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Corrao G, Marvaso G, Mastroleo F, Biffi A, Pellegrini G, Minari S, Vincini MG, Zaffaroni M, Zerini D, Volpe S, Gaito S, Mazzola GC, Bergamaschi L, Cattani F, Petralia G, Musi G, Ceci F, De Cobelli O, Orecchia R, Alterio D, Jereczek-Fossa BA. Photon vs proton hypofractionation in prostate cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 195:110264. [PMID: 38561122 DOI: 10.1016/j.radonc.2024.110264] [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: 12/14/2023] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND High-level evidence on hypofractionated proton therapy (PT) for localized and locally advanced prostate cancer (PCa) patients is currently missing. The aim of this study is to provide a systematic literature review to compare the toxicity and effectiveness of curative radiotherapy with photon therapy (XRT) or PT in PCa. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched up to April 2022. Men with a diagnosis of PCa who underwent curative hypofractionated RT treatment (PT or XRT) were included. Risk of grade (G) ≥ 2 acute and late genitourinary (GU) OR gastrointestinal (GI) toxicity were the primary outcomes of interest. Secondary outcomes were five-year biochemical relapse-free survival (b-RFS), clinical relapse-free, distant metastasis-free, and prostate cancer-specific survival. Heterogeneity between study-specific estimates was assessed using Chi-square statistics and measured with the I2 index (heterogeneity measure across studies). RESULTS A total of 230 studies matched inclusion criteria and, due to overlapped populations, 160 were included in the present analysis. Significant lower rates of G ≥ 2 acute GI incidence (2 % vs 7 %) and improved 5-year biochemical relapse-free survival (95 % vs 91 %) were observed in the PT arm compared to XRT. PT benefits in 5-year biochemical relapse-free survival were maintained for the moderate hypofractionated arm (p-value 0.0122) and among patients in intermediate and low-risk classes (p-values < 0.0001 and 0.0368, respectively). No statistically relevant differences were found for the other considered outcomes. CONCLUSION The present study supports that PT is safe and effective for localized PCa treatment, however, more data from RCTs are needed to draw solid evidence in this setting and further effort must be made to identify the patient subgroups that could benefit the most from PT.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Annalisa Biffi
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Samuele Minari
- National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Simona Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Clinical Cancer Science, School of Medical Sciences, The University of Manchester, Manchester, UK
| | | | - Luca Bergamaschi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Nishioka K, Hashimoto T, Mori T, Uchinami Y, Kinoshita R, Katoh N, Taguchi H, Yasuda K, Ito YM, Takao S, Tamura M, Matsuura T, Shimizu S, Shirato H, Aoyama H. A Single-Institution Prospective Study To Evaluate the Safety and Efficacy of Real- Time Image-Gated Spot-Scanning Proton Therapy (RGPT) for Prostate Cancer. Adv Radiat Oncol 2024; 9:101464. [PMID: 38560429 PMCID: PMC10981019 DOI: 10.1016/j.adro.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose In real-time image-gated spot-scanning proton therapy (RGPT), the dose distribution is distorted by gold fiducial markers placed in the prostate. Distortion can be suppressed by using small markers and more than 2 fields, but additional fields may increase the dose to organs at risk. Therefore, we conducted a prospective study to evaluate the safety and short-term clinical outcome of RGPT for prostate cancer. Methods and Materials Based on the previously reported frequency of early adverse events (AE) and the noninferiority margin of 10%, the required number of cases was calculated to be 43 using the one-sample binomial test by the Southwest Oncology Group statistical tools with the one-sided significance level of 2.5% and the power 80%. Patients with localized prostate cancer were enrolled and 3 to 4 pure gold fiducial markers of 1.5-mm diameter were inserted in the prostate. The prescribed dose was 70 Gy(relative biologic effectiveness) in 30 fractions, and treatment was performed with 3 fields from the left, right, and the back, or 4 fields from either side of slightly anterior and posterior oblique fields. The primary endpoint was the frequency of early AE (≥grade 2) and the secondary endpoint was the biochemical relapse-free survival rate and the frequency of late AE. Results Forty-five cases were enrolled between 2015 and 2017, and all patients completed the treatment protocol. The median follow-up period was 63.0 months. The frequency of early AE (≥grade 2) was observed in 4 cases (8.9%), therefore the noninferiority was verified. The overall 5-year biochemical relapse-free survival rate was 88.9%. As late AE, grade 2 rectal bleeding was observed in 8 cases (17.8%). Conclusions The RGPT for prostate cancer with 1.5-mm markers and 3- or 4- fields was as safe as conventional proton therapy in early AE, and its efficacy was comparable with previous studies.
