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Hong SS, Bae SH, Hwang J, Lee EJ. Transperineal versus transrectal prostate fiducial insertion in radiation treatment of prostate cancer: a systematic review and meta-analysis. Ultrasonography 2024; 43:229-237. [PMID: 38898635 PMCID: PMC11222131 DOI: 10.14366/usg.23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To provide more accurate and definitive conclusions regarding the clinical and technical complications associated with the transperineal (TP) and transrectal (TR) approaches, a comprehensive review of observational studies and randomized controlled trials was conducted. This systematic review covered all eligible studies to facilitate a thorough comparison of complications linked to the two fiducial marker insertion methods, TP and TR. METHODS A comprehensive search of the literature was conducted, encompassing databases such as PubMed, Embase, and the Cochrane Library, up to July 7, 2023. The relative risk and 95% confidence interval were utilized to evaluate the diagnosis and complication rates. RESULTS The final selection for the methodological quality analysis included 13 observational studies that utilized TP and TR gold fiducial insertion approaches. The meta-analysis revealed significantly lower risks of urinary tract infections (UTI) and rectal bleeding with the TP approach. CONCLUSION The use of both TP and TR techniques for placing gold seed fiducial markers has proven to be an effective, safe, and well-tolerated method for image-guided radiation therapy in prostate cancer patients. A significant benefit of the TP technique is its ability to avoid rectal puncture, thereby reducing the risk of UTIs. Although the incidence of UTIs and rectal bleeding associated with the TR method is relatively low, these complications can disrupt patient wellbeing and potentially cause delays in treatment.
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Affiliation(s)
- Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung Hwan Bae
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Icht O, Schlosser S, Weinstock-Sabbah M, Rephael M, Bragilovski D, Moore A, Shochat T, Limon D, Fredman E. The role of a radiopaque peri-rectal hydrogel spacer in aiding accurate daily image-guidance for prostate stereotactic radiotherapy. Front Oncol 2024; 14:1386058. [PMID: 38957327 PMCID: PMC11217322 DOI: 10.3389/fonc.2024.1386058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Precise patient positioning with image guidance (IGRT) is essential for safe prostate radiotherapy. We present the first report of utilizing a CT-visible hydrogel spacer, used to decrease rectal radiation dose, as a surrogate fiducial marker to aid in daily IGRT with cone-beam CT (CBCT) in stereotactic radiotherapy (SABR) for prostate cancer. Materials and methods Prior to CT simulation, patients underwent placement of three intraprostatic gold fiducial markers and radiopaque hydrogel spacer per standard practice. At treatment, after initial setup, a CBCT was acquired and fused to the planning CT based on 3-dimensional matching of the spacer. A second alignment was then performed based on the fiducial markers. The six directional shifts (three linear and three rotational) were recorded, and the differences compared. Results 140 individual fractions across 41 consecutive patients were evaluated. Mean/median differences between hydrogel spacer-based and fiducial-based alignment in linear (vertical, longitudinal, lateral) and rotational (rotation, pitch, roll) shifts were 0.9/0.6mm, 0.8/0.5mm, and 0.6/0.4mm, and 0.38/0, 0.62/0, and 0.35/0 degrees, respectively. No difference was observed in 9.9%, 22.9%, and 22.14% of linear shifts, and 65.7%, 65%, and 66.4% rotational shifts, respectively. Significantly smaller differences were observed in the latter 70 fractions vs. the former, and results were consistent across evaluators. Conclusions For precise daily IGRT with CBCT for prostate SABR, alignment using a radiopaque hydrogel spacer was highly comparable to intraprostatic fiducial markers. This represents the first report supporting an additional indication of IGRT for a CT-visible hydrogel spacer, to further enhance treatment accuracy and potentially obviate the need for the additional fiducial marker procedure.
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Affiliation(s)
- Oded Icht
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shir Schlosser
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miriam Weinstock-Sabbah
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
| | - Mor Rephael
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
| | - Dimitri Bragilovski
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
| | - Assaf Moore
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tzippora Shochat
- Department of Biostatistics, Rabin Medical Center, Petah Tikvah, Israel
| | - Dror Limon
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elisha Fredman
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Górecka Ż, Idaszek J, Heljak M, Martinez DC, Choińska E, Kulas Z, Święszkowski W. Indocyanine green and iohexol loaded hydroxyapatite in poly(L-lactide-co-caprolactone)-based composite for bimodal near-infrared fluorescence- and X-ray-based imaging. J Biomed Mater Res B Appl Biomater 2024; 112:e35313. [PMID: 37596854 DOI: 10.1002/jbm.b.35313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
This study aimed to develop material for multimodal imaging by means of X-ray and near-infrared containing FDA- and EMA-approved iohexol and indocyanine green (ICG). The mentioned contrast agents (CAs) are hydrophilic and amphiphilic, respectively, which creates difficulties in fabrication of functional polymeric composites for fiducial markers (FMs) with usage thereof. Therefore, this study exploited for the first time the possibility of enhancing the radiopacity and introduction of the NIR fluorescence of FMs by adsorption of the CAs on hydroxyapatite (HAp) nanoparticles. The particles were embedded in the poly(L-lactide-co-caprolactone) (P[LAcoCL]) matrix resulting in the composite material for bimodal near-infrared fluorescence- and X-ray-based imaging. The applied method of material preparation provided homogenous distribution of both CAs with high iohexol loading efficiency and improved fluorescence signal due to hindered ICG aggregation. The material possessed profound contrasting properties for both imaging modalities. Its stability was evaluated during in vitro experiments in phosphate-buffered saline (PBS) and foetal bovine serum (FBS) solutions. The addition of HAp nanoparticles had significant effect on the fluorescence signal. The X-ray radiopacity was stable within minimum 11 weeks, even though the addition of ICG contributed to a faster release of iohexol. The stiffness of the material was not affected by iohexol or ICG, but incorporation of HAp nanoparticles elevated the values of bending modulus by approximately 70%. Moreover, the performed cell study revealed that all tested materials were not cytotoxic. Thus, the developed material can be successfully used for fabrication of FMs.
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Affiliation(s)
- Żaneta Górecka
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
- Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, Warsaw, Poland
| | - Joanna Idaszek
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Marcin Heljak
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Diana C Martinez
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Emilia Choińska
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Zbigniew Kulas
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Wojciech Święszkowski
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
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Li Y, Liu H, Ding Y, Li W, Zhang Y, Luo S, Xiang Q. The Use of Hydrogel-Based Materials for Radioprotection. Gels 2023; 9:gels9040301. [PMID: 37102914 PMCID: PMC10137482 DOI: 10.3390/gels9040301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Major causes of the radiation-induced disease include nuclear accidents, war-related nuclear explosions, and clinical radiotherapy. While certain radioprotective drug or bioactive compounds have been utilized to protect against radiation-induced damage in preclinical and clinical settings, these strategies are hampered by poor efficacy and limited utilization. Hydrogel-based materials are effective carriers capable of enhancing the bioavailability of compounds loaded therein. As they exhibit tunable performance and excellent biocompatibility, hydrogels represent promising tools for the design of novel radioprotective therapeutic strategies. This review provides an overview of common approaches to radioprotective hydrogel preparation, followed by a discussion of the pathogenesis of radiation-induced disease and the current states of research focused on using hydrogels to protect against these diseases. These findings ultimately provide a foundation for discussions of the challenges and future prospects associated with the use of radioprotective hydrogels.
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Affiliation(s)
- Yang Li
- Center of Emergency, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Chongqing 400038, China
| | - Han Liu
- Center of Emergency, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yaqun Ding
- Center of Emergency, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wanyu Li
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Chongqing 400038, China
| | - Yuansong Zhang
- Center of Emergency, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Shenglin Luo
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Chongqing 400038, China
| | - Qiang Xiang
- Center of Emergency, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
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Williams J, Millan KM, Bolton D, Tan A, Cham CW, Pham T, Pan D, Liu M, Chan Y, Manohar P, Thomas J, Koufogiannis G, Ho H, Guerrieri M, Ng M, Boike T, Macleod C, Joon DL, Foroudi F, Chao M. Hyaluronic acid rectal spacer in EBRT: Usability, safety and symmetry related to user experience. J Med Imaging Radiat Sci 2022; 53:640-647. [PMID: 36202722 DOI: 10.1016/j.jmir.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To report on the usability, safety, symmetry, and effectiveness of hyaluronic acid (HA) injected between the prostate and the rectum for patients undergoing treatment for prostate cancer with external beam radiotherapy (EBRT), and present a novel definition of rectal spacer symmetry that is reproducible and independent of patient anatomy. PATIENTS AND METHODS 102 consecutive patients with clinical stage of T1c-3b prostate cancer underwent general anaesthesia for fiducial marker insertion and injection of HA into the perirectal space before EBRT. HA safety, symmetry, separation, and usability based on user experience were assessed. RESULTS HA insertion was completed with a 100% success rate independent of user experience, rated as 'easy' or 'very easy' in all cases. There were no postoperative complications reported. The mean (SD) recto-prostatic separation for all patients at the base, midgland and apex were 12 (±2) mm, 11 (±2) mm, and 9 (±1) mm respectively. The mean sagittal length of the implant was 43 (±5) mm. The implant was rated as symmetrical in 98% of cases. The mean rV70Gy was 1.6% (IQR 0.8-3.3%) for patients receiving 78-80Gy. The mean rV53Gy was 2.8% (IQR 1.2-4.8%) for patients receiving 60-62Gy. The median prostate size was 43.5 cc (IQR 32-57). CONCLUSION Injection of HA was able to achieve highly symmetrical recto-prostatic separation, with new users able to produce excellent separation, particularly at the apex, achieving similar dosimetry outcomes as competent and experienced users. HA is safe, easy to use, and significantly reduced mean rV70Gy and rV53Gy compared to non-spacer patients.
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Affiliation(s)
- Jack Williams
- Albury Wodonga Health, 201 Borella Rd, Albury, NSW 2640, Australia; Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Kevin Mc Millan
- Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia
| | - Damien Bolton
- Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | - Alwin Tan
- The Bays Hospital, 262 Main St, Mornington, VIC 3931, Australia
| | - Chee Wee Cham
- The Bays Hospital, 262 Main St, Mornington, VIC 3931, Australia
| | - Trung Pham
- Monash Health, 246, Clayton Rd, Clayton, VIC 3168, Australia
| | - David Pan
- Monash Health, 246, Clayton Rd, Clayton, VIC 3168, Australia
| | - Madalena Liu
- Monash Health, 246, Clayton Rd, Clayton, VIC 3168, Australia
| | - Yee Chan
- Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | - Paul Manohar
- Monash Health, 246, Clayton Rd, Clayton, VIC 3168, Australia
| | - Joe Thomas
- Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia
| | - George Koufogiannis
- Ringwood Private Hospital, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Huong Ho
- Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Mario Guerrieri
- Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Michael Ng
- Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Thomas Boike
- Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia; Michigan Health Professionals Radiation Oncology, 4550 Investment Dr, Suite B111, Troy, MI 8098, US
| | - Craig Macleod
- Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia
| | - Daryl Lim Joon
- Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | - Farshad Foroudi
- Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | - Michael Chao
- Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia; Ringwood Private Hospital, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia; Genesis Care Victoria, 36 Mt Dandenong Rd, Ringwood East, VIC 3135, Australia.
