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Takai K, Watanabe R, Hyogo KI, Ito Y, Minagawa N, Sato Y, Matsuda Y, Nemoto K. Treatment outcome of localized prostate cancer using transperineal ultrasound image-guided radiotherapy. Radiat Oncol 2024; 19:100. [PMID: 39090614 PMCID: PMC11292876 DOI: 10.1186/s13014-024-02490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND We report the results of a retrospective analysis of localized prostate cancer (LPCa) treated with transperineal ultrasound image-guided radiotherapy (TPUS-IGRT). METHODS A total of 124 patients (median age: 74 y, 46-84 y) with LPCa who underwent TPUS-IGRT (Clarity Autoscan system; CAS, Elekta; Stockholm, Sweden) between April 2016 and October 2021 for curative/after hormone induction were enrolled. The number of patients by risk (National Comprehensive Cancer Network 2019) was 7, 25, 42, and 50 for low (LR), good intermediate (good IR), poor intermediate (poor IR), and high (HR)/very high (VHR), respectively. Ninety-five patients were given neoadjuvant hormonal therapy. The planning target volume margin setting was 3 mm for rectal in most cases, 5-7 mm for superior/inferior, and 5 mm for anterior/right/left. The principle prescribed dose is 74 Gy (LR), 76 Gy (good IR), and 76-78 Gy (poor IR or above). CAS was equipped with a real-time prostate intrafraction monitoring (RTPIFM) system. When a displacement of 2-3 mm or more was detected, irradiation was paused, and the patients were placed on standby for prostate reinstatement/recorrection. Of the 3135 fractions in 85 patients for whom RTPIFM was performed, 1008 fractions (32.1%) were recorrected at least once after starting irradiation. RESULTS A total of 123 patients completed the radiotherapy course. The 5-year overall survival rate was 95.9%. The 5-year biological prostate-specific antigen relapse-free survival rate (bPFS) was 100% for LR, 92.9% for intermediate IR, and 93.2% for HR/VHR (Phoenix method). The 5-year late toxicity rate of Grade 2+ was 7.4% for genitourinary (GU) and 6.5% for gastrointestinal (GI) organs. Comparing the ≤ 76 Gy group to the 78 Gy group for both GU and GI organs, the incidence was higher in the 78 Gy group for both groups. CONCLUSION These results suggest that TPUS-IGRT is well tolerated, as the bPFS and incidence of late toxicity are almost comparable to those reported by other sources of image-guided radiotherapy.
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Affiliation(s)
- Kenji Takai
- Department of Radiology, Yamagata City Hospital Saiseikan, Yamagata, Japan.
| | - Ryota Watanabe
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Ken-Ichi Hyogo
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yuri Ito
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Nobuko Minagawa
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yusuke Sato
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yoshikazu Matsuda
- Central Radiology Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University, Yamagata, Japan
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Kita N, Shibamoto Y, Takemoto S, Manabe Y, Yanagi T, Sugie C, Tomita N, Iwata H, Murai T, Hashimoto S, Ishikura S. Comparison of intensity-modulated radiotherapy with the 5-field technique, helical tomotherapy and volumetric modulated arc therapy for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2022; 63:666-674. [PMID: 35726342 PMCID: PMC9303627 DOI: 10.1093/jrr/rrac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/04/2022] [Indexed: 06/15/2023]
Abstract
The outcomes of three methods of intensity-modulated radiation therapy (IMRT) for localized prostate cancer were evaluated. Between 2010 and 2018, 308 D'Amico intermediate- or high-risk patients were treated with 2.2 Gy daily fractions to a total dose of 74.8 Gy in combination with hormonal therapy. Overall, 165 patients were treated with 5-field IMRT using a sliding window technique, 66 were then treated with helical tomotherapy and 77 were treated with volumetric modulated arc therapy (VMAT). The median age of patients was 71 years. The median follow-up period was 75 months. Five-year overall survival (OS) and biochemical or clinical failure-free survival (FFS) rates were 95.5 and 91.6% in the 5-field IMRT group, 95.1 and 90.3% in the tomotherapy group and 93.0 and 88.6% in the VMAT group, respectively, with no significant differences among the three groups. The 5-year cumulative incidence of late grade ≥2 genitourinary and gastrointestinal toxicities were 7.3 and 6.2%, respectively, for all patients. Late grade ≥2 gastrointestinal toxicities were less frequent in patients undergoing VMAT (0%) than in patients undergoing 5-field IMRT (7.3%) and those undergoing tomotherapy (11%) (P = 0.025), and this finding appeared to be correlated with the better rectal DVH parameters in patients undergoing VMAT. Other toxicities did not differ significantly among the three groups, although bladder dose-volume parameters were slightly worse in the tomotherapy group than in the other groups. Despite differences in the IMRT delivery methods, X-ray energies and daily registration methods, all modalities may be used as IMRT for localized prostate cancer.
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Affiliation(s)
- Nozomi Kita
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuhocho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. Tel.: +81-52-853-8276; Fax: +81-52-852-5244; E-mail:
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
- Department of Proton Therapy, Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi, Aichi, 441-8021, Japan
| | - Shinya Takemoto
- Department of Radiology, Fujieda Heisei Memorial Hospital, 123-1 Mizukami, Fujieda, Shizuoka, 426-8662, Japan
| | - Yoshihiko Manabe
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Shimajiri-gun, Okinawa, 901-0493, Japan
| | - Takeshi Yanagi
- Department of Proton Therapy, Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi, Aichi, 441-8021, Japan
| | - Chikao Sugie
- Department of Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shingo Hashimoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Sasamura K, Soyano T, Kozuka T, Yuasa T, Yamamoto S, Yonese J, Oguchi M, Yoshimura R, Yoshioka Y. Outcomes of intensity-modulated radiation therapy for intermediate- or high-risk prostate cancer: a single-institutional study. Jpn J Clin Oncol 2022; 52:170-178. [PMID: 34689189 DOI: 10.1093/jjco/hyab167] [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: 07/08/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are few reports from Japan about the outcomes of intensity-modulated radiation therapy for localized prostate cancer. This study was aimed at assessing the efficacy and toxicity of intensity-modulated radiation therapy in patients with intermediate- or high-risk prostate cancer. METHODS We conducted a review of the data, retrieved from our institutional database, of patients who had received intensity-modulated radiation therapy for localized prostate cancer at a radiation dose of 78 Gy in 39 fractions. Data of 201 patients with intermediate-risk prostate cancer and 311 patients with high-risk prostate cancer were analyzed. RESULTS The median follow-up period after the completion of intensity-modulated radiation therapy was 100 months (range, 24-154). The rates of cause-specific survival, overall survival, metastasis-free survival and biochemical recurrence-free survival in the intermediate-risk patients were 99, 95, 95 and 94% at 5 years and 99, 91, 90 and 86% at 8 years, respectively; the corresponding rates in the high-risk patients were 100, 97, 91 and 84% at 5 years and 96, 92, 84 and 76% at 8 years, respectively. The crude incidence of late grade 2-3 genitourinary toxicity was 28.1%, and that of late grade 3 genitourinary toxicity was 2.0%. The crude incidence of late grade 2 gastrointestinal toxicity was 5.1%, and there were no cases of late grade 3 gastrointestinal toxicity. CONCLUSIONS Our data demonstrated that intensity-modulated radiation therapy is effective for patients with localized intermediate-risk or high-risk prostate cancer while having minimal toxicity.