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Affiliation(s)
- Kentaro Nishioka
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M. Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Shirato
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
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SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
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Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Alexander S, Oelfke U, Westley R, McNair H, Tree A. Prostate cancer image guided radiotherapy: Why the commotion over rectal volume and motion? Clin Transl Radiat Oncol 2023; 43:100685. [PMID: 37842073 PMCID: PMC10570575 DOI: 10.1016/j.ctro.2023.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Distended rectums on pre-radiotherapy scans are historically associated with poorer outcomes in patients treated with two-dimensional IGRT. Subsequently, strict rectal tolerances and preparation regimes were implemented. Contemporary IGRT, daily online registration to the prostate, corrects interfraction motion but intrafraction motion remains. We re-examine the need for rectal management strategies when using contemporary IGRT by quantifying rectal volume and its effect on intrafraction motion. Materials and methods Pre and during radiotherapy rectal volumes and intrafraction motion were retrospectively calculated for 20 patients treated in 5-fractions and 20 treated in 20-fractions. Small (rectal volume at planning-CT ≤ median), and large (volume > median) subgroups were formed, and rectal volume between timepoints and subgroups compared. Rectal volume and intrafraction motion correlation was examined using Spearman's rho. Intrafraction motion difference between small and large subgroups and between fractions with rectal volume < or ≥ 90 cm3 were assessed. Results Median rectal volume was 74 cm3, 64 cm3 and 65 cm3 on diagnostic-MRI, planning-CT and treatment imaging respectively (ns). No significant correlation was found between patient's rectal volume at planning-CT and median intrafraction motion, nor treatment rectal volume and intrafraction motion for individual fractions. No significant difference in intrafraction motion between small and large subgroups presented and for fractions where rectal volume breached 90 cm3, motion during that fraction was not significantly greater. Conclusion Larger rectal volumes before radiotherapy and during treatment did not cause greater intrafraction motion. Findings support the relaxation of strict rectal diameter tolerances and do not support the need for rectal preparation when delivering contemporary IGRT to the prostate.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, the Royal Marsden Hospital and the Institute of Cancer Research, United Kingdom
| | - R. Westley
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Kato Y, Okumiya S, Okudaira K, Ito J, Kumagai M, Kamomae T, Noguchi Y, Kawamura M, Ishihara S, Naganawa S. Urethral identification using three-dimensional magnetic resonance imaging and interfraction urethral motion evaluation for prostate stereotactic body radiotherapy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:504-517. [PMID: 37829483 PMCID: PMC10565580 DOI: 10.18999/nagjms.85.3.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2023]
Abstract
Prostatic urethra identification is crucial in prostate stereotactic body radiotherapy (SBRT) to reduce the risk of urinary toxicity. Although computed tomography (CT) with a catheter is commonly employed, it is invasive, and catheter placement may displace the urethral position, resulting in possible planning inaccuracies. However, magnetic resonance imaging (MRI) can overcome these weaknesses. Accurate urethral identification and minimal daily variation could ensure a highly accurate SBRT. In this study, we investigated the usefulness of a three-dimensional (3D) T2-weighted (T2W) sequence for urethral identification, and the interfractional motion of the prostatic urethra on CT with a catheter and MRI without a catheter for implementing noninvasive SBRT. Thirty-two patients were divided into three groups. The first group underwent MRI without a catheter to evaluate urethral identification by two-dimensional (2D)- and 3D-T2W sequences using mean slice-wise Hausdorff distance (MSHD) and Dice similarity coefficient (DSC) of the contouring by two operators and using visual assessment. The second group provided 3-day MRI data without a catheter using 3D-T2W, and the third provided 3-day CT data with a catheter to evaluate the interfractional motion using MSHD, DSC, and displacement distance (Dd). The MSHD and DSC for the interoperator variability in urethral identification and visual assessment were superior in 3D-T2W than in 2D-T2W. Regarding interfractional motion, the Dd value for prostatic urethra was smaller in MRI than in CT. These findings indicate that the 3D-T2W yielded adequate prostatic urethral identification, and catheter-free MRI resulted in less interfractional motion, suggesting that 3D-T2W MRI without a catheter is a feasible noninvasive approach to performing prostate SBRT.
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Affiliation(s)
- Yutaka Kato
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Shintaro Okumiya
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Kuniyasu Okudaira
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Junji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Motoki Kumagai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yumiko Noguchi
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Arumugam S, Young T, Do V, Chlap P, Tawfik C, Udovitch M, Wong K, Sidhom M. Assessment of intrafraction motion and its dosimetric impact on prostate radiotherapy using an in-house developed position monitoring system. Front Oncol 2023; 13:1082391. [PMID: 37519787 PMCID: PMC10375704 DOI: 10.3389/fonc.2023.1082391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To implement an in-house developed position monitoring software, SeedTracker, for conventional fractionation prostate radiotherapy, and study the effect on dosimetric impact and intrafraction motion. Methods Thirty definitive prostate radiotherapy patients with implanted fiducial markers were included in the study. All patients were treated with VMAT technique and plans were generated using the Pinnacle planning system using the 6MV beam model for Elekta linear accelerator. The target dose of 60 Gy in 20 fractions was prescribed for 29 of 30 patients, and one patient was treated with the target dose of 78 Gy in 39 fractions. The SeedTracker position monitoring system, which uses the x-ray images acquired during treatment delivery in the Elekta linear accelerator and associated XVI system, was