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de Leon J, Jelen U, Carr M, Crawford D, Picton M, Tran C, McKenzie L, Peng V, Twentyman T, Jameson MG, Batumalai V. Adapting outside the box: Simulation-free MR-guided stereotactic ablative radiotherapy for prostate cancer. Radiother Oncol 2024; 200:110527. [PMID: 39242030 DOI: 10.1016/j.radonc.2024.110527] [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: 07/07/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows. RESULTS All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min. CONCLUSION This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.
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Affiliation(s)
| | - Urszula Jelen
- GenesisCare, St Vincent's Hospital, Sydney, Australia
| | - Madeline Carr
- GenesisCare, St Vincent's Hospital, Sydney, Australia
| | | | | | - Charles Tran
- GenesisCare, St Vincent's Hospital, Sydney, Australia
| | | | - Valery Peng
- GenesisCare, St Vincent's Hospital, Sydney, Australia
| | | | - Michael G Jameson
- GenesisCare, St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Vikneswary Batumalai
- GenesisCare, St Vincent's Hospital, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia; The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia.
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Duque-Santana V, Diaz-Gavela A, Recio M, Guerrero LL, Peña M, Sanchez S, López-Campos F, Thuissard IJ, Andreu C, Sanz-Rosa D, Achard V, Gómez-Iturriaga A, Molina Y, Del Cerro Peñalver E, Couñago F. Jorge clinical study: 10-year outcomes of risk-adapted radiotherapy defined by multiparametric MRI for prostate cancer. World J Urol 2023; 41:3829-3838. [PMID: 37966505 DOI: 10.1007/s00345-023-04682-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE To analyze the 10-year biochemical relapse-free survival (BRFS), locoregional relapse-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) in patients diagnosed with localized prostate adenocarcinoma treated with radiotherapy (RT) ± androgen deprivation therapy (ADT), according to the risk groups based on multiparametric magnetic resonance imaging (mpMRI) instead of digital rectal exam (DRE). METHODS We retrospectively evaluated 140 consecutive patients diagnosed with localized prostate adenocarcinoma, stratified into different risk groups-low (LR), intermediate (IR), and high (HR) by mpMRI results. RESULTS After a median follow-up of 104 months, in LR group (n = 15), 10-year BRFS was 86.7%, 10-year LRFS was 86.7%, 10-year MFS was 93.3%, and 10-year OS was 100%. In IR group (n = 80), 10-year BRFS was 80.5%, 10-year LRFS was 86.1%, 10-year MFS was 92.6%, and 10-year OS was 76%. In HR group (n = 45), 10-year BRFS was 72.8%, 10-year LRFS was 78.7%, 10-year MFS was 82.1%, and 10-year OS was 77% (2 deaths from prostate cancer). According to mpMRI results, 36 (25.7%) patients change the risk group and 125 (89.28%) patients change the TNM stage. There was a trend for higher metastatic relapse in patients who switched from IR to HR (due to mpMRI) versus the patients who remained in the IR (20%, vs. 1.81% p = 0.059). Multivariate analysis showed that locoregional relapse was strongly associated with distant relapse (OR = 9.28; 95%CI: 2.60-33.31). There were no cases of acute grade 3 toxicity. Late grade 3 genitourinary, gastrointestinal, and sexual toxicity were 2.8%, 0.7%, and 1.2%, respectively. CONCLUSION This is the first study with a 10-year median follow-up of patients diagnosed with localized prostate cancer treated with radiotherapy according to the risk groups established by mpMRI. Our findings show that mpMRI is a key tool to diagnose and establish risk groups in these patients, to optimize their treatment.
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Affiliation(s)
- Victor Duque-Santana
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Diaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Luis Leonardo Guerrero
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Marina Peña
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Sofia Sanchez
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Israel J Thuissard
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Andreu
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - David Sanz-Rosa
- Department of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Yolanda Molina
- Department of Medical Physics, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Elia Del Cerro Peñalver
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid y Hospital La Luz, Universidad Europea de Madrid, Madrid, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital San Francisco de Asís y La Milagrosa, Clinical Director, National Chair of Research and Clinical Trials, GenesisCare, Madrid, Spain.
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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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Brown A, Pain T, Tan A, Anable L, Callander E, Watt K, Street D, De Abreu Lourenco R. Men's preferences for image-guidance in prostate radiation therapy: A discrete choice experiment. Radiother Oncol 2021; 167:49-56. [PMID: 34890737 DOI: 10.1016/j.radonc.2021.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are several options for real-time prostate monitoring during radiation therapy including fiducial markers (FMs) and transperineal ultrasound (TPUS). However, the patient experience for these procedures is very different. This study aimed to determine patient preferences around various aspects of prostate image-guidance, focusing on FMs and TPUS. METHODS A discrete choice experiment (DCE) was conducted, describing the image-guidance approach by: pain, cost, accuracy, side effects, additional appointments, and additional time. Participants were males with prostate cancer (PCa) and from the general Australian population. A DCE survey required participants to make hypothetical choices in each of 8 choice sets. Multinomial logit modelling and Latent Class Analysis (LCA) were used to analyse the responses. Marginal willingness to pay (mWTP) was calculated. RESULTS 476 respondents completed the survey (236 PCa patients and 240 general population). The most important attributes for both cohorts were pain, cost and accuracy (p < 0.01). PCa patients were willing to pay more to avoid the worst pain than the general population, and willing to pay more for increased accuracy. LCA revealed 3 groups: 2 were focused more on the process-related attributes of pain and cost, and the third was focused on the clinical efficacy attributes of accuracy and side effects. CONCLUSION Both cohorts preferred less cost and pain and improved accuracy, with men with PCa valuing accuracy more than the general population. In addition to the clinical and technical evidence, radiation oncology centres should consider the preferences of patients when considering choice of image-guidance techniques.