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Affiliation(s)
- Kazuma Sasamura
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Soyano
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Takuyo Kozuka
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Oguchi
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Yoshioka
- Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Takakusagi Y, Usui K, Mizoguchi N, Nagatsuka J, Hikage T, Kodama Y, Ezura T, Kusunoki T, Oizumi Y. Comparison of Moderate Hypofractionated Volumetric-Modulated Arc Therapy Plans With and Without Flattening Filter for Localized Prostate Cancer. Cureus 2021; 13:e18034. [PMID: 34671522 PMCID: PMC8520568 DOI: 10.7759/cureus.18034] [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] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aim The aim of this study was to compare volumetric-modulated arc therapy (VMAT) radiation plans between conventional VMAT with flattening filter (cFF-VMAT) and flattening filter-free VMAT (FFF-VMAT) for localized prostate cancer. Materials and methods Ten patients with localized prostate cancer who underwent cFF-VMAT at Yokosuka General Hospital Uwamachi, Yokosuka, Japan, from July 2020 to October 2020 were enrolled. Dose-volume histogram (DVH) parameters of the target volume, normal organs, monitor units (MU), and beam-on time (BOT) were compared between cFF-VMAT and FFF-VMAT plans. Results No significant difference was observed for DVH parameters for the target volume. No significant difference was observed in all parameters for the bladder and rectum between the cFF-VMAT and FFF-VMAT groups. The mean values of MU were 686 ± 52 and 784 ± 80 in cFF-VMAT and FFF-VMAT, respectively (p < 0.001). The mean BOT was 97.0 ± 6.6 s and 72.9 ± 1.4 s for cFF-VMAT and FFF-VMAT, respectively (p < 0.001). Conclusion DVH parameters of the target volume and normal organs were not significantly different between the cFF-VMAT and FFF-VMAT plans. In FFF-VMAT, MU was significantly higher, and the BOT was significantly shorter than those in cFF-VMAT.
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Affiliation(s)
- Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, JPN
| | - Keisuke Usui
- Department of Radiation Oncology, Juntendo University, Tokyo, JPN
| | | | - Jun Nagatsuka
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Takeshi Hikage
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Yasuhiko Kodama
- Department of Radiology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
| | - Takatomo Ezura
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, JPN
| | - Terufumi Kusunoki
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, JPN
| | - Yukio Oizumi
- Department of Radiation Oncology, Yokosuka General Hospital Uwamachi, Yokosuka, JPN
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Kajikawa T, Kadoya N, Tanaka S, Nemoto H, Takahashi N, Chiba T, Ito K, Katsuta Y, Dobashi S, Takeda K, Yamada K, Jingu K. Dose distribution correction for the influence of magnetic field using a deep convolutional neural network for online MR-guided adaptive radiotherapy. Phys Med 2020; 80:186-192. [PMID: 33189049 DOI: 10.1016/j.ejmp.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/20/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aimed to develop a deep convolutional neural network (CNN)-based dose distribution conversion approach for the correction of the influence of a magnetic field for online MR-guided adaptive radiotherapy. METHODS Our model is based on DenseNet and consists of two 2D input channels and one 2D output channel. These three types of data comprise dose distributions without a magnetic field (uncorrected), electron density (ED) maps, and dose distributions with a magnetic field. These data were generated as follows: both types of dose distributions were created using 15-field IMRT in the same conditions except for the presence or absence of a magnetic field with the GPU Monte Carlo dose in Monaco version 5.4; ED maps were acquired with planning CT images using a clinical CT-to-ED table at our institution. Data for 50 prostate cancer patients were used; 30 patients were allocated for training, 10 for validation, and 10 for testing using 4-fold cross-validation based on rectum gas volume. The accuracy of the model was evaluated by comparing 2D gamma-indexes against the dose distributions in each irradiation field with a magnetic field (true). RESULTS The gamma indexes in the body for CNN-corrected uncorrected dose against the true dose were 94.95% ± 4.69% and 63.19% ± 3.63%, respectively. The gamma indexes with 2%/2-mm criteria were improved by 10% in most test cases (99.36%). CONCLUSIONS Our results suggest that the CNN-based approach can be used to correct the dose-distribution influences with a magnetic field in prostate cancer treatment.
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Affiliation(s)
- Tomohiro Kajikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hikaru Nemoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahito Chiba
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Takagi H, Kadoya N, Kajikawa T, Tanaka S, Takayama Y, Chiba T, Ito K, Dobashi S, Takeda K, Jingu K. Multi-atlas-based auto-segmentation for prostatic urethra using novel prediction of deformable image registration accuracy. Med Phys 2020; 47:3023-3031. [PMID: 32201958 DOI: 10.1002/mp.14154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 02/04/2020] [Accepted: 03/14/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Accurate identification of the prostatic urethra and bladder can help determine dosing and evaluate urinary toxicity during intensity-modulated radiation therapy (IMRT) planning in patients with localized prostate cancer. However, it is challenging to locate the prostatic urethra in planning computed tomography (pCT). In the present study, we developed a multiatlas-based auto-segmentation method for prostatic urethra identification using deformable image registration accuracy prediction with machine learning (ML) and assessed its feasibility. METHODS We examined 120 patients with prostate cancer treated with IMRT. All patients underwent temporary urinary catheter placement for identification and contouring of the prostatic urethra in pCT images (ground truth). Our method comprises the following three steps: (a) select four atlas datasets from the atlas datasets using the deformable image registration (DIR) accuracy prediction model, (b) deform them by structure-based DIR, (3) and propagate urethra contour using displacement vector field calculated by the DIR. In (a), for identifying suitable datasets, we used the trained support vector machine regression (SVR) model and five feature descriptors (e.g., prostate volume) to increase DIR accuracy. This method was trained/validated using 100 patients and performance was evaluated within an independent test set of 20 patients. Fivefold cross-validation was used to optimize the hype parameters of the DIR accuracy prediction model. We assessed the accuracy of our method by comparing it with those of two others: Acostas method-based patient selection (previous study method, by Acosta et al.), and the Waterman's method (defines the prostatic urethra based on the center of the prostate, by Waterman et al.). We used the centerlines distance (CLD) between the ground truth and the predicted prostatic urethra as the evaluation index. RESULTS The CLD in the entire prostatic urethra was 2.09 ± 0.89 mm (our proposed method), 2.77 ± 0.99 mm (Acosta et al., P = 0.022), and 3.47 ± 1.19 mm (Waterman et al., P < 0.001); our proposed method showed the highest accuracy. In segmented CLD, CLD in the top 1/3 segment was highly improved from that of Waterman et.al. and was slightly improved from that of Acosta et.al., with results of 2.49 ± 1.78 mm (our proposed method), 2.95 ± 1.75 mm (Acosta et al., P = 0.42), and 5.76 ± 3.09 mm (Waterman et al., P < 0.001). CONCLUSIONS We developed a DIR accuracy prediction model-based multiatlas-based auto-segmentation method for prostatic urethra identification. Our method identified prostatic urethra with mean error of 2.09 mm, likely due to combined effects of SVR model employment in patient selection, modified atlas dataset characteristics and DIR algorithm. Our method has potential utility in prostate cancer IMRT and can replace use of temporary indwelling urinary catheters.