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6
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Górecka Ż, Choińska E, Heljak M, Święszkowski W. Long-Term In Vitro Assessment of Biodegradable Radiopaque Composites for Fiducial Marker Fabrication. Int J Mol Sci 2022; 23:ijms232214363. [PMID: 36430842 PMCID: PMC9697335 DOI: 10.3390/ijms232214363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Abstract
Biodegradable polymer-based composite materials may be successfully utilised to fabricate fiducial markers (FMs), which are intended to precisely label tumour margins during image-guided surgery or radiotherapy. However, due to matrix degradability, the stability of the functional properties of FMs depends on the chosen polymer. Thus, this study aimed to investigate novel radiopaque composites which varied in the polymeric matrix-polycaprolactone (PCL), poly(L-lactide-co-caprolactone) (P[LAcoCL]) with two molar ratios (70:30 and 85:15), and poly(L-lactide-co-glycolide) (with molar ratio 82:18). The radiopaque component of the materials was a mixture of barium sulphate and hydroxyapatite. The changes in water contact angle, stiffness, and radiopacity occurring during the 24-week-long degradation experiment were examined for the first time. This study comprehensively analyses the microstructural causes of composites behaviour within degradation experiments using thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), gel permitted chromatography (GPC), and scanning electron microscopy (SEM). The obtained results suggest that the utilized biodegradable matrix plays an essential role in radiopaque composite properties and stability thereof. This long-term in vitro assessment enabled a comparison of the materials and aided in choosing the most favourable composite for FMs' fabrication.
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Affiliation(s)
- Żaneta Górecka
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
- Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, 19 Poleczki Str., 02-882 Warsaw, Poland
| | - Emilia Choińska
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
| | - Marcin Heljak
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
| | - Wojciech Święszkowski
- Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, 19 Poleczki Str., 02-882 Warsaw, Poland
- Correspondence:
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7
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Wang S, Tang W, Luo H, Jin F, Wang Y. The Role of Image-guided Radiotherapy in Prostate Cancer: A Systematic Review and Meta-Analysis. Clin Transl Radiat Oncol 2022; 38:81-89. [DOI: 10.1016/j.ctro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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8
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Górecka Ż, Grzelecki D, Paskal W, Choińska E, Gilewicz J, Wrzesień R, Macherzyński W, Tracz M, Budzińska-Wrzesień E, Bedyńska M, Kopka M, Jackowska-Tracz A, Świątek-Najwer E, Włodarski PK, Jaworowski J, Święszkowski W. Biodegradable Fiducial Markers for Bimodal Near-Infrared Fluorescence- and X-ray-Based Imaging. ACS Biomater Sci Eng 2022; 8:859-870. [PMID: 35020357 DOI: 10.1021/acsbiomaterials.1c01259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study aimed to evaluate, for the first time, implantable, biodegradable fiducial markers (FMs), which were designed for bimodal, near-infrared fluorescence-based (NIRF) and X-ray-based imaging. The developed FMs had poly(l-lactide-co-caprolactone)-based core-shell structures made of radiopaque (core) and fluorescent (shell) composites with a poly(l-lactide-co-caprolactone) matrix. The approved for human use contrast agents were utilized as fillers. Indocyanine green was applied to the shell material, whereas in the core materials, iohexol and barium sulfate were compared. Moreover, the possibility of tailoring the stability of the properties of the core materials by the addition of hydroxyapatite (HAp) was examined. The performed in situ (porcine tissue) and in vivo experiment (rat model) confirmed that the developed FMs possessed pronounced contrasting properties in NIRF and X-ray imaging. The presence of HAp improved the radiopacity of FMs at the initial state. It was also proved that, in iohexol-containing FMs, the presence of HAp slightly decreased the stability of contrasting properties, while in BaSO4-containing ones, changes were less pronounced. A comprehensive material analysis explaining the differences in the stability of the contrasting properties was also presented. The tissue response around the FMs with composite cores was comparable to that of the FMs with a pristine polymeric core. The developed composite FMs did not cause serious adverse effects on the surrounding tissues even when irradiated in vivo. The developed FMs ensured good visibility for NIRF image-supported tumor surgery and the following X-ray image-guided radiotherapy. Moreover, this study replenishes a scanty report regarding similar biodegradable composite materials with a high potential for application.
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Affiliation(s)
- Żaneta Górecka
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland.,Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, 02-822 Warsaw, Poland
| | - Dariusz Grzelecki
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.,Department of Orthopedics and Rheumoorthopedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, 05-400 Otwock, Poland
| | - Wiktor Paskal
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Emilia Choińska
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
| | - Joanna Gilewicz
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Robert Wrzesień
- Central Laboratory of Experimental Animal, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Wojciech Macherzyński
- Faculty of Microsystem Electronics and Photonics, Wroclaw University of Science and Technology, 50-372 Wroclaw, Poland
| | - Michał Tracz
- Institute of Veterinary Medicine, Department of Food Hygiene and Public Health Protection, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | | | - Maria Bedyńska
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Michał Kopka
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Agnieszka Jackowska-Tracz
- Institute of Veterinary Medicine, Department of Food Hygiene and Public Health Protection, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Ewelina Świątek-Najwer
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, 50-371 Wroclaw, Poland
| | - Paweł K Włodarski
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Janusz Jaworowski
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Wojciech Święszkowski
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
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Luo HL, Liu HY, Chang YL, Su YL, Huang CC, Lin XJ, Chuang YC. Extracorporeal Shock Wave Enhances the Cisplatin Efficacy by Improving Tissue Infiltration and Cellular Uptake in an Upper Urinary Tract Cancer Animal and Human-Derived Organoid Model. Cancers (Basel) 2021; 13:cancers13184558. [PMID: 34572785 PMCID: PMC8471724 DOI: 10.3390/cancers13184558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Upper urinary tract urothelial carcinoma (UTUC) is a relatively rare cancer with a poor prognosis if diagnosed at an advanced stage. Although cisplatin-based chemotherapy is a common treatment strategy, it has a limited response rate. Shock wave lithotripsy is a common treatment for upper urinary tract stones. Low-energy shock waves (LESWs) temporarily increase tissue permeability and enhance drug penetration to the targeted tissue. However, no study has investigated the efficacy of the combination of shock wave lithotripsy and chemotherapy in UTUC. Hence, in this study, we aimed to identify the potential application of the combination of LESW and chemotherapy in UTUC. We evaluated the synergistic effects of LESW and cisplatin in vitro, in vivo, and in patient-derived organoid (PDO) models. Compared with cisplatin alone, the combination treatment caused more significant tumour suppression in vitro and in animal models, without increased toxicity. Histological examination showed that compared with animals treated with cisplatin alone, those who received the combination treatment showed more deteriorated cell arrangement and cell oedema. Moreover, LESW improved the cytotoxicity of cisplatin in the preclinical PDO model of UTUC. Thus, LESW combined with cisplatin is a potential new antitumour strategy for improving the treatment response in locally advanced UTUC.
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Affiliation(s)
- Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hui-Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
| | - Yin-Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
| | - Yu-Li Su
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Xin-Jie Lin
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-L.L.); (H.-Y.L.); (Y.-L.C.); (X.-J.L.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7317123 (ext. 8094); Fax: +886-7-7354309
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10
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Bahl A, Challapalli A, Jain S, Payne H. Rectal spacers in patients with prostate cancer undergoing radiotherapy: A survey of UK uro-oncologists. Int J Clin Pract 2021; 75:e14338. [PMID: 33966327 DOI: 10.1111/ijcp.14338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
AIM To understand the awareness and use of rectal spacers for prostate cancer patients undergoing radical radiotherapy in the United Kingdom. METHODS An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). RESULTS Sixty-three specialists completed the survey (50% of BUG members at that point in time). Only 37% had used rectal spacers, mostly for private patients or those with pre-existing bowel conditions. However, many (68%) would like to use these devices in future. More than 70% of the uro-oncologists felt that bowel toxicity was underreported, but 60% believed that the use of radiotherapy without bowel toxicity was achievable with the use of rectal spacers. CONCLUSIONS The current use of rectal spacers by UK uro-oncologists for patients with localised or locally advanced prostate cancer receiving radiotherapy is low and largely restricted by resourcing issues.
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Affiliation(s)
- Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Amarnath Challapalli
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Suneil Jain
- Queen's University Belfast and Northern Ireland Cancer Centre, Belfast, UK
| | - Heather Payne
- Oncology Department, University College London Hospitals, London, UK
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A cone beam CT-based study on fiducial seed migration and planning target volume margin in prostate radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:This study attempts to investigate fiducial marker (FM) migration and calculate the prostate planning target volume (PTV) margin considering the setup errors after translation corrections alone (T) and translation plus rotational corrections (T+R) and anatomy variation with respect to the corrected fiducial position, analysed on cone beam computed tomography (CBCT) images.Methods and materials:CBCT images from 25 patients are analysed for FM movements, setup error and anatomy variation with respect to the seed match positions. Systematic and random components of setup error and prostate movements are used to calculate the PTV margin for CBCT-based FM localisation in two scenarios, translation corrections only and translation plus rotational correction. MTNW887825 soft tissue gold markers (Civco, Orange City, FL, USA) were used with the department-specific immobilisation system and rectal and bladder filling protocols.Results:The average directional inter-marker distance variation is −0·05 ± 0·90 mm. The systematic setup errors for T+R are 0·40, 0·63 and 0·80 mm in right–left (RL), anterior–posterior (AP) and superior–inferior (SI), respectively. The corresponding values for T only are 0·54, 0·69 and 0·90 mm. The systematic prostate movement from T+R corrected FM positions are 0·65, 1·27 and 1·32 mm in the RL, AP and SI directions.Findings:Minimal FM movements are noted from the study. The PTV margins to incorporate the daily T+R corrected setup error and prostate deformation are found to be 2·5, 4·5 and 5·2 mm in the RL, AP and SI directions, respectively. The corresponding margins for T only corrected scenario are found to be 2·8, 4·8 and 5·7 mm.