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Affiliation(s)
- Amy Brown
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia.
| | - Tilley Pain
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Alex Tan
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Lux Anable
- Townsville Hospital and Health Service, Townsville, Australia
| | - Emily Callander
- Monash University, Melbourne, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Kerrianne Watt
- James Cook University - Bebegu Yumba Campus, Townsville, Australia
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Moderately hypofractionated radiotherapy as definitive treatment for localized prostate cancer: Pattern of practice in German-speaking countries : A survey of the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society (DKG-ARO). Strahlenther Onkol 2021; 197:993-1000. [PMID: 34463814 PMCID: PMC8545730 DOI: 10.1007/s00066-021-01820-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022]
Abstract
Purpose Various randomized phase III clinical trials have compared moderately hypofractionated to normofractionated radiotherapy (RT). These modalities showed similar effectiveness without major differences in toxicity. This project was conducted by the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party on Radiation Oncology of the German Cancer Society. We aimed to investigate expert opinions on the use of moderately hypofractionated RT as a definitive treatment for localized prostate cancer in German-speaking countries. Methods A 25-item, web-based questionnaire on moderate-hypofractionation RT was prepared by an internal committee. The experts of the DEGRO were asked to complete the questionnaire. Results Fourteen active members of DEGRO completed the questionnaire. The questions described indications for selecting patients eligible to receive moderate hypofractionation based on clinical and pathological factors such as age, urinary symptoms, and risk-group. The questions also collected information on the technical aspects of selection criteria, including the definition of a clinical target volume, the use of imaging, protocols for bladder and rectal filling, the choice of a fractionation schedule, and the use of image guidance. Moreover, the questionnaire collected information on post-treatment surveillance after applying moderately hypofractionated RT. Conclusion Although opinions varied on the use of moderate-hypofractionation RT, the current survey reflected broad agreement on the notion that moderately hypofractionated RT could be considered a standard treatment for localized prostate cancer in German-speaking countries.
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Patel D, Tan A, Brown A, Pain T. Absence of prostate oedema obviates the need for delay between fiducial marker insertion and radiotherapy simulation. J Med Radiat Sci 2020; 67:302-309. [PMID: 32614152 PMCID: PMC7753875 DOI: 10.1002/jmrs.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Fiducial markers (FMs) are commonly inserted into the prostate for image guided radiation therapy. This study aimed to quantify prostate oedema immediately following FM insertion compared to prostate volumes measured a week later, at the time of simulation for radiation therapy. METHODS Thirty patients underwent a verification computed tomography (VCT) scan in treatment position immediately after the fiducial insertion and their planning computed tomography scan (PCT) one week after. Patient data sets were retrospectively evaluated, comparing prostate volumes and planning target volumes (PTV). Volumes were delineated by a single radiation oncologist, blinded to whether the scan was VCT or PCT. Distances between the FMs were measured on both scans. Descriptive statistics described the data, DICE similarity co-efficient (DSC) calculated, and paired t-tests were used to compare paired data. RESULTS The median prostate volume was 35.09 cc and 36.31 cc for VCT and PCT data sets, respectively, and median PTV was 118.56 cc and 127.04 cc for VCT and PCT, respectively. There was no significant difference in prostate volumes (P = 0.3037) or PTV (P = 0.1279), with a DSC of 0.87 (range 0.76-0.91) and 0.91 (range 0.85 to 0.95), respectively. Similarly, there was no significant difference in distance between fiducial markers (P > 0.05). CONCLUSION This study demonstrates no statistically significant difference in prostate or PTV volumes (P > 0.05) between the CT acquired at fiducial marker insertion compared with the CT acquired a week later. Therefore, oedema is not significant enough to justify a delay between FM insertion and simulation.
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Affiliation(s)
- Deepti Patel
- Townsville Cancer Centre, Townsville University HospitalTownsvilleQueenslandAustralia
| | - Alex Tan
- Townsville Cancer Centre, Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Amy Brown
- Townsville Cancer Centre, Townsville University HospitalTownsvilleQueenslandAustralia
| | - Tilley Pain
- James Cook UniversityTownsvilleQueenslandAustralia
- Townsville University HospitalTownsvilleQueenslandAustralia
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Rajković KM, Dabić-Stanković K, Stanković J, Aćimović M, Đukanović N, Nikolin B. Modelling and optimisation of treatment parameters in high-dose-rate mono brachytherapy for localised prostate carcinoma using a multilayer artificial neural network and a genetic algorithm: Pilot study. Comput Biol Med 2020; 126:104045. [PMID: 33099047 DOI: 10.1016/j.compbiomed.2020.104045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND High-dose-rate mono brachytherapy (HDR-MB) is employed in the treatment of prostate carcinoma (CaP). As an ideal plan of CaP brachytherapy cannot be created, it is necessary to identify a reliable tool to optimise the parameters of HDR-MB. This paper applies a multilayer artificial neural network (MANN) and a genetic algorithm (GA) to optimise brachytherapy parameters based on an individual dose-volumetric analysis. METHODS Patients with localised CaP of various risks were treated with HDR-MB. Consecutive levels of the biochemical control parameter (prostate specific antigen (PSA) nadir) have been collected after completion of HDR-MB in the range 2-9 years. The Kaplan-Meier regression analysis of biochemical-free survival (BFS) was applied. The clinical risk of recurrent CaP (RCaP), the therapy dose (TD), TD coverage index (CI100%) and PSA nadir were modelled using the MANN and GA. RESULTS In the low-risk group, BFS was achieved in 100% of treated patients, while in the group of patients with high risk, BFS was achieved in 95.8% of treated patients. The MANN-GA model optimises a TD of 47.3 Gy and CI100% of 1.14 as well as a TD of 50.4 Gy and CI100% of 1.6 for the low-risk group and high-risk group, respectively, of localised CaP. The optimised PSA nadir was 0.047 and 0.25 ng cm-3 for low-risk group and high-risk group, respectively. CONCLUSIONS The developed MANN-GA model presents a method for optimising the treatment parameters in radiation therapy, which could be a valuable tool in planning of the HDR-MB.