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Affiliation(s)
- Hisamichi Takagi
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Tomohiro Kajikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Yoshiki Takayama
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takahito Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Suguru Dobashi
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
| | - Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
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Kajikawa T, Kadoya N, Ito K, Takayama Y, Chiba T, Tomori S, Nemoto H, Dobashi S, Takeda K, Jingu K. A convolutional neural network approach for IMRT dose distribution prediction in prostate cancer patients. JOURNAL OF RADIATION RESEARCH 2019; 60:685-693. [PMID: 31322704 PMCID: PMC6805973 DOI: 10.1093/jrr/rrz051] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/06/2019] [Indexed: 06/10/2023]
Abstract
The purpose of the study was to compare a 3D convolutional neural network (CNN) with the conventional machine learning method for predicting intensity-modulated radiation therapy (IMRT) dose distribution using only contours in prostate cancer. In this study, which included 95 IMRT-treated prostate cancer patients with available dose distributions and contours for planning target volume (PTVs) and organs at risk (OARs), a supervised-learning approach was used for training, where the dose for a voxel set in the dataset was defined as the label. The adaptive moment estimation algorithm was employed for optimizing a 3D U-net similar network. Eighty cases were used for the training and validation set in 5-fold cross-validation, and the remaining 15 cases were used as the test set. The predicted dose distributions were compared with the clinical dose distributions, and the model performance was evaluated by comparison with RapidPlan™. Dose-volume histogram (DVH) parameters were calculated for each contour as evaluation indexes. The mean absolute errors (MAE) with one standard deviation (1SD) between the clinical and CNN-predicted doses were 1.10% ± 0.64%, 2.50% ± 1.17%, 2.04% ± 1.40%, and 2.08% ± 1.99% for D2, D98 in PTV-1 and V65 in rectum and V65 in bladder, respectively, whereas the MAEs with 1SD between the clinical and the RapidPlan™-generated doses were 1.01% ± 0.66%, 2.15% ± 1.25%, 5.34% ± 2.13% and 3.04% ± 1.79%, respectively. Our CNN model could predict dose distributions that were superior or comparable with that generated by RapidPlan™, suggesting the potential of CNN in dose distribution prediction.
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Affiliation(s)
- Tomohiro Kajikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiki Takayama
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahito Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seiji Tomori
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Radiology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hikaru Nemoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, School of Health Sciences, Faculty of medicine, Tohoku University, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of medicine, Tohoku University, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Murata K, Saga R, Monzen S, Tsuruga E, Hasegawa K, Hosokawa Y. Understanding the mechanism underlying the acquisition of radioresistance in human prostate cancer cells. Oncol Lett 2019; 17:5830-5838. [PMID: 31186811 DOI: 10.3892/ol.2019.10219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/15/2019] [Indexed: 01/19/2023] Open
Abstract
Acquisition of radioresistance (RR) has been reported during cancer treatment with fractionated irradiation. However, RR is poorly understood in the prognosis of radiotherapy. Although radiotherapy is important in the treatment of prostate cancer (PCa), acquisition of RR has been reported in PCa with an increased number of cancer stem cells (CSCs), neuroendocrine differentiation (NED) and epithelial-mesenchymal transition. However, to the best of our knowledge, the mechanism underlying RR acquisition during fractionated irradiation remains unclear. In the present study, human PCa cell lines were subjected to fractionated irradiation according to a fixed schedule as follows: Irradiation (IR)1, 2 Gy/day with a total of 20 Gy; IR2, 4 Gy/day with a total of 20 Gy; and IR3, 4 Gy/day with a total of 56 Gy. The expression of cluster of differentiation (CD)44, a CSC marker, was identified to be increased by fractionated irradiation, particularly in DU145 cells. The expression levels of CD133 and CD138 were increased compared with those in parental cells following a single irradiation or multiple irradiations; however, the expression levels decreased with subsequent irradiation. RR was evidently acquired by exposure to 56 Gy radiation, which resulted in increased expression of the NED markers CD133 and CD138, and increased mRNA expression levels of the pluripotency-associated genes octamer-binding transcription factor 4 and Nanog homeobox. These data indicate that radiation-induced CSCs emerge due to the exposure of cells to fractionated irradiation. In addition, the consequent increase in the expression of NED markers is possibly induced by the increased expression of pluripotency-associated genes. Therefore, it can be suggested that cancer cells acquire RR due to increased expression of pluripotency-associated genes following exposure to fractionated irradiation.
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Affiliation(s)
- Kosho Murata
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Ryo Saga
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Satoru Monzen
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Echi Tsuruga
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Kazuki Hasegawa
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Yoichiro Hosokawa
- Department of Radiation Science, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
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Takakusagi Y, Kawamura H, Okamoto M, Kaminuma T, Kubo N, Mizukami T, Sato H, Onishi M, Ohtake N, Sekihara T, Nakano T. Long-term outcome of hypofractionated intensity-modulated radiotherapy using TomoTherapy for localized prostate cancer: A retrospective study. PLoS One 2019; 14:e0211370. [PMID: 30807581 PMCID: PMC6391012 DOI: 10.1371/journal.pone.0211370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, the clinical outcome of prostate cancer treated by hypofractionated radiation therapy has been reported. However, there are few reports from Japan. In Hidaka Hospital, hypofractionated intensity-modulated radiotherapy (HIMRT) for prostate cancer was initiated in 2007. The purpose of this study is to analyze the long-term outcome. METHODS Ninety-two patients with localized prostate cancer treated with HIMRT at Hidaka Hospital between 2007 and 2009 were retrospectively analyzed. HIMRT was delivered using TomoTherapy. The prescription dose was 66 Gy at 95% of the PTV in 22 fractions performed 3 days a week over 7 weeks in all patients. The overall survival rate, biochemical relapse-free rate, and acute and late toxicities were evaluated. RESULTS The median follow-up duration was 78 (range 14-100) months. The median age at the start of the HIMRT was 72 (range 46-84) years. The disease characteristics were as follows: stage T1c, 45; T2a, 20; T2b, 5; T2c, 1; T3a, 13; T3b, 6; T4, 2; Gleason score 6, 13; 7, 44; 8, 20; 9, 15; 10, 0; pretreatment PSA ≤10 ng/mL, 42; 10 to ≤20, 27; and >20, 23. According to the D'Amico classification system, 10, 37, and 45 patients were classified as low-risk, intermediate-risk, and high-risk. The overall survival rate, the cause-specific survival rate, and the biochemical relapse-free rate at 5 years was 94.7%, 100% and 98.9%, respectively. Severe acute toxicity (grade 3 or more) was not observed. The late urinary toxicity was 52.2% in grade 0, 28.3% in grade 1, 19.6% in grade 2, and 2.2% in grade 3. The late rectal toxicity was 78.3% in grade 0, 7.6% in grade 1, 9.8% in grade 2, and 4.3% in grade 3. CONCLUSIONS The present study demonstrated that HIMRT using TomoTherapy for prostate cancer has a favorable outcome with tolerable toxicity.
