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Wieslander E, Jóhannesson V, Nilsson P, Kjellén E, Gunnlaugsson A. Ultrahypofractionated Radiation Therapy for Prostate Cancer Including Seminal Vesicles in the Target Volume: A Treatment-planning Study Based on the HYPO-RT-PC Fractionation Schedule. Adv Radiat Oncol 2024; 9:101531. [PMID: 38883997 PMCID: PMC11176962 DOI: 10.1016/j.adro.2024.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/25/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Ultrahypofractionated (UHF) radiation therapy (RT) has become a treatment alternative for patients with localized prostate cancer. In more advanced cases, seminal vesicles (SVs) are routinely included in the target volume. The Scandinavian HYPO-RT-PC trial, which compared 42.7 Gy in 7 fractions (fr) to conventional fractionation (CF), did not include SVs in the clinical target volume. The primary objective of the present work was to implement a ultrahypofractionated-simultaneous integrated boost (UHF-SIB) for prostate cancer RT, incorporating SVs into the target volume based on this fractionation schedule. A secondary objective was to analyze the unintentional dose coverage of SVs from state-of-the-art volumetric modulated arc therapy treatments to the prostate gland only. Methods and Materials Two different equieffective UHF-SIB treatment schedules to SVs were derived based on the CF clinical schedule (50.0 Gy/25 fr to elective SVs and 70.0 Gy/35 fr to verified SV-invasion (SVI)) using the linear quadric model with α/β = 2 Gy and 3 Gy. The dose to the prostate was 42.7 Gy/7 fr in both schedules, with 31.2 Gy/37.8 Gy (α/β = 2 Gy) and 32.7 Gy/40.1 Gy (α/β = 3 Gy) to elective SV/verified SVI. Volumetric modulated arc therapy plans to the proximal 10 mm and 20 mm were optimized, and dose-volume metrics for target volumes and organs at risk were evaluated. Results Dose metrics were overall lower for UHF-SIB compared with CF. QUANTEC-based volume criteria were 2% to 7% lower for the rectum and 2% to 4% lower for the bladder in the UHF-SIB. The D98% to elective SV was 7 to 12 Gy3 lower with UHF-SIB, and the corresponding data for verified SVI were approximately 2 to 3 Gy3. The SV(10 mm) V90%/(29.5 Gy) for prostate-only treatments (42.7 Gy) were as follows: median (IQR), 99% (87-100) and 78% (58-99) for the clinical target volume and planning target volume, respectively. Conclusions UHF RT based on the HYPO-RT-PC fractionation schedule, with a SIB technique, to the prostate and the base of the SV can be planned with lower doses (EQD2) to organs at risk, compared with CF. The unintentional dose to the proximal parts of SVs in prostate-only treatment can be substantial.
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Affiliation(s)
- Elinore Wieslander
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Medical Radiation Physics, Lund, Sweden
| | - Vilberg Jóhannesson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Oncology and Pathology, Lund, Sweden
| | - Per Nilsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Medical Radiation Physics, Lund, Sweden
| | - Elisabeth Kjellén
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Oncology and Pathology, Lund, Sweden
| | - Adalsteinn Gunnlaugsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Oncology and Pathology, Lund, Sweden
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Lim Joon D, Chao M, Piccolo A, Schneider M, Anderson N, Handley M, Benci M, Ong WL, Daly K, Morrell R, Wan K, Lawrentschuk N, Foroudi F, Jenkins T, Angus D, Wada M, Sengupta S, Khoo V. Proximal seminal vesicle displacement and margins for prostate cancer radiotherapy. J Med Radiat Sci 2021; 68:289-297. [PMID: 33432719 PMCID: PMC8424309 DOI: 10.1002/jmrs.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Guidelines recommend that the proximal seminal vesicles (PrSV) should be included in the clinical target volume for locally advanced prostate cancer patients undergoing radiotherapy. Verification and margins for the prostate may not necessarily account for PrSV displacement. The purpose was to determine the inter-fraction displacement of the PrSV relative to the prostate during radiotherapy. METHODS Fiducials were inserted into the prostate, and right and left PrSV (RSV and LSV) in 30 prostate cancer patients. Correctional shifts for the prostate, right and left PrSV and pelvic bones were determined from each patient's 39 daily orthogonal portal images relative to reference digitally reconstructed radiographs. RESULTS There was a significant displacement of the RSV relative to the prostate in all directions: on average 0.38 mm (95% confidence interval (CI) 0.26 to 0.50) to the left, 0.80-0.81 mm (CI 0.68 to 0.93) superiorly and 1.51 mm (CI 1.36 to 1.65) posteriorly. The LSV was significantly displaced superiorly to the prostate 1.09-1.13 mm (CI 0.97 to 1.25) and posteriorly 1.81 mm (CI 1.67 to 1.96), but not laterally (mean 0.06, CI -0.06 to 0.18). The calculated PTV margins (left-right, superior-inferior, posterior-anterior) were 4.9, 5.3-5.6 and 4.8 mm for the prostate, 5.2, 7.1-8.0 and 9.7 mm for the RSV, and 7.2, 7.5-7.6 and 8.6 mm for the LSV. CONCLUSION There is a significant displacement of the PrSV relative to the prostate during radiotherapy. Greater margins are recommended for the PrSV compared to the prostate.
