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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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Aizawa R, Inokuchi H, Ikeda I, Nakamura K, Ogata T, Akamatsu S, Goto T, Masui K, Sumiyoshi T, Kita Y, Kobayashi T, Mizowaki T. Impact of prostate position-based image-guidance in intensity-modulated radiation therapy for localized prostate cancer. Int J Clin Oncol 2024; 29:325-332. [PMID: 38191958 DOI: 10.1007/s10147-023-02456-1] [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: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND/PURPOSE The long-term clinical impact of prostate position-based image-guided radiotherapy (IGRT) for localized prostate cancer remains unclear. MATERIALS AND METHODS We retrospectively compared clinical outcomes following intensity-modulated radiation therapy (IMRT) with cone-beam computed tomography-based prostate position-based IGRT (P-IGRT) or without P-IGRT (non-P-IGRT). From June 2011, we applied P-IGRT in IMRT for intermediate-risk (IR) prostate cancer (PCa) (D'Amico risk classification) (76 Gy in 38 fractions, with smaller margins). Clinical outcomes of patients who received P-IGRT between June 2011 and June 2019 were retrospectively compared with those of patients with IR PCa who received IMRT without P-IGRT between October 2002 and May 2011 in our institution (74 Gy in 37 fractions). RESULTS A total of 222 consecutive patients were analyzed: 114 in the P-IGRT cohort and 108 in the non-P-IGRT cohort. The median follow-up period after IMRT was 7.1 years for the P-IGRT cohort and 10.8 years for the non-P-IGRT cohort. The biochemical failure-free rate was significantly better in the P-IGRT cohort (94.9% for the P-IGRT cohort vs 82.7% for the non-P-IGRT cohort at 10 years, p = 0.041). The rate of rectal bleeding which needs intervention including the use of suppositories was significantly lower in the P-IGRT cohort (p < 0.001). CONCLUSIONS The use of P-IGRT with higher doses and smaller margins was correlated with significantly better biochemical control, and a lower incidence of rectal bleeding in IMRT for intermediate-risk prostate cancer. The enhanced accuracy using P-IGRT has the potential to independently improve disease control and reduce late rectal bleeding.
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Affiliation(s)
- Rihito Aizawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Itaru Ikeda
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Ogata
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kimihiko Masui
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayuki Sumiyoshi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuki Kita
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Le Guevelou J, Bosetti DG, Castronovo F, Angrisani A, de Crevoisier R, Zilli T. State of the art and future challenges of urethra-sparing stereotactic body radiotherapy for prostate cancer: a systematic review of literature. World J Urol 2023; 41:3287-3299. [PMID: 37668718 PMCID: PMC10632210 DOI: 10.1007/s00345-023-04579-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Doses delivered to the urethra have been associated with an increased risk to develop long-term urinary toxicity in patients undergoing stereotactic body radiotherapy (SBRT) for prostate cancer (PCa). Aim of the present systematic review is to report on the role of urethra-sparing SBRT (US-SBRT) techniques for prostate cancer, with a focus on outcome and urinary toxicity. METHOD A systematic review of the literature was performed on the PubMed database on May 2023. Based on the urethra-sparing technique, 13 studies were selected for the analysis and classified in the two following categories: "urethra-steering" SBRT (restriction of hotspots to the urethra) and "urethra dose-reduction" SBRT (dose reduction to urethra below the prescribed dose). RESULTS By limiting the urethra Dmax to 90GyEQD2 (α/β = 3 Gy) with urethra-steering SBRT techniques, late genitourinary (GU) grade 2 toxicity remains mild, ranging between 12.1% and 14%. With dose-reduction strategies decreasing the urethral dose below 70 GyEQD2, the risk of late GU toxicity was further reduced (< 8% at 5 years), while maintaining biochemical relapse-free survival rates up to 93% at 5 years. CONCLUSION US-SBRT techniques limiting maximum doses to urethra below a 90GyEQD2 (α/β = 3 Gy) threshold result in a low rate of acute and late grade ≥ 2 GU toxicity. A better understanding of clinical factors and anatomical substructures involved in the development of GU toxicity, as well as the development and use of adapted dose constraints, is expected to further reduce the long-term GU toxicity of prostate cancer patients treated with SBRT.