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Lundqvist M, Levin LÅ. Cost-Effectiveness of the Use of Gold Anchor™ Markers in Prostate Cancer. Cureus 2020; 12:e11229. [PMID: 33269157 PMCID: PMC7706143 DOI: 10.7759/cureus.11229] [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] [Indexed: 11/10/2022] Open
Abstract
Introduction A common treatment for prostate cancer is external beam radiation therapy. A way to target the radiation is to use implantable gold fiducial markers (GFMs). The GFMs serve as reference points enabling tumor localization during treatment. Today, there are several GFMs available on the market but no clinical guidelines as to which one to use. The aim of this study was to estimate the cost-effectiveness of Gold Anchor GFMs (Naslund Medical AB, Huddinge, Sweden) implanted with a 22G needle, compared to other GFMs implanted with a 17-18G needle, in the prostate gland of patients with prostate cancer. Methods Costs, life years, and quality-adjusted life years (QALYs) were estimated over a lifelong time horizon for each treatment strategy using a decision-analytic model. Data used in the model were obtained from published literature or were estimated by an expert elicitation technique. The primary outcome measure was an incremental cost-effectiveness ratio (ICER). Results Gold Anchor GFM was found to be a dominant alternative with both lower costs [-8.7 US Dollars (USD)] and a gain in QALYs (0.015) when compared with other GFMs. The lower cost was achieved by fewer visits for imaging in treatment planning, and by reduced risk of infections and sepsis. The QALY gain was driven by a reduced risk of sepsis. Conclusion The use of Gold Anchor GFMs as reference points to target radiation is a cost-effective alternative when compared to other GFMs. However, this analysis is based on expert elicitation regarding some crucial parameters, and further clinical studies of the use of GFMs are needed.
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Affiliation(s)
- Martina Lundqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWE
| | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWE
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Takei Y, Monzen H, Tamura M, Doi H, Nishimura Y. Dose reduction potential of using gold fiducial markers for kilovoltage image-guided radiotherapy. J Appl Clin Med Phys 2020; 21:151-157. [PMID: 32959957 PMCID: PMC7592977 DOI: 10.1002/acm2.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/19/2022] Open
Abstract
This study aimed to evaluate the possibility of reducing the imaging dose for image-guided radiotherapy by using planar kilovoltage orthogonal imaging and fiducial markers (kV-FM). We tested kilovoltage planar images under clinical imaging conditions for the pelvis (75 kVp, 200 mA, 50 ms) at a decreasing tube current (from 200 to 10 mA). Imaging doses were measured with a semiconductor detector. The visibility of the kV-FM, aspects of image quality (spatial resolution, low contrast resolution), and the resultant image registration reproducibility were evaluated using various shapes (folded, linear, tadpole-like) of fiducial markers containing 0.5% iron [Gold Anchor™ (GA); Naslund Medical AB, Huddinge, Sweden]. The GA phantom was created by placing these variously shaped GAs in an agar phantom. The imaging doses with 200 and 10 mA were approximately 0.74 and 0.04 mGy and they were correlated to the tube current (R2 = 0.999). Regardless of the marker's shape, the GA phantom ensured visibility even when the tube current was reduced to the minimum value (10 mA). The low contrast resolution was gradually decreased at less than 50 mA, but the spatial resolution did not change. Although the auto-registration function could not be used, manual-registration could be achieved with an accuracy of within 1 mm, even when the imaging dose was reduced to 1/20 of the clinical imaging condition for the pelvis. When using the GA as the fiducial marker, the imaging dose could be reduced to 1/20 of that used clinically while maintaining the accuracy of manual-registration using the kV-FM for image-guided radiotherapy of the pelvis.
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Affiliation(s)
- Yoshiki Takei
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
- Department of Radiology, Kindai University Nara Hospital, Ikoma, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Japan
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Kaneda T, Ohashi T, Hanada T, Takenaka K, Nishimura S, Sakayori M, Sutani S, Momma T, Shigematsu N. Comparison of prostate verification with implanted gold markers in tissue surrounding the prostate and pelvic bony anatomy for external beam radiation therapy following low-dose-rate brachytherapy: a prospective clinical trial. JOURNAL OF RADIATION RESEARCH 2020; 61:784-790. [PMID: 32808018 PMCID: PMC7482168 DOI: 10.1093/jrr/rraa063] [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: 05/02/2020] [Revised: 05/16/2020] [Indexed: 06/11/2023]
Abstract
We aimed to investigate whether gold marker implantation in the tissue surrounding the prostate could accurately monitor setup errors during external beam radiation therapy (EBRT) following low-dose-rate (LDR) brachytherapy. Thirty-eight patients had confirmed intermediate- or high-risk prostate cancer and received EBRT following LDR brachytherapy. In >175 computed tomography imaging sessions, the average values of the weekly setup error during EBRT to the prostate centroid at the time of gold marker matching in the surrounding tissue of the prostate and pelvic bone matching were measured and then compared using the Wilcoxon signed-rank test. Gold marker matching in the surrounding tissue of the prostate estimated setup errors better than those estimated by bone matching (3D displacement = 2.7 ± 2.0 vs 3.8 ± 2.6 mm, P < 0.01). Overall, the standard deviation of systematic (Σ) and random (σ) setup error was lower with gold marker matching than with bone matching (3D displacement = 1.8 and 1.1 mm vs 2.1 and 1.6 mm, respectively). With gold marker matching, the setup error of the position of the prostate centroid was smaller, and the optimal setup margin was lower than that with bone matching (2Σ + 0.7σ and 2.5Σ + 0.7σ of 3D displacement = 4.3 and 5.2 mm vs 5.3 and 6.4 mm, respectively). This high-precision radiotherapy approach placing gold markers in the surrounding tissue of the prostate can allow more accurate setup during EBRT following LDR brachytherapy.
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Affiliation(s)
- Tomoya Kaneda
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Radiology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan
| | - Toshio Ohashi
- Corresponding author. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Tel: +81-3-3353-1211; Fax: +81-3-3359-7425;
| | - Takashi Hanada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Koji Takenaka
- Department of Radiology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan
| | - Shuichi Nishimura
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masanori Sakayori
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Radiology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan
| | - Shinya Sutani
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.Materials and methods:The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.Results:Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.Conclusion:In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.
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Costing Urologic Complications Following Pelvic Radiation Therapy. Urology 2020; 140:64-69. [DOI: 10.1016/j.urology.2020.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 01/04/2023]
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Boateng F, Ngwa W. Delivery of Nanoparticle-Based Radiosensitizers for Radiotherapy Applications. Int J Mol Sci 2019; 21:ijms21010273. [PMID: 31906108 PMCID: PMC6981554 DOI: 10.3390/ijms21010273] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023] Open
Abstract
Nanoparticle-based radiosensitization of cancerous cells is evolving as a favorable modality for enhancing radiotherapeutic ratio, and as an effective tool for increasing the outcome of concomitant chemoradiotherapy. Nevertheless, delivery of sufficient concentrations of nanoparticles (NPs) or nanoparticle-based radiosensitizers (NBRs) to the targeted tumor without or with limited systemic side effects on healthy tissues/organs remains a challenge that many investigators continue to explore. With current systemic intravenous delivery of a drug, even targeted nanoparticles with great prospect of reaching targeted distant tumor sites, only a portion of the administered NPs/drug dosage can reach the tumor, despite the enhanced permeability and retention (EPR) effect. The rest of the targeted NPs/drug remain in systemic circulation, resulting in systemic toxicity, which can decrease the general health of patients. However, the dose from ionizing radiation is generally delivered across normal tissues to the tumor cells (especially external beam radiotherapy), which limits dose escalation, making radiotherapy (RT) somewhat unsafe for some diseased sites despite the emerging development in RT equipment and technologies. Since radiation cannot discriminate healthy tissue from diseased tissue, the radiation doses delivered across healthy tissues (even with nanoparticles delivered via systemic administration) are likely to increase injury to normal tissues by accelerating DNA damage, thereby creating free radicals that can result in secondary tumors. As a result, other delivery routes, such as inhalation of nanoparticles (for lung cancers), localized delivery via intratumoral injection, and implants loaded with nanoparticles for local radiosensitization, have been studied. Herein, we review the current NP delivery techniques; precise systemic delivery (injection/infusion and inhalation), and localized delivery (intratumoral injection and local implants) of NBRs/NPs. The current challenges, opportunities, and future prospects for delivery of nanoparticle-based radiosensitizers are also discussed.
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Affiliation(s)
- Francis Boateng
- TIDTAC LLC, Orlando, FL 32828, USA
- Correspondence: ; Tel.: +1-7745264723
| | - Wilfred Ngwa
- TIDTAC LLC, Orlando, FL 32828, USA
- Department of Physics and Applied Physics, University of Massachusetts Lowell Lowell, MA 01854, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, MA 02115, USA
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de Muinck Keizer DM, Kerkmeijer LGW, Maspero M, Andreychenko A, van der Voort van Zyp JRN, van den Berg CAT, Raaymakers BW, Lagendijk JJW, de Boer JCJ. Soft-tissue prostate intrafraction motion tracking in 3D cine-MR for MR-guided radiotherapy. Phys Med Biol 2019; 64:235008. [PMID: 31698351 DOI: 10.1088/1361-6560/ab5539] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To develop a method to automatically determine intrafraction motion of the prostate based on soft tissue contrast on 3D cine-magnetic resonance (MR) images with high spatial and temporal resolution. Twenty-nine patients who underwent prostate stereotactic body radiotherapy (SBRT), with four implanted cylindrical gold fiducial markers (FMs), had cine-MR imaging sessions after each of five weekly fractions. Each cine-MR session consisted of 55 sequentially obtained 3D data sets ('dynamics') and was acquired over an 11 s period, covering a total of 10 min. The prostate was delineated on the first dynamic of every dataset and this delineation was used as the starting position for the soft tissue tracking (SST). Each subsequent dynamic was rigidly aligned to the first dynamic, based on the contrast of the prostate. The obtained translation and rotation describes the intrafraction motion of the prostate. The algorithm was applied to 6270 dynamics over 114 scans of 29 patients and the results were validated by comparing to previously obtained fiducial marker tracking data of the same dataset. Our proposed tracking method was also retro-perspectively applied to cine-MR images acquired during MR-guided radiotherapy of our first prostate patient treated on the MR-Linac. The difference in the 3D translation results between the soft tissue and marker tracking was below 1 mm for 98.2% of the time. The mean translation at 10 min were X: 0.0 [Formula: see text] 0.8 mm, Y: 1.0 [Formula: see text] 1.8 mm and Z: [Formula: see text] mm. The mean rotation results at 10 min were X: [Formula: see text], Y: 0.1 [Formula: see text] 0.6° and Z: 0.0 [Formula: see text] 0.7°. A fast, robust and accurate SST algorithm was developed which obviates the need for FMs during MR-guided prostate radiotherapy. To our knowledge, this is the first data using full 3D cine-MR images for real-time soft tissue prostate tracking, which is validated against previously obtained marker tracking data.