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Affiliation(s)
| | | | | | | | - Nina Đukanović
- High Medical School "Milutin Milanković", Belgrade, Serbia
| | - Borislava Nikolin
- Oncology Institute of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
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Nguyen TTT, Arimura H, Asamura R, Hirose TA, Ohga S, Fukunaga JI. Comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy prostate cancer plans accounting for cold spots. Radiol Phys Technol 2019; 12:137-148. [PMID: 30805779 DOI: 10.1007/s12194-019-00502-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/25/2022]
Abstract
This study compared dosimetric indices of volumetric-modulated arc therapy (VMAT) with intensity-modulated radiation therapy (IMRT) accounting for cold spots in prostate cancer plans. IMRT plans were retrospectively generated from 30 prostate cancer patients with ten cases for each risk group, who received VMAT plans. The mean, maximum, and minimum doses, and conformity and homogeneity indexes were evaluated for planning target volume (PTV) and the mean dose and V20-V70 for organs at risk (OAR) including the rectum, bladder, right and left femoral heads, and rectum overlapped with PTV (ROP) regions. The numbers and volume percentages of cold spots within PTVs and ROP regions were measured using in-house software. Three-dimensional probabilistic distributions of the probability and distributions of cold spots were generated using a centroid matching technique for visualization and analysis. There was a statistically better dose conformity in the PTV, rectum, and bladder dose-sparing in VMAT compared to that in the IMRT plans, whereas VMAT had statistically worse target dose homogeneity, and right and left femoral head dose-sparing than those of the IMRT plans. The average volume percentage of cold spots per PTV for the VMAT was 4.37 ± 2.68%, which was smaller than the 5.72 ± 1.84% observed for IMRT plans (P = 0.007). The volume percentage of cold spots per ROP for the VMAT did not significantly differ from those for the IMRT plans. Compared with IMRT, the VMAT plans achieved better PTV dose conformity, OAR dose-sparing, and smaller cold spots in the treatment of prostate cancer.
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Affiliation(s)
- Tran Thi Thao Nguyen
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Japan Society for the Promotion of Science, 5-3-1, Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Hidetaka Arimura
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ryosuke Asamura
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taka-Aki Hirose
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Saiji Ohga
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun-Ichi Fukunaga
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Effect of accounting for interfractional CTV shape variations in PTV margins on prostate cancer radiation treatment plans. Phys Med 2018; 54:66-76. [DOI: 10.1016/j.ejmp.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/01/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022] Open
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Richardson M, Sidhom M, Gallagher S, Grand M, Pryor D, Bucci J, Wilton L, Arumugam S, Keats S, Martin JM. PROstate Multicentre External beam radioTHErapy Using a Stereotactic boost: the PROMETHEUS study protocol. BMC Cancer 2018; 18:588. [PMID: 29793444 PMCID: PMC5968492 DOI: 10.1186/s12885-018-4511-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background High Dose Rate Brachytherapy (HDRB) boost is a well-established treatment for prostate cancer (PC). We describe the PROstate Multicentre External beam radioTHErapy Using Stereotactic boost (PROMETHEUS) study. Non-surgical stereotactic techniques are used to deliver similar doses to HDRB boost regimens with a dose escalation sub-study. Methods Eligible patients have intermediate or high risk PC. PROMETHEUS explores the safety, efficacy and feasibility of multiple Australian centres cooperating in the delivery of Prostate Stereotactic Body Radiotherapy (SBRT) technology. A SBRT boost component Target Dose (TD) of 19Gy in two fractions is to be delivered, followed by a subsequent EBRT component of 46Gy in 23 fractions. Once accrual triggers have been met, SBRT doses can be escalated in 1 Gy increments to a maximum of 22Gy in two fractions. Patient safety will also be measured with the rate of both acute and late moderate to severe Gastro-Intestinal (GI) and Genito-Urinary (GU) Common Terminology Criteria for Adverse Events (CTCAE) toxicities as well as patient reported quality of life. Efficacy will be assessed via biochemical control after 3 years. Discussion PROMETHEUS aims to generate evidence for a non-surgical possible future alternative to HDRB boost regimens, and introduce advanced radiotherapy techniques across multiple Australian cancer centres. Trial registration The study was retrospectively registered on the ANZCTR (Australian New Zealand Clinical Trials Registry) with trial ID: ACTRN12615000223538.
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Affiliation(s)
| | - Mark Sidhom
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | | | - Mel Grand
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.,Ingham Institute, Liverpool, NSW, Australia
| | - David Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Joseph Bucci
- St. George Hospital Cancer Centre, Sydney, NSW, Australia
| | - Lee Wilton
- Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Sarah Keats
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Lancee M, Tikkinen KA, de Reijke TM, Kataja VV, Aben KK, Vernooij RW. Guideline of guidelines: primary monotherapies for localised or locally advanced prostate cancer. BJU Int 2018; 122:535-548. [DOI: 10.1111/bju.14237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Michelle Lancee
- Utrecht University; Utrecht The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
| | - Kari A.O. Tikkinen
- Departments of Urology and Public Health; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Theo M. de Reijke
- Department of Urology; Academic Medical Center; Amsterdam The Netherlands
| | - Vesa V. Kataja
- Central Finland Central Hospital; Central Finland Health Care District; Jyväskylä Finland
| | - Katja K.H. Aben
- Department of Research; Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
- Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Robin W.M. Vernooij
- Department of Research; Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
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12
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Brown A, Tan A, Cooper S, Fielding A. Obesity does not influence prostate intrafractional motion. J Med Radiat Sci 2018; 65:31-38. [PMID: 29359862 PMCID: PMC5846017 DOI: 10.1002/jmrs.255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Motion of the prostate is problematic in the accurate delivery of external beam radiation therapy (EBRT) for prostate cancer. This study investigated the relationship between body mass index (BMI), an easily measured indicator of obesity, and prostate motion. Methods Prostate motion during EBRT was assessed by measuring the displacement of fiducial markers implanted within the prostate in 130 prostate cancer patients. Interfractional motion was corrected on daily imaging through pre‐treatment cone‐beam‐computed tomography (CBCT) and intrafractional motion measured using movie sequences captured using an electronic portal imaging device (EPID) during treatment delivery. Results There was no statistically significant relationship between the mean intrafractional motion and BMI, except in the left‐right (LR) translation (P = 0.049) over the study population. For each BMI category, there was no statistical significance (P > 0.05) between any of the translations/rotations except LR (P = 0.003). Conclusion While intrafractional motion is an important consideration, prostate motion cannot be reliably predicted through measurement of patient's BMI.