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Affiliation(s)
- Yosuke Takakusagi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
- Oncology Center, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
- Oncology Center, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
- * E-mail:
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Tatsuji Mizukami
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Hiro Sato
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Masahiro Onishi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Nobuaki Ohtake
- Department of Urology, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Tetsuo Sekihara
- Department of Urology, Hidaka Hospital, Nakao-machi, Takasaki, Gunma, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
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Pelvic bone anatomy vs implanted gold seed marker registration for image-guided intensity modulated radiotherapy for prostate carcinoma: Comparative analysis of inter-fraction motion and toxicities. J Egypt Natl Canc Inst 2017; 29:185-190. [PMID: 29129577 DOI: 10.1016/j.jnci.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We compared the prostate motion variability and toxicities between patients treated with gold marker registration based IG-IMRT (IG-IMRT-M) and bony landmark registration based IG-IMRT (IG-IMRT-B). METHODS T1c-T3b (node negative), intermediate and high risk (non-metastatic) adenocarcinoma of prostate, age ≥18years, Karnofsky Performance Status of ≥70 were included in this retrospective study. The prostate motion variability, acute and late radiation toxicities between the two treatment arms (IG-IMRT-M versus IG-IMRT-B) were compared. RESULTS Total of 35 patients (17 for IG-IMRT-M and 18 for IG-IMRT-B) were treated with a median radiotherapy dose of 76 Gray. The prostate variability observed with and without markers in millimeter was 4.1±2.3 vs 3.7±2.1 [Antero-Posterior (A-P); p=0.001], 2.3±1.5 vs 2.1±1.2 [Superior-Inferior (S-I); p=0.095] and 1.1±1.7 vs 0.4±1.4 [Left-Right (L-R); p=0.003]. There was higher acute toxicity in IG-IMRT-B arm compared to IG-IMRT-M arm in terms of grade ≥2 diarrhea [50% vs 11% OR=7.5 (1.3-42.7); p=0.02] and grade ≥2 proctitis [38% vs 5.8%, OR=10.1 (1.09-94.1); p=0.04]. At a median follow up of 36months, the late genitourinary toxicities grade ≥2 [27% vs 0%; p=0.04] were higher in the IG-IMRT-B arm compared to IG-IMRT-M arm. CONCLUSIONS IG-IMRT-M detects higher prostate motion variability as compared to IG-IMRT-B, inferring a significant prostate motion inside fixed pelvic bony cavity. The addition of marker based image guidance results in higher precision of prostate localization and lesser acute and late toxicities.
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11
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Kasuya G, Ishikawa H, Tsuji H, Haruyama Y, Kobashi G, Ebner DK, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Makishima H, Nomiya T, Kamada T, Tsujii H. Cancer-specific mortality of high-risk prostate cancer after carbon-ion radiotherapy plus long-term androgen deprivation therapy. Cancer Sci 2017; 108:2422-2429. [PMID: 28921785 PMCID: PMC5715357 DOI: 10.1111/cas.13402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
The treatment outcomes of patients with high‐risk localized prostate cancer (PC) after carbon‐ion radiotherapy (CIRT) combined with long‐term androgen deprivation therapy (LTADT) were analyzed, and compared with those of other treatment modalities, focusing on PC‐specific mortality (PCSM). A total of 1247 patients were enrolled in three phase II clinical trials of fixed‐dose CIRT between 2000 and 2013. Excluding patients with T4 disease, 608 patients with high‐risk or very‐high‐risk PC, according to the National Comprehensive Cancer Network classification system, who received CIRT with LTADT were evaluated. The median follow‐up time was 88.4 months, and the 5‐/10‐year PCSM rates were 1.5%/4.3%, respectively. T3b disease, Gleason score of 9–10 and percentage of positive biopsy cores >75% were associated with significantly higher PCSM on univariate and multivariate analyses. The 10‐year PCSM rates of patients having all three (n = 16), two (n = 74) or one of these risk factors (n = 217) were 27.1, 11.6 and 5.7%, respectively. Of the 301 patients with none of these factors, only 1 PCSM occurred over the 10‐year follow‐up (10‐year PCSM rate, 0.3%), and significant differences were observed among the four stratified groups (P <0.001). CIRT combined with LTADT yielded relatively favorable treatment outcomes in patients with high‐risk PC and very favorable results in patients without any of the three abovementioned factors for PCSM. Because a significant difference in PCSM among the high‐risk PC patient groups was observed, new categorization and treatment intensity adjustment may be required for high‐risk PC patients treated with CIRT.
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Affiliation(s)
- Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, Graduate School of Medicine, Tsukuba University, Ibaraki, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Daniel K Ebner
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Brown University Alpert Medical School, Providence, RI, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hirohiko Tsujii
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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12
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Takayama Y, Kadoya N, Yamamoto T, Ito K, Chiba M, Fujiwara K, Miyasaka Y, Dobashi S, Sato K, Takeda K, Jingu K. Evaluation of the performance of deformable image registration between planning CT and CBCT images for the pelvic region: comparison between hybrid and intensity-based DIR. JOURNAL OF RADIATION RESEARCH 2017; 58:567-571. [PMID: 28158642 PMCID: PMC5569957 DOI: 10.1093/jrr/rrw123] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/17/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to evaluate the performance of the hybrid deformable image registration (DIR) method in comparison with intensity-based DIR for pelvic cone-beam computed tomography (CBCT) images, using intensity and anatomical information. Ten prostate cancer patients treated with intensity-modulated radiation therapy (IMRT) were studied. Nine or ten CBCT scans were performed for each patient. First, rigid registration was performed between the planning CT and all CBCT images using gold fiducial markers, and then DIR was performed. The Dice similarity coefficient (DSC) and center of mass (COM) displacement were used to evaluate the quantitative DIR accuracy. The average DSCs for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 0.84 ± 0.05, 0.75 ± 0.05, 0.69 ± 0.07 and 0.65 ± 0.11, respectively, whereas those values for hybrid DIR were 0.98 ± 0.00, 0.97 ± 0.01, 0.98 ± 0.00 and 0.94 ± 0.03, respectively (P < 0.05). The average COM displacements for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 2.0 ± 1.5, 3.7 ± 1.4, 7.8 ± 2.2 and 3.6 ± 1.2 mm, whereas those values for hybrid DIR were 0.1 ± 0.0, 0.3 ± 0.2, 0.2 ± 0.1 and 0.6 ± 0.6 mm, respectively (P < 0.05). These results showed that the DSC for hybrid DIR had a higher DSC value and smaller COM displacement for all structures and all patients, compared with intensity-based DIR. Thus, the accumulative dose based on hybrid DIR might be trusted as a high-precision dose estimation method that takes into account organ movement during treatment radiotherapy.
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Affiliation(s)
- Yoshiki Takayama
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Mizuki Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kousei Fujiwara
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, Graduate School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyokazu Sato
- Radiation Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiological Technology, Graduate School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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13
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O'Neill AGM, Jain S, Hounsell AR, O'Sullivan JM. Fiducial marker guided prostate radiotherapy: a review. Br J Radiol 2016; 89:20160296. [PMID: 27585736 PMCID: PMC5604907 DOI: 10.1259/bjr.20160296] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.