used for online prostate position monitoring. The position tolerance for online verification was progressively reduced from 5 mm, 4 mm, and to 3 mm in 10 patient cohorts to effectively manage the treatment interruptions resulting from intrafraction motion in routine clinical practice. The delivered dose to target volumes and organs at risk in each of the treatment fractions was assessed by incorporating the observed target positions into the original treatment plan. Results In 27 of 30 patients, at least one gating event was observed, with a total of 177 occurrences of position deviation detected in 146 of 619 treatment fractions. In 5 mm, 4 mm, and 3 mm position tolerance cohorts, the position deviations were observed in 13%, 24%, and 33% of treatment fractions, respectively. Overall, the mean (range) deviation of -0.4 (-7.2 to 5.3) mm, -0.9 (-6.1 to 15.6) mm, and -1.7 (-7.0 to 6.1) mm was observed in Left-Right, Anterior-Posterior, and Superior-Inferior directions, respectively. The prostate CTV D99 would have been reduced by a maximum value of 1.3 Gy compared to the planned dose if position deviations were uncorrected, but with corrections, it was 0.3 Gy. Similarly, PTV D98 would have been reduced by a maximum value of 7.6 Gy uncorrected, with this difference reduced to 2.2 Gy with correction. The V60 to the rectum increased by a maximum of 1.0% uncorrected, which was reduced to 0.5%. Conclusion Online target position monitoring for conventional fractionation prostate radiotherapy was successfully implemented on a standard Linear accelerator using an in-house developed position monitoring software, with an improvement in resultant dose to prostate target volume.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tony Young
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Phillip Chlap
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine Tawfik
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Udovitch
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Arumugam S, Wong K, Do V, Sidhom M. Reducing the margin in prostate radiotherapy: optimizing radiotherapy with a general-purpose linear accelerator using an in-house position monitoring system. Front Oncol 2023; 13:1116999. [PMID: 37519807 PMCID: PMC10373585 DOI: 10.3389/fonc.2023.1116999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To study the feasibility of optimizing the Clinical Target Volume to Planning Target Volume (CTV-PTV) margin in prostate radiotherapy(RT) with a general-purpose linear accelerator using an in-house developed position monitoring system, SeedTracker. Methods A cohort of 30 patients having definitive prostate radiotherapy treated within an ethics-approved prospective trial was considered for this study. The intrafraction prostate motion and the position deviations were measured using SeedTracker system during each treatment fraction. Using this data the CTV-PTV margin required to cover 90% of the patients with a minimum of 95% of the prescription dose to CTV was calculated using van Herk's formula. The margin calculations were performed for treatment scenarios both with and without applying the position corrections for observed position deviations. The feasibility of margin reduction with real-time monitoring was studied by assessing the delivered dose that incorporates the actual target position during treatment delivery and comparing it with the planned dose. This assessment was performed for plans generated with reduced CTV-PTV margin in the range of 7mm-3mm. Results With real-time monitoring and position corrections applied the margin of 2.0mm, 2.1mm and 2.1mm in LR, AP and SI directions were required to meet the criteria of 90% population to receive 95% of the dose prescription to CTV. Without position corrections applied for observed position deviations a margin of 3.1mm, 4.0mm and 3.0mm was required in LR, AP and SI directions to meet the same criteria. A mean ± SD reduction of 0.5 ± 1.8% and 3 ± 7% of V60 for the rectum and bladder can be achieved for every 1mm reduction of PTV margin. With position corrections applied, the CTV D99 can be delivered within -0.2 ± 0.3 Gy of the planned dose for plans with a 3mm margin. Without applying corrections for position deviations the CTV D99 was reduced by a maximum of 1.1 ± 1.1 Gy for the 3mm margin plan and there was a statistically significant difference between planned and delivered dose for 3mm and 4mm margin plans. Conclusion This study demonstrates the feasibility of reducing the margin in prostate radiotherapy with SeedTracker system without compromising the dose delivery accuracy to CTV while reducing dose to critical structures.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Prostatic urinary tract visualization with super-resolution deep learning models. PLoS One 2023; 18:e0280076. [PMID: 36607999 PMCID: PMC9821403 DOI: 10.1371/journal.pone.0280076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
In urethra-sparing radiation therapy, prostatic urinary tract visualization is important in decreasing the urinary side effect. A methodology has been developed to visualize the prostatic urinary tract using post-urination magnetic resonance imaging (PU-MRI) without a urethral catheter. This study investigated whether the combination of PU-MRI and super-resolution (SR) deep learning models improves the visibility of the prostatic urinary tract. We enrolled 30 patients who had previously undergone real-time-image-gated spot scanning proton therapy by insertion of fiducial markers. PU-MRI was performed using a non-contrast high-resolution two-dimensional T2-weighted turbo spin-echo imaging sequence. Four different SR deep learning models were used: the enhanced deep SR network (EDSR), widely activated SR network (WDSR), SR generative adversarial network (SRGAN), and residual dense network (RDN). The complex wavelet structural similarity index measure (CW-SSIM) was used to quantitatively assess the performance of the proposed SR images compared to PU-MRI. Two radiation oncologists used a 1-to-5 scale to subjectively evaluate the visibility of the prostatic urinary tract. Cohen's weighted kappa (k) was used as a measure of agreement of inter-operator reliability. The mean CW-SSIM in EDSR, WDSR, SRGAN, and RDN was 99.86%, 99.89%, 99.30%, and 99.67%, respectively. The mean prostatic urinary tract visibility scores of the radiation oncologists were 3.70 and 3.53 for PU-MRI (k = 0.93), 3.67 and 2.70 for EDSR (k = 0.89), 3.70 and 2.73 for WDSR (k = 0.88), 3.67 and 2.73 for SRGAN (k = 0.88), and 4.37 and 3.73 for RDN (k = 0.93), respectively. The results suggest that SR images using RDN are similar to the original images, and the SR deep learning models subjectively improve the visibility of the prostatic urinary tract.
