooperative group prepares a protocol to define the goals of the trial, the rationale for its design, and the details of the treatment procedure to be followed. The Radiological Physics Center (RPC) is one of several quality assurance (QA) offices that is charged with assuring that participating institutions deliver doses that are clinically consistent and comparable. The RPC does this by conducting a variety of independent audits and credentialing processes. The RPC has compiled data showing that credentialing can help institutions comply with the requirements of a cooperative group clinical protocol. Phantom irradiations have been demonstrated to exercise an institution's procedures for planning and delivering advanced external beam techniques (1-3). Similarly, RPC data indicate that a rapid review of patient treatment records or planning procedures can improve compliance with clinical trials (4). The experiences of the RPC are presented as examples of the contributions that a national clinical trials QA center can make to cooperative group trials. These experiences illustrate the critical need for comprehensive QA to assure that clinical trials are successful and cost-effective. The RPC is supported by grants CA 10953 and CA 81647 from the National Cancer Institute, NIH, DHHS.
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Affiliation(s)
- Geoffrey S Ibbott
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Miles E, Venables K. Radiotherapy Quality Assurance: Facilitation of Radiotherapy Research and Implementation of Technology. Clin Oncol (R Coll Radiol) 2012; 24:710-2. [DOI: 10.1016/j.clon.2012.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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QA makes a clinical trial stronger: Evidence-based medicine in radiation therapy. Radiother Oncol 2012; 105:4-8. [DOI: 10.1016/j.radonc.2012.08.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/15/2012] [Accepted: 08/16/2012] [Indexed: 11/17/2022]
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A study of the effect on accuracy of the introduction of a bellyboard as an immobilisation device to the radical radiotherapy treatment of prostate cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2011. [DOI: 10.1017/s1460396911000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractEnsuring reproducibility in any radiotherapy technique is vital to ensure that a geometric miss does not occur. Patient position and comfort play a major part in the reproducibility of setups.Purpose: To study the effect on accuracy of the introduction of a bellyboard to the existing prone technique used for radical radiotherapy treatment of prostate cancer.Materials and Methods: Thirty patients were treated using the bellyboard in the standard method. Portal images were compared with those of a control group of patients who had treatment with no rigid immobilisation. Patients in both groups were males with prostate cancer, who underwent radical radiotherapy treatment. Images were analysed using anatomy matching, and deviations from the isocentre were noted.Results: Statistical analysis of the results showed no statistical significance between the groups, though within the control group there were more deviations over 0.5 cm from the isocentre position than in the bellyboard group.Conclusions: Introduction of the bellyboard was seen to be equivalent to the use of the control technique. When the deviations from isocentre position were evaluated for each group, the control group had more deviations over 0.5 cm than the bellyboard group.
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Giordani AJ, Dias RS, Segreto HRC, Segreto RA. Acurácia na reprodutibilidade do posicionamento diário de pacientes submetidos a radioterapia conformada (RT3D) para câncer de próstata. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a reprodutibilidade do posicionamento de pacientes com diagnóstico de câncer de próstata submetidos a radioterapia conformada. MATERIAIS E MÉTODOS: Foram avaliados 960 (posições anterior e lateral) filmes radiológicos, de um total de 120 pacientes que receberam radioterapia conformada na próstata com técnica isocêntrica. As imagens foram obtidas em acelerador linear de partículas 6 MV. Aplicou-se protocolo específico para planejamento e tratamento da próstata, com o paciente em posição supina, mãos colocadas sobre o tórax, pés apoiados em suporte apropriado. Diariamente, os pacientes foram posicionados conforme demarcações na pele, coincidentes com os lasers da sala. Os filmes radiológicos foram comparados com as radiografias reconstruídas digitalmente (digitally reconstructed radiography - DRR) em sistema de planejamento computadorizado Eclipse, a partir das tomografias. As radiografias de posicionamento foram realizadas no primeiro dia e após, semanalmente, até o término do tratamento. RESULTADOS: As médias dos deslocamentos observados foram de 1,99 ± 1,25 mm no sentido crânio-caudal, 1,37 ± 0,84 mm no látero-lateral e 1,94 ± 1,10 mm no ântero-posterior. CONCLUSÃO: O uso de protocolos específicos para posicionamento dos pacientes é possível na prática clínica, possibilita reprodutibilidade adequada e rápida correção dos possíveis erros.
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Assuring high quality treatment delivery in clinical trials – Results from the Trans-Tasman Radiation Oncology Group (TROG) study 03.04 “RADAR” set-up accuracy study. Radiother Oncol 2009; 90:299-306. [DOI: 10.1016/j.radonc.2008.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 08/24/2008] [Accepted: 10/04/2008] [Indexed: 11/20/2022]
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