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Affiliation(s)
| | - Davide Giovanni Bosetti
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Francesco Castronovo
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Antonio Angrisani
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland
| | | | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 6500, Bellinzona, Switzerland.
- Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Hwang C. Impact of dose distribution on rotational setup errors in radiotherapy for prostate cancer. Med Dosim 2023:S0958-3947(23)00028-6. [PMID: 37085402 DOI: 10.1016/j.meddos.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/10/2023] [Accepted: 03/18/2023] [Indexed: 04/23/2023]
Abstract
This study aimed to assess the impact of rotational setup errors on the target volume's dose distribution during radiotherapy for prostate cancer. A 6D robotic couch was used to describe the rotational setup error, and the dosage change in the target volume was analyzed using the planning evaluation factors. Treatment plans for three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc radiotherapy (VMAT) were established after contouring the target volume and surrounding normal tissues on tomography obtained from the humanoid phantom. A 6D robotic couch was employed in the radiation room to describe the rotational setup errors of ±1° to ±5° in roll, yaw, and pitch, and cone beam computed tomography (CBCT) images were obtained. Furthermore, the dose distribution was extracted from the 3DCRT, IMRT, and VMAT treatment plans, dose mapping was performed on CBCT that depicts the rotational setup error. Target coverage(TC) decreased by 0.39% to 2.17% in roll, 0.43% to 2.59% in yaw, and 0.70% to 4.12% in pitch, respectively. In the comparison using the Radiation Therapy Oncology Group (RTOG) protocol criteria, when the rotational setup error of VMAT pitch was -2° or more, more than +1°, a target coverage of 95% or lower was shown, indicating the greatest effect among rotational setup errors. Furthermore, in 3DCRT, IMRT, and VMAT, the rotational setup error showed the greatest effect in pitch, and the dose change was larger in VMAT than in 3DCRT and IMRT. Therefore, specific rotational error due to pitch during radiotherapy for prostate cancer requires special consideration. Moreover, the more sophisticated and complex algorithms, such as VMAT, applied, the greater the dose change of target coverage due to rotational error; therefore, caution is required.
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Affiliation(s)
- Chulhwan Hwang
- Department of Radiology, Masan University, Changwon-si, Gyeongsangnam-do, 51217, Republic of Korea.
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Shinde P, Jadhav A, Shankar V, Dhoble SJ. Evaluation of the dosimetric influence of interfractional 6D setup error in hypofractionated prostate cancer treated with IMRT and VMAT using daily kV-CBCT. J Med Imaging Radiat Sci 2022; 53:693-703. [PMID: 36289030 DOI: 10.1016/j.jmir.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common malignant tumors in men and is usually treated with advanced intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). Significant uncorrected interfractional 6-Dimensional setup errors could impact the delivered dose. The aim of this study was to assess the dosimetric impact of 6D interfractional setup errors in hypofractionated prostate cancer using daily kilovoltage cone-beam computed tomography (kV-CBCT). METHODS This retrospective study comprised twenty prostate cancer patients treated with hypofractionated IMRT (8) and VMAT (12) with daily kV-CBCT image guidance. Interfraction 6D setup errors along lateral, longitudinal, vertical, pitch, roll, and yaw axes were evaluated for 400 CBCTs. For targets and organs at risk (OARs), the dosimetric impact of rotational error (RError), translational error (TError), and translational plus rotational error (T+RError) were evaluated on kV-CBCT images. RESULTS The single fraction maximum TError ranged from 12-20 mm, and the RError ranged from 2.80-3.00. The maximum mean absolute dose variation ΔD in D98% (dose to 98% volume) of CTV-55 and PTV-55 was -0.66±0.82 and -5.94±3.8 Gy, respectively, in the T+RError. The maximum ΔD (%) for D98% and D0.035cc in CTV-55 was -4.29% and 2.49%, respectively, while in PTV-55 it was -24.9% and 2.36%. The mean dose reduction for D98% in CTV-55 and D98% and D95% in PTV-55 was statistically significant (p<0.05) for TError and T+RError. The mean dose variation for Dmean and D50% in the rectum was statistically significant (p<0.05) for TError and T+RError. CONCLUSION The uncorrected interfractional 6D setup error results in significant target underdosing and OAR overdosing in prostate cancer. This emphasizes the need to correct interfractional 6D setup errors daily in IMRT and VMAT.