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Affiliation(s)
- Amy Brown
- Townsville Cancer Centre, The Townsville Hospital, Townsville, Queensland, Australia
| | - Alex Tan
- Townsville Cancer Centre, The Townsville Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Scott Cooper
- Townsville Cancer Centre, The Townsville Hospital, Townsville, Queensland, Australia
| | - Andrew Fielding
- Queensland University of Technology, Brisbane, Queensland, Australia
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13
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Pryor DI, Turner SL, Tai KH, Tang C, Sasso G, Dreosti M, Woo HH, Wilton L, Martin JM. Moderate hypofractionation for prostate cancer: A user's guide. J Med Imaging Radiat Oncol 2018; 62:232-239. [PMID: 29336109 DOI: 10.1111/1754-9485.12703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/12/2017] [Indexed: 01/16/2023]
Abstract
Three large randomised controlled trials have been published in the last year demonstrating the non-inferiority of moderate hypofractionation compared to conventional fractionation for localised prostate cancer with respect to both disease control and late toxicity at 5 years. Furthermore, no clinically significant differences in patient-reported outcomes have emerged. More mature follow-up data are now also available from phase 2 studies confirming that moderate hypofractionation is associated with low rates of significant toxicity at 10 years. Moving forward it is likely that appropriate patient selection, integration of androgen deprivation and attention to optimising technique will play a more important role than modest differences in dose-fractionation schedules. Here we briefly review the evidence, discuss issues of patient selection and provide an approach to implementing moderately hypofractionated radiation therapy for prostate cancer in clinical practice.
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Affiliation(s)
- David I Pryor
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,APCRC-Q, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sandra L Turner
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Keen Hun Tai
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Giuseppe Sasso
- Auckland City Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Marcus Dreosti
- Genesis Cancer Care, Adelaide, South Australia, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lee Wilton
- Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Jarad M Martin
- Calvary Mater Newcastle, Waratah, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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14
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Improving plan quality for prostate volumetric-modulated arc therapy. Med Dosim 2017; 42:348-356. [DOI: 10.1016/j.meddos.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/16/2017] [Accepted: 07/03/2017] [Indexed: 11/22/2022]
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15
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Couñago F, Del Cerro E, Díaz-Gavela AA, Marcos FJ, Recio M, Sanz-Rosa D, Thuissard I, Olaciregui K, Mateo M, Cerezo L. Tumor staging using 3.0 T multiparametric MRI in prostate cancer: impact on treatment decisions for radical radiotherapy. SPRINGERPLUS 2015; 4:789. [PMID: 26702378 PMCID: PMC4684563 DOI: 10.1186/s40064-015-1596-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/05/2015] [Indexed: 12/23/2022]
Abstract
To assess and validate the incorporation of the multiparametric magnetic resonance imaging (mpMRI) tumour category (mT-category) to the conventional clinical tumour category (cT-category), in order to guide the radiotherapy (RT) treatment decisions in prostate cancer. In addition, to identify the clinical factors associated to the technique reliability. mpMRI was performed in 274 prostate cancer patients in order to refine the treatment decisions according to PSA, Gleason Score (GS) and cT-category. Comparisons between the cT and mT-category were performed, as well as the impact on the RT treatment [target volume, doses and hormonal therapy (HT)] independently if it was finally performed. Changes in HT indication for intermediate risk were also analyzed. mpMRI validation was performed with pathological staging (n = 90 patients finally decided to join surgery). The mpMRI upstaging range was 86-94 % for any PSA value or GS. Following mpMRI, 32.8 % of the patients (90/274) were assigned to a different risk group. Compared to cT-category, mpMRI identified more intermediate-risk (46.4 vs. 59.5 %) and high-risk (19.0 vs. 28.8 %) prostate cancer patients. This resulted in a higher indication (p < 0.05) of seminal vesicle irradiation (63.5 vs. 70.0 %), inclusion of any extracapsular disease (T3-T4) within the target volume (1.8 vs. 18.2 %), higher doses (65.3 vs. 88.3 %) and HT associated to RT (45.6 vs. 62.4 %). Global accuracy for mpMRI was higher compared to DRE/TRUS (8.9 vs. 71.1 %, p < 0.05). mpMRI reliability was independent of PSA or GS. mpMRI tumor staging significantly modified the RT treatment decisions in all prostate cancer risk groups.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Elia Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Ana Aurora Díaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Francisco José Marcos
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quiron, Madrid, Spain
| | - David Sanz-Rosa
- Clinical Department, School of Biomedical Sciences, Universidad Europea, Madrid, Spain
| | - Israel Thuissard
- School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain
| | | | - María Mateo
- Hospital Universitario Quiron, Madrid, Spain
| | - Laura Cerezo
- Departament of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
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16