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Affiliation(s)
- Angela G M O'Neill
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Alan R Hounsell
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
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14
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Hannan R, Tumati V, Xie XJ, Cho LC, Kavanagh BD, Brindle J, Raben D, Nanda A, Cooley S, Kim DWN, Pistenmaa D, Lotan Y, Timmerman R. Stereotactic body radiation therapy for low and intermediate risk prostate cancer-Results from a multi-institutional clinical trial. Eur J Cancer 2016; 59:142-151. [PMID: 27035363 DOI: 10.1016/j.ejca.2016.02.014] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/28/2016] [Accepted: 02/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND We report the outcome of a phase I/II clinical trial of stereotactic body radiation therapy (SBRT) for low (LR) and select intermediate risk (IR) prostate cancer (PCa) patients. PATIENTS AND METHODS Eligible patients included men with prostate adenocarcinoma with Gleason score 6 with PSA ≤ 20 or Gleason 7 with PSA ≤ 15 and clinical stage ≤ T2b. For the phase I portion of the study patients in cohorts of 15 received 45, 47.5, or 50 Gray (Gy) in five fractions. Since the maximally tolerated dose was not met in the phase I study, an additional 47 patients received 50 Gy in five fractions in the phase II study. Toxicity using Common Toxicity Criteria for Adverse Events v. 3.0, quality of life, and outcome data was collected. RESULTS A total of 91 patients are included for analysis; 63.7% had NCCN IR and 36.3% had LR PCa. At a median follow up of 54 months the actuarial freedom from biochemical failure was 100% at 3 years and 98.6% at 5 years. Actuarial distant metastasis free survival was 100% at 3 and 5 years. Overall survival was 94% at 3 years and 89.7% at 5 years with no deaths attributed to PCa. Acute and late urinary grade ≥ III toxicity occurred in 0% and 5.5% of patients, respectively. Gastrointestinal (GI) acute and late toxicity of grade ≥ III occurred in 2% and 7% of patients, respectively. A total of four men experienced grade IV toxicity (three GI, one genitourinary). CONCLUSION SBRT treatment results in excellent biochemical control rates at 5 years for LR and IR PCa patients although doses greater than 47.5 Gy in five fractions led to increased severe late toxicity.
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Affiliation(s)
- Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, USA
| | - Vasu Tumati
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, USA
| | - Xian-Jin Xie
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, USA
| | - L Chinsoo Cho
- Department of Radiation Oncology, University of Minnesota, USA
| | | | - Jeffrey Brindle
- Department of Radiation Oncology, Prairie Lakes Hospital, USA
| | - David Raben
- Department of Radiation Oncology, University of Colorado, USA
| | - Akash Nanda
- Department of Radiation Oncology, Orlando Health, USA
| | - Susan Cooley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, USA
| | | | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, USA.
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15
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Mizowaki T, Norihisa Y, Takayama K, Ikeda I, Inokuchi H, Nakamura K, Kamba T, Inoue T, Kamoto T, Ogawa O, Hiraoka M. Ten-year outcomes of intensity-modulated radiation therapy combined with neoadjuvant hormonal therapy for intermediate- and high-risk patients with T1c-T2N0M0 prostate cancer. Int J Clin Oncol 2016; 21:783-790. [PMID: 26843024 DOI: 10.1007/s10147-016-0954-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to analyze the 10-year outcomes of intensity-modulated radiation therapy (IMRT) combined with neoadjuvant hormonal therapy (HT) for patients with intermediate- and high-risk T1c-T2N0M0 prostate cancer. METHODS Fifty patients with T1c-T2N0M0 prostate cancer, who were treated with high-dose IMRT combined with neoadjuvant HT, were evaluated. Of these patients, 19 and 31 were classified into the intermediate- and high-risk groups, respectively. Neoadjuvant HT was administered over a median duration of 6 months; 74 and 78 Gy in 2 Gy per fraction were essentially delivered to the intermediate- and high-risk cases, respectively. Adjuvant HT was not administered to any of the patients after the completion of IMRT. RESULTS Over a median follow-up period of 118 months, the 10-year prostate-specific antigen failure-free survival, prostate-specific antigen failure-free, salvage hormonal therapy-free, prostate cancer-specific survival, and overall survival rates were 70.2 %, 78.7 %, 89.2 %, 100 %, and 88.8 %, respectively. No grade 3 or higher acute or late toxicities were observed. The 10-year likelihoods of developing grade 2 late urinary and rectal toxicities were 13.7 % and 4.2 %, respectively. Compared with the outcomes of a cohort of historical controls who were locally irradiated with 70 Gy by three-dimensional conformal radiotherapy, the prostate-specific antigen failure-free rate was significantly better in the IMRT groups (78.7 % vs. 53.4 % at 10 years; p = 0.027). CONCLUSIONS High-dose IMRT combined with neoadjuvant HT achieved not only high prostate-specific antigen control, but also excellent survival outcomes with acceptable morbidities, for a Japanese cohort of intermediate- and high-risk T1c-T2N0M0 prostate cancer patients, and these results warrant further investigation.
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Affiliation(s)
- 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.
| | - Yoshiki Norihisa
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kenji Takayama
- 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
| | - 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
| | - 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
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takahiro Inoue
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Hiraoka
- 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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16
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Rudat V, Nour A, Hammoud M, Alaradi A, Mohammed A. Image-guided intensity-modulated radiotherapy of prostate cancer: Analysis of interfractional errors and acute toxicity. Strahlenther Onkol 2015; 192:109-17. [PMID: 26545764 PMCID: PMC4718949 DOI: 10.1007/s00066-015-0919-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/20/2015] [Indexed: 12/25/2022]
Abstract
Purpose The aim of the study was to estimate interfractional deviations in patient and prostate position, the impact of the frequency of online verification on the treatment margins, and to assess acute radiation reactions of high-dose external beam image-guided intensity-modulated radiotherapy (IG-IMRT) of localized prostate cancer. Patients and methods IG-IMRT was performed by daily online verification of implanted fiducial prostate markers using a megavoltage electronic portal imaging device (EPID). A total of 1011 image-guided treatment fractions from 23 consecutive unselected prostate cancer patients were analyzed. The median total dose was 79.2 Gy (range 77.4–81.0 Gy). Acute radiation reactions were assessed weekly during radiotherapy using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.03. Results A relevant combined patient set-up and prostate motion population random error of 4–5 mm was observed. Compared to daily IGRT, image guidance every other day required an expansion of the CTV–PTV (clinical target volume–planning target volume) margin of 8.1, 6.6, and 4.1 mm in the longitudinal, vertical, and lateral directions, thereby, increasing the PTV by approximately 30–40 %. No grade 3 or 4 acute radiation reactions were observed with daily IG-IMRT. Conclusion A high dose with surprisingly low acute toxicity can be applied with daily IG-IMRT using implanted fiducial prostate markers. Daily image guidance is clearly superior to image guidance every other fraction concerning adequate target coverage with minimal margins.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, 31952, Al Khobar, Saudi Arabia.