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Affiliation(s)
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, 400004, India
| | - V Shankar
- Department of Radiation Oncology, Apollo Cancer Center, Chennai, 600035, India
| | - S J Dhoble
- Department of Physics, R. T. M. Nagpur University, Nagpur, 440033, India
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Gallagher BD, Coughlin EC, Nair-Shalliker V, McCaffery K, Smith DP. Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis. Cancer Epidemiol 2022; 79:102164. [DOI: 10.1016/j.canep.2022.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/18/2022] [Accepted: 04/16/2022] [Indexed: 11/02/2022]
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Lara-Velazquez M, Mehkri Y, Panther E, Hernandez J, Rao D, Fiester P, Makary R, Rutenberg M, Tavanaiepour D, Rahmathulla G. Current Advances in the Management of Adult Craniopharyngiomas. Curr Oncol 2022; 29:1645-1671. [PMID: 35323338 PMCID: PMC8946973 DOI: 10.3390/curroncol29030138] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/23/2022] Open
Abstract
Craniopharyngiomas (CPs) are slow growing, histologically benign intracranial tumors located in the sellar–suprasellar region. Although known to have low mortality, their location and relationship to the adjacent neural structures results in patients having significant neurologic, endocrine, and visual comorbidities. The invasive nature of this tumor makes complete resection a challenge and contributes to its recurrence. Additionally, these tumors are bimodally distributed, being treated with surgery, and are followed by other adjuncts, such as focused radiation therapy, e.g., Gamma knife. Advances in surgical techniques, imaging tools, and instrumentations have resulted in the evolution of surgery using endoscopic techniques, with residual components being treated by radiotherapy to target the residual tumor. Advances in molecular biology have elucidated the main pathways involved in tumor development and recurrence, but presently, no other treatments are offered to patients, besides surgery, radiation, and endocrine management, as the disease and tumor evolve. We review the contemporary management of these tumors, from the evolution of surgical treatments, utilizing standard open microscopic approaches to the more recent endoscopic surgery, and discuss the current recommendations for care of these patients. We discuss the developments in radiation therapy, such as radiosurgery, being used as treatment strategies for craniopharyngioma, highlighting their beneficial effects on tumor resections while decreasing the rates of adverse outcomes. We also outline the recent chemotherapy modalities, which help control tumor growth, and the immune landscape on craniopharyngiomas that allow the development of novel immunotherapies.
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Affiliation(s)
- Montserrat Lara-Velazquez
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
| | - Yusuf Mehkri
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
| | - Eric Panther
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
| | - Jairo Hernandez
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
| | - Dinesh Rao
- Department of Neuroradiology, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (D.R.); (P.F.)
| | - Peter Fiester
- Department of Neuroradiology, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (D.R.); (P.F.)
| | - Raafat Makary
- Department of Pathology, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA;
| | - Michael Rutenberg
- Department of Radiation Oncology, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA;
| | - Daryoush Tavanaiepour
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
| | - Gazanfar Rahmathulla
- Department of Neurosurgery, College of Medicine, University of Florida, 653 8th St W., Jacksonville, FL 32209, USA; (M.L.-V.); (Y.M.); (E.P.); (J.H.); (D.T.)