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Affiliation(s)
- D M de Muinck Keizer
- Department of Radiotherapy, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands. Author to whom any correspondence should be addressed
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Scher N, Bollet M, Bouilhol G, Tannouri R, Khemiri I, Vouillaume A, Sellami N, Von Eyben R, Vannetzel JM, Darmon I, Rotenberg L, Lamallem H, Bauduceau O, Foster D, Toledano A. Safety and efficacy of fiducial marker implantation for robotic stereotactic body radiation therapy with fiducial tracking. Radiat Oncol 2019; 14:167. [PMID: 31519194 PMCID: PMC6743112 DOI: 10.1186/s13014-019-1373-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/02/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose The purpose of this study was to assess the feasibility, efficacy and toxicity of fiducial marker implantation and tracking in CyberKnife® stereotactic radiation therapy (SBRT) applied to extracranial locations. Materials and method This is a retrospective, single-centre, observational study to collect the data of all patients treated by stereotactic radiation therapy with fiducial marker tracking at extracranial locations, conducted between June 2014 and November 2017. Information regarding the implantation procedure, the types of toxicity related to marker implantation and the number of markers implanted/tracked during treatment were collected. Complication rates were evaluated using the CTCAE v4 [Common Terminology Criteria for Adverse Events] scale. The technical success rate was based on the ability to optimally track the tumor throughout all treatment fractions. Results Out of 2505 patients treated by stereotactic radiation therapy, 25% received treatment with fiducial marker tracking. The total number of implantation procedures was 616 and 1543 fiducial markers were implanted. The implantation-related complication rate was 3%, with 16 Grade 1 events and 4 Grade 2 events. The number of treated patients and the number of implanted markers has gradually increased since the technique was first implemented. The median treatment time was 27 min (range 10–76). 1295 fiducials were effectively tracked throughout all treatment fractions, corresponding to a technical success rate of 84%. The difference between the number of fiducials implanted and those tracked during treatment decreased significantly as the site’s experience increased. Conclusion Fiducial marker implantation and tracking is feasible, well-tolerated, and technically effective technique in SBRT for extracranial tumors.
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Affiliation(s)
- Nathaniel Scher
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France.
| | - Marc Bollet
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France.,Rafael Institute, Center for Predictive Medicine, 3 boulevard Bineau, Levallois-Perret, France
| | - Gauthier Bouilhol
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Remi Tannouri
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Imane Khemiri
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Aurelie Vouillaume
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Noura Sellami
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Rie Von Eyben
- Department of Statistical Analysis, Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, California, USA
| | - Jean-Michel Vannetzel
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Ilan Darmon
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Luc Rotenberg
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Hanah Lamallem
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France.,Rafael Institute, Center for Predictive Medicine, 3 boulevard Bineau, Levallois-Perret, France
| | - Olivier Bauduceau
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France.,Rafael Institute, Center for Predictive Medicine, 3 boulevard Bineau, Levallois-Perret, France
| | - Denis Foster
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France
| | - Alain Toledano
- Hartmann Radiotherapy Institute, Levallois-Perret, 4 rue Kleber, Levallois-Perret, France.,Rafael Institute, Center for Predictive Medicine, 3 boulevard Bineau, Levallois-Perret, France
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Shcherbakova Y, Bartels LW, Mandija S, Beld E, Seevinck PR, van der Voort van Zyp JRN, Kerkmeijer LGW, Moonen CTW, Lagendijk JJW, van den Berg CAT. Visualization of gold fiducial markers in the prostate using phase-cycled bSSFP imaging for MRI-only radiotherapy. ACTA ACUST UNITED AC 2019; 64:185001. [DOI: 10.1088/1361-6560/ab35c3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Scher N, Bauduceau O, Bollet M, Lamallem H, Charas T, Garaud P, Foster D, Fawzi M, Labidi M, Toledano A. Stereotactic prostate focal reirradiation therapy for local recurrence: preliminary results of Hartmann Oncology Radiotherapy Group. BJR Open 2019; 1:20180027. [PMID: 33178921 PMCID: PMC7592466 DOI: 10.1259/bjro.20180027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/05/2022] Open
Abstract
Objective Our objective was to report our experience and to evaluate the feasibility and toxicity of focal salvage stereotactic body radiation therapy (SBRT) in patients with post-radiation local recurrence of prostate cancer. Methods We retrospectively reviewed medical records of patients treated with Cyberknife ® between October 2014 and April 2017 at our institution for a focal reirradiation delivered to the prostate/prostatic bed for local recurrence after radical or adjuvant radiotherapy. All patients underwent prostate biopsies at recurrence at the time of fiducial markers placement, had choline PET/CT and pelvic MRI. The treatment consisted in 36 Gy in six fractions delivered every other day. Post reirradiation toxicities were assessed according to the CTCAE v4 (Common Terminology Criteria for Adverse Events). Results 42 patients were treated with followed with a median follow-up of 21 months (range 3 - 31). 34 patients had biopsy proven recurrence. The initial treatment was radical prostatectomy and radiation therapy for 9 patients and radiation therapy alone for 33 patients. 23 patients from the group of prostate reirradiation had placement of rectal spacers. No Grade 4 or 5 toxicity were observed. 27 acute urinary events were recorded: 18 patients experienced Grade 1, 9 patients experienced Grade 2 toxicity and 1 patient experienced Grade 3 urinary toxicity, namely cystitis and/or dysuria. No Grade 2 or more digestive toxicity was observed. Rectal doses were significantly lower with rectal spacers. Conclusion Salvage focal Cyberknife ® seems feasible and show promising results. Advances in knowledge SBRT for local prostate cancer recurrence after initial radiotherapy is well tolerated with short follow-up.
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Affiliation(s)
| | | | | | | | - Tomer Charas
- Department of Radiation Oncology, MSKCC, New York, USA
| | - Pascal Garaud
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Denis Foster
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Maher Fawzi
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Mona Labidi
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
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Lin D, Lehrer EJ, Rosenberg J, Trifiletti DM, Zaorsky NG. Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis. Radiother Oncol 2019; 135:147-152. [DOI: 10.1016/j.radonc.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
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Alexander SE, Kinsella J, McNair HA, Tree AC. National survey of fiducial marker insertion for prostate image guided radiotherapy. Radiography (Lond) 2018; 24:275-282. [PMID: 30292494 DOI: 10.1016/j.radi.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the United Kingdom fiducial marker IGRT is the second most common verification method employed in radical prostate radiotherapy yet little evidence exists to support centres introducing or developing this practice. We developed a survey to elicit current fiducial marker practices adopted in the UK, to recommend standardisation of practice. METHODS A 16 question survey was distributed across UK Radiotherapy centres via promotion at the British Uro-Oncology Group Conference, 2016. Included were questions relating to workforce planning, patient preparation, insertion procedure and verification methods. The survey was open from September 2016 to January 2017. RESULTS Results from 15 centres routinely inserting fiducial markers for prostate IGRT are presented. Eleven professional groups insert fiducial markers across the UK. Fourteen centres insert fiducial markers trans-rectally; one trans-perineally. Centres adopting a trans-rectal approach administer prophylactic ciprofloxacin as a single agent or combined with gentamicin or metronidazole; poor agreement between regimes presented. One centre has introduced targeted antibiotic prophylaxis. Five brands of fiducial markers are utilised nationally. Fourteen centres standardly insert three single fiducial markers, two common configurations emerged. Coupled fiducial markers are routinely implanted by one centre. All centres delay at least one week between fiducial marker insertion and planning CT; seven centres wait two weeks. The most common fiducial verification method is two-dimensional, paired kilo Voltage imaging. CONCLUSION Variation in fiducial marker practice across the UK is considerable. Standardisation is required to support centres and healthcare professionals developing this service. Seven recommendations, to unify practice, have been proposed based on survey results and literature.
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Affiliation(s)
| | - J Kinsella
- The Royal Marsden NHS Foundation Trust, UK.
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
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24
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Gustafsson C, Persson E, Gunnlaugsson A, Olsson LE. Using C-Arm X-ray images from marker insertion to confirm the gold fiducial marker identification in an MRI-only prostate radiotherapy workflow. J Appl Clin Med Phys 2018; 19:185-192. [PMID: 30354010 PMCID: PMC6236813 DOI: 10.1002/acm2.12478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/30/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer radiotherapy workflows, solely based on magnetic resonance imaging (MRI), are now in clinical use. In these workflows, intraprostatic gold fiducial markers (GFM) show similar signal behavior as calcifications and bleeding in T2‐weighted MRI‐images. Accurate GFM identification in MRI‐only radiotherapy workflows is therefore a major challenge. C‐arm X‐ray images (CkV‐images), acquired at GFM implantation, could provide GFM position information and be used to confirm correct identification in T2‐weighted MRI‐images. This would require negligible GFM migration between implantation and MRI‐imaging. Marker migration was therefore investigated. The aim of this study was to show the feasibility of using CkV‐images to confirm GFM identification in an MRI‐only prostate radiotherapy workflow. An anterior‐posterior digitally reconstructed radiograph (DRR)‐image and a mirrored posterior‐anterior CkV‐image were acquired two weeks apart for 16 patients in an MRI‐only radiotherapy workflow. The DRR‐image originated from synthetic CT‐images (created from MRI‐images). A common image geometry was defined between the DRR‐ and CkV‐image for each patient. A rigid registration between the GFM center of mass (CoM) coordinates was performed and the distance between each of the GFM in the DRR‐ and registered CkV‐image was calculated. The same methodology was used to assess GFM migration for 31 patients in a CT‐based radiotherapy workflow. The distance calculated was considered a measure of GFM migration. A statistical test was performed to assess any difference between the cohorts. The mean absolute distance difference for the GFM CoM between the DRR‐ and CkV‐image in the MRI‐only cohort was 1.7 ± 1.4 mm. The mean GFM migration was 1.2 ± 0.7 mm. No significant difference between the measured total distances of the two cohorts could be detected (P = 0.37). This demonstrated that, a C‐Arm X‐ray image acquired from the GFM implantation procedure could be used to confirm GFM identification from MRI‐images. GFM migration was present but did not constitute a problem.