| | - A Nour
- Department of Radiation Oncology, Saad Specialist Hospital, 31952, Al Khobar, Saudi Arabia
| | - M Hammoud
- Department of Radiation Oncology, Saad Specialist Hospital, 31952, Al Khobar, Saudi Arabia
| | - A Alaradi
- Department of Radiation Oncology, Saad Specialist Hospital, 31952, Al Khobar, Saudi Arabia
| | - A Mohammed
- Department of Radiation Oncology, Saad Specialist Hospital, 31952, Al Khobar, Saudi Arabia
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17
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Tomita N, Oze I, Shimizu H, Yoshida M, Kimura K, Takehana K, Shimizu A, Makita C, Tachibana H, Kodaira T, Soga N, Ogura Y, Hayashi N. International prostate symptom score (IPSS) change and changing factor in intensity-modulated radiotherapy combined with androgen deprivation therapy for prostate cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2015; 77:637-46. [PMID: 26663942 PMCID: PMC4664595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purposes of this study on prostate cancer are to demonstrate the time course of International Prostate Symptom Score (IPSS) after intensity-modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) and to examine the factor associated with the IPSS change. This study included 216 patients treated with IMRT between 2006 and 2010. Patients were evaluated in three groups according to baseline IPSS as defined by the American Urological Association classification, where IPSSs of 0 to 7, 8 to 19, and 20 to 35 represent mild (n = 124), moderate (n = 70), and severe (n = 22) symptom groups, respectively. The average IPSSs ± standard deviation at baseline vs. those at 24 months after IMRT were 3.5 ± 2.1 vs. 5.1 ± 3.6 in the mild group (P < 0.001), 12.6 ± 3.4 vs. 10.0 ± 6.0 in the moderate group (P = 0.0015), and 23.8 ± 2.9 vs. 14.4 ± 9.1 in the severe group (P < 0.001). Among factors of patient and treatment characteristics, age, IPSS classification, pretreatment GU medications, and positive biopsy rates were associated with the IPSS difference between baseline and 24 months (P = 0.023, < 0.001, 0.044, and 0.028, respectively). In conclusion, patients with moderate to severe urinary symptoms can exhibit improvement in urinary function after IMRT, whereas patients with mild symptoms may have slightly worsened functions. Age, baseline IPSS, GU medications, and tumor burden in the prostate can have an effect on the IPSS changes.
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Affiliation(s)
- Natsuo Tomita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Isao Oze
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Maiko Yoshida
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kana Kimura
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Arisa Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norihito Soga
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuji Ogura
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norio Hayashi
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
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Hayashi A, Shibamoto Y, Hattori Y, Tamura T, Iwabuchi M, Otsuka S, Sugie C, Yanagi T. Dose-volume histogram comparison between static 5-field IMRT with 18-MV X-rays and helical tomotherapy with 6-MV X-rays. JOURNAL OF RADIATION RESEARCH 2015; 56:338-45. [PMID: 25609741 PMCID: PMC4380056 DOI: 10.1093/jrr/rru111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We treated prostate cancer patients with static 5-field intensity-modulated radiation therapy (IMRT) using linac 18-MV X-rays or tomotherapy with 6-MV X-rays. As X-ray energies differ, we hypothesized that 18-MV photon IMRT may be better for large patients and tomotherapy may be more suitable for small patients. Thus, we compared dose-volume parameters for the planning target volume (PTV) and organs at risk (OARs) in 59 patients with T1-3 N0M0 prostate cancer who had been treated using 5-field IMRT. For these same patients, tomotherapy plans were also prepared for comparison. In addition, plans of 18 patients who were actually treated with tomotherapy were analyzed. The evaluated parameters were homogeneity indicies and a conformity index for the PTVs, and D2 (dose received by 2% of the PTV in Gy), D98, Dmean and V10-70 Gy (%) for OARs. To evaluate differences by body size, patients with a known body mass index were grouped by that index ( <21; 21-25; and >25 kg/m(2)). For the PTV, all parameters were higher in the tomotherapy plans compared with the 5-field IMRT plans. For the rectum, V10 Gy and V60 Gy were higher, whereas V20 Gy and V30 Gy were lower in the tomotherapy plans. For the bladder, all parameters were higher in the tomotherapy plans. However, both plans were considered clinically acceptable. Similar trends were observed in 18 patients treated with tomotherapy. Obvious trends were not observed for body size. Tomotherapy provides equivalent dose distributions for PTVs and OARs compared with 18-MV 5-field IMRT. Tomotherapy could be used as a substitute for high-energy photon IMRT for prostate cancer regardless of body size.
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Affiliation(s)
- Akihiro Hayashi
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan Department of Radiology, Okazaki City Hospital, 3-1 Aza-Goshoai, Koryuzi-cho, Okazaki, Aichi 444-8553, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan
| | - Yukiko Hattori
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi 462-8508, Japan
| | - Takeshi Tamura
- Yokohama Cyberknife Center, Yokohama, Kanagawa 241-0014, Japan
| | - Michio Iwabuchi
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan Yokohama Cyberknife Center, Yokohama, Kanagawa 241-0014, Japan
| | - Shinya Otsuka
- Department of Radiology, Okazaki City Hospital, 3-1 Aza-Goshoai, Koryuzi-cho, Okazaki, Aichi 444-8553, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan
| | - Takeshi Yanagi
- Department of Radiology, Nagoya City University Graduate school of Medical Science, Nagoya 467-8601, Japan
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19
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Kobayashi M, Hatano K, Fukasawa S, Komaru A, Namekawa T, Imagumbai T, Araki H, Hara R, Ichikawa T, Ueda T. Therapeutic outcomes of neoadjuvant and concurrent androgen-deprivation therapy and intensity-modulated radiation therapy with gold marker implantation for intermediate-risk and high-risk prostate cancer. Int J Urol 2015; 22:477-82. [PMID: 25684541 DOI: 10.1111/iju.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/19/2014] [Accepted: 12/09/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate the therapeutic outcomes of neoadjuvant and concurrent androgen-deprivation therapy and intensity-modulated radiation therapy with gold marker implantation for intermediate- and high-risk prostate cancer. METHODS This was a retrospective study of 325 patients with intermediate- or high-risk prostate cancer according to the National Comprehensive Cancer Network guidelines who underwent androgen-deprivation therapy and intensity-modulated radiation therapy (76 Gy) after gold marker implantation between 2001 and 2010. RESULTS The 5-year distant metastasis-free survival rate was significantly lower for very high-risk patients than for intermediate- and high-risk patients (82.6% vs 99.4% and 96.5%, respectively; P < 0.01). The 5-year biochemical relapse-free survival rates significantly declined with increasing prostate cancer risk (P < 0.01), and were 95.9%, 87.2%, and 73.1% for the intermediate-risk, high-risk and very high-risk patients, respectively. Acute genitourinary and gastrointestinal toxicity grade ≥3 were not observed in any of the patients. Late grade 3 genitourinary toxicity occurred in 0.3% of patients. CONCLUSION Combination androgen-deprivation therapy and 76-Gy intensity-modulated radiation therapy with gold marker implantation offers good therapeutic outcomes with few serious complications in patients with intermediate- and high-risk prostate cancer.