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Yoshimura T, Nishioka K, Hashimoto T, Seki K, Kogame S, Tanaka S, Kanehira T, Tamura M, Takao S, Matsuura T, Kobashi K, Kato F, Aoyama H, Shimizu S. A treatment planning study of urethra-sparing intensity-modulated proton therapy for localized prostate cancer. Phys Imaging Radiat Oncol 2021; 20:23-29. [PMID: 34693040 PMCID: PMC8517200 DOI: 10.1016/j.phro.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
US-IMPT can potentially reduce the risk of genitourinary toxicities. The urethral NTCP value in US-IMPT is significantly lower than in the clinical plan. TCP for CTV did not differ significantly between the clinical and US-IMPT plans.
Background and Purpose Urethra-sparing radiation therapy for localized prostate cancer can reduce the risk of radiation-induced genitourinary toxicity by intentionally underdosing the periurethral transitional zone. We aimed to compare the clinical impact of a urethra-sparing intensity-modulated proton therapy (US-IMPT) plan with that of conventional clinical plans without urethral dose reduction. Materials and Methods This study included 13 patients who had undergone proton beam therapy. The prescribed dose was 63 GyE in 21 fractions for 99% of the clinical target volume. To compare the clinical impact of the US-IMPT plan with that of the conventional clinical plan, tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated with a generalized equivalent uniform dose-based Lyman–Kutcher model using dose volume histograms. The endpoints of these model parameters for the rectum, bladder, and urethra were fistula, contraction, and urethral stricture, respectively. Results The mean NTCP value for the urethra in US-IMPT was significantly lower than that in the conventional clinical plan (0.6% vs. 1.2%, p < 0.05). There were no statistically significant differences between the conventional and US-IMPT plans regarding the mean minimum dose for the urethra with a 3-mm margin, TCP value, and NTCP value for the rectum and bladder. Additionally, the target dose coverage of all plans in the robustness analysis was within the clinically acceptable range. Conclusions Compared with the conventional clinically applied plans, US-IMPT plans have potential clinical advantages and may reduce the risk of genitourinary toxicities, while maintaining the same TCP and NTCP in the rectum and bladder.
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuya Seki
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shouki Kogame
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sodai Tanaka
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Takahiro Kanehira
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Seishin Takao
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Taeko Matsuura
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Keiji Kobashi
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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10
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Uchinami Y, Katoh N, Abo D, Taguchi H, Yasuda K, Nishioka K, Soyama T, Morita R, Miyamoto N, Suzuki R, Sho T, Nakai M, Ogawa K, Kakisaka T, Orimo T, Kamiyama T, Shimizu S, Aoyama H. Treatment outcomes of stereotactic body radiation therapy using a real-time tumor-tracking radiotherapy system for hepatocellular carcinomas. Hepatol Res 2021; 51:870-879. [PMID: 33894086 DOI: 10.1111/hepr.13649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 01/07/2023]
Abstract
AIM To report the outcomes of stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system for hepatocellular carcinoma patients. METHODS From January 2005 to July 2018, 63 patients with 74 lesions with a maximum diameter ≤52 mm were treated by stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system. No patient with a Child-Pugh Score ≥9 was included, and 85.6% had a score of 5 or 6. Using the biological effective dose (BED) with an α/β ratio of 10 (BED10 ), the median dose in BED10 at the reference point was 76.8 Gy (range 60-122.5 Gy). Overall survival (OS) and local control rates were assessed using the Kaplan-Meier method. RESULTS With a median follow-up period of 24.6 months (range 0.9-118.4 months), the 1-year and 2-year OS rates were 86.8% (95% confidence interval [95% CI] 75.8-93.3) and 71.1% (57.8-81.6), respectively. The 2-year OS was 89.6% in patients with the baseline modified albumin-bilirubin (mALBI) grade =1, and 61.7% in patients with grade ≥2a. In the multivariate analysis, the mALBI grade (=1 vs. ≥2a) was a significant factor for OS (p = 0.028, 95% CI 1.11-6.18). The 1-year and 2-year local control rates were 100% (100-100%) and 92.0% (77.5-97.5%). The local control rates were significantly higher in the BED10 ≥100 Gy group than in the BED10 <100 Gy group (2-year 100% vs. 86.5%, p = 0.049) at the reference point. CONCLUSION This retrospective study of stereotactic body radiotherapy using real-time tumor-tracking radiotherapy for hepatocellular carcinoma showed favorable outcomes with lower incidence of toxicities, especially in patients treated with BED10 ≥100 Gy to the reference point.
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Affiliation(s)
- Yusuke Uchinami
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Ryo Morita
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Ryusuke Suzuki
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Sho
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masato Nakai
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Koji Ogawa
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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11
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Visualising the proximal urethra by MRI voiding scan: results of a prospective clinical trial evaluating a novel approach to radiotherapy simulation for prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Delineating the proximal urethra can be critical for radiotherapy planning but is challenging on computerised tomography (CT) imaging.