- Correspondence: ; Tel.: +1-904-244-1418; Fax: +1-888-939-4093
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Quintero-Martinez JA, Cordova-Madera SN, Villarraga HR. Radiation-Induced Heart Disease. J Clin Med 2021; 11:146. [PMID: 35011887 PMCID: PMC8745750 DOI: 10.3390/jcm11010146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20-55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value.
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Affiliation(s)
| | | | - Hector R. Villarraga
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; (J.A.Q.-M.); (S.N.C.-M.)
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Rezaeijo SM, Hashemi B, Mofid B, Bakhshandeh M, Mahdavi A, Hashemi MS. The feasibility of a dose painting procedure to treat prostate cancer based on mpMR images and hierarchical clustering. Radiat Oncol 2021; 16:182. [PMID: 34544468 PMCID: PMC8454023 DOI: 10.1186/s13014-021-01906-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to assess the feasibility of a dose painting (DP) procedure, known as simultaneous integrated boost intensity modulated radiation Therapy (SIB-IMRT), for treating prostate cancer with dominant intraprostatic lesions (DILs) based on multi-parametric magnetic resonance (mpMR) images and hierarchical clustering with a machine learning technique. METHODS The mpMR images of 120 patients were used to create hierarchical clustering and draw a dendrogram. Three clusters were selected for performing agglomerative clustering. Then, the DIL acquired from the mpMR images of 20 patients were categorized into three groups to have them treated with a DP procedure being composed of three planning target volumes (PTVs) determined as PTV1, PTV2, and PTV3 in treatment plans. The DP procedure was carried out on the patients wherein a total dose of 80, 85 and 91 Gy were delivered to the PTV1, PTV2, and PTV3, respectively. Dosimetric and radiobiologic parameters [Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP)] of the DP procedure were compared with those of the conventional IMRT and Three-Dimensional Conformal Radiation Therapy (3DCRT) procedures carried out on another group of 20 patients. A post-treatment follow-up was also made four months after the radiotherapy procedures. RESULTS All the dosimetric variables and the NTCPs of the organs at risks (OARs) revealed no significant difference between the DP and IMRT procedures. Regarding the TCP of three investigated PTVs, significant differences were observed between the DP versus IMRT and also DP versus 3DCRT procedures. At post-treatment follow-up, the DIL volumes and apparent diffusion coefficient (ADC) values in the DP group differed significantly (p-value < 0.001) from those of the IMRT. However, the whole prostate ADC and prostate-specific antigen (PSA) indicated no significant difference (p-value > 0.05) between the DP versus IMRT. CONCLUSIONS The results of this comprehensive clinical trial illustrated the feasibility of our DP procedure for treating prostate cancer based on mpMR images validated with acquired patients' dosimetric and radiobiologic assessment and their follow-ups. This study confirms significant potential of the proposed DP procedure as a promising treatment planning to achieve effective dose escalation and treatment for prostate cancer. TRIAL REGISTRATION IRCT20181006041257N1; Iranian Registry of Clinical Trials, Registered: 23 October 2019, https://en.irct.ir/trial/34305 .
