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Jiao S, Zhao X, Zhou P, Geng M. Technical note: MR image-based synthesis CT for CyberKnife robotic stereotactic radiosurgery. Biomed Phys Eng Express 2024; 10:057002. [PMID: 39094608 DOI: 10.1088/2057-1976/ad6a62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/02/2024] [Indexed: 08/04/2024]
Abstract
The purpose of this study is to investigate whether deep learning-based sCT images enable accurate dose calculation in CK robotic stereotactic radiosurgery. A U-net convolutional neural network was trained using 2446 MR-CT pairs and used it to translate 551 MR images to sCT images for testing. The sCT of CK patient was encapsulated into a quality assurance (QA) validation phantom for dose verification. The CT value difference between CT and sCT was evaluated using mean absolute error (MAE) and the statistical significance of dose differences between CT and sCT was tested using the Wilcoxon signed rank test. For all CK patients, the MAE value of the whole brain region did not exceed 25 HU. The percentage dose difference between CT and sCT was less than ±0.4% on GTV (D2(Gy), -0.29%, D95(Gy), -0.09%), PTV (D2(Gy), -0.25%, D95(Gy), -0.10%), and brainstem (max dose(Gy), 0.31%). The percentage dose difference between CT and sCT for most regions of interest (ROIs) was no more than ±0.04%. This study extended MR-based sCT prediction to CK robotic stereotactic radiosurgery, expanding the application scenarios of MR-only radiation therapy. The results demonstrated the remarkable accuracy of dose calculation on sCT for patients treated with CK robotic stereotactic radiosurgery.
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Affiliation(s)
- Shengxiu Jiao
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Xiaoqian Zhao
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Peng Zhou
- Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing People's Republic of China
| | - Mingying Geng
- Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing People's Republic of China
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Does CyberKnife improve dose distribution versus IMRT and VMAT on a linear accelerator in low-risk prostate cancer? Radiol Oncol 2022; 56:259-266. [PMID: 35344646 PMCID: PMC9122296 DOI: 10.2478/raon-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypofractionated stereotactic body radiation therapy (SBRT) for prostate cancer (PCa) can be delivered with the robot-assisted CyberKnife (CK) system or on a linear accelerator using dynamic intensity-modulated radiotherapy (IMRT) or volumetric arc radiotherapy (VMAT). This retrospective study was performed to determine whether CK offers better dose distribution than IMRT and/or VMAT. MATERIALS AND METHODS Treatment plans for three techniques were prepared using the same treatment parameters (36.35 Gy, 7.25 Gy/fr). We evaluated target coverage, conformity index (CI), homogeneity index (HI), gamma index (GI), and organs at risk (OAR) constraints. RESULTS The mean planning target volume (PTV) dose for CK (39.58 Gy) was significantly greater than VMAT or IMRT (both 36.25 Gy). However, CK resulted in a wider dose range (31.48 to 45.89 Gy) vs. VMAT and IMRT (34.6-38.76 Gy). The mean dose to the rectum (V36Gy, mm3) was significantly lower (p < 0.001) in the CK plans (219.78 vs. 519.59 and 422.62, respectively). The mean bladder dose (V37Gy, mm3) was significantly greater for CK (3256 vs. 1090.75 for VMAT and 4.5 for IMRT (p < 0.001). CK yielded significantly better CI (1.07 vs. 1.17 and 1.25 for VMAT and IMRT, respectively; p < 0.01) and HI values (1.27 vs. 1.07 and 1.04; p < 0.01). GI values for the δd = 3mm, δ% = 3% criteria were 99.86 (VMAT), 99.07 (IMRT) and 99.99 (CK). For δd = 2mm, δ% = 2%, the corresponding values were 98.3, 93.35, and 97.12, respectively. CONCLUSIONS For most variables, CK was superior to both VMAT and IMRT. However, dynamic IMRT techniques, especially VMAT, do not differ significantly from CK plans and are therefore acceptable alternatives to CyberKnife.