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Affiliation(s)
- Christian Gustafsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Emilia Persson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Adalsteinn Gunnlaugsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lars E Olsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden
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25
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The use of hydrogel spacer in men undergoing high-dose prostate cancer radiotherapy: results of a prospective phase 2 clinical trial. World J Urol 2018; 37:1111-1116. [PMID: 30251049 DOI: 10.1007/s00345-018-2502-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The purpose of this study was to determine whether the degree of prostate to rectal separation using a hydrogel spacer (HS) and its effect on decreasing rectal dose can be reproduced in the community setting. METHODS Thirty one patients with cT1-3aN0M0 prostate adenocarcinoma receiving radical radiotherapy to 78 Gy were recruited to the study. The primary endpoint was the proportion of patients achieving at least 25% reduction in volume of rectum receiving 70 Gy (rV70). Other endpoints included degree of prostate to rectum separation, HS insertion-related adverse events and the proportion of patients with grade 1 or worse acute or late gastrointestinal (GI) and genitourinary (GU) toxicity. RESULTS All patients had successful insertion of their HS with no peri-operative toxicity. The mean prostate-rectal separation achieved was 10.5 mm. Twenty nine (93.5%) patients achieved a reduction in rV70 of at least 25%. Acute grade 1 GI toxicity was reported in 3 patients. All symptoms had resolved by 3 months post RT. Late grade 1 GI toxicity was reported in one patient (3.2%) with bowel frequency occurring at 6 months and resolving by 12 months post RT. There was no grade 2 or 3 acute or late GI toxicity seen. CONCLUSION In conclusion, this study illustrates that the application and benefits of HS on reducing GI rectal dose endpoints and toxicities during prostate cancer RT can be reliably replicated in a community setting similar to centres participating in the randomised trial under high quality assurance trial monitoring.
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26
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Kerkmeijer LGW, Maspero M, Meijer GJ, van der Voort van Zyp JRN, de Boer HCJ, van den Berg CAT. Magnetic Resonance Imaging only Workflow for Radiotherapy Simulation and Planning in Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:692-701. [PMID: 30244830 DOI: 10.1016/j.clon.2018.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/29/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging (MRI) is often combined with computed tomography (CT) in prostate radiotherapy to optimise delineation of the target and organs-at-risk (OAR) while maintaining accurate dose calculation. Such a dual-modality workflow requires two separate imaging sessions, and it has some fundamental and logistical drawbacks. Due to the availability of new MRI hardware and software solutions, CT examinations can be omitted for prostate radiotherapy simulations. All information for treatment planning, including electron density maps and bony anatomy, can nowadays be obtained with MRI. Such an MRI-only simulation workflow reduces delineation ambiguities, eases planning logistics, and improves patient comfort; however, careful validation of the complete MRI-only workflow is warranted. The first institutes are now adopting this MRI-only workflow for prostate radiotherapy. In this article, we will review technology and workflow requirements for an MRI-only prostate simulation workflow.
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Affiliation(s)
- L G W Kerkmeijer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands.
| | - M Maspero
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | | | - H C J de Boer
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | - C A T van den Berg
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
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27
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Maspero M, Seevinck PR, Willems NJW, Sikkes GG, de Kogel GJ, de Boer HCJ, van der Voort van Zyp JRN, van den Berg CAT. Evaluation of gold fiducial marker manual localisation for magnetic resonance-only prostate radiotherapy. Radiat Oncol 2018; 13:105. [PMID: 29871656 PMCID: PMC5989467 DOI: 10.1186/s13014-018-1029-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/13/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of intraprostatic gold fiducial markers (FMs) ensures highly accurate and precise image-guided radiation therapy for patients diagnosed with prostate cancer thanks to the ease of localising FMs on photon-based imaging, like Computed Tomography (CT) images. Recently, Magnetic Resonance (MR)-only radiotherapy has been proposed to simplify the workflow and reduce possible systematic uncertainties. A critical, determining factor in the accuracy of such an MR-only simulation will be accurate FM localisation using solely MR images. PURPOSE The aim of this study is to evaluate the performances of manual MR-based FM localisation within a clinical environment. METHODS We designed a study in which 5 clinically involved radiation therapy technicians (RTTs) independently localised the gold FMs implanted in 16 prostate cancer patients in two scenarios: employing a single MR sequence or a combination of sequences. Inter-observer precision and accuracy were assessed for the two scenarios for localisation in terms of 95% limit of agreement on single FMs (LoA)/ centre of mass (LoA CM) and inter-marker distances (IDs), respectively. RESULTS The number of precisely located FMs (LoA <2 mm) increased from 38/48 to 45/48 FMs when localisation was performed using multiple sequences instead of single one. When performing localisation on multiple sequences, imprecise localisation of the FMs (3/48 FMs) occurred for 1/3 implanted FMs in three different patients. In terms of precision, we obtained LoA CM within 0.25 mm in all directions over the precisely located FMs. In terms of accuracy, IDs difference of manual MR-based localisation versus CT-based localisation was on average (±1 STD) 0.6 ±0.6 mm. CONCLUSIONS For both the investigated scenarios, the results indicate that when FM classification was correct, the precision and accuracy are high and comparable to CT-based FM localisation. We found that use of multiple sequences led to better localisation performances compared with the use of single sequence. However, we observed that, due to the presence of calcification and motion, the risk of mislocated patient positioning is still too high to allow the sole use of manual FM localisation. Finally, strategies to possibly overcome the current challenges were proposed.
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Affiliation(s)
- Matteo Maspero
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands.
| | - Peter R Seevinck
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Nicole J W Willems
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Gonda G Sikkes
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Geja J de Kogel
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Hans C J de Boer
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
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A single institution analysis of low-dose-rate brachytherapy: 5-year reported survival and late toxicity outcomes. J Contemp Brachytherapy 2018; 10:155-161. [PMID: 29789764 PMCID: PMC5961530 DOI: 10.5114/jcb.2018.75600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/13/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the 5-year biochemical relapse-free survival (BRFS), overall survival (OS), and long-term toxicity outcomes of patients treated with low-dose-rate (LDR) brachytherapy as monotherapy for low- to intermediate-risk prostate cancer. Material and methods Between 2004 and 2011, 371 patients were treated with LDR brachytherapy as monotherapy. Of these, 102 patients (27%) underwent transurethral resection of the prostate (TURP) prior to implantation. Follow-up was performed every 3 months for 12 months, then every 6 months over 4 years and included prostate specific antigen evaluation. The biochemical relapse-free survival (BRFS) was defined according to the Phoenix criteria. Acute and late toxicities were documented using the Common Terminology Criteria for Adverse Events version 4.0. The BRFS and OS estimates were calculated using Kaplan-Meier plots. Univariate and multivariate analyses were performed to evaluate outcomes by pre-treatment clinical prognostic factors and radiation dosimetry. Results The median follow-up of all patients was 5.45 years. The 5-year BRFS and OS rates were 95% and 96%, respectively. The BRFS rates for patients with Gleason score (GS) > 7 and GS ≤ 6 were 96% and 91% respectively (p = 0.06). On univariate analysis, T1 and T2 staging, risk-group classification, and prostate volumes had no impact on survival at 5 years (p > 0.1). Late grade 2 and 3 genitourinary (GU) toxicities were observed in 10% and 5% of patients respectively. Additionally, patients with prior TURP had a greater incidence of late grade 2 or 3 urinary retention (p = 0.001). There were 14 deaths in total; however, none were attributed to prostate cancer. Conclusions LDR brachytherapy is an effective treatment option in low- to intermediate-risk prostate cancer patients. We observed low biochemical relapse rates and minimal GU toxicities several years after treatment in patients with or without TURP. However, a small risk of urinary retention was observed in some patients.
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De Roover R, Crijns W, Poels K, Peeters R, Draulans C, Haustermans K, Depuydt T. Characterization of a novel liquid fiducial marker for multimodal image guidance in stereotactic body radiotherapy of prostate cancer. Med Phys 2018. [PMID: 29537613 DOI: 10.1002/mp.12860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Liquid fiducial markers have shown to be a promising alternative to solid gold markers in terms of imaging artifact reduction, patient comfort, and compatibility with different imaging modalities. This study aims to investigate the performance of the novel BioXmark® liquid marker for state-of-the-art multimodal imaging used in prostate cancer (PCa) radiotherapy, encompassing kV CT/CBCT, multiparametric MRI, and kV x-ray imaging. In addition, automatic detection of the liquid markers in x-ray imaging for prostate motion monitoring during treatment was investigated. METHODS A total of eight BioXmark® liquid markers with varying volumes (range 5-300 μL) were casted on a square grid into a gelatin phantom insert. A cylindrical gold marker (QLRAD, length = 7 mm, Ø = 1 mm) was inserted for reference. Liquid marker visibility and streaking artifacts in CT/CBCT imaging were evaluated by placing the gelatin phantom into a CIRS anthropomorphic phantom. Relevant MRI characteristics such as the T2 and T1 relaxation times, the ADC value, and the relative proton density (ρH) were quantified by placing the gelatin phantom insert next to a T1MES mapping phantom and a water-filled syringe for reference. Ex vivo multiparametric MRI images were acquired by placing the gelatin phantom next to a resected prostate specimen. Anterior-posterior x-ray projection images were obtained by placing the gelatin phantom insert on top of an anthropomorphic pelvic phantom with internal pelvic bony structures and were acquired for five positions relative to the bony anatomy and 24 clinically relevant x-ray exposure settings. To quantify individual automatic marker detection, single markers were artificially isolated in the x-ray images using postprocessing. RESULTS Markers of all sizes were clearly visible on CT and CBCT images with only the largest marker volumes (100-300 μL) displaying artifacts similar in size to the gold fiducial marker. Artifact size increased with increasing liquid marker volume. Liquid markers displayed good contrast in ex vivo T1-weighted and ρH-weighted images. The markers were not visible in the ex vivo T2-weighted image. The liquid markers induced a chemical shift artifact in the obtained ADC-map. Automated detection in x-ray imaging was feasible with high detection success (four of five positions) for marker volumes in the range of 25-200 μL. None of the liquid markers were detected successfully when superimposed on a bony edge, independent of their size. CONCLUSIONS This study is the first to show the compatibility of BioXmark® liquid markers with multimodal image-guided radiotherapy for PCa. Compared to a solid gold marker, they had favorable results in both visibility and induced imaging artifacts. Liquid marker visibility in MRI imaging of the prostate does not solely depend on the low ρH value (not visible on T2-weighted image) but is also influenced by its relaxation times. Automated marker detection in x-ray images was feasible but better adapted marker detection algorithms are necessary for marker localization in the presence of bony edges. Hence, the liquid marker provides a minimally invasive (fine needles) and highly applicable alternative to current solid gold markers for multimodal image-guided prostate radiotherapy treatments.