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Affiliation(s)
- Seyed Masoud Rezaeijo
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Bijan Hashemi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Manabe Y, Hashimoto S, Mukouyama H, Shibamoto Y. Stereotactic body radiotherapy using a hydrogel spacer for localized prostate cancer: A dosimetric comparison between tomotherapy with the newly-developed tumor-tracking system and cyberknife. J Appl Clin Med Phys 2021; 22:66-72. [PMID: 34415658 PMCID: PMC8504610 DOI: 10.1002/acm2.13395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose With a new tumor‐tracking system (Synchrony®) for tomotherapy (Radixact®), the internal and set‐up margins can be tightened, like cyberknife (CyberKnife®), in the planning of stereotactic body radiotherapy (SBRT) for prostate cancer. Recently, the usefulness of placing a hydrogel spacer between the prostate and rectum has been established in prostate radiotherapy. We evaluated the characteristics of tomotherapy plans with the tumor‐tracking system and compared them with cyberknife SBRT plans for localized prostate cancer using a hydrogel spacer. Methods In 20 patients, two plans were created and compared using tomotherapy and cyberknife. All patients underwent hydrogel spacer injection behind the prostate before simulation CT and MRI for fusion. For all plans, 36.25 Gy in 7.25‐Gy fractions for a minimum coverage dose of 95% of planning target volume (PTV) (D95%) was prescribed. The D99% of PTV and D0.1 ml of the PTV, urethra, bladder, and rectum were intended to be > 90%, 110–130%, 100–110%, <110%, and <100%, respectively, of the prescribed doses. Results All plans using tomotherapy and cyberknife achieved the intended dose constraints. The cyberknife plans yielded better median PTV‐V110% (volume of PTV covered by 110% isodose line, 54.8%), maintaining lower median D0.1 ml of the urethra (37.5 Gy) and V80% of the bladder (11.0 ml) compared to the tomotherapy plans (39.0%; p < 0.0001, 38.2 Gy; p < 0.0001, and 18.3 ml; p < 0.0001, respectively). The tomotherapy plans were superior to the cyberknife plans for the rectum (V80% = 0.4 vs. 1.0 ml, p < 0.001; D1ml = 26.4 vs. 29.0 Gy, p = 0.013). Conclusions Our results suggested that tomotherapy with the tumor‐tracking system has reasonable potential for SBRT for localized prostate cancer using a hydrogel spacer.
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Affiliation(s)
- Yoshihiko Manabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.,Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Seiji Hashimoto
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Hideki Mukouyama
- Department of Urology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa, 901-0493, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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11
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Miyasaka Y, Kawamura H, Sato H, Kubo N, Mizukami T, Matsui H, Miyazawa Y, Ito K, Nakano T, Suzuki K, Ohno T. Carbon ion radiotherapy for prostate cancer with bladder invasion. BMC Urol 2021; 21:106. [PMID: 34362355 PMCID: PMC8349048 DOI: 10.1186/s12894-021-00871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background The optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain.
At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. Hence, we evaluated CIRT for PC with bladder invasion in terms of the safety and efficacy. Methods Between March 2010 and December 2016, a total of 1337 patients with nonmetastatic PC received CIRT at a total dose of 57.6 Gy (RBE) in 16 fractions over 4 weeks. Among them, seven patients who had locally advanced PC with bladder invasion were identified. Long-term androgen-deprivation therapy (ADT) was also administered to these patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Event version 5.0. Results At the completion of our study, all the patients with cT4 PC were alive with a median follow-up period of 78 months. Grade 2 acute urinary disorders were observed in only one patient. Regarding late toxicities, only one patient developed grade 2 hematuria and urinary urgency. There was no grade 3 or worse toxicity, and gastrointestinal toxicity was not observed. Six (85.7%) patients had no recurrence or metastasis. One patient had biochemical and local failures 42 and 45 months after CIRT, respectively. However, the recurrent disease has been well controlled by salvage ADT. Conclusions Seven patients with locally advanced PC invading the bladder treated with CIRT were evaluated. Our findings seem to suggest positive safety and efficacy profiles for CIRT.