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Shiomi H, Akino Y, Sumida I, Masai N, Oh RJ, Ogawa K. Development of raster scanning IMRT using a robotic radiosurgery system. JOURNAL OF RADIATION RESEARCH 2021; 62:364-373. [PMID: 33454766 PMCID: PMC7948854 DOI: 10.1093/jrr/rraa136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Treatment time with the CyberKnife frameless radiosurgery system is prolonged due to the motion of the robotic arm. We have developed a novel scanning irradiation method to reduce treatment time. We generated treatment plans mimicking eight-field intensity-modulated radiotherapy (IMRT) plans generated for the Novalis radiosurgery system. 2D dose planes were generated with multiple static beam spots collimated by a fixed circular cone. The weights of the uniformly distributed beam spots in each dose plane were optimized using the attraction-repulsion model. The beam spots were converted to the scanning speed to generate the raster scanning plan. To shorten treatment time, we also developed a hybrid scanning method which combines static beams with larger cone sizes and the raster scanning method. Differences between the Novalis and the scanning plan's dose planes were evaluated with the criterion of a 5% dose difference. The mean passing rates of three cases were > 85% for cone sizes ≤ 12.5 mm. Although the total monitor units (MU) increased for smaller cone sizes in an inverse-square manner, the hybrid scanning method greatly reduced the total MU, while maintaining dose distributions comparable to those with the Novalis plan. The estimated treatment time of the hybrid scanning with a 12.5 mm cone size was on average 22% shorter than that of the sequential plans. This technique will be useful in allowing the CyberKnife with conventional circular cones to achieve excellent dose distribution with a shortened treatment time.
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Affiliation(s)
- Hiroya Shiomi
- Miyakojima IGRT Clinic, Miyakojima-ku, Osaka 534-0021, Japan
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Soseikai Clinic CyberKnife Center, Fushimi, Kyoto 612-8248, Japan
- RADLab Inc., Kawachinagano, Osaka 586-0092, Japan
| | - Yuichi Akino
- Soseikai Clinic CyberKnife Center, Fushimi, Kyoto 612-8248, Japan
- Oncology Center, Osaka University Hospital, Suita, Osaka 565-0871, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Norihisa Masai
- Department of Radiology, North Medical Center Kyoto Prefectural University of Medicine, Yosano-cho, Yosa-gun, Kyoto 629-2261, Japan
| | - Ryoong-Jin Oh
- Miyakojima IGRT Clinic, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Draulans C, De Roover R, van der Heide UA, Haustermans K, Pos F, Smeenk RJ, De Boer H, Depuydt T, Kunze-Busch M, Isebaert S, Kerkmeijer L. Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus. Radiother Oncol 2019; 140:131-142. [PMID: 31276989 DOI: 10.1016/j.radonc.2019.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) is gaining interest by the recent publication of the first phase III trials on prostate SBRT and the promising results of many other phase II trials. Before long term results became available, the major concern for implementing SBRT in PCa in daily clinical practice was the potential risk of late genitourinary (GU) and gastrointestinal (GI) toxicity. A number of recently published trials, including late outcome and toxicity data, contributed to the growing evidence for implementation of SBRT for PCa in daily clinical practice. However, there exists substantial variability in delivering SBRT for PCa. The aim of this topical review is to present a number of prospective trials and retrospective analyses of SBRT in the treatment of PCa. We focus on the treatment strategies and techniques used in these trials. In addition, recent literature on a simultaneous integrated boost to the tumor lesion, which could create an additional value in the SBRT treatment of PCa, was described. Furthermore, we discuss the multicenter consensus of the FLAME consortium on SBRT for PCa with a focal boost to the macroscopic intraprostatic tumor nodule(s).
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Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Hans De Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Tom Depuydt
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Linda Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
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Cao T, Dai Z, Ding Z, Li W, Quan H. Analysis of different evaluation indexes for prostate stereotactic body radiation therapy plans: conformity index, homogeneity index and gradient index. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.1072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Tingting Cao
- School of Physics and TechnologyWuhan University Wuhan China
- Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Zhitao Dai
- School of Physics and TechnologyWuhan University Wuhan China
- Cancer Hospital Chinese Academy of Medical SciencesShenzhen Center Shenzhen China
| | - Zhen Ding
- Cancer Hospital Chinese Academy of Medical SciencesShenzhen Center Shenzhen China
| | - Wuzhou Li
- School of Physics and TechnologyWuhan University Wuhan China
| | - Hong Quan
- School of Physics and TechnologyWuhan University Wuhan China
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Varnava M, Sumida I, Mizuno H, Shiomi H, Suzuki O, Yoshioka Y, Ogawa K. A new plan quality objective function for determining optimal collimator combinations in prostate cancer treatment with stereotactic body radiation therapy using CyberKnife. PLoS One 2018; 13:e0208086. [PMID: 30481228 PMCID: PMC6258559 DOI: 10.1371/journal.pone.0208086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/12/2018] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiation therapy with CyberKnife for prostate cancer has long treatment times compared with conventional radiotherapy. This arises the need for designing treatment plans with short execution times. We propose an objective function for plan quality evaluation, which was used to determine an optimal combination between small and large collimators based on short treatment times and clinically acceptable dose distributions. Data from 11 prostate cancer patients were used. For each patient, 20 plans were created based on all combinations between one small (⌀ 10–25 mm) and one large (⌀ 35–60 mm) Iris collimator size. The objective function was assigned to each combination as a penalty, such that plans with low penalties were considered superior. This function considered the achievement of dosimetric planning goals, tumor control probability, normal tissue complication probability, relative seriality parameter, and treatment time. Two methods were used to determine the optimal combination. First, we constructed heat maps representing the mean penalty values and standard deviations of the plans created for each collimator combination. The combination giving a plan with the smallest mean penalty and standard deviation was considered optimal. Second, we created two groups of superior plans: group A plans were selected by histogram analysis and group B plans were selected by choosing the plan with the lowest penalty from each patient. In both groups, the most used small and large collimators were assumed to represent the optimal combination. The optimal combinations obtained from the heat maps included the 25 mm as a small collimator, giving small/large collimator sizes of 25/35, 25/40, 25/50, and 25/60 mm. The superior-group analysis indicated that 25/50 mm was the optimal combination. The optimal Iris combination for prostate cancer treatment using CyberKnife was determined to be a collimator size between 25 mm (small) and 50 mm (large).