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Wu R, Woodford H, Capp A, Hunter P, Cowin G, Tai KH, Nguyen PL, Chong P, Martin J. A prospective study of nomogram-based adaptation of prostate radiotherapy target volumes. Radiat Oncol 2015; 10:243. [PMID: 26607977 PMCID: PMC4660680 DOI: 10.1186/s13014-015-0545-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A prospective clinical trial was conducted to evaluate the feasibility of a novel approach to the treatment of patients with high risk prostate cancer (HRPC) through the use of a nomogram to tailor radiotherapy target volumes. METHODS Twenty seven subjects with HRPC were treated with a mildly hypofractionated radiotherapy regimen using image-guided IMRT technique between Jun/2013-Jan/2015. A set of validated prognostic factors were inputted into the Memorial-Sloan-Kettering Cancer Center (MSKCC) prostate cancer nomogram to estimate risk of loco-regional spread (LRS). The nomogram risk estimates for extra-capsular extension (ECE), seminal vesicles involvement (SVI), and pelvic lymph nodes involvement (LNI) were used to adapt radiotherapy treatment volumes based on a risk threshold of ≥15 % in all cases. A planning guide was used to delineate target volumes and organs at risk (OAR). Up to three dose levels were administered over 28 fractions; 70Gy for gross disease in the prostate +/- seminal vesicles (2.5Gy/fraction), 61.6Gy for subclinical peri-prostatic disease (2.2Gy/fraction) and 50.4Gy to pelvic nodes (1.8Gy/fraction). Data regarding protocol adherence, nomogram use, radiotherapy dose distribution, and acute toxicity were collected. RESULTS Nomogram use 100 % of patients were treated for ECE, 88.9 % for SVI, and 70.4 % for LNI. The three areas at risk of LRS were appropriately treated according to the study protocol in 98.8 % cases. The MSKCC nomogram estimates for LRS differed significantly between the time of recruitment and analysis. Contouring protocol compliance Compliance with the trial contouring protocol for up to seven target volumes was 93.0 % (159/171). Compliance with protocol for small bowel contouring was poor (59.3 %). Dose constraints compliance Compliance with dose constraints for target volumes was 97.4 % (191/196). Compliance with dose constraints for OAR was 88.2 % (285/323). Acute toxicity There were no grade 3 acute toxicities observed. 20/27 (74.1 %) and 6/27 (22.2 %) patients experienced a grade 2 genitourinary and gastrointestinal toxicity respectively. CONCLUSIONS We have demonstrated the feasibility of this novel risk-adapted radiation treatment protocol for HRPC. This study has identified key learning points regarding this approach, including the importance of standardization and updating of risk quantification tools, and the utility of an observer to verify their correct use. TRIAL REGISTRATION ClincialTrials.gov identifier NCT01418040 . Hunter New England Human Research Ethics Committee (HNEHREC) reference number 12/08/15/4.02.
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Affiliation(s)
- Raymond Wu
- Department of Radiation Oncology, Calvary Mater Newcastle, Edith Street, Waratah, NSW, 2298, Australia.
| | - Hannah Woodford
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, 2308, Australia.
| | - Anne Capp
- Department of Radiation Oncology, Calvary Mater Newcastle, Edith Street, Waratah, NSW, 2298, Australia.
| | - Perry Hunter
- Department of Radiation Oncology, Calvary Mater Newcastle, Edith Street, Waratah, NSW, 2298, Australia.
| | - Gary Cowin
- University of Queensland, The Centre for Advanced Imaging, Building 57, Research Road, St Lucia, QLD, 4072, Australia.
| | - Keen-Hun Tai
- Department of Radiation Oncology, Peter MacCallum Cancer Institute, St Andrews Place, East Melbourne, VIC, 3002, Australia.
| | - Paul L Nguyen
- Brigham and Women's Hospital, Radiation Oncology, 75 Francis Street, Boston, MA, 02115, USA.
| | - Peter Chong
- Sky Central East, Level 3, Suite 2, 20 Smart Street, Charlestown, NSW, 2290, Australia.
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Edith Street, Waratah, NSW, 2298, Australia. .,University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, 2308, Australia. .,University of Queensland, The Centre for Advanced Imaging, Building 57, Research Road, St Lucia, QLD, 4072, Australia.
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17
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Jameson MG, Ohanessian L, Batumalai V, Patel V, Holloway LC. Comparison of Oncentra® Brachy IPSA and graphical optimisation techniques: a case study of HDR brachytherapy head and neck and prostate plans. J Med Radiat Sci 2015; 62:168-74. [PMID: 26229683 PMCID: PMC4462990 DOI: 10.1002/jmrs.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
Abstract
There are a number of different dwell positions and time optimisation options available in the Oncentra® Brachy (Elekta Brachytherapy Solutions, Veenendaal, The Netherlands) brachytherapy treatment planning system. The purpose of this case study was to compare graphical (GRO) and inverse planning by simulated annealing (IPSA) optimisation techniques for interstitial head and neck (HN) and prostate plans considering dosimetry, modelled radiobiology outcome and planning time. Four retrospective brachytherapy patients were chosen for this study, two recurrent HN and two prostatic boosts. Manual GRO and IPSA plans were generated for each patient. Plans were compared using dose–volume histograms (DVH) and dose coverage metrics including; conformity index (CI), homogeneity index (HI) and conformity number (CN). Logit and relative seriality models were used to calculate tumour control probability (TCP) and normal tissue complication probability (NTCP). Approximate planning time was also recorded. There was no significant difference between GRO and IPSA in terms of dose metrics with mean CI of 1.30 and 1.57 (P > 0.05) respectively. IPSA achieved an average HN TCP of 0.32 versus 0.12 for GRO while for prostate there was no significant difference. Mean GRO planning times were greater than 75 min while average IPSA planning times were less than 10 min. Planning times for IPSA were greatly reduced compared to GRO and plans were dosimetrically similar. For this reason, IPSA makes for a useful planning tool in HN and prostate brachytherapy.