Materials and methods:
We trialed a novel non-invasive technique to allow visualisation of the proximal urethra using a rapid sequence magnetic resonance imaging (MRI) protocol to visualise the urinary flow in patients voiding during the simulation scan.
Results:
Of the seven patients enrolled, four were able to void during the MRI scan. For these four patients, direct visualisation of urinary flow through the proximal urethra was achieved. The average volume of the proximal urethra contoured on voiding MRI was significantly higher than the proximal urethra contoured on CT, 4·07 and 1·60 cc, respectively (p = 0·02). The proximal urethra location also differed; the Dice coefficient average was 0·28 (range 0–0·62).
Findings:
In this small, proof-of-concept prospective clinical trial, the volume and location of the proximal urethra differed significantly when contoured on a voiding MRI scan compared to that determined by a conventional CT simulation. The shape of the proximal urethra on voiding MRI may be more anatomically correct compared to the proximal urethra shape determined with a semi-rigid catheter in place.
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12
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Yoshimura T, Nishioka K, Hashimoto T, Fujiwara T, Ishizaka K, Sugimori H, Kogame S, Seki K, Tamura H, Tanaka S, Matsuo Y, Dekura Y, Kato F, Aoyama H, Shimizu S. Visualizing the urethra by magnetic resonance imaging without usage of a catheter for radiotherapy of prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:1-4. [PMID: 34258400 PMCID: PMC8254197 DOI: 10.1016/j.phro.2021.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Post urination MRI is useful for urethra-sparing radiotherapy treatment planning. This prospective clinical trial included 11 prostate cancer patients. Post urination MRI is the identification method of prostatic urinary tract in non-invasive manner.
The urethra position may shift due to the presence/absence of the catheter. Our proposed post-urination-magnetic resonance imaging (PU-MRI) technique is possible to identify the urethra without catheter. We aimed to verify the inter-operator difference in contouring the urethra by PU-MRI. The mean values of the evaluation indices of dice similarity coefficient, mean slice-wise Hausdorff distance, and center coordinates were 0.93, 0.17 mm, and 0.36 mm for computed tomography, and 0.75, 0.44 mm, and 1.00 mm for PU-MRI. Therefore, PU-MRI might be useful for identifying the prostatic urinary tract without using a urethral catheter. Clinical trial registration: Hokkaido University Hospital for Clinical Research (018-0221).
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Taro Fujiwara
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Sugimori
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shoki Kogame
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuya Seki
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Tamura
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Yuto Matsuo
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Yasuhiro Dekura
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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13
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Ileana PÁS, Rubi RP, Javier LRF, Sagrario MGMD, Haydeé FBC. Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases. Rep Pract Oncol Radiother 2020; 25:548-555. [PMID: 32494227 DOI: 10.1016/j.rpor.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/23/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
Aim Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. Background The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. Materials and methods We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. Cases description We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). Conclusion When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient's specific setting. Recent publications recommend KT mean dose <4 Gy, but graft proximity to CTV makes this unfeasible. We present 2 cases where dose constraint was not achieved, and to a short follow-up of 20 months renal toxicity has not been documented. We recommend the lowest possible mean dose to the KT, but never compromising the CTV coverage, since morbimortality from recurrent or progressive cancer disease outweighs the risk of graft injury.
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Key Words
- BF, Biochemical failure
- BT, Brachytherapy
- C3D-RT, Conformal three-dimensional radiation therapy
- CBCT, Cone-beam computed tomography
- CCa, Cervix cancer
- Dmax, Maximum dose
- Dmean, Mean dose
- Dmin, Minimum dose
- Dx, Dose (in Gy) receiving x% of a volume or more
- EBRT, External beam radiation therapy
- EQD2, Equivalent dose in 2-Gy fractions
- ESKD, End-stage kidney disease
- FU, Follow-up
- HPV, Human papillomavirus
- IBT, Intracavitary brachytherapy
- IMRT, Intensity-modulated radiation therapy
- KT, Kidney transplant
- Kidney allograft
- LRDRT, Living related donor renal transplantation
- MMF, Mycophenolate mofetil
- NED, No evidence of disease
- OAR, Organs at risk
- OS, Overall survival
- PCa, Prostate cancer
- PDN, Prednisone
- PP, Post-prostatectomy
- PSA, Prostate-specific antigen
- PTV, Planning target volume
- Pelvic radiotherapy
- Prostate cancer
- RR, Risk ratio
- RT, Radiation therapy
- Renal transplant
- SCCVa, Squamous cell carcinoma of the vagina
- SIR, Standardized Incidence Ratio
- TBI, Total body irradiation
- VCa, Vaginal cancer
- VMAT, Volumetric Modulated Arc Therapy
- Vaginal cancer
- Vx, Volume (in percentage) receiving x dose or more (in Gy)
- fr, Fractions
- mo, Months
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Affiliation(s)
- Pérez Álvarez Sandra Ileana
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Ramos Prudencio Rubi
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Lozano Ruiz Francisco Javier
- Department of Radiation Oncology, Médica Sur Hospital. 150 Puente de Piedra, Toriello Guerra, Tlalpan, Mexico City, 14050, Mexico
| | | | - Flores Balcazar Christian Haydeé
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
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14