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Affiliation(s)
- Maria Varnava
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail: (MV); (IS)
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail: (MV); (IS)
| | - Hirokazu Mizuno
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroya Shiomi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Miyakojima IGRT Clinic, Miyakojima-ku, Osaka, Japan
| | - Osamu Suzuki
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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7
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Seppälä J, Suilamo S, Tenhunen M, Sailas L, Virsunen H, Kaleva E, Keyriläinen J. Dosimetric Comparison and Evaluation of 4 Stereotactic Body Radiotherapy Techniques for the Treatment of Prostate Cancer. Technol Cancer Res Treat 2016; 16:238-245. [PMID: 28279147 PMCID: PMC5616037 DOI: 10.1177/1533034616682156] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to compare dosimetric characteristics, monitor unit, and delivery efficiency of 4 different stereotactic body radiotherapy techniques for the treatment of prostate cancer. METHODS This study included 8 patients with localized prostate cancer. Dosimetric assets of 4 delivery techniques for stereotactic body radiotherapy were evaluated: robotic CyberKnife, noncoplanar intensity-modulated radiotherapy, and 2 intensity-modulated arc therapy techniques (RapidArc and Elekta volumetric-modulated arc therapy). All the plans had equal treatment margins and a prescription dose of 35 Gy in 5 fractions. RESULTS Statistically significant differences were observed in homogeneity index and mean doses of bladder wall and penile bulb, all of which were highest with CyberKnife. No significant differences were observed in the mean doses of rectum, with values of 15.2 ± 2.6, 13.3 ± 2.6, 13.1 ± 2.8, and 13.8 ± 1.6 Gy with CyberKnife, RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy, respectively. The highest dose conformity was realized with RapidArc. The dose coverage of the planning target volume was lowest with noncoplanar intensity-modulated radiotherapy. Treatment times and number of monitor units were largest with CyberKnife (on average 34.0 ± 5.0 minutes and 8704 ± 1449 monitor units) and least with intensity-modulated arc therapy techniques (on average 5.1 ± 1.1 minutes and 2270 ± 497 monitor units). CONCLUSION Compared to CyberKnife, the RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy produced treatment plans with similar dosimetric quality, with RapidArc achieving the highest dose conformity. Overall, the dosimetric differences between the studied techniques were marginal, and thus, the choice of the technique should rather focus on the delivery accuracies and dose delivery times.