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Affiliation(s)
- Yuhei Miyasaka
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Gunma University Heavy Ion Medical Center, Maebashi, Japan.
| | - Hiro Sato
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tatsuji Mizukami
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hiroshi Matsui
- Gunma University Heavy Ion Medical Center, Maebashi, Japan.,Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshiyuki Miyazawa
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuto Ito
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Kurosawa Hospital, Takasaki, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kazuhiro Suzuki
- Gunma University Heavy Ion Medical Center, Maebashi, Japan.,Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
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12
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Kim DW, Sung J, Son J, Shin HB, Kim MJ, Noh YY, Kim H, Han MC, Kim J, Han SC, Chang KH, Kim H, Park K, Yoon M, Kim J, Shin D. Sensitivity of radio-photoluminescence glass dosimeters to accumulated doses. PLoS One 2020; 15:e0234829. [PMID: 33270667 PMCID: PMC7714242 DOI: 10.1371/journal.pone.0234829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background This study investigated the effect of accumulated doses on radio-photoluminescence glass dosimeters (RPLGDs) from measurements involving mega-voltage photons. Methods Forty-five commercially available RPLGDs were irradiated to estimate their dose responses. Photon beams of 6, 10, and 15 MV were irradiated onto the RPLGDs inside a phantom, which were divided into five groups with different doses and energies. Groups 1 and 2 were irradiated at 1, 5, 10, 50, and 100 Gy in a sequential manner; Group 3 was irradiated 10 times with a dose of 10 Gy; and Groups 4 and 5 followed the same method as that of Group 3, but with doses of 50 Gy and 100 Gy, respectively. Each device was subjected to a measurement reading procedure each time irradiation. Results For the annealed Group 1, RPLGD exhibited a linearity response with variance within 5%. For the non-annealed Group 2, readings demonstrated hyperlinearity at 6 MV and 10 MV, and linearity at 15 MV. Following the 100 Gy irradiation, the readings for Group 2 were 118.7 ± 1.9%, 112.2 ± 2.7%, and 101.5 ± 2.3% at 6, 10, and 15 MV, respectively. For Groups 3, 4, and 5, the responsiveness of the RPLGDs gradually decreased as the number of repeated irradiations increased. The percentage readings for the 10th beam irradiation with respect to the readings for the primary beam irradiation were 84.6 ± 1.9%, 87.5 ± 2.4%, and 93.0 ± 3.0% at 6 MV, 10 MV, and 15 MV, respectively. Conclusions The non-annealed RPLGD response to dose was hyperlinear for the 6 MV and 10 MV photon beams but not for the 15 MV photon beam. Additionally, the annealed RPLGD exhibited a fading phenomenon when the measurement was repeated several times and demonstrated a relatively large fading effect at low energies than at high energies.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jiwon Sung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Han-Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Joo Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yu-Yun Noh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hojae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Su Chul Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Myonggeun Yoon
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| | - Jinsung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dongho Shin
- Proton Therapy Center, National Cancer Center, Goyang, Korea
- * E-mail:
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13
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Roberts C, Paterson C. An Exploration of the Rs of Radiobiology in Prostate Cancer. Semin Oncol Nurs 2020; 36:151054. [PMID: 32669231 DOI: 10.1016/j.soncn.2020.151054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the four Rs of radiobiology (Repair, Reoxygenation, Reassortment, and Repopulation) as a means to understand the effects of ionising radiation on biological tissue and subsequently as the basis for conventional fractionated treatment schedules. These radiobiological principles will form a rationale for combined regimens in prostate cancer treatment involving androgen deprivation therapy and radiation therapy and the associated toxicities of this approach will be discussed. DATA SOURCES Electronic databases including CINAHL, MEDLINE, Scopus, professional websites, books and grey literature were searched using Google Scholar. CONCLUSION It is important for nurses to understand the four Rs of radiobiology to grasp the effects of ionising radiation on biological tissue as the basis for conventional fractionated treatment schedules in prostate cancer. Men can experience a sequalae of physical and psychological side effects of treatment that can negatively impact quality of life. IMPLICATIONS FOR NURSING PRACTICE Men can experience a range of unmet supportive care needs particularly related to informational, sexual, and psychological needs. For men affected by prostate cancer opting for radiation therapy (+/-) androgen deprivation therapy, nurses should ask targeted questions based on the Common Terminology Criteria for Adverse Events related to urinary and bowel function, potency and fatigue, and sexual health. We also recommend the use of holistic needs assessments to tailor self-management care plans. Evidence-based self-management advice should be provided in response to each man's unique needs.