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Affiliation(s)
- Robin De Roover
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Wouter Crijns
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Kenneth Poels
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Cédric Draulans
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Karin Haustermans
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Tom Depuydt
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
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30
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Chao M, Ho H, Chan Y, Tan A, Pham T, Bolton D, Troy A, Temelcos C, Sengupta S, McMillan K, Cham CW, Liu M, Ding W, Subramanian B, Wasiak J, Lim Joon D, Spencer S, Lawrentschuk N. Prospective analysis of hydrogel spacer for patients with prostate cancer undergoing radiotherapy. BJU Int 2018. [PMID: 29520983 DOI: 10.1111/bju.14192] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To report on the dosimetric benefits and late toxicity outcomes after injection of hydrogel spacer (HS) between the prostate and rectum for patients treated with prostate radiotherapy (RT). PATIENTS AND METHODS In all, 76 patients with a clinical stage of T1-T3a prostate cancer underwent general anaesthesia for fiducial marker insertion plus injection of the HS into the perirectal space before intensity-modulated RT (IMRT) or volumetric-modulated arc RT (VMAT). HS safety, dosimetric benefits, and the immediate- to long-term effects of gastrointestinal (GI) toxicity were assessed. RESULTS There were no postoperative complications reported. The mean (range) prostate size was 66.0 (25.0-187.0) mm. Rectal dose volume parameters were observed and the volume of rectum receiving 70 Gy (rV70 ), 75 Gy (rV75 ) and 78 Gy (rV78 ) was 7.8%, 3.6% and 0.4%, respectively. In all, 21% of patients (16/76) developed acute Grade 1 GI toxicities, but all were resolved completely by 3 months after treatment; whilst, 3% of patients (2/76) developed late Grade 1 GI toxicities. No patients had acute or late Grade ≥2 GI toxicities. CONCLUSION Injection of HS resulted in a reduction of irradiated rectal dose volumes along with minimal GI toxicities, irrespective of prostate size.
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Affiliation(s)
- Michael Chao
- The Austin Hospital, Heidelberg, Vic., Australia.,Genesis Cancer Care Victoria, Ringwood East, Vic., Australia
| | - Huong Ho
- Genesis Cancer Care Victoria, Ringwood East, Vic., Australia
| | - Yee Chan
- The Austin Hospital, Heidelberg, Vic., Australia.,Ringwood Private Hospital, Ringwood East, Vic., Australia
| | - Alwin Tan
- The Bays Hospital, Mornington, Vic., Australia
| | - Trung Pham
- The Valley Private Hospital, Mulgrave, Vic., Australia
| | - Damien Bolton
- The Austin Hospital, Heidelberg, Vic., Australia.,Ringwood Private Hospital, Ringwood East, Vic., Australia
| | - Andrew Troy
- The Austin Hospital, Heidelberg, Vic., Australia
| | | | - Shomik Sengupta
- The Austin Hospital, Heidelberg, Vic., Australia.,Melbourne University; Eastern Health Clinical School, Monash University, Clayton, Vic., Australia
| | - Kevin McMillan
- Ringwood Private Hospital, Ringwood East, Vic., Australia
| | | | - Madalena Liu
- Ringwood Private Hospital, Ringwood East, Vic., Australia
| | - Wei Ding
- Genesis Cancer Care Victoria, Ringwood East, Vic., Australia
| | | | - Jason Wasiak
- The Austin Hospital, Heidelberg, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - Daryl Lim Joon
- The Austin Hospital, Heidelberg, Vic., Australia.,Genesis Cancer Care Victoria, Ringwood East, Vic., Australia
| | - Sandra Spencer
- Genesis Cancer Care Victoria, Ringwood East, Vic., Australia
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31
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Bakaric M, Martin E, S Georgiou P, T Cox B, Payne H, E Treeby B. Experimental study of beam distortion due to fiducial markers during salvage HIFU in the prostate. J Ther Ultrasound 2018; 6:1. [PMID: 29588854 PMCID: PMC5863876 DOI: 10.1186/s40349-018-0109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prostate cancer is frequently treated using external beam radiation therapy (EBRT). Prior to therapy, the prostate is commonly implanted with a small number of permanent fiducial markers used to monitor the position of the prostate during therapy. In the case of local cancer recurrence, high-intensity focused ultrasound (HIFU) provides a non-invasive salvage treatment option. However, the impact of the fiducial markers on HIFU treatment has not been thoroughly studied to date. The objective of this study was to experimentally investigate the effect of a single EBRT fiducial marker on the efficacy of HIFU treatment delivery using a tissue-mimicking material (TMM). Methods A TMM with the acoustic properties of the prostate was developed based on a polyacrylamide hydrogel containing bovine serum albumin. Each phantom was implanted with a cylindrical fiducial marker and then sonicated using a 3.3 MHz focused bowl HIFU transducer. Two sets of experiments were performed. In the first, a single lesion was created at different positions along either the anteroposterior or left-right axes relative to the marker. In the second, a larger ablation volume was created by raster scanning. The size and position of the ablated volume were assessed using a millimetre grid overlaid on the phantom. Results The impact of the marker on the position and size of the HIFU lesion was significant when the transducer focus was positioned within 7 mm anteriorly, 18 mm posteriorly or within 3 mm laterally of the marker. Beyond this, the generated lesion was not affected. When the focus was anterior to the marker, the lesion increased in size due to reflections. When the focus was posterior, the lesion decreased in size or was not present due to shadowing. Conclusions The presence of an EBRT fiducial marker may result in an undertreated region beyond the marker due to reduced energy arriving at the focus, and an overtreated region in front of the marker due to reflections. Depending on the position of the targeted regions and the distribution of the markers, both effects may be undesirable and reduce treatment efficacy. Further work is necessary to investigate whether these results indicate the necessity to reconsider patient selection and treatment planning for prostate salvage HIFU after failed EBRT.
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Affiliation(s)
- Marina Bakaric
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Eleanor Martin
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Panayiotis S Georgiou
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Benjamin T Cox
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Heather Payne
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK.,2Department of Oncology, University College London Hospitals, 235 Euston Road, London, NW1 2BU UK
| | - Bradley E Treeby
- 1Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
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32
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Biswal NC, Swann B, McKenna MG, Singh R. UroLift as a surrogate for fiducial markers in IGRT planning of prostate cancer in BPH patients. Pract Radiat Oncol 2018; 8:e231-e233. [PMID: 29452872 DOI: 10.1016/j.prro.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Nrusingh C Biswal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Radiation Oncology, Robert Wood Johnson University Hospital, Hamilton, New Jersey.
| | - Beth Swann
- Department of Radiation Oncology, Robert Wood Johnson University Hospital, Hamilton, New Jersey
| | - Michael G McKenna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Radiation Oncology, Robert Wood Johnson University Hospital, Hamilton, New Jersey
| | - Rachana Singh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Radiation Oncology, Robert Wood Johnson University Hospital, Hamilton, New Jersey
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33
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Han Y, Oakley E, Shafirstein G, Rabin Y, Kara LB. Reconstruction of a Deformed Tumor Based on Fiducial Marker Registration: A Computational Feasibility Study. Technol Cancer Res Treat 2018; 17:1533034618766792. [PMID: 29658392 PMCID: PMC5909864 DOI: 10.1177/1533034618766792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interstitial photodynamic therapy has shown promising results in the treatment of locally advanced head and neck cancer. In this therapy, systemic administration of a light-sensitive drug is followed by insertion of multiple laser fibers to illuminate the tumor and its margins. Image-based pretreatment planning is employed in order to deliver a sufficient light dose to the complex locally advanced head-and-neck cancer anatomy, in order to meet clinical requirements. Unfortunately, the tumor may deform between pretreatment imaging for the purpose of planning and intraoperative imaging when the plan is executed. Tumor deformation may result from the mechanical forces applied by the light fibers and variation of the patient’s posture. Pretreatment planning is frequently done with the assistance of computed tomography or magnetic resonance imaging in an outpatient suite, while treatment monitoring and control typically uses ultrasound imaging due to considerations of costs and availability in the operation room. This article presents a computational method designed to bridge the gap between the 2 imaging events by taking a tumor geometry, reconstructed during preplanning, and by following the displacement of fiducial markers, which are initially placed during the preplanning procedure. The deformed tumor shape is predicted by solving an inverse problem, seeking for the forces that would have resulted in the corresponding fiducial marker displacements. The computational method is studied on spheres of variable sizes and demonstrated on computed tomography reconstructed locally advanced head and neck cancer model. Results of this study demonstrate an average error of less than 1 mm in predicting the deformed tumor shape, where 1 mm is typically the order of uncertainty in distance measurements using magnetic resonance imaging or computed tomography imaging and high-quality ultrasound imaging. This study further demonstrates that the deformed shape can be calculated in a few seconds, making the proposed method clinically relevant.
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Affiliation(s)
- Ye Han
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Emily Oakley
- 2 Photodynamic Therapy Center, Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gal Shafirstein
- 2 Photodynamic Therapy Center, Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Yoed Rabin
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Levent Burak Kara
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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Maspero M, van den Berg CAT, Landry G, Belka C, Parodi K, Seevinck PR, Raaymakers BW, Kurz C. Feasibility of MR-only proton dose calculations for prostate cancer radiotherapy using a commercial pseudo-CT generation method. Phys Med Biol 2017; 62:9159-9176. [PMID: 29076458 DOI: 10.1088/1361-6560/aa9677] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A magnetic resonance (MR)-only radiotherapy workflow can reduce cost, radiation exposure and uncertainties introduced by CT-MRI registration. A crucial prerequisite is generating the so called pseudo-CT (pCT) images for accurate dose calculation and planning. Many pCT generation methods have been proposed in the scope of photon radiotherapy. This work aims at verifying for the first time whether a commercially available photon-oriented pCT generation method can be employed for accurate intensity-modulated proton therapy (IMPT) dose calculation. A retrospective study was conducted on ten prostate cancer patients. For pCT generation from MR images, a commercial solution for creating bulk-assigned pCTs, called MR for Attenuation Correction (MRCAT), was employed. The assigned pseudo-Hounsfield Unit (HU) values were adapted to yield an increased agreement to the reference CT in terms of proton range. Internal air cavities were copied from the CT to minimise inter-scan differences. CT- and MRCAT-based dose calculations for opposing beam IMPT plans were compared by gamma analysis and evaluation of clinically relevant target and organ at risk dose volume histogram (DVH) parameters. The proton range in beam's eye view (BEV) was compared using single field uniform dose (SFUD) plans. On average, a [Formula: see text] mm) gamma pass rate of 98.4% was obtained using a [Formula: see text] dose threshold after adaptation of the pseudo-HU values. Mean differences between CT- and MRCAT-based dose in the DVH parameters were below 1 Gy ([Formula: see text]). The median proton range difference was [Formula: see text] mm, with on average 96% of all BEV dose profiles showing a range agreement better than 3 mm. Results suggest that accurate MR-based proton dose calculation using an automatic commercial bulk-assignment pCT generation method, originally designed for photon radiotherapy, is feasible following adaptation of the assigned pseudo-HU values.