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Affiliation(s)
- Michael G Jameson
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia
| | - Lucy Ohanessian
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia
| | - Virendra Patel
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia
| | - Lois C Holloway
- Liverpool and Macarthur Cancer Therapy Centres Liverpool, New South Wales, Australia ; Centre for Medical Radiation Physics, University of Wollongong Wollongong, New South Wales, Australia ; Ingham Institute of Applied Medical Research Liverpool, New South Wales, Australia ; South Western Sydney Clinical School, School of Medicine University of New South Wales, Australia ; Institute of Medical Physics, School of Physics, University of Sydney Sydney, New South Wales, Australia
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18
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Yamaguchi S, Ohguri T, Fujii M, Yahara K, Hayashida Y, Fujimoto N, Korogi Y. Definitive 3D-CRT for clinically localized prostate cancer: modifications of the clinical target volume following a prostate MRI and the clinical benefits. SPRINGERPLUS 2015; 4:347. [PMID: 26191474 PMCID: PMC4502053 DOI: 10.1186/s40064-015-1138-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/06/2015] [Indexed: 12/29/2022]
Abstract
Purpose To evaluate the modifications of the tumor stage and clinical target volume following a prostate magnetic resonance imaging (MRI) to evaluate the tumor (T) staging, and the clinical benefits for prostate cancer. Methods A total of 410 patients with newly diagnosed and clinically localized prostate cancer were retrospectively analyzed. The patients were treated with definitive three-dimensional conformal radiotherapy (3D-CRT). In all of the patients, digital rectal examination, transrectal ultrasound, prostate biopsy and computed tomography were performed to evaluate the clinical stage. Of the 410 patients, 189 patients had undergone a prostate MRI study to evaluate the T staging, and 221 patients had not. Results Modification of the T stage after the prostate MRI was seen in 39 (25%) of the 157 evaluable patients, and a modification of the risk group was made in 14 (9%) patients. Eventually, a modification of the CTV in 3D-CRT planning was made in 13 (8%) patients, and 10 of these had extracapsular disease. Most of the other modifications of the T staging were associated with intracapsular lesions of prostate cancer which did not change the CTV. There were no significant differences in the biological relapse-free survival between the patients with and without a prostate MRI study. Conclusions Modification of the CTV were recognized in only 8% of the patients, most of whom had extracapsular disease, although that of the T stage was seen in approximately one-quarter of the patients. Prostate MRI should only be selected for patients with a high probability of extracapsular involvement.
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Affiliation(s)
| | - Takayuki Ohguri
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Masami Fujii
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Katsuya Yahara
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
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19
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The use of probiotics versus psyllium husk as a bowel preparation for prostate radiotherapy: a retrospective analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractIntroductionThe use of bowel preparation strategies to reduce the degree of rectal distension during prostate radiotherapy is well documented. This retrospective pilot study analysed and compared a probiotic agent against a psyllium-supplemented diet to establish the feasibility of probiotics as a bowel preparation for patients receiving radical radiotherapy for prostate cancer.MethodA retrospective chart review of five patients taking probiotics and five taking psyllium husk (psyllium) during their course of radiotherapy treatment was conducted. On treatment, cone beam computed tomography (CBCT) scans were compared with planning CTs to quantify inter-fractional variation in rectal volume and distension.ResultsForty-five CBCT scans were available in both the psyllium and probiotics groups for analysis. Variation in mean difference in rectal volume from planning (ΔRV), mean rectal cross-section area (CSA) and mean relative cross-section area (CSArel) was significantly increased for the probiotics group compared with the psyllium group (p=0·001, 0·008 and 0·007, respectively). No statistically significant differences in mean ΔRV, CSA and CSArel were detected between the two groups.ConclusionThis retrospective analysis suggests that a probiotics-based bowel preparation that utilises Lactobacillus acidophilus and Bifidobacterium lactis may result in increased rectal volume and CSA variation throughout treatment in comparison with a psyllium-supplemented diet.
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20
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Novaes P, Mottas RT, Lundgren M. Treatment of prostate cancer with intensity modulated radiation therapy (IMRT). Rev Assoc Med Bras (1992) 2015; 61:8-16. [PMID: 25909199 DOI: 10.1590/1806-9282.61.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Freeman AR, Roos DE, Kim L. Quality indicators for prostate radiotherapy: are patients disadvantaged by receiving treatment in a 'generalist' centre? J Med Imaging Radiat Oncol 2014; 59:255-64. [PMID: 25345594 DOI: 10.1111/1754-9485.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/06/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this retrospective review was to evaluate concordance with evidence-based quality indicator guidelines for prostate cancer patients treated radically in a 'generalist' (as distinct from 'sub-specialist') centre. We were concerned that the quality of treatment may be lower in a generalist centre. If so, the findings could have relevance for many radiotherapy departments that treat prostate cancer. METHODS Two hundred fifteen consecutive patients received external beam radiotherapy (EBRT) and/or brachytherapy between 1.10.11 and 30.9.12. Treatment was deemed to be in line with evidence-based guidelines if the dose was: (i) 73.8-81 Gy at 1.8-2.0 Gy/fraction for EBRT alone (eviQ guidelines); (ii) 40-50 Gy (EBRT) for EBRT plus high-dose rate (HDR) brachytherapy boost (National Comprehensive Cancer Network (NCCN) guidelines); and (iii) 145 Gy for low dose rate (LDR) I-125 monotherapy (NCCN). Additionally, EBRT beam energy should be ≥6 MV using three-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), and high-risk patients should receive neo-adjuvant androgen-deprivation therapy (ADT) (eviQ/NCCN). Treatment of pelvic nodes was also assessed. RESULTS One hundred four high-risk, 84 intermediate-risk and 27 low-risk patients (NCCN criteria) were managed by eight of nine radiation oncologists. Concordance with guideline doses was confirmed in: (i) 125 of 136 patients (92%) treated with EBRT alone; (ii) 32 of 34 patients (94%) treated with EBRT + HDR BRT boost; and (iii) 45 of 45 patients (100%) treated with LDR BRT alone. All EBRT patients were treated with ≥6 MV beams using 3D-CRT (78%) or IMRT (22%). 84%, 21% and 0% of high-risk, intermediate-risk and low-risk patients received ADT, respectively. Overall treatment modality choice (including ADT use and duration where assessable) was concordant with guidelines for 176/207 (85%) of patients. CONCLUSION The vast majority of patients were treated concordant with evidence-based guidelines suggesting that, within the limits of the selected criteria, prostate cancer patients are unlikely to be disadvantaged by receiving radiotherapy in this 'generalist' centre.