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Affiliation(s)
- C Roberts
- Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, ACT, Australia.
| | - C Paterson
- Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, ACT, Australia; ACT Synergy Nursing and Midwifery Research Centre, Canberra Hospital, ACT, Australia
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14
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Kodama H, Hatakeyama S, Momota M, Togashi K, Hamaya T, Hamano I, Fujita N, Kojima Y, Okamoto T, Yoneyama T, Yamamoto H, Yoshikawa K, Yoneyama T, Hashimoto Y, Ohyama C. Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC Study). Urol Oncol 2020; 39:191.e1-191.e8. [PMID: 32684512 DOI: 10.1016/j.urolonc.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine how frailty and comorbidities affect surgical contraindication in patients with localized prostate cancer (CaP). MATERIALS AND METHODS We evaluated the effects of frailty in 479 patients with localized CaP who were treated with robot-assisted radical prostatectomy (RARP), or radiotherapy (RT) eligible for surgery (RT-nonfrail), or those with RT ineligible for surgery due to frailty or comorbidity (RT-frail) from February 2017 to April 2020. We retrospectively compared the geriatric 8 screening (G8) scores between patients with surgical indications (RARP and RT-nonfrail groups) and those with surgical contraindications (RT-frail group). The effect of G8 score in the RT-frail groups was investigated using multivariate logistic regression analysis. We developed and validated a nomogram for surgical contraindication in patients with localized CaP. RESULTS The median age of patients was 70 years. There were 256, 60, and 163 patients in the RARP, RT-nonfrail, and RT-frail, respectively. The G8 score in the RARP and RT-nonfrail groups was significantly higher than in the RT-frail group (15 vs. 14, respectively, P < 0.001). Age, comorbidities (cerebrocardiovascular disease or chronic respiratory disease), and G8 score were significantly associated with the RT-frail group. The nomogram showed that the area under the curve was 0.872 and 0.923 in the training and validation sets, respectively. The cutoff for surgical contraindication was >39.5%. CONCLUSIONS The G8 score and comorbidities have a significant effect on surgical contraindication in patients with localized CaP.
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Affiliation(s)
- Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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15
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Prediction of prostate cancer aggressiveness using 18F-Fluciclovine (FACBC) PET and multisequence multiparametric MRI. Sci Rep 2020; 10:9407. [PMID: 32523075 PMCID: PMC7287051 DOI: 10.1038/s41598-020-66255-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this prospective single-institution clinical trial (NCT02002455) was to evaluate the potential of advanced post-processing methods for 18F-Fluciclovine PET and multisequence multiparametric MRI in the prediction of prostate cancer (PCa) aggressiveness, defined by Gleason Grade Group (GGG). 21 patients with PCa underwent PET/CT, PET/MRI and MRI before prostatectomy. DWI was post-processed using kurtosis (ADCk, K), mono- (ADCm), and biexponential functions (f, Dp, Df) while Logan plots were used to calculate volume of distribution (VT). In total, 16 unique PET (VT, SUV) and MRI derived quantitative parameters were evaluated. Univariate and multivariate analysis were carried out to estimate the potential of the quantitative parameters and their combinations to predict GGG 1 vs >1, using logistic regression with a nested leave-pair out cross validation (LPOCV) scheme and recursive feature elimination technique applied for feature selection. The second order rotating frame imaging (RAFF), monoexponential and kurtosis derived parameters had LPOCV AUC in the range of 0.72 to 0.92 while the corresponding value for VT was 0.85. The best performance for GGG prediction was achieved by K parameter of kurtosis function followed by quantitative parameters based on DWI, RAFF and 18F-FACBC PET. No major improvement was achieved using parameter combinations with or without feature selection. Addition of 18F-FACBC PET derived parameters (VT, SUV) to DWI and RAFF derived parameters did not improve LPOCV AUC.