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Affiliation(s)
- Masayuki Kobayashi
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
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20
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Nguyen NP, Davis R, Bose SR, Dutta S, Vinh-Hung V, Chi A, Godinez J, Desai A, Woods W, Altdorfer G, D'Andrea M, Karlsson U, Vo RA, Sroka T. Potential applications of image-guided radiotherapy for radiation dose escalation in patients with early stage high-risk prostate cancer. Front Oncol 2015; 5:18. [PMID: 25699239 PMCID: PMC4313771 DOI: 10.3389/fonc.2015.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/15/2015] [Indexed: 01/21/2023] Open
Abstract
Patients with early stage high-risk prostate cancer (prostate specific antigen > 20, Gleason score > 7) are at high risk of recurrence following prostate cancer irradiation. Radiation dose escalation to the prostate may improve biochemical-free survival for these patients. However, high rectal and bladder dose with conventional three-dimensional conformal radiotherapy may lead to excessive gastrointestinal and genitourinary toxicity. Image-guided radiotherapy (IGRT), by virtue of combining the steep dose gradient of intensity-modulated radiotherapy and daily pretreatment imaging, may allow for radiation dose escalation and decreased treatment morbidity. Reduced treatment time is feasible with hypo-fractionated IGRT and it may improve patient quality of life.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Rick Davis
- Department of Radiation Oncology, Michael D. Wachtel Cancer Center , Oskosh, WI , USA
| | - Satya R Bose
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Suresh Dutta
- Department of Radiation Oncology, Medicine and Radiation Oncology PA , San Antonio, TX , USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Martinique University Hospital , Martinique , France
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Juan Godinez
- Department of Radiation Oncology, Rochester Radiation Oncology Group , Rochester, NY , USA
| | - Anand Desai
- Department of Radiation Oncology, Akron City Hospital , Akron, OH , USA
| | - William Woods
- Department of Radiation Oncology, Richard A. Henson Institute , Salisbury, ML , USA
| | - Gabor Altdorfer
- Department of Radiation Oncology, Camden Clark Cancer Center , Parkersburg, WV , USA
| | - Mark D'Andrea
- Department of Radiation Oncology, University Cancer Centers , Houston, TX , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Richard A Vo
- University of Galveston School of Medicine , Galveston, TX , USA
| | - Thomas Sroka
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Dartmouth College , Hanover, NH , USA
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21
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Ingrosso G, Carosi A, Ponti E, Murgia A, di Cristino D, Barbarino R, Benassi M, Di Murro L, Giudice E, Bove P, Santoni R. Acute and Late Toxicity after Three-Dimensional Conformal Image-Guided Radiotherapy for Localized Prostate Cancer. Cancer Invest 2014; 32:526-32. [DOI: 10.3109/07357907.2014.970193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Shioyama Y, Tsuji H, Suefuji H, Sinoto M, Matsunobu A, Toyama S, Nakamura K, Kudo S. Particle radiotherapy for prostate cancer. Int J Urol 2014; 22:33-9. [PMID: 25308767 DOI: 10.1111/iju.12640] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/03/2014] [Indexed: 01/03/2023]
Abstract
Recent advances in external beam radiotherapy have allowed us to deliver higher doses to the tumors while decreasing doses to the surrounding tissues. Dose escalation using high-precision radiotherapy has improved the treatment outcomes of prostate cancer. Intensity-modulated radiation therapy has been widely used throughout the world as the most advanced form of photon radiotherapy. In contrast, particle radiotherapy has also been under development, and has been used as an effective and non-invasive radiation modality for prostate and other cancers. Among the particles used in such treatments, protons and carbon ions have the physical advantage that the dose can be focused on the tumor with only minimal exposure of the surrounding normal tissues. Furthermore, carbon ions also have radiobiological advantages that include higher killing effects on intrinsic radio-resistant tumors, hypoxic tumor cells and tumor cells in the G0 or S phase. However, the degree of clinical benefit derived from these theoretical advantages in the treatment of prostate cancer has not been adequately determined. The present article reviews the available literature on the use of particle radiotherapy for prostate cancer as well as the literature on the physical and radiobiological properties of this treatment, and discusses the role and the relative merits of particle radiotherapy compared with current photon-based radiotherapy, with a focus on proton beam therapy and carbon ion radiotherapy.
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23
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Wilcox SW, Aherne NJ, Benjamin LC, Wu B, de Campos Silva T, McLachlan CS, McKay MJ, Last AJ, Shakespeare TP. Long-term outcomes from dose-escalated image-guided intensity-modulated radiotherapy with androgen deprivation: encouraging results for intermediate- and high-risk prostate cancer. Onco Targets Ther 2014; 7:1519-23. [PMID: 25210465 PMCID: PMC4155897 DOI: 10.2147/ott.s65238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Dose-escalated (DE) radiotherapy in the setting of localized prostate cancer has been shown to improve biochemical disease-free survival (bDFS) in several studies. In the same group of patients, androgen deprivation therapy (ADT) has been shown to confer a survival benefit when combined with radiotherapy doses of up to 70 Gy; however, there is currently little long-term data on patients who have received high-dose intensity-modulated radiotherapy (IMRT) with ADT. We report the long-term outcomes in a large cohort of patients treated with the combination of DE image-guided IMRT (IG-IMRT) and ADT. METHODS AND MATERIALS Patients with localized prostate cancer were identified from a centralized database across an integrated cancer center. All patients received DE IG-IMRT, combined with ADT, and had a minimum follow up of 12 months post-radiotherapy. All relapse and toxicity data were collected prospectively. Actuarial bDFS, metastasis-free survival, prostate cancer-specific survival, and multivariate analyses were calculated using the SPSS v20.0 statistical package. RESULTS Seven hundred and eighty-two eligible patients were identified with a median follow up of 46 months. Overall, 4.3% of patients relapsed, 2.0% developed distant metastases, and 0.6% died from metastatic prostate cancer. At 5-years, bDFS was 88%, metastasis-free survival was 95%, and prostate cancer-specific survival was 98%. Five-year grade 2 genitourinary and gastrointestinal toxicity was 2.1% and 3.4%, respectively. No grade 3 or 4 late toxicities were reported. Pretreatment prostate specific antigen (P=0.001) and Gleason score (P=0.03) were significant in predicting biochemical failure on multivariate analysis. CONCLUSION There is a high probability of tumor control with DE IG-IMRT combined with androgen deprivation, and this is a technique with a low probability of significant late toxicity. Our long term results corroborate the safety and efficacy of treating with IG-IMRT to high doses and compares favorably with published series for the treatment of prostate cancer.
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Affiliation(s)
- Shea W Wilcox
- North Coast Cancer Institute, Port Macquarie, NSW, Australia ; The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia
| | - Noel J Aherne
- North Coast Cancer Institute, Coffs Harbour, NSW, Australia ; The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia
| | | | - Bosco Wu
- North Coast Cancer Institute, Port Macquarie, NSW, Australia
| | | | - Craig S McLachlan
- The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia
| | - Michael J McKay
- North Coast Cancer Institute, Lismore, NSW, Australia ; The University of Sydney, Sydney, NSW, Australia
| | - Andrew J Last
- North Coast Cancer Institute, Port Macquarie, NSW, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Port Macquarie, NSW, Australia ; North Coast Cancer Institute, Coffs Harbour, NSW, Australia ; North Coast Cancer Institute, Lismore, NSW, Australia ; The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia
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24
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Manabe Y, Shibamoto Y, Sugie C, Baba F, Ayakawa S, Nagai A, Takemoto S, Hayashi A, Kawai N, Takeuchi M, Ishikura S, Kohri K, Yanagi T. Toxicity and efficacy of three dose-fractionation regimens of intensity-modulated radiation therapy for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2014; 55:494-501. [PMID: 24135154 PMCID: PMC4014149 DOI: 10.1093/jrr/rrt124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 05/24/2023]
Abstract
Outcomes of three protocols of intensity-modulated radiation therapy (IMRT) for localized prostate cancer were evaluated. A total of 259 patients treated with 5-field IMRT between 2005 and 2011 were analyzed. First, 74 patients were treated with a daily fraction of 2.0 Gy to a total of 74 Gy (low risk) or 78 Gy (intermediate or high risk). Then, 101 patients were treated with a 2.1-Gy daily fraction to 73.5 or 77.7 Gy. More recently, 84 patients were treated with a 2.2-Gy fraction to 72.6 or 74.8 Gy. The median patient age was 70 years (range, 54-82) and the follow-up period for living patients was 47 months (range, 18-97). Androgen deprivation therapy was given according to patient risk. The overall and biochemical failure-free survival rates were, respectively, 96 and 82% at 6 years in the 2.0-Gy group, 99 and 96% at 4 years in the 2.1-Gy group, and 99 and 96% at 2 years in the 2.2-Gy group. The biochemical failure-free rate for high-risk patients in all groups was 89% at 4 years. Incidences of Grade ≥ 2 acute genitourinary toxicities were 9.5% in the 2.0-Gy group, 18% in the 2.1-Gy group, and 15% in the 2.2-Gy group (P = 0.29). Cumulative incidences of Grade ≥ 2 late gastrointestinal toxicity were 13% in the 2.0-Gy group at 6 years, 12% in the 2.1-Gy group at 4 years, and 3.7% in the 2.2-Gy group at 2 years (P = 0.23). So far, this stepwise shortening of treatment periods seems to be successful.