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Affiliation(s)
- Jan Seppälä
- 1 Radiotherapy Department, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Suilamo
- 2 Department of Medical Physics & Department of Radiotherapy and Oncology, Turku University Hospital, Turku, Finland
| | - Mikko Tenhunen
- 3 Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Liisa Sailas
- 4 Department of Radiotherapy, North Karelia Central Hospital, Joensuu, Finland
| | - Heli Virsunen
- 1 Radiotherapy Department, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna Kaleva
- 3 Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland.,5 Lahti Department of Radiotherapy, Tampere University Hospital, Lahti, Finland
| | - Jani Keyriläinen
- 2 Department of Medical Physics & Department of Radiotherapy and Oncology, Turku University Hospital, Turku, Finland.,3 Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
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8
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Kathriarachchi V, Shang C, Evans G, Leventouri T, Kalantzis G. Dosimetric and radiobiological comparison of CyberKnife M6™ InCise multileaf collimator over IRIS™ variable collimator in prostate stereotactic body radiation therapy. J Med Phys 2016; 41:135-43. [PMID: 27217626 PMCID: PMC4871003 DOI: 10.4103/0971-6203.181638] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The impetus behind our study was to establish a quantitative comparison between the IRIS collimator and the InCise multileaf collimator (MLC) (Accuray Inc. Synnyvale, CA) for prostate stereotactic body radiation therapy (SBRT). Treatment plans for ten prostate cancer patients were performed on MultiPlan™ 5.1.2 treatment planning system utilizing MLC and IRIS for 36.25 Gy in five fractions. To reduce the magnitude of variations between cases, the planning tumor volume (PTV) was defined and outlined for treating prostate gland only, assuming no seminal vesicle or ex-capsule involvement. Evaluation indices of each plan include PTV coverage, conformity index (CI), Paddick's new CI, homogeneity index, and gradient index. Organ at risk (OAR) dose sparing was analyzed by the bladder wall Dmax and V37Gy, rectum Dmax and V36Gy. The radiobiological response was evaluated by tumor control probability and normal tissue complication probability based on equivalent uniform dose. The dose delivery efficiency was evaluated on the basis of planned monitor units (MUs) and the reported treatment time per fraction. Statistical significance was tested using the Wilcoxon signed rank test. The studies indicated that CyberKnife M6™ IRIS and InCise™ MLC produce equivalent SBRT prostate treatment plans in terms of dosimetry, radiobiology, and OAR sparing, except that the MLC plans offer improvement of the dose fall-off gradient by 29% over IRIS. The main advantage of replacing the IRIS collimator with MLC is the improved efficiency, determined from the reduction of MUs by 42%, and a 36% faster delivery time.
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Affiliation(s)
| | - Charles Shang
- Department of Physics, Florida Atlantic University, Boca Raton, FL, USA; Lynn Cancer Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
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9
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Baker BR, Basak R, Mohiuddin JJ, Chen RC. Use of stereotactic body radiotherapy for prostate cancer in the United States from 2004 through 2012. Cancer 2016; 122:2234-41. [PMID: 27171855 DOI: 10.1002/cncr.30034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is a newer treatment option for patients with localized prostate cancer. The rates of diffusion of this technology across the United States are unknown. The goal of the current study was to describe the use of SBRT among patients with prostate cancer based on different risk groups (low, intermediate, or high risk) and by type of facility (community cancer program, comprehensive community cancer program, or academic program) in which patients were treated. METHODS Using the National Cancer Data Base, a national registry that contains approximately 70% of patients with cancer in the United States, the authors identified 274,466 men between the ages of 40 to 80 years who were diagnosed from 2004 to 2012 with localized prostate cancer and received radiation therapy (RT) as their initial treatment. The authors described the prevalence of SBRT use each year, and multivariable analysis was used to examine factors associated with the receipt of SBRT. RESULTS In 2004, SBRT use was low (<1% in all patient groups), and was observed to increase steadily each year. By 2012, 8.8% of low-risk patients treated at academic centers with RT received SBRT. Uptake of SBRT was highest in patients with low-risk or intermediate-risk disease. Multivariable analysis demonstrated that year of diagnosis, type of center, risk group, and race were all significantly associated with the use of SBRT. CONCLUSIONS To the authors' knowledge, the current study is the first report of the adoption of SBRT for localized prostate cancer across the United States. Diffusion was noted to be slowest at community cancer programs, reflecting potential barriers of cost or expertise for this new technology. Adoption of SBRT was found to be highest among patients with low-risk or intermediate-risk disease, in accordance with the bulk of patients included in published SBRT studies. Cancer 2016;122:2234-41. © 2016 American Cancer Society.