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Dekura Y, Nishioka K, Hashimoto T, Miyamoto N, Suzuki R, Yoshimura T, Matsumoto R, Osawa T, Abe T, Ito YM, Shinohara N, Shirato H, Shimizu S. The urethral position may shift due to urethral catheter placement in the treatment planning for prostate radiation therapy. Radiat Oncol 2019; 14:226. [PMID: 31831045 PMCID: PMC6909476 DOI: 10.1186/s13014-019-1424-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/20/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine the best method to contour the planning organ at risk volume (PRV) for the urethra, this study aimed to investigate the displacement of a Foley catheter in the urethra with a soft and thin guide-wire. METHODS For each patient, the study used two sets of computed tomography (CT) images for radiation treatment planning (RT-CT): (1) set with a Foley urethral catheter (4.0 mm diameter) plus a guide-wire (0.46 mm diameter) in the first RT-CT and (2) set with a guide-wire alone in the second CT recorded 2 min after the first RT-CT. Using three fiducial markers in the prostate for image fusion, the displacement between the catheter and the guide-wire in the prostatic urethra was calculated. In 155 consecutive patients treated between 2011 and 2017, 5531 slices of RT-CT were evaluated. RESULTS Assuming that ≥3.0 mm of difference between the catheter and the guide-wire position was a significant displacement, the urethra with the catheter was displaced significantly from the urethra with the guide-wire alone in > 20% of the RT-CT slices in 23.2% (36/155) of the patients. The number of patients who showed ≥3.0 mm anterior displacement with the catheter in ≥20% RT-CT slices was significantly larger at the superior segment (38/155) than at the middle (14/155) and inferior segments (18/155) of the prostatic urethra (p < 0.0167). CONCLUSIONS The urethral position with a Foley catheter is different from the urethral position with a thin and soft guide-wire in a significant proportion of the patients. This should be taken into account for the PRV of the urethra to ensure precise radiotherapy such as in urethra-sparing radiotherapy.
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Affiliation(s)
- Yasuhiro Dekura
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Takayuki Hashimoto
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Global Station for Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoki Miyamoto
- Global Station for Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Medical Physics, Hokkaido University Hospital, North-14, West-5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Ryusuke Suzuki
- Department of Medical Physics, Hokkaido University Hospital, North-14, West-5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics, 10-3, Midori-cho, Tachikawa, Tokyo, 190-0014, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Global Station for Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Global Station for Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University, North-15, West-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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15
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Murthy V, Sinha S, Kannan S, Datta D, Das R, Bakshi G, Prakash G, Krishnatry R. Safety of Prostate Stereotactic Body Radiation Therapy after Transurethral Resection of Prostate (TURP): A Propensity Score Matched Pair Analysis. Pract Radiat Oncol 2019; 9:347-353. [PMID: 30978467 DOI: 10.1016/j.prro.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the genitourinary (GU) toxicity outcomes in prostate cancer patients treated with stereotactic body radiation therapy (SBRT) who have undergone a prior transurethral resection of prostate (TURP) and compare it to a similar non-TURP cohort. MATERIALS AND METHODS Fifty prostate cancer patients who had undergone a single TURP, had a good baseline urinary function, and had been subsequently treated with SBRT were chosen from a prospectively maintained database. These were propensity score matched to a similar non-TURP cohort treated during the same period. Matching was done for diabetes mellitus and volume of radiation therapy. Acute GU and late GU toxicity were scored using the Radiation Therapy Oncology Group (RTOG) criteria. Stricture and incontinence were scored using Common Terminology for Common Adverse Events version 4.0. RESULTS Median follow-up for the entire cohort was 26 months (non-TURP vs TURP, 30 months vs 22 months, P = .34). The median duration between TURP and start of SBRT was 10 months. There was no significant difference between non-TURP versus TURP cohort in terms of RTOG acute GU toxicities grade ≥2 (8% vs 6%, P = .45), RTOG late GU toxicities grade ≥2 (8% vs 12%, P = .10), stricture rates (4% vs 6%, P = .64), and incontinence rates (0% vs 4%, P = .15). The median duration of time to late toxicity was 16 months vs 10 months (P = .12) in non-TURP and TURP cohort, respectively. CONCLUSIONS Although modestly increased as compared with non-TURP patients, GU toxicities remains low with SBRT in post-TURP patients. SBRT can be safely performed in carefully selected post-TURP prostate cancer patients.
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Affiliation(s)
- Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India.
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Debanjali Datta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rabi Das
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Ganesh Bakshi
- Division of Urology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Gagan Prakash
- Division of Urology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
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16
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Hunt A, Hansen VN, Oelfke U, Nill S, Hafeez S. Adaptive Radiotherapy Enabled by MRI Guidance. Clin Oncol (R Coll Radiol) 2018; 30:711-719. [PMID: 30201276 DOI: 10.1016/j.clon.2018.08.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
Adaptive radiotherapy (ART) strategies systematically monitor variations in target and neighbouring structures to inform treatment-plan modification during radiotherapy. This is necessary because a single plan designed before treatment is insufficient to capture the actual dose delivered to the target and adjacent critical structures during the course of radiotherapy. Magnetic resonance imaging (MRI) provides superior soft-tissue image contrast over current standard X-ray-based technologies without additional radiation exposure. With integrated MRI and radiotherapy platforms permitting motion monitoring during treatment delivery, it is possible that adaption can be informed by real-time anatomical imaging. This allows greater treatment accuracy in terms of dose delivered to target with smaller, individualised treatment margins. The use of functional MRI sequences would permit ART to be informed by imaging biomarkers, so allowing both personalised geometric and biological adaption. In this review, we discuss ART solutions enabled by MRI guidance and its potential gains for our patients across tumour types.