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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
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Fumiya Baba
- Department of Radiation Oncology, West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Shiho Ayakawa
- Department of Radiology, Social Insurance Chukyo Hospital, 1-1-10 Sanjo,Minami-ku, Nagoya 457-8510, Japan
| | - Aiko Nagai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shinya Takemoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Akihiro Hayashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Noriyasu Kawai
- Department of Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Mitsuru Takeuchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Satoshi Ishikura
- Department of Radiation Oncology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kenjiro Kohri
- Department of Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takeshi Yanagi
- 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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25
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Onozato Y, Kadoya N, Fujita Y, Arai K, Dobashi S, Takeda K, Kishi K, Umezawa R, Matsushita H, Jingu K. Evaluation of on-board kV cone beam computed tomography-based dose calculation with deformable image registration using Hounsfield unit modifications. Int J Radiat Oncol Biol Phys 2014; 89:416-23. [PMID: 24685445 DOI: 10.1016/j.ijrobp.2014.02.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to estimate the accuracy of the dose calculation of On-Board Imager (Varian, Palo Alto, CA) cone beam computed tomography (CBCT) with deformable image registration (DIR), using the multilevel-threshold (MLT) algorithm and histogram matching (HM) algorithm in pelvic radiation therapy. METHODS AND MATERIALS One pelvis phantom and 10 patients with prostate cancer treated with intensity modulated radiation therapy were studied. To minimize the effect of organ deformation and different Hounsfield unit values between planning CT (PCT) and CBCT, we modified CBCT (mCBCT) with DIR by using the MLT (mCBCT(MLT)) and HM (mCBCT(HM)) algorithms. To evaluate the accuracy of the dose calculation, we compared dose differences in dosimetric parameters (mean dose [D(mean)], minimum dose [D(min)], and maximum dose [D(max)]) for planning target volume, rectum, and bladder between PCT (reference) and CBCTs or mCBCTs. Furthermore, we investigated the effect of organ deformation compared with DIR and rigid registration (RR). We determined whether dose differences between PCT and mCBCTs were significantly lower than in CBCT by using Student t test. RESULTS For patients, the average dose differences in all dosimetric parameters of CBCT with DIR were smaller than those of CBCT with RR (eg, rectum; 0.54% for DIR vs 1.24% for RR). For the mCBCTs with DIR, the average dose differences in all dosimetric parameters were less than 1.0%. CONCLUSIONS We evaluated the accuracy of the dose calculation in CBCT, mCBCT(MLT), and mCBCT(HM) with DIR for 10 patients. The results showed that dose differences in D(mean), D(min), and D(max) in mCBCTs were within 1%, which were significantly better than those in CBCT, especially for the rectum (P<.05). Our results indicate that the mCBCT(MLT) and mCBCT(HM) can be useful for improving the dose calculation for adaptive radiation therapy.
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Affiliation(s)
- Yusuke Onozato
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan.
| | - Yukio Fujita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuhiro Arai
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Kazuma Kishi
- Radiation Technology, Tohoku University Hospital, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
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Macias VA, Perez-Romasanta LA. A clinical review on extreme hypofractionated stereotactic body radiation therapy for localized prostate cancer using nonrobotic linear accelerators. Cancer Invest 2014; 32:191-6. [PMID: 24654695 DOI: 10.3109/07357907.2014.896015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Seven phase I-II studies fell within the inclusion criteria. Details on the radiotherapy technique, patient selection, fractionation scheme, exclusion criteria, treatment toxicity, quality-of-life, and tumor control were collected. The studies provide encouraging results of acute and late toxicity, with rare grade 3 events, that seem comparable to robotic SBRT. The biochemical disease-free survival rates look promising, but most patients belong to the low-risk group. The trials are limited by a short follow-up, small number of patients, and different approaches in prescribing dose and defining the acceptable dose heterogeneities. Currently, nonrobotic SBRT regimens should be used in the context of clinical trials.
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Affiliation(s)
- Victor A Macias
- Department of Radiation Oncology, Salamanca University Hospital, Salamanca, Spain
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27
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Orth M, Lauber K, Niyazi M, Friedl AA, Li M, Maihöfer C, Schüttrumpf L, Ernst A, Niemöller OM, Belka C. Current concepts in clinical radiation oncology. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:1-29. [PMID: 24141602 PMCID: PMC3935099 DOI: 10.1007/s00411-013-0497-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/05/2013] [Indexed: 05/04/2023]
Abstract
Based on its potent capacity to induce tumor cell death and to abrogate clonogenic survival, radiotherapy is a key part of multimodal cancer treatment approaches. Numerous clinical trials have documented the clear correlation between improved local control and increased overall survival. However, despite all progress, the efficacy of radiation-based treatment approaches is still limited by different technological, biological, and clinical constraints. In principle, the following major issues can be distinguished: (1) The intrinsic radiation resistance of several tumors is higher than that of the surrounding normal tissue, (2) the true patho-anatomical borders of tumors or areas at risk are not perfectly identifiable, (3) the treatment volume cannot be adjusted properly during a given treatment series, and (4) the individual heterogeneity in terms of tumor and normal tissue responses toward irradiation is immense. At present, research efforts in radiation oncology follow three major tracks, in order to address these limitations: (1) implementation of molecularly targeted agents and 'omics'-based screening and stratification procedures, (2) improvement of treatment planning, imaging, and accuracy of dose application, and (3) clinical implementation of other types of radiation, including protons and heavy ions. Several of these strategies have already revealed promising improvements with regard to clinical outcome. Nevertheless, many open questions remain with individualization of treatment approaches being a key problem. In the present review, the current status of radiation-based cancer treatment with particular focus on novel aspects and developments that will influence the field of radiation oncology in the near future is summarized and discussed.
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Affiliation(s)
- Michael Orth
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Kirsten Lauber
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anna A. Friedl
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Minglun Li
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Cornelius Maihöfer
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lars Schüttrumpf
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anne Ernst
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Olivier M. Niemöller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
- Present Address: Clinic for Radiation Oncology, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
| | - Claus Belka
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
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