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Affiliation(s)
- Brock R Baker
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jahan J Mohiuddin
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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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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11
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Sheng K, Shepard DM, Orton CG. Point/Counterpoint. Noncoplanar beams improve dosimetry quality for extracranial intensity modulated radiotherapy and should be used more extensively. Med Phys 2015; 42:531-3. [PMID: 25652473 DOI: 10.1118/1.4895981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ke Sheng
- Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095 (Tel: 310-983-3146; E-mail: )
| | - David M Shepard
- Medical Physics, Swedish Cancer Institute, Seattle, Washington 98104 (Tel: 206-215-3306; E-mail: )
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12
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Stereotactic Ablative Radiotherapy with CyberKnife in the Treatment of Locally Advanced Prostate Cancer: Preliminary Results. TUMORI JOURNAL 2015; 101:684-91. [DOI: 10.5301/tj.5000355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/20/2022]
Abstract
Aims and Background Recent clinical reports of stereotactic ablative radiotherapy (SABR) in the treatment of low-risk prostate cancer have been encouraging. Our study evaluates the efficacy and safety of SABR using the CyberKnife system for treating intermediate- to very-high-risk prostate cancer. Methods and Study Design Between May 2010 and June 2013, 31 patients (15 intermediate risk, 14 high risk, and 2 very high risk) without pelvic lymph node metastasis were enrolled retrospectively. The treatment consisted of 37.5 Gy in 5 fractions over 1-2 weeks using CyberKnife SABR. Twenty-five patients (81%) received androgen deprivation therapy (ADT). Biochemical failure was defined using the nadir + 2 criterion. Toxicity was assessed with the Common Terminology Criteria of Adverse Events (version 4). Results The median follow-up was 36 months (range 7-58 months). The median pretreatment prostate-pecific antigen (PSA) was 13.5 ng/mL (range 4.5-124.0 ng/mL). The median PSA decreased to 0.09 ng/mL (range <0.04-5.38 ng/mL) and 0.12 ng/mL (range <0.04-2.63 ng/mL) at 6 months and 12 months after SABR, respectively. The 3-year biochemical relapse-free survival was 90.2% for all patients, 100% for the intermediate-risk patients, and 82% for the high- and very-high-risk patients (p = 0.186). No patient experienced ≥ grade 3 toxicity. There were 7 acute and 5 late grade 2 genitourinary toxicities and 1 acute and no late grade 2 gastrointestinal toxicity. Conclusions Our preliminary results support that CyberKnife SABR with ADT is safe and feasible in patients with intermediate- to high-risk prostate cancer. A further large-scale clinical trial with longer follow-up is warranted.
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13
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Hernández TG, González AV, Peidro JP, Ferrando JVR, González LB, Cabañero DG, Torrecilla JL. Radiobiological comparison of two radiotherapy treatment techniques for high-risk prostate cancer. Rep Pract Oncol Radiother 2013; 18:265-71. [PMID: 24416563 DOI: 10.1016/j.rpor.2012.12.006] [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: 04/20/2012] [Revised: 07/23/2012] [Accepted: 12/30/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To make a radiobiological comparison, for high risk prostate cancer (T3a, PSA > 20 ng/ml or Gleason > 7) of two radiotherapy treatment techniques. One technique consists of a treatment in three phases of the pelvic nodes, vesicles and prostate using a conventional fractionation scheme of 2 Gy/fraction (SIMRT). The other technique consists of a treatment in two phases that gives simultaneously different dose levels in each phase, 2 Gy/fraction, 2.25 Gy/fraction and 2.5 Gy/fraction to the pelvic nodes, vesicles and prostate, respectively (SIBIMRT). MATERIALS AND METHODS The equivalent dose at fractionation of 2 Gy (EQD2), calculated using the linear quadratic model with α/β prostate = 1.5 Gy, was the same for both treatment strategies. For comparison the parameters employed were D95, mean dose and Tumour Control Probabilities for prostate PTV and D15, D25, D35, D50, mean dose and Normal Tissue Complication Probabilities for the rectum and bladder, with physical doses converted to EQD2. Parameters were obtained for α/β prostate = 1.5, 3 and 10 Gy and for α/β oar = 1, 2, 3, 4, 6 and 8. RESULTS For prostate PTV, both treatment strategies are equivalent for α/β prostate = 1.5 Gy but for higher α/β prostate, EQD2 and TCP, decrease for the SIBIMRT technique. For the rectum and bladder when α/β oar ≤ 2 Gy, EQD2 and NTCP are lower for the SIMRT technique or equal in both techniques. For α/β oar ≥ 2-3 Gy, EQD2 and NTCP increase for the SIMRT treatment. CONCLUSIONS A comparison between two radiotherapy techniques is presented. The SIBIMRT technique reduces EQD2 and NTCP for α/β oar from 2 to 8 Gy.