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Affiliation(s)
- Daryl Lim Joon
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Michael Chao
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Angelina Piccolo
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Nigel Anderson
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Monica Handley
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Margaret Benci
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Wee Loon Ong
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Karen Daly
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Rebecca Morrell
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Kenneth Wan
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Farshad Foroudi
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Trish Jenkins
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - David Angus
- Department of UrologyAustin HealthMelbourneVic.Australia
| | - Morikatsu Wada
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Vincent Khoo
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
- Monash UniversityMelbourneVic.Australia
- Royal Marsden NHS Foundation TrustLondonUK
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Bayman NA, Wylie JP. When should the seminal vesicles be included in the target volume in prostate radiotherapy? Clin Oncol (R Coll Radiol) 2007; 19:302-7. [PMID: 17448647 DOI: 10.1016/j.clon.2007.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 02/17/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
External beam radiotherapy to the prostate and seminal vesicles as a radical treatment for prostate cancer can result in a significant dose being delivered to the rectum. This can be reduced if the target volume includes the prostate only. Using a Medline search, published studies are reviewed to show that the risk of seminal vesicle involvement can be accurately predicted using readily available pre-treatment parameters. We recommend when to exclude the seminal vesicles from a target volume, and the proportion of seminal vesicles that should be included in a target volume in higher risk patients.
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Affiliation(s)
- N A Bayman
- Department of Clinical Oncology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK.
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Dearnaley DP. Radiotherapy in locally advanced prostate cancer. EJC Suppl 2005. [DOI: 10.1016/s1359-6349(05)80291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Nichol A, Chung P, Lockwood G, Rosewall T, Divanbiegi L, Sweet J, Toi A, Bayley A, Bristow R, Crook J, Gospodarowicz M, McLean M, Milosevic M, Warde P, Catton C. A phase II study of localized prostate cancer treated to 75.6Gy with 3D conformal radiotherapy. Radiother Oncol 2005; 76:11-7. [PMID: 15990187 DOI: 10.1016/j.radonc.2005.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 04/25/2005] [Accepted: 06/05/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE To prospectively evaluate toxicity, biochemical failure-free survival (bFFS) and biopsy-proven local control for prostate cancer patients treated with 75.6 Gy in 42 fractions using 6-field conformal radiotherapy to prostate alone. PATIENTS AND METHODS From 1997 to 1999, 140 patients with T1-2NxM0, Gleason score<or=8, and PSA<or=20 ng/ml prostate cancer were assessed using Radiation Therapy Oncology Group acute and late toxicity scores. bFFS was determined for 120 patients treated without hormones. Post-treatment prostate biopsies were performed at a median of 3 years and a late toxicity questionnaire was administered at a median of 5 years. RESULTS Clinically important acute toxicities were gastrointestinal (GI) grade 2: 22% and 3: 0%, and genitourinary (GU) grade 2: 24% and 3: 2%. Late physician-assessed toxicities were GI>or=grade 2: 2%, and GU>or=grade 2: 1%. The 3-year bFFS of patients failure-free before biopsy was 93% (95% CI: 83-100) from a negative biopsy and 22% (95% CI: 0-56) from a positive biopsy (P=0.001). Patients reported significantly more late toxicity than physicians (GI: P=0.003, GU: P<0.001). At 5.0 years median follow-up, cause-specific survival was 98% (95% CI: 96-100), overall survival was 91% (95% CI: 86-97), and bFFS was 55% (95% CI: 45-64). CONCLUSIONS 75.6 Gy caused modest levels of acute and late toxicity. Three-year biopsies predicted subsequent biochemical outcome.