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Affiliation(s)
- Matteo Maspero
- Center for Image Sciences, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
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Maspero M, van den Berg CAT, Zijlstra F, Sikkes GG, de Boer HCJ, Meijer GJ, Kerkmeijer LGW, Viergever MA, Lagendijk JJW, Seevinck PR. Evaluation of an automatic MR-based gold fiducial marker localisation method for MR-only prostate radiotherapy. ACTA ACUST UNITED AC 2017; 62:7981-8002. [DOI: 10.1088/1361-6560/aa875f] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Hamilton DG, McKenzie DP, Perkins AE. Comparison between electromagnetic transponders and radiographic imaging for prostate localization: A pelvic phantom study with rotations and translations. J Appl Clin Med Phys 2017; 18:43-53. [PMID: 28699243 PMCID: PMC5875817 DOI: 10.1002/acm2.12119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the differences in target localization between Calypso®, kV orthogonal imaging and cone‐beam computed tomography (CBCT) for combined translations and rotations of an anthropomorphic pelvic phantom. The phantom was localized using all three systems in 50 different positions, with applied translational and rotational offsets randomly sampled from representative normal distributions of prostate motion. Lin's concordance correlation coefficient (ρc) and 95% confidence intervals were calculated to assess the agreement between the localization systems. Mean differences and difference vectors between the three systems were also calculated. Agreement between systems for lateral, vertical, and longitudinal translations was excellent, with ρc values of greater than 0.98 between all three systems in all axes. There was excellent agreement between the systems for rotations around the lateral axis (pitch) (ρc > 0.99), and around the vertical axis (yaw) (ρc > 0.97). However, somewhat poorer agreement for rotations around the longitudinal axis (roll) was observed, with the lowest correlation observed between Calypso and kV orthogonal imaging (ρc = 0.895). Mean differences between the phantom position reported by Calypso and the radiographic systems were less than 1 mm and 1° for all translations and rotations. The results for translations are consistent with the publications of previous authors. There is no comparable published data for rotations. While there is lower correlation between the three systems for roll than for the other angles, the mean differences in reported rotations are not clinically significant.
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Affiliation(s)
- Daniel G Hamilton
- Epworth Radiation Oncology, Epworth Hospital, Richmond, Victoria, Australia
| | - Dean P McKenzie
- Research, Development and Governance, Epworth Healthcare, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne E Perkins
- Epworth Radiation Oncology, Epworth Hospital, Richmond, Victoria, Australia
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Zaorsky NG, Showalter TN, Ezzell GA, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Taira AV, Vapiwala N, Davis BJ. ACR Appropriateness Criteria for external beam radiation therapy treatment planning for clinically localized prostate cancer, part II of II. Adv Radiat Oncol 2017; 2:437-454. [PMID: 29114613 PMCID: PMC5605284 DOI: 10.1016/j.adro.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/10/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To present the most updated American College of Radiology (ACR) Appropriateness Criteria formed by an expert panel on the appropriate delivery of external beam radiation to manage stage T1 and T2 prostate cancer (in the definitive setting and post-prostatectomy) and to provide clinical variants with expert recommendations based on accompanying Appropriateness Criteria for target volumes and treatment planning. METHODS AND MATERIALS The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a panel of multidisciplinary experts. The guideline development and revision process includes an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In instances in which evidence is lacking or equivocal, expert opinion may supplement available evidence to recommend imaging or treatment. RESULTS The panel summarizes the most recent and relevant literature on the topic, including organ motion and localization methods, image guidance, and delivery techniques (eg, 3-dimensional conformal intensity modulation). The panel presents 7 clinical variants, including (1) a standard case and cases with (2) a distended rectum, (3) a large-volume prostate, (4) bilateral hip implants, (5) inflammatory bowel disease, (6) prior prostatectomy, and (7) a pannus extending into the radiation field. Each case outlines the appropriate techniques for simulation, treatment planning, image guidance, dose, and fractionation. Numerical rating and commentary is given for each treatment approach in each variant. CONCLUSIONS External beam radiation is a key component of the curative management of T1 and T2 prostate cancer. By combining the most recent medical literature, these Appropriateness Criteria can aid clinicians in determining the appropriate treatment delivery and personalized approaches for individual patients.
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Affiliation(s)
| | | | - Gary A. Ezzell
- Mayo Clinic, Phoenix, Arizona (research author [contributing])
| | - Paul L. Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (panel vice-chair)
| | - Dean G. Assimos
- University of Alabama School of Medicine, Birmingham, Alabama (American Urological Association)
| | - Anthony V. D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (American Society of Clinical Oncology)
| | | | | | | | | | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | | | | | - Al V. Taira
- Mills Peninsula Hospital, San Mateo, California
| | - Neha Vapiwala
- University of Pennsylvania, Philadelphia, Pennsylvania
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Tanaka O, Iida T, Komeda H, Tamaki M, Seike K, Kato D, Yokoyama T, Hirose S, Kawaguchi D. Initial experience of using an iron-containing fiducial marker for radiotherapy of prostate cancer: Advantages in the visualization of markers in Computed Tomography and Magnetic Resonance Imaging. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2016. [DOI: 10.1515/pjmpe-2016-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Visualization of markers is critical for imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). However, the size of the marker varies according to the imaging technique. While a large-sized marker is more useful for visualization in MRI, it results in artifacts on CT and causes substantial pain on administration. In contrast, a small-sized marker reduces the artifacts on CT but hampers MRI detection. Herein, we report a new ironcontaining marker and compare its utility with that of non-iron-containing markers. Five patients underwent CT/MRI fusion-based intensity-modulated radiotherapy, and the markers were placed by urologists. A Gold Anchor™ (GA; diameter, 0.28 mm; length, 10 mm) was placed using a 22G needle on the right side of the prostate. A VISICOIL™ (VIS; diameter, 0.35 mm; length, 10 mm) was placed using a 19G needle on the left side. MRI was performed using T2*-weighted imaging. Three observers evaluated and scored the visual qualities of the acquired images. The mean score of visualization was almost identical between the GA and VIS in radiography and cone-beam CT (Novalis Tx). The artifacts in planning CT were slightly larger using the GA than using the VIS. The visualization of the marker on MRI using the GA was superior to that using the VIS. In conclusion, the visualization quality of radiography, conebeam CT, and planning CT was roughly equal between the GA and VIS. However, the GA was more strongly visualized than was the VIS on MRI due to iron containing.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Takayoshi Iida
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Hisao Komeda
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Masayoshi Tamaki
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Kensaku Seike
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Daiki Kato
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Takamasa Yokoyama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Shigeki Hirose
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Daisuke Kawaguchi
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
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Georgiou PS, Jaros J, Payne H, Allen C, Shah TT, Ahmed HU, Gibson E, Barratt D, Treeby BE. Beam distortion due to gold fiducial markers during salvage high-intensity focused ultrasound in the prostate. Med Phys 2016; 44:679-693. [PMID: 28032342 DOI: 10.1002/mp.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 11/17/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HIFU) provides a non-invasive salvage treatment option for patients with recurrence after external beam radiation therapy (EBRT). As part of EBRT the prostate is frequently implanted with permanent fiducial markers. To date, the impact of these markers on subsequent HIFU treatment is unknown. The objective of this work was to systematically investigate, using computational simulations, how these fiducial markers affect the delivery of HIFU treatment. METHODS A series of simulations was performed modelling the propagation of ultrasound pressure waves in the prostate with a single spherical or cylindrical gold marker at different positions and orientations. For each marker configuration, a set of metrics (spatial-peak temporal-average intensity, focus shift, focal volume) was evaluated to quantify the distortion introduced at the focus. An analytical model was also developed describing the marker effect on the intensity at the focus. The model was used to examine the marker's impact in a clinical setting through case studies. RESULTS The simulations show that the presence of the marker in the pre-focal region causes reflections which induce a decrease in the focal intensity and focal volume, and a shift of the maximum pressure point away from the transducer's focus. These effects depend on the shape and orientation of the marker and become more pronounced as its distance from the transducer's focus decreases, with the distortion introduced by the marker greatly increasing when placed within 5 mm of the focus. The analytical model approximates the marker's effect and can be used as an alternative method to the computationally intensive and time consuming simulations for quickly estimating the intensity at the focus. A retrospective review of a small patient cohort selected for focal HIFU after failed EBRT indicates that the presence of the marker may affect HIFU treatment delivery. CONCLUSIONS The distortion introduced by the marker to the HIFU beam when positioned close to the focus may result in an undertreated region beyond the marker due to less energy arriving at the focus, and an overtreated region due to reflections. Further work is necessary to investigate whether the results presented here justify the revision of the patient selection criteria or the markers' placement protocol.
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Affiliation(s)
- P S Georgiou
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - J Jaros
- Faculty of Information Technology, Brno University of Technology, Brno, Czech Republic
| | - H Payne
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Oncology, University College London Hospitals, London, UK
| | - C Allen
- Department of Oncology, University College London Hospitals, London, UK
| | - T T Shah
- Division of Surgery and Interventional Science, University College London, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
| | - E Gibson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Barratt
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - B E Treeby
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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40
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Keehn A, Fram E, Garg M, Maria P. UroLift in Place of Fiducial Markers for Patients With Benign Prostatic Hyperplasia Undergoing External Beam Radiation Therapy. Urology 2016; 104:230-234. [PMID: 27988266 DOI: 10.1016/j.urology.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/06/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate if using a novel treatment for obstructive benign prostatic hyperplasia (UroLift) to relive lower urinary tract symptoms (LUTS) prior to external beam radiotherapy (EBRT) could also supplant the use of fiducial markers obviating the need for a second transrectal procedure while facilitating symptom-free voiding during and after EBRT a series of patients are reported on. METHODS The medical records of 7 consecutive patients who underwent placement of UroLift for simultaneous treatment of obstructive LUTS due to benign prostatic hyperplasia and targeting of EBRT for treatment of prostate cancer between September and December of 2015 were reviewed. RESULTS The UroLift clips were sufficiently radiopaque to make targeting possible for EBRT. All patients were able to complete a full course of radiotherapy without placement of fiducial markers. No patient experienced complications that could be attributed to the UroLift implants or procedure during their course of radiotherapy. None of the patients required additional alpha-blockers during radiation therapy. CONCLUSION The UroLift system can serve as fiducial markers in patients undergoing EBRT. Although the current clip utilized in the UroLift system is generally radiopaque, it does not project well on the sagittal plane and would be significantly enhanced if a more strongly opaque substance was incorporated. It remains to be proven if the UroLift system can significantly reduce the symptoms of LUTS during and post EBRT.