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Affiliation(s)
- Trinitat García Hernández
- Radiotherapy Physics Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - Aurora Vicedo González
- Radiotherapy Physics Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - Jorge Pastor Peidro
- Clinical Radiotherapy Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - Juan V Roselló Ferrando
- Radiotherapy Physics Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - Luis Brualla González
- Radiotherapy Physics Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - Domingo Granero Cabañero
- Radiotherapy Physics Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
| | - José López Torrecilla
- Clinical Radiotherapy Department, Exploraciones Radiológicas Especiales (ERESA), Hospital General Universitario, Valencia, Spain
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14
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Urbański B. The future of Radiation Oncology: Considerations of Young Medical Doctor. Rep Pract Oncol Radiother 2012; 17:288-93. [PMID: 24669310 DOI: 10.1016/j.rpor.2012.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 09/02/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022] Open
Abstract
Radiation therapy plays an increasingly important role in the management of cancer. Currently, more than 50% of all cancer patients can expect to receive radiotherapy during the course of their disease, either in a primary management (radical or adjuvant radiotherapy) or for symptom control (palliative radiotherapy). Radiation oncology is a very unique branch of medicine connected with clinical knowledge and also with medical physics. In recent years, this approach has become increasingly absorbed with technological advances. This increasing emphasis on technology, together with other important changes in the health-care economic environment, now place the specialty of radiation oncology in a precarious position. New treatment technologies are evolving at a rate unprecedented in radiation therapy, paralleled by improvements in computer hardware and software. These techniques allow assessment of changes in the tumour volume and its location during the course of therapy (interfraction motion) so that re-planning can adjust for such changes in an adaptive radiotherapy process. If radiation oncologists become simply the guardians of a single therapeutic modality they may find that time marches by and, while the techniques will live on, the specialty may not. This article discusses these threats to the field and examines strategies by which we may evolve, diversify, and thrive.
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Affiliation(s)
- Bartosz Urbański
- Greater Poland Cancer Center, Department of Radiotherapy and Gynaecological Oncology, Poznań, Poland
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15
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Paluska P, Hanus J, Sefrova J, Rouskova L, Grepl J, Jansa J, Kasaova L, Hodek M, Zouhar M, Vosmik M, Petera J. Utilization of cone-beam CT for offline evaluation of target volume coverage during prostate image-guided radiotherapy based on bony anatomy alignment. Rep Pract Oncol Radiother 2012; 17:134-40. [PMID: 24377014 DOI: 10.1016/j.rpor.2012.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/11/2012] [Accepted: 03/10/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To assess target volume coverage during prostate image-guided radiotherapy based on bony anatomy alignment and to assess possibility of safety margin reduction. BACKGROUND Implementation of IGRT should influence safety margins. Utilization of cone-beam CT provides current 3D anatomic information directly in irradiation position. Such information enables reconstruction of the actual dose distribution. MATERIALS AND METHODS Seventeen prostate patients were treated with daily bony anatomy image-guidance. Cone-beam CT (CBCT) scans were acquired once a week immediately after bony anatomy alignment. After the prostate, seminal vesicles, rectum and bladder were contoured, the delivered dose distribution was reconstructed. Target dose coverage was evaluated by the proportion of the CTV encompassed by the 95% isodose. Original plans employed a 1 cm safety margin. Alternative plans assuming a smaller 7 mm margin between CTV and PTV were evaluated in the same way. Rectal and bladder volumes were compared with the initial ones. Rectal and bladder volumes irradiated with doses higher than 75 Gy, 70 Gy, 60 Gy, 50 Gy and 40 Gy were analyzed. RESULTS In 12% of reconstructed plans the prostate coverage was not sufficient. The prostate underdosage was observed in 5 patients. Coverage of seminal vesicles was not satisfactory in 3% of plans. Most of the target underdosage corresponded to excessive rectal or bladder filling. Evaluation of alternative plans assuming a smaller 7 mm margin revealed 22% and 11% of plans where prostate and seminal vesicles coverage, respectively, was compromised. These were distributed over 8 and 7 patients, respectively. CONCLUSION Sufficient dose coverage of target volumes was not achieved for all patients. Reducing of safety margin is not acceptable. Initial rectal and bladder volumes cannot be considered representative for subsequent treatment.