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16
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Comparative Effectiveness of Radiotherapy versus Focal Laser Ablation in Patients with Low and Intermediate Risk Localized Prostate Cancer. Sci Rep 2020; 10:9112. [PMID: 32499484 PMCID: PMC7272634 DOI: 10.1038/s41598-020-65863-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/07/2020] [Indexed: 02/05/2023] Open
Abstract
At present, focal laser ablation (FLA) as a new PCa local treatment has attracted attention. We aim at comparing the survival outcomes between radiotherapy (RT) and FLA to reveal whether FLA can be used as an alternative to RT for patients with low and intermediate-risk localized PCa.We conducted analyses with data from the SEER database (2004-2015). Propensity score matching and instrumental variate (IV) were used to reduce the influence of bias and unmeasured confounders maximally.In the adjusted multivariate regression, FLA had lower overall survival (OS) benefits (HR = 1.49; 95%CI: 1.18-1.87; p < 0.001). After propensity score matching, RT still had better OS (HR = 1.50; 95%CI: 1.17-1.93; p = 0.001). The outcomes of IV-adjusted analysis showed FLA was significantly inferior to RT in OS (HR = 1.49; 95%CI: 1.18-1.87). In the subgroup analyses, for those with PSA < 4 ng/mL, FLA showed markedly worse OS and cancer-specific mortality (CSM) outcomes (OS HR = 1.89; 95%CI: 1.01-3.53; p = 0.0466 and CSM HR = 4.25; 95%CI: 1.04-17.43; p = 0.044).FLA is a promising focal therapy of PCa. But our research demonstrated RT still had an obvious advantage in survival benefits over FLA. Using FLA as an alternative treatment for RT requires careful consideration by clinicians.
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17
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Jeong Y, Oh JG, Kang JK, Moon SR, Lee KK. Three-dimensional dose reconstruction-based pretreatment dosimetric verification in volumetric modulated arc therapy for prostate cancer. Radiat Oncol J 2020; 38:60-67. [PMID: 32229810 PMCID: PMC7113150 DOI: 10.3857/roj.2020.00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose We performed three-dimensional (3D) dose reconstruction-based pretreatment verification to evaluate gamma analysis acceptance criteria in volumetric modulated arc therapy (VMAT) for prostate cancer. Materials and Methods Pretreatment verification for 28 VMAT plans for prostate cancer was performed using the COMPASS system with a dolphin detector. The 3D reconstructed dose distribution of the treatment planning system calculation (TC) was compared with that of COMPASS independent calculation (CC) and COMPASS reconstruction from the dolphin detector measurement (CR). Gamma results (gamma failure rate and average gamma value [GFR and γAvg]) and dose-volume histogram (DVH) deviations, 98%, 2% and mean dose-volume difference (DD98%, DD2% and DDmean), were evaluated. Gamma analyses were performed with two acceptance criteria, 2%/2 mm and 3%/3 mm. Results The GFR in 2%/2 mm criteria were less than 8%, and those in 3%/3 mm criteria were less than 1% for all structures in comparisons between TC, CC, and CR. In the comparison between TC and CR, GFR and γAvg in 2%/2 mm criteria were significantly higher than those in 3%/3 mm criteria. The DVH deviations were within 2%, except for DDmean (%) for rectum and bladder. Conclusions The 3%/3 mm criteria were not strict enough to identify any discrepancies between planned and measured doses, and DVH deviations were less than 2% in most parameters. Therefore, gamma criteria of 2%/2 mm and DVH related parameters could be a useful tool for pretreatment verification for VMAT in prostate cancer.
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Affiliation(s)
- Yuri Jeong
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Jeong Geun Oh
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Jeong Ku Kang
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Sun Rock Moon
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Kang Kyoo Lee
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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