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Affiliation(s)
- Aryeh Keehn
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ethan Fram
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Madhur Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Pedro Maria
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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Ngwa W, Boateng F, Kumar R, Irvine DJ, Formenti S, Ngoma T, Herskind C, Veldwijk MR, Hildenbrand GL, Hausmann M, Wenz F, Hesser J. Smart Radiation Therapy Biomaterials. Int J Radiat Oncol Biol Phys 2016; 97:624-637. [PMID: 28126309 DOI: 10.1016/j.ijrobp.2016.10.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 12/22/2022]
Abstract
Radiation therapy (RT) is a crucial component of cancer care, used in the treatment of over 50% of cancer patients. Patients undergoing image guided RT or brachytherapy routinely have inert RT biomaterials implanted into their tumors. The single function of these RT biomaterials is to ensure geometric accuracy during treatment. Recent studies have proposed that the inert biomaterials could be upgraded to "smart" RT biomaterials, designed to do more than 1 function. Such smart biomaterials include next-generation fiducial markers, brachytherapy spacers, and balloon applicators, designed to respond to stimuli and perform additional desirable functions like controlled delivery of therapy-enhancing payloads directly into the tumor subvolume while minimizing normal tissue toxicities. More broadly, smart RT biomaterials may include functionalized nanoparticles that can be activated to boost RT efficacy. This work reviews the rationale for smart RT biomaterials, the state of the art in this emerging cross-disciplinary research area, challenges and opportunities for further research and development, and a purview of potential clinical applications. Applications covered include using smart RT biomaterials for boosting cancer therapy with minimal side effects, combining RT with immunotherapy or chemotherapy, reducing treatment time or health care costs, and other incipient applications.
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Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Physics and Applied Physics, University of Massachusetts, Lowell, Massachusetts.
| | - Francis Boateng
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rajiv Kumar
- Department of Physics, Northeastern University, Dana-Farber Cancer Institute, Massachusetts
| | - Darrell J Irvine
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Silvia Formenti
- Department of Radiation Oncology, Cornell University, Ithaca, New York
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Carsten Herskind
- University Medical Center Mannheim, University of Heidelberg, Germany
| | - Marlon R Veldwijk
- University Medical Center Mannheim, University of Heidelberg, Germany
| | | | - Michael Hausmann
- Kirchhoff-Institute for Physics, University of Heidelberg, Germany
| | - Frederik Wenz
- University Medical Center Mannheim, University of Heidelberg, Germany
| | - Juergen Hesser
- University Medical Center Mannheim, University of Heidelberg, Germany
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Basu A, Haim-Zada M, Domb AJ. Biodegradable inflatable balloons for tissue separation. Biomaterials 2016; 105:109-116. [DOI: 10.1016/j.biomaterials.2016.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/27/2022]
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De Bari B, Arcangeli S, Ciardo D, Mazzola R, Alongi F, Russi EG, Santoni R, Magrini SM, Jereczek-Fossa BA. Extreme hypofractionation for early prostate cancer: Biology meets technology. Cancer Treat Rev 2016; 50:48-60. [PMID: 27631875 DOI: 10.1016/j.ctrv.2016.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
The aim of this review is to present the available radiobiological, technical and clinical data about extreme hypofractionation in primary prostate cancer radiotherapy. The interest in this technique is based on the favourable radiobiological characteristics of prostate cancer and supported by advantageous logistic aspects deriving from short overall treatment time. The clinical validity of short-term treatment schedule is proven by a body of non-randomised studies, using both isocentric (LINAC-based) or non-isocentric (CyberKnife®-based) stereotactic body irradiation techniques. Twenty clinical studies, each enrolling more than 40 patients for a total of 1874 treated patients, were revised in terms of technological setting, toxicity, outcome and quality of life assessment. The implemented strategies for the tracking of the prostate and the sparing of the rectal wall have been investigated with particular attention. The urinary toxicity after prostate stereotactic body irradiation seems slightly more pronounced as compared to rectal adverse events, and this is more evident for late occurring events, but no worse as respect to conventional fractionation schemes. As far as the rate of severe acute toxicity is concerned, in all the available studies the treatment was globally well tolerated. While awaiting long-term data on efficacy and toxicity, the analysed studies suggest that the outcome profile of this approach, alongside the patient convenience and reduced costs, is promising. Forty-eight ongoing clinical trials are also presented as a preview of the expectation from the near future.
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Affiliation(s)
- Berardino De Bari
- Division of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Stefano Arcangeli
- Division of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Rosario Mazzola
- Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Filippo Alongi
- Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Elvio G Russi
- S.C. di Radioterapia Oncologica, Azienda ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Riccardo Santoni
- Università di Roma, Tor Vergata, U.O.C. di Radioterapia, Policlinico Tor Vergata, Roma, Italy
| | - Stefano M Magrini
- Istituto del Radio "O. Alberti", Spedali Civili, Università di Brescia, Brescia, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Müller AC, Mischinger J, Klotz T, Gagel B, Habl G, Hatiboglu G, Pinkawa M. Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients. Radiol Oncol 2016; 50:329-36. [PMID: 27679550 PMCID: PMC5024663 DOI: 10.1515/raon-2016-0036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/17/2016] [Indexed: 12/19/2022] Open
Abstract
Background The aim of the study was to reach a consensus on indication and application of a hydrogel spacer based on multicentre experience and give new users important information to shorten the learning curve for this innovative technique. Methods The interdisciplinary meeting was attended by radiation oncologists and urologists, each with experience of 23 – 138 hydrogel injections (SpaceOAR®) in prostate cancer patients before dose-escalated radiotherapy. User experience was discussed and questions were defined to comprise practical information relevant for successful hydrogel injection and treatment. Answers to the defined key questions were generated. Hydrogel-associated side effects were collected to estimate the percentage, treatment and prognosis of potential risks. Results The main indication for hydrogel application was dose-escalated radiotherapy for histologically confirmed low or intermediate risk prostate cancer. It was not recommended in locally advanced prostate cancer. The injection or implantation was performed under transrectal ultrasound guidance via the transperineal approach after prior hydrodissection. The rate of injection-related G2-toxicity was 2% (n = 5) in a total of 258 hydrogel applications. The most frequent complication (n = 4) was rectal wall penetration, diagnosed at different intervals after hydrogel injection and treated conservatively. Conclusions A consensus was reached on the application of a hydrogel spacer. Current experience demonstrated feasibility, which could promote initiation of this method in more centres to reduce radiation-related gastrointestinal toxicity of dose-escalated IGRT. However, a very low rate of a potential serious adverse event could not be excluded. Therefore, the application should carefully be discussed with the patient and be balanced against potential benefits.
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Affiliation(s)
| | | | - Theodor Klotz
- Department of Urology, Hospital Weiden, Weiden, Germany
| | - Bernd Gagel
- Department of Radiation Oncology, Hospital Weiden, Weiden, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Technical University Munich, Munich, Germany
| | - Gencay Hatiboglu
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
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Tanaka O, Komeda H, Iida T, Tamaki M, Seike K, Kato D, Yokoyama T, Hirose S, Kawaguchi D, Yama E. RETRACTED: <i>Usefulness of Iron-Containing Fiducial Marker for Prostate Radiotherapy</i>. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijmpcero.2016.54033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tromp D, Christie DRH. Acute and Late Bowel Toxicity in Radiotherapy Patients with Inflammatory Bowel Disease: A Systematic Review. Clin Oncol (R Coll Radiol) 2015; 27:536-41. [PMID: 26021592 DOI: 10.1016/j.clon.2015.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/17/2015] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
AIMS Inflammatory bowel disease has traditionally been considered a relative contraindication for radiotherapy due to a perceived increased risk of disease exacerbation and bowel toxicity. The aim of this review was to evaluate the current literature regarding rates of radiotherapy-induced acute and late bowel toxicity in patients with inflammatory bowel disease and to compare these data with those of patients without the disease. MATERIALS AND METHODS An Ovid Medline search was conducted to identify original articles pertaining to the review question. Using the PRISMA convention a total of 442 articles screened, resulting 8 articles which were suitable for inclusion in the review. RESULTS In general, the grading of toxicity was scored using either the Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. It was found that acute bowel toxicity of ≥ grade 3 occurred in 20% of patients receiving external beam radiotherapy (EBRT) and in 7% of patients receiving brachytherapy. Late bowel toxicity ≥ grade 3 occurred in 15% of EBRT patients and in 5% of patients receiving brachytherapy. Brachytherapy was shown to have similar rates of toxicity and EBRT produced a moderate increase in both acute and late toxicity when compared with individuals without inflammatory bowel disease. CONCLUSION In view of these results, we suggest that brachytherapy should be considered as a suitable treatment option for treating pelvic malignancy in patients with inflammatory bowel disease, whereas EBRT should be used with caution.
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Affiliation(s)
- D Tromp
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University Gold Coast Campus, Southport, Queensland, Australia.
| | - D R H Christie
- Genesis CancerCare Queensland, Tugun, Queensland, Australia; Bond University, Robina, Queensland, Australia
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Teh AYM, Ko HT, Barr G, Woo HH. Rectal ulcer associated with SpaceOAR hydrogel insertion during prostate brachytherapy. BMJ Case Rep 2014; 2014:bcr-2014-206931. [PMID: 25535226 DOI: 10.1136/bcr-2014-206931] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of rectal ulceration associated with SpaceOAR hydrogel insertion during low-dose-rate (LDR) brachytherapy in a patient with prostate cancer.
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Affiliation(s)
- Amy Y M Teh
- Radiation Oncology Institute, Sydney, New South Wales, Australia
| | - Hung-Ta Ko
- Department of Urology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Gavin Barr
- Mater Hospital, Sydney, New South Wales, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- Nathan Lawrentschuk
- University of Melbourne, Department of Surgery and Ludwig Institute for Cancer Research, Austin Hospital and Peter MacCallum Cancer Centre, Department of Surgical Oncology, Melbourne, VIC, Australia.
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