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Ratnayake G, Martin J, Plank A, Wong W. Incremental changes verses a technological quantum leap: The additional value of intensity-modulated radiotherapy beyond image-guided radiotherapy for prostate irradiation. J Med Imaging Radiat Oncol 2014. [DOI: 10.1111/1754-9485.12153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gishan Ratnayake
- Department of Radiation Oncology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jarad Martin
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
| | - Ashley Plank
- Oncology Research Australia; Toowoomba Queensland Australia
| | - Winnie Wong
- Radiation Oncology Queensland; Toowoomba Queensland Australia
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23
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Healy B, Frantzis J, Murry R, Martin J, Plank A, Middleton M, Catton C, Kron T. Results from a multicenter prostate IMRT dosimetry intercomparison for an OCOG-TROG clinical trial. Med Phys 2014; 40:071706. [PMID: 23822410 DOI: 10.1118/1.4808151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A multi-institution dosimetry intercomparison has been undertaken of prostate intensity modulated radiation therapy (IMRT) delivery. The dosimetry intercomparison was incorporated into the quality assurance for site credentialing for the Trans-Tasman Radiation Oncology Group Prostate Fractionated Irradiation Trial 08.01 clinical trial. METHODS An anthropomorphic pelvic phantom with realistic anatomy was used along with multiplanar dosimetry tools for the assessment. Nineteen centers across Australia and New Zealand participated in the study. RESULTS In comparing planned versus measured dose to the target at the isocenter within the phantom, all centers were able to achieve a total delivered dose within 3% of planned dose. In multiplanar analysis with radiochromic film using the gamma analysis method to compare delivered and planned dose, pass rates for a 5%/3 mm criterion were better than 90% for a coronal slice through the isocenter. Pass rates for an off-axis coronal slice were also better than 90% except for one instance with 84% pass rate. CONCLUSIONS Strengths of the dosimetry assessment procedure included the true anthropomorphic nature of the phantom used, the involvement of an expert from the reference center in carrying out the assessment at every site, and the ability of the assessment to detect and resolve dosimetry discrepancies.
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Affiliation(s)
- B Healy
- Radiation Oncology Queensland, Toowoomba, Queensland 4350, Australia.
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Martin J, Nicholson G, Cowin G, Ilente C, Wong W, Kennedy D. Rapid determination of vertebral fat fraction over a large range of vertebral bodies. J Med Imaging Radiat Oncol 2013; 58:155-63. [DOI: 10.1111/1754-9485.12143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Jarad Martin
- Calvary Mater Newcastle; Newcastle New South Wales Australia
- School of Medicine; University of Queensland; Toowoomba Queensland Australia
- Centre for Advanced Imaging; University of Queensland; Brisbane Queensland Australia
| | - Geoffrey Nicholson
- School of Medicine; University of Queensland; Toowoomba Queensland Australia
| | - Gary Cowin
- Centre for Advanced Imaging; University of Queensland; Brisbane Queensland Australia
| | - Clare Ilente
- Toowoomba Cancer Research Centre; Toowoomba Queensland Australia
| | - Winnie Wong
- Toowoomba Cancer Research Centre; Toowoomba Queensland Australia
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25
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Lehman M, Hayden AJ, Martin JM, Christie D, Kneebone AB, Sidhom M, Skala M, Tai KH. FROGG high-risk prostate cancer workshop: patterns of practice and literature review: part I: intact prostate. J Med Imaging Radiat Oncol 2013; 58:257-65. [PMID: 24304822 DOI: 10.1111/1754-9485.12142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022]
Abstract
Australian and New Zealand radiation oncologists with an interest in uro-oncology were invited to participate in a pattern-of-practice survey dealing with the management of intact high-risk prostate cancer. Responses from 46 practitioners (representing 73% of all potential respondents) revealed that high-dose radiation therapy is the standard of care. However, there is variability in practice with regard to the methods used to achieve dose escalation, the use of whole-pelvic radiation therapy and the optimal duration of androgen deprivation therapy employed. A review of the literature outlining the current body of knowledge and the planned and ongoing studies in intact high-risk prostate cancer is presented.
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Affiliation(s)
- Margot Lehman
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Chang JH, Lim Joon D, Nguyen BT, Hiew CY, Esler S, Angus D, Chao M, Wada M, Quong G, Khoo V. MRI scans significantly change target coverage decisions in radical radiotherapy for prostate cancer. J Med Imaging Radiat Oncol 2013; 58:237-43. [PMID: 24690247 DOI: 10.1111/1754-9485.12107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 07/25/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Conventional clinical staging for prostate cancer has many limitations. This study evaluates the impact of adding MRI scans to conventional clinical staging for guiding decisions about radiotherapy target coverage. METHODS This was a retrospective review of 115 patients who were treated between February 2002 and September 2005 with radical radiotherapy for prostate cancer. All patients had MRI scans approximately 2 weeks before the initiation of radiotherapy. The T stage was assessed by both conventional clinical methods (cT-staging) as well as by MRI (mT-staging). The radiotherapy target volumes were determined first based on cT-staging and then taking the additional mT staging into account. The number of times extracapsular extension or seminal vesicle invasion was incorporated into target volumes was quantified based on both cT-staging and the additional mT-staging. RESULTS Extracapsular extension was incorporated into target volumes significantly more often with the addition of mT-staging (46 patients (40%) ) compared with cT-staging alone (37 patients (32%) ) (P = 0.002). Seminal vesicle invasion was incorporated into target volumes significantly more often with the addition of mT-staging (21 patients (18%) ) compared with cT-staging alone (three patients (3%) ) (P < 0.001). A total of 23 patients (20%) had changes to their target coverage based on the mT-staging. CONCLUSIONS MRI scans can significantly change decisions about target coverage in radical radiotherapy for prostate cancer.