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Affiliation(s)
- A Hunt
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - V N Hansen
- The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Nill
- The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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17
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Dubouloz A, Rouzaud M, Tsvang L, Verbakel W, Björkqvist M, Linthout N, Lencart J, Pérez-Moreno JM, Ozen Z, Escude L, Zilli T, Miralbell R. Urethra-sparing stereotactic body radiotherapy for prostate cancer: how much can the rectal wall dose be reduced with or without an endorectal balloon? Radiat Oncol 2018; 13:114. [PMID: 29921291 PMCID: PMC6008922 DOI: 10.1186/s13014-018-1059-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background This is a dosimetric comparative study intended to establish appropriate low-to-intermediate dose-constraints for the rectal wall (Rwall) in the context of a randomized phase-II trial on urethra-sparing stereotactic body radiotherapy (SBRT) for prostate cancer. The effect of plan optimization on low-to-intermediate Rwall dose and the potential benefit of an endorectal balloon (ERB) are investigated. Methods Ten prostate cancer patients, simulated with and without an ERB, were planned to receive 36.25Gy (7.25Gyx5) to the planning treatment volume (PTV) and 32.5Gy to the urethral planning risk volume (uPRV). Reference plans with and without the ERB, optimized with respect to PTV and uPRV coverage objectives and the organs at risk dose constraints, were further optimized using a standardized stepwise approach to push down dose constraints to the Rwall in the low to intermediate range in five sequential steps to obtain paired plans with and without ERB (Vm1 to Vm5). Homogeneity index for the PTV and the uPRV, and the Dice similarity coefficient (DSC) for the PTV were analyzed. Dosimetric parameters for Rwall including the median dose and the dose received by 10 to 60% of the Rwall, bladder wall (Bwall) and femoral heads (FHeads) were compared. The monitor units (MU) per plan were recorded. Results Vm4 reduced by half D30%, D40%, D50%, and Dmed for Rwall and decreased by a third D60% while HIPTV, HIuPRV and DSC remained stable with and without ERB compared to Vmref. HIPTV worsened at Vm5 both with and without ERB. No statistical differences were observed between paired plans on Rwall, Bwall except a higher D2% for Fheads with and without an ERB. Conclusions Further optimization to the Rwall in the context of urethra sparing prostate SBRT is feasible without compromising the dose homogeneity to the target. Independent of the use or not of an ERB, low-to-intermediate doses to the Rwall can be significantly reduced using a four-step sequential optimization approach.
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Affiliation(s)
- Angèle Dubouloz
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland. .,Radiation Oncology Department, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
| | - Michel Rouzaud
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Lev Tsvang
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel
| | - Wilko Verbakel
- Department of Radiation Oncology, VU medical center, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Mikko Björkqvist
- Department of Oncology and Radiotherapy, Turku University Hospital, PO Box 52, 20521, Turku, Finland.,Department of Medical Physics, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Nadine Linthout
- Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
| | - Joana Lencart
- Serviço de Radioterapia Externa, Instituto Portugues de Oncologia, Rua Dr Antonio Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Juan María Pérez-Moreno
- Servicio de Oncología Radioterápica, Centro Integral Oncológico "Clara Campal", Hospital Universitario Madrid Sanchinarro, C/ Oña 10, 28050, Madrid, Spain
| | - Zeynep Ozen
- Neolife Medical Center, Nisbetiye Mah. Yucel Sokak, No: 6 Besiktas, 34340, Istanbul, Turkey
| | - Lluís Escude
- Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
| | - Thomas Zilli
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Raymond Miralbell
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
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18
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Pathmanathan AU, van As NJ, Kerkmeijer LGW, Christodouleas J, Lawton CAF, Vesprini D, van der Heide UA, Frank SJ, Nill S, Oelfke U, van Herk M, Li XA, Mittauer K, Ritter M, Choudhury A, Tree AC. Magnetic Resonance Imaging-Guided Adaptive Radiation Therapy: A "Game Changer" for Prostate Treatment? Int J Radiat Oncol Biol Phys 2018; 100:361-373. [PMID: 29353654 DOI: 10.1016/j.ijrobp.2017.10.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
Abstract
Radiation therapy to the prostate involves increasingly sophisticated delivery techniques and changing fractionation schedules. With a low estimated α/β ratio, a larger dose per fraction would be beneficial, with moderate fractionation schedules rapidly becoming a standard of care. The integration of a magnetic resonance imaging (MRI) scanner and linear accelerator allows for accurate soft tissue tracking with the capacity to replan for the anatomy of the day. Extreme hypofractionation schedules become a possibility using the potentially automated steps of autosegmentation, MRI-only workflow, and real-time adaptive planning. The present report reviews the steps involved in hypofractionated adaptive MRI-guided prostate radiation therapy and addresses the challenges for implementation.