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Affiliation(s)
- Alan Nichol
- Radiation Medicine Program, Princess Margaret Hospital and University of Toronto, Toronto, Canada
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Henry AM, Price P, Logue JP, Cowan RA, Shanks JH, Dearnaley DP, Khoo VS. Controversies in the radiotherapeutic management of poor prognosis locally advanced prostate cancer. Clin Oncol (R Coll Radiol) 2004; 16:87-94. [PMID: 15074729 DOI: 10.1016/j.clon.2003.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Grand Round was held at the Christie Hospital, Manchester, U.K., on 30 November 2002. It followed a presentation by Dr David Dearnaley from the Royal Marsden Hospital in Sutton on 'Novel approaches and trials in prostate cancer'. Controversies in the management of locally advanced prostate cancer were illustrated by a case presentation and followed by a discussion on the evaluation of disease extent, and the roles of radiotherapy and hormone ablation.
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Affiliation(s)
- A M Henry
- Academic Department of Radiation Oncology, Christie Hospital NHS Trust, Manchester, UK
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Greco C, Mazzetta C, Cattani F, Tosi G, Castiglioni S, Fodor A, Orecchia R. Finding dose–volume constraints to reduce late rectal toxicity following 3D-conformal radiotherapy (3D-CRT) of prostate cancer. Radiother Oncol 2003; 69:215-22. [PMID: 14643961 DOI: 10.1016/j.radonc.2003.08.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE The rectum is known to display a dose-volume effect following high-dose 3D-conformal radiotherapy (3D-CRT). The aim of the study is to search for significant dose-volume combinations with the specific treatment technique and patient set-up currently used in our institution. PATIENTS AND METHODS We retrospectively analyzed the dose-volume histograms (DVH) of 135 patients with stage T1b-T3b prostate cancer treated consecutively with 3D-CRT between 1996 and 2000 to a total dose of 76 Gy. The median follow-up was 28 months (range 12-62). All late rectal complications were scored using RTOG criteria. Time to late toxicity was assessed using the Kaplan-Meyer method. The association between variables at baseline and > or=2 rectal toxicity was tested using chi(2) test or Fisher's exact test. A multivariate analysis using logistic regression was performed. RESULTS Late rectal toxicity grade > or=2 was observed in 24 of the 135 patients (17.8%). A 'grey area' of increased risk has been identified. Average DVHs of the bleeding and non-bleeding patients were generated. The area under the percent volume DVH for the rectum of the bleeding patients was significantly higher than that of patients without late rectal toxicity. On multivariate analysis the correlation between the high risk DVHs and late rectal bleeding was confirmed. CONCLUSIONS The present analysis confirms the role of the rectal DVH as a tool to discriminate patients undergoing high-dose 3D-CRT into a low and a high risk of developing late rectal bleeding. Based on our own results and taking into account the data published in the literature, we have been able to establish new dose-volume constraints for treatment planning: if possible, the percentage of rectal volume exposed to 40, 50, 60, 72 and 76 Gy should be limited to 60, 50, 25, 15 and 5%, respectively.
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Affiliation(s)
- Carlo Greco
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, Milan 2014, Italy.
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