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Affiliation(s)
- Joe H Chang
- Radiation Oncology Centre, Austin Health, Melbourne, Victoria, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
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Trada Y, Plank A, Martin J. Defining a dose-response relationship for prostate external beam radiotherapy. J Med Imaging Radiat Oncol 2012; 57:237-46. [DOI: 10.1111/1754-9485.12008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Yuvnik Trada
- School of Medicine; University of Queensland; Brisbane
| | - Ash Plank
- Toowoomba Cancer Research Centre; Toowoomba; Queensland
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Mak D, Gill S, Paul R, Stillie A, Haworth A, Kron T, Cramb J, Knight K, Thomas J, Duchesne G, Foroudi F. Seminal vesicle interfraction displacement and margins in image guided radiotherapy for prostate cancer. Radiat Oncol 2012; 7:139. [PMID: 22889144 PMCID: PMC3487760 DOI: 10.1186/1748-717x-7-139] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/04/2012] [Indexed: 12/25/2022] Open
Abstract
Background To analyze interfraction motion of seminal vesicles (SV), and its motion relative to rectal and bladder filling. Methods and Materials SV and prostate were contoured on 771 daily computed tomography “on rails” scans from 24 prostate cancer patients undergoing radiotherapy. Random and systematic errors for SV centroid displacement were measured relative to the prostate centroid. Margins required for complete geometric coverage of SV were determined using isotropic expansion of reference contours. SV motion relative to rectum and bladder was determined. Results Systematic error for the SV was 1.9 mm left-right (LR), 2.9 mm anterior-posterior (AP) and 3.6 mm superior-inferior (SI). Random error was 1.4 mm (LR), 2.7 mm (AP) and 2.1 mm (SI). 10 mm margins covered the entire left SV and right SV on at least 90% of fractions in 50% and 33% of patients and 15 mm margins covered 88% and 79% respectively. SV AP movement correlated with movement of the most posterior point of the bladder (mean R2 = 0.46, SD = 0.24) and rectal area (mean R2 = 0.38, SD = 0.21). Conclusions Considerable interfraction displacement of SV was observed in this cohort of patients. Bladder and rectal parameters correlated with SV movement.
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Affiliation(s)
- Daisy Mak
- Radiation Oncology Division, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, VIC, 8006, Australia.
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Hindson BR, Turner SL, Millar JL, Foroudi F, Gogna NK, Skala M, Kneebone A, Christie DRH, Lehman M, Wiltshire KL, Tai KH. Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder. J Med Imaging Radiat Oncol 2012; 56:18-30. [PMID: 22339742 DOI: 10.1111/j.1754-9485.2011.02336.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes.
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Affiliation(s)
- Benjamin R Hindson
- William Buckland Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.
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Sia J, Joon DL, Viotto A, Mantle C, Quong G, Rolfo A, Wada M, Anderson N, Rolfo M, Khoo V. Toxicity and Long-Term Outcomes of Dose-Escalated Intensity Modulated Radiation Therapy to 74Gy for Localised Prostate Cancer in a Single Australian Centre. Cancers (Basel) 2011; 3:3419-31. [PMID: 24212961 PMCID: PMC3759203 DOI: 10.3390/cancers3033419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/22/2022] Open
Abstract
Purpose To report the toxicity and long-term outcomes of dose-escalated intensity-modulated radiation therapy (IMRT) for patients with localised prostate cancer. Methods and Materials From 2001 to 2005, a total of 125 patients with histologically confirmed T1-3N0M0 prostate cancer were treated with IMRT to 74Gy at the Austin Health Radiation Oncology Centre. The median follow-up was 5.5 years (range 0.5–8.9 years). Biochemical prostate specific antigen (bPSA) failure was defined according to the Phoenix consensus definition (absolute nadir + 2ng/mL). Toxicity was scored according to the RTOG/EORTC criteria. Kaplan-Meier analysis was used to calculate toxicity rates, as well as the risks of bPSA failure, distant metastases, disease-specific and overall survival, at 5 and 8-years post treatment. Results All patients completed radiotherapy without any treatment breaks. The 8-year risks of ≥ Grade 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 6.4% and 5.8% respectively, and the 8-year risks of ≥ Grade 3 GU and GI toxicity were both < 0.05%. The 5 and 8-year freedom from bPSA failure were 76% and 58% respectively. Disease-specific survival at 5 and 8 years were 95% and 91%, respectively, and overall survival at 5 and 8 years were 90% and 71%, respectively. Conclusions These results confirm existing international data regarding the safety and efficacy of dose-escalated intensity-modulated radiation therapy for localised prostate cancer within an Australian setting.
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Affiliation(s)
- Joseph Sia
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Daryl Lim Joon
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Angela Viotto
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Carmel Mantle
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - George Quong
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Aldo Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Morikatsu Wada
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Nigel Anderson
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Maureen Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Vincent Khoo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Department of Medicine, University of Melbourne, Melbourne Victoria 3053, Australia
- Royal Marsden Hospital & Institute of Cancer Research, London SW3 6JJ, UK
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-3-9496 2800; Fax: +61-3-9496 2826
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Brown S, Lehman M, Ferrari-Anderson J, Glyde A, Burmeister E, Nicol D. Assessment of prostatic fiducial marker introduction: Patient morbidity, staff satisfaction and improved treatment field placement. J Med Imaging Radiat Oncol 2011; 55:417-24. [DOI: 10.1111/j.1754-9485.2011.02278.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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