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Conroy D, Becht K, Forsthoefel M, Pepin AN, Lei S, Rashid A, Collins BT, Lischalk JW, Suy S, Aghdam N, Hankins RA, Collins SP. Utilization of Iodinated SpaceOAR Vue™ During Robotic Prostate Stereotactic Body Radiation Therapy (SBRT) to Identify the Rectal-Prostate Interface and Spare the Rectum: A Case Report. Front Oncol 2021; 10:607698. [PMID: 33489918 PMCID: PMC7817609 DOI: 10.3389/fonc.2020.607698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022] Open
Abstract
We describe the utilization of SpaceOAR Vue™, a new iodinated rectal spacer, during Robotic Stereotactic Body Radiation Therapy (SBRT) for a Prostate Cancer Patient with a contraindication to Magnetic Resonance Imaging. A 69-year-old Caucasian male presented with unfavorable intermediate risk prostate cancer and elected to undergo SBRT. His medical history was significant for atrial fibrillation on Rivaroxaban with a pacemaker. He was felt to be at increased risk of radiation proctitis following SBRT due to the inability to accurately contour the anterior rectal wall at the prostate apex without a treatment planning MRI and an increased risk of late rectal bleeding due to prescribed anticoagulants. In this case report, we discuss the technical aspects of appropriate placement and treatment planning for utilizing SpaceOAR Vue™ with Robotic SBRT.
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Affiliation(s)
- Dylan Conroy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Kelly Becht
- Georgetown University School of Medicine, Washington, DC, United States
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Abigail N Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Abdul Rashid
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian Timothy Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Jonathan W Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Ryan Andrew Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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Lock MI, Heinrichs A, Bhattacharya G, Cusano E, Ash R, D'Souza D, Rodrigues G, Dinniwell R, Venkatesan V, Bauman G, Wong E. The Utility of Penile Bulb Contouring to Localise the Prostate Apex as Compared to Urethrography. J Med Imaging Radiat Sci 2018; 49:76-83. [PMID: 30479293 DOI: 10.1016/j.jmir.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE High-precision radiotherapy relies on accurate anatomic localisation. Urethrography is often used to localise the prostatic apex. However, urethrography is an invasive localisation procedure and may introduce a systemic error. The penile bulb (PB) is contoured to minimise the risk of erectile dysfunction. The purpose of this study is to assess the value of using the PB, as an alternative to urethrography, to localise the prostate. METHODS AND MATERIALS The PB was localised on 10 patients treated with simplified intensity-modulated arc radiotherapy at computed tomography simulation during treatment weeks 1 and 7. All patients underwent placement of fiducial markers. Urethrography was used only at simulation. Distances from the superior PB contour to the inferior prostate contour, the apex fiducial marker, and to the inferior prostate contour were obtained as well. The PB was contoured by two observers independently. Agreement coefficients and analysis of variance were used to assess reliability between rates and consistency of measurements over time. RESULTS The PB-apex distance was greater than or equal to the urethrogram-apex distance in 24/30 (80%) measurements, and the median difference was 3 mm and was consistent between raters. The greatest variation in PB-IM distance between weeks was 6 mm, the median was 3 mm, and the agreements of measurements between weeks for raters 1 and 2 were 0.79 and 0.69, respectively. These differences were not statistically different and were consistent with the computed tomography slice thickness. CONCLUSIONS The PB can be used to identify the prostate apex and can be reliably contoured between observers. Measurements are consistent between patients and through the duration of treatment. The PB distance measurements support studies indicating that urethrography causes a shift of the prostate superiorly. The distance from the PB to prostate apex remains stable during treatment for individual patients but varies between patients.
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Affiliation(s)
- Michael I Lock
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
| | - Alicia Heinrichs
- Department of Physics and Astronomy, University of Western Ontario, London, Ontario, Canada
| | - Gaurav Bhattacharya
- Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Ellen Cusano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Ash
- Valley Radiotherapy, St. Joseph Hospital Orange, California, USA
| | - David D'Souza
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - George Rodrigues
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Robert Dinniwell
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Varagur Venkatesan
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Eugene Wong
- Division of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada; Department of Physics and Astronomy, University of Western Ontario, London, Ontario, Canada
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Paydar I, Kim BS, Cyr RA, Rashid H, Anjum A, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP. Urethrogram-Directed Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer in Patients with Contraindications to Magnetic Resonance Imaging. Front Oncol 2015; 5:194. [PMID: 26389077 PMCID: PMC4556038 DOI: 10.3389/fonc.2015.00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/10/2015] [Indexed: 12/21/2022] Open
Abstract
Purpose Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer. Methods Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram-directed SBRT with or without supplemental intensity-modulated radiation therapy (IMRT) at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35–36.25 Gy in five fractions or as a boost of 19.5 Gy in three fractions followed by supplemental conventionally fractionated IMRT (45–50.4 Gy). Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). Results The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70), and comorbidities were common (Carlson comorbidity index ≥2 in 36%). Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia. The 3-year actuarial incidence rates of ≥Grade 3 GU toxicity and ≥Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities. Conclusion Magnetic resonance imaging is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram-directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.
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Affiliation(s)
- Ima Paydar
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Robyn A Cyr
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Harriss Rashid
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Amna Anjum
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
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