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Affiliation(s)
- Angela U Pathmanathan
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Nicholas J van As
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | - Danny Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steven J Frank
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simeon Nill
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Uwe Oelfke
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Marcel van Herk
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Mittauer
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark Ritter
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ananya Choudhury
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Alison C Tree
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
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19
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Abstract
We reviewed the literature on the use of margins in radiotherapy of patients with prostate cancer, focusing on different options for image guidance (IG) and technical issues. The search in PubMed database was limited to include studies that involved external beam radiotherapy of the intact prostate. Post-prostatectomy studies, brachytherapy and particle therapy were excluded. Each article was characterized according to the IG strategy used: positioning on external marks using room lasers, bone anatomy and soft tissue match, usage of fiducial markers, electromagnetic tracking and adapted delivery. A lack of uniformity in margin selection among institutions was evident from the review. In general, introduction of pre- and in-treatment IG was associated with smaller planning target volume (PTV) margins, but there was a lack of definitive experimental/clinical studies providing robust information on selection of exact PTV values. In addition, there is a lack of comparative research regarding the cost-benefit ratio of the different strategies: insertion of fiducial markers or electromagnetic transponders facilitates prostate gland localization but at a price of invasive procedure; frequent pre-treatment imaging increases patient in-room time, dose and labour; online plan adaptation should improve radiation delivery accuracy but requires fast and precise computation. Finally, optimal protocols for quality assurance procedures need to be established.
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Affiliation(s)
- Slav Yartsev
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
| | - Glenn Bauman
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
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20
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Repka MC, Guleria S, Cyr RA, Yung TM, Koneru H, Chen LN, Lei S, Collins BT, Krishnan P, Suy S, Dritschilo A, Lynch J, Collins SP. Acute Urinary Morbidity Following Stereotactic Body Radiation Therapy for Prostate Cancer with Prophylactic Alpha-Adrenergic Antagonist and Urethral Dose Reduction. Front Oncol 2016; 6:122. [PMID: 27242962 PMCID: PMC4870496 DOI: 10.3389/fonc.2016.00122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to the adjacent critical organs. Large fraction sizes may increase urinary morbidity due to unavoidable treatment of the prostatic urethra. This study reports rates of acute urinary morbidity following SBRT for localized prostate cancer with prophylactic alpha-adrenergic antagonist utilization and urethral dose reduction (UDR). METHODS From April 2013 to September 2014, 102 patients with clinically localized prostate cancer were treated with robotic SBRT to a total dose of 35-36.25 Gy in five fractions. UDR was employed to limit the maximum point dose of the prostatic urethra to 40 Gy. Prophylactic alpha-adrenergic antagonists were initiated 5 days prior to SBRT and continued until resolution of urinary symptoms. Quality of life (QoL) was assessed before and after treatment using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite-26 (EPIC-26). Clinical significance was assessed using a minimally important difference (MID) of one half SD change from baseline. RESULTS One hundred two patients underwent definitive prostate SBRT with UDR and were followed for 3 months. No patient experienced acute urinary retention requiring catheterization. A mean baseline AUA symptom score of 9.06 significantly increased to 11.83 1-week post-SBRT (p = 0.0024) and 11.84 1-month post-SBRT (p = 0.0023) but returned to baseline by 3 months. A mean baseline EPIC-26 irritative/obstructive score of 87.7 decreased to 74.1 1-week post-SBRT (p < 0.0001) and 77.8 1-month post-SBRT (p < 0.0001) but returned to baseline at 3 months. EPIC-26 irritative/obstructive score changes were clinically significant, exceeding the MID of 6.0. At baseline, 8.9% of men described their urinary function as a moderate to big problem, and that proportion increased to 37.6% 1 week following completion of SBRT before returning to baseline by 3 months. CONCLUSION Stereotactic body radiation therapy for localized prostate cancer with utilization of prophylactic alpha-adrenergic antagonist and UDR was well tolerated as determined by acute urinary function and bother, and symptoms were comparable to those observed following conventionally fractionated external beam radiation therapy (EBRT). Longer follow-up is required to assess long-term toxicity and efficacy following SBRT with UDR.
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Affiliation(s)
- Michael C. Repka
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shan Guleria
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Robyn A. Cyr
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Thomas M. Yung
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Harsha Koneru
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Leonard N. Chen
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Pranay Krishnan
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John Lynch
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sean P. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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21
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Oderda M, Gontero P. Comment on: Radiation Dose to the Penile Structures and Patient-Reported Sexual Dysfunction in Long-Term Prostate Cancer Survivors. J Sex Med 2015; 12:2398-9 discussion 2400. [DOI: 10.1111/jsm.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Influence of Intensity-Modulated Radiation Therapy on the Life Quality of Patients with Nasopharyngeal Carcinoma. Cell Biochem Biophys 2015; 73:731-6. [DOI: 10.1007/s12013-015-0638-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Ballhausen H, Li M, Hegemann NS, Ganswindt U, Belka C. Intra-fraction motion of the prostate is a random walk. Phys Med Biol 2014; 60:549-63. [DOI: 10.1088/0031-9155/60/2/549] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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