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Affiliation(s)
- Petr Paluska
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Czech Republic ; Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Josef Hanus
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Czech Republic
| | - Jana Sefrova
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Lucie Rouskova
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Jakub Grepl
- Department of Radiology, University Hospital, Hradec Kralove, Czech Republic
| | - Jan Jansa
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Linda Kasaova
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Milan Zouhar
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Milan Vosmik
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Petera
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
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16
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Skórska M, Piotrowski T. Optimization of treatment planning parameters used in tomotherapy for prostate cancer patients. Phys Med 2012; 29:273-85. [PMID: 22521735 DOI: 10.1016/j.ejmp.2012.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 03/22/2012] [Accepted: 03/27/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Tomotherapy treatment planning depends on parameters that are not used conventionally such as: field width (FW), pitch factor (PF) and modulation factor (MF). The aim of this study is to analyze the relationship between these parameters and their influence on the quality of treatment plans and beam-on time. MATERIAL AND METHODS Ten prostate cancer patients were included in the study. For each patient, two cases of irradiation were considered depending on the target volume: PTV1 included the prostate gland, seminal vesicles, pelvic lymph nodes and a 1 cm margin, whereas PTV2 included only the prostate gland with a 1 cm margin. For each patient and each case of irradiation (PTV1 and PTV2) 8 treatment plans were created - all consisted of a different combination of planning parameters (FW = 1.05, 2.5, 5 cm; PF = 0.107, 0.215, 0.43; MF = 1.5, 2.5, 3.5). Default values used in this study were FW = 2.5 cm, PF = 0.215 and MF = 2.5. Hence, for plans with different FWs, parameters of PF and MF were 0.215 and 2.5, respectively; for different PFs, FW and MF were 2.5 and 2.5, respectively; finally for different MFs, FW and PF were 2.5 and 0.215, respectively. The reference plan was optimized for FW = 1.05 cm, PF = 0.107 and MF = 3.5, which was assumed to result in the best dose distribution and the longest treatment time. As a result, 160 plans were created. Each plan was analyzed for dose distribution and execution time. RESULTS AND CONCLUSION : Treatment plans with FW of 5 cm resulted in the shortest execution time compromising the dose distribution. Moreover, the dose fall off in the longitudinal direction was not sharp. FW of 1.05 cm and PF of 0.107 were not recommended for routine prostate plans due to long execution time, which was 3 times longer than for plans with FW = 5 cm. There was no substantial decrease of irradiation time when PF was increased from 0.215 to 0.43 for both cases (PTV1 and PTV2); however, the dose distribution was slightly compromised. Finally, decreasing MF from 2.5 to 1.5 was useless because it did not change the beam-on time; however, it did remarkably decrease the dose distribution. Nevertheless, increasing MF up to 3.5 could be considered. The lowest EUD for the rectum and intestines, could be observed for PF = 0.107. For the other plans the differences were rather small (the EUD was almost the same). By reducing PF from 0.43 to 0.107 or FW from 5 to 1.05 the EUD for bladder (in PTV1 case) decreased by 3.13% and 2.60%. When PTV2 was a target volume, the EUD for bladder decreased by 4.54% and 3.43% when FW was changed from 5 to 1.05 and MF from 1.5 to 3.5, respectively. For optimal balance between beam-on time and dose distribution in OARs for routine patients, the authors would suggest to use: FW = 2.5, PF = 0.215 and MF = 2.5.
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Affiliation(s)
- M Skórska
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.
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17
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Malicki J. The importance of accurate treatment planning, delivery, and dose verification. Rep Pract Oncol Radiother 2012; 17:63-5. [PMID: 24377001 DOI: 10.1016/j.rpor.2012.02.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Julian Malicki
- Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland ; Electroradiology Department, University of Medical Sciences, Poznan, Poland
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18
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Adamczyk M, Piotrowski T, Adamiak E. Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients. Rep Pract Oncol Radiother 2012; 17:104-9. [PMID: 24377008 PMCID: PMC3863327 DOI: 10.1016/j.rpor.2012.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 11/15/2011] [Accepted: 01/13/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Radiotherapy treatment requires delivering high homogenous dose to target volume while sparing organs at risk. That is why accurate patient positioning is one of the most important steps during the treatment process. It reduces set-up errors which have a strong influence on the doses given to the target and surrounding tissues. AIM The aim of this study was to investigate the efficiency of combining bony anatomy and soft tissue imaging position correction strategies for patients with prostate cancer. MATERIALS AND METHODS The study based on pre-treatment position verification results determined for 10 patients using kV images and CBCT match. At the same patients' position, two orthogonal kV images and set of CT scans were acquired. Both verification methods gave the information about patients' position changes in vertical, longitudinal and lateral directions. RESULTS For 93 verifications, the mean values of kV shifts in vertical, longitudinal and lateral directions equaled: -0.11 ± 0.54 cm, 0.26 ± 0.38 cm and -0.06 ± 0.47 cm, respectively. The same values achieved for CBCT matching equaled: 0.07 ± 0.62 cm, 0.22 ± 0.36 cm and -0.02 ± 0.45 cm. Statistically significant changes between the values of shifts received during the first week of treatment and the rest time of the irradiation process were found for 2 patients in the lateral direction and 2 patients in vertical direction among kV results and for 3 patients in the longitudinal direction among CBCT results. A significant difference between kV and CBCT match results was found in the vertical direction. CONCLUSIONS In clinical practice, CBCT combined with kV or even portal imaging improves precision and effectiveness of prostate cancer treatment accuracy.
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Affiliation(s)
- Marta Adamczyk
- Department of Medical Physics, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
| | - Tomasz Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
| | - Ewa Adamiak
- Radiotherapy Ward I, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznań, Poland
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19
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Kubeš J, Jakub C, Vladimir V, Jan D, Sona A, Matej N, Jan B. Results of combined radiotherapy and hormonal treatment of prostate cancer patients with initial PSA value >40 ng/ml. Rep Pract Oncol Radiother 2012; 17:79-84. [PMID: 24377004 DOI: 10.1016/j.rpor.2012.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 12/14/2011] [Accepted: 01/15/2012] [Indexed: 10/14/2022] Open
Abstract
AIM To evaluate the outcome of prostate cancer patients with initial PSA value >40 ng/ml. BACKGROUND The outcome of prostate cancer patients with very high initial PSA value is not known and patients are frequently treated with palliative intent. We analyzed the outcome of radical combined hormonal treatment and radiotherapy in prostate cancer patients with initial PSA value >40 ng/ml. METHODS Between January 2003 and December 2007 we treated, with curative intent, 56 patients with non-metastatic prostate cancer and initial PSA value >40 ng/ml. The treatment consisted of two months of neoadjuvant hormonal treatment (LHRH analog), radical radiotherapy (68-78 Gy, conformal technique) and an optional two-year adjuvant hormonal treatment. RESULTS The median time of follow up was 61 months. 5-Year overall survival was 90%. 5-Year biochemical disease free survival was 62%. T stage, Gleason score, PSA value, and radiotherapy dose did not significantly influence the outcome. Late genitourinal and gastrointestinal toxicity was acceptable. CONCLUSION Radical treatment in combination with hormonal treatment and radiotherapy can be recommended for this subgroup of prostate cancer patients with good performance status and life expectancy.
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Affiliation(s)
- Jiri Kubeš
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
| | - Cvek Jakub
- Oncological Clinic, Faculty Hospital Ostrava, 17. listopadu 1790, Ostrava-Poruba 708 52, Czech Republic
| | - Vondráček Vladimir
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
| | - Dvořák Jan
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
| | - Argalacsová Sona
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
| | - Navrátil Matej
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
| | - Buřil Jan
- Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic
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Bajon T, Piotrowski T, Antczak A, Bąk B, Błasiak B, Kaźmierska J. Comparison of dose volume histograms for supine and prone position in patients irradiated for prostate cancer-A preliminary study. Rep Pract Oncol Radiother 2011; 16:65-70. [PMID: 24376959 DOI: 10.1016/j.rpor.2011.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 12/31/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022] Open
Abstract
AIM To compare DVHs for OARs in two different positions - prone and supine - for prostate cancer patients irradiated with a Tomotherapy unit. BACKGROUND In the era of dose escalation, the choice of optimal patient immobilization plays an essential role in radiotherapy of prostate cancer. MATERIALS AND METHODS The study included 24 patients who were allocated to 3 risk groups based on D'Amico criteria; 12 patients represented a low or intermediate and 12 a high risk group. FOR EACH PATIENT TWO TREATMENT PLANS WERE PERFORMED: one in the supine and one in the prone position. PTV included the prostate, seminal vesicles and lymph nodes for the high risk group and the prostate and seminal vesicles for the intermediate or low risk groups. DVHs for the two positions were compared according to parameters: Dmean, D70, D50 and D20 for the bladder and rectum and Dmean, D10 for the intestine. The position accuracy was verified using daily MVCT. RESULTS Prone position was associated with lower doses in OARs, especially in the rectum. Despite the fact that in the entire group the differences between tested parameters were not large, the Dmean and D10 for the intestine were statistically significant. In the case of irradiation only to the prostate and seminal vesicles, the prone position allowed for substantial reduction of all tested DVH parameters in the bladder and rectum, except D20 for bladder. Moreover, the Dmean and D50 parameter differences for the bladder were statistically significant. No significant differences between positions reproducibility were demonstrated. CONCLUSION In patients irradiated to prostate and seminal vesicles, the prone position may support sparing of the rectum and bladder. The reproducibility of position arrangement in both positions is comparable.
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Affiliation(s)
- Tomasz Bajon
- II Radiotherapy Department, Greater Poland Cancer Centre, Poland
| | | | - Andrzej Antczak
- Department of Urology and Oncology, Poznan University of Medical Sciences, Poland
| | - Bartosz Bąk
- II Radiotherapy Department, Greater Poland Cancer Centre, Poland
| | - Barbara Błasiak
- Department of Medical Physics, Greater Poland Cancer Centre, Poland
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