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Fonteyne V, Berghen C, Van Praet C, Vanderstraeten B, Verbeke S, Villeirs G, Colman R, Vanneste B, Ost P, De Meerleer G, Lumen N. Moderate hypofractionated radiotherapy for prostate cancer: 3-year toxicity results of a multicentre randomized phase 3, non-inferiority trial. Radiother Oncol 2024; 193:110089. [PMID: 38278333 DOI: 10.1016/j.radonc.2024.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND PURPOSE Moderate hypofractionated radiotherapy (HFRT) is a standard treatment for prostate cancer patients. We compared 2 moderate HFRT regimens, with a biologically equivalent dose of 80 Gy in 2 Gy fractions, with a modest simultaneous integrated boost to the dominant intraprostatic lesion. MATERIAL AND METHODS This is a multicenter, non-inferiority, randomized phase 3 trial with acute toxicity as the primary endpoint, comparing: 56 Gy in 4 weeks (16x3.5 Gy, 4 days/week, Arm A) with 67 Gy in 5 weeks (25x2.68 Gy, 5 days/week, Arm B). The H0 hypothesis is that both regimens are equivalent in terms of acute grade ≥ 2 gastro-intestinal toxicity, defined as a difference in acute grade ≥ 2 gastro-intestinal toxicity of ≤ 10 %. Here we report on acute and late toxicity. RESULTS We included 170 patients in Arm A and 172 patients in Arm B. The median follow-up time for all patients was 42 months. Acute grade ≥ 2 gastrointestinal toxicity was reported by 24 % of patients in both groups. Acute grade 2 and 3 urinary toxicity was observed in 52 % and 9 % of patients in Arm A and 53 % and 7 % in Arm B. Late grade 2 and grade ≥ 3 gastrointestinal toxicity occurred in 19 % and 4 % of patients in Arm A compared with 15 % and 4 % in Arm B. Late grade 2 and grade ≥ 3 urinary toxicity was observed in 37 % and 10 % of patients in Arm A and 36 % and 6 % in Arm B. CONCLUSION This analysis confirms that both HFRT regimens are safe and equivalent in terms of acute grade ≥ 2 gastrointestinal toxicity.
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Affiliation(s)
- V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - C Berghen
- Department of Radiotherapy and Oncology, Leuven University Hospitals, Louvain, Belgium
| | - C Van Praet
- Department of Urology, ERN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - B Vanderstraeten
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - S Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - G Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - R Colman
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - B Vanneste
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - P Ost
- Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - G De Meerleer
- Department of Radiotherapy and Oncology, Leuven University Hospitals, Louvain, Belgium
| | - N Lumen
- Department of Urology, ERN Accredited Centre, Ghent University Hospital, Ghent, Belgium
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Vanderstraeten B, Johnston N, Ketelaars J. PO-1493 Comparison of CBCT Hounsfield Unit to density conversion methods for treatment plan evaluation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Johnston N, De Rycke J, Lievens Y, Vanderstraeten B. PO-1652 Clinical evaluation of deep learning for auto-segmentation of CT images in RT for lung cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Paelinck L, Wuyts E, Vanderstraeten B, De Wagter C, Lievens Y. EP-1732 The effect of different table top models on patient-specific QA. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vanderstraeten B, Goddeeris B, Derie C, Vandecasteele K, Van Eijkeren M, Paelinck L, De Wagter C, Lievens Y. OC-0079: Automated instead of manual planning for lung SBRT? Aplan comparison based on dose-volume statistics. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paelinck L, Vanderstraeten B, Srivastava R, Olteanu L, De Wagter C. EP-1524: The effect of the table top modeling on calculations and measurements for the Delta4 phantom. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vanderstraeten B, Veldeman L, Dhondt R, De Wagter C, Lievens Y. Implementation and Clinical Evaluation of Automated Planning for IMRT Treatment of Breast Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pittomvils G, Olteanu L, Vanderstraeten B, De Wagter C, Lievens Y. EP-1422: Influence of the grid size on the dosimetric characteristics of IMRT beams and on overall treatment plans. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goddeeris B, Vanderstraeten B, Vandecasteele K, Van Eijkeren M, Derie C, De Wagter C, Lievens Y. PO-1098 Automated planning for lung SBRT: faster optimization without compromise on plan quality. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41090-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vanderstraeten B, Berwouts D, Goddeeris B, Duprez F, De Neve W, Lievens Y. Adaptive Intensity-Modulated Radiation Therapy for Head and Neck Cancer: Is it Affordable? Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Van den Berghe L, Vanderstraeten B, Veldeman L, Flamée N, Lievens Y. PO-0701: From supine to prone breast radiotherapy: an unaffordable cost? Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vanderstraeten B, Verstraete J, De Croock R, De Neve W, Lievens Y. PD-0372: The cost of hadron therapy in Belgium: Comparison of a business model with activity-based costing. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Smedt B, Vanderstraeten B, Reynaert N, De Neve W, Thierens H. 326 The effect of geometrical and scoring voxel dimensions on accuracy and efficacy of Monte Carlo dose calculations for IMRT. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Smedt B, Vanderstraeten B, Reynaert N, De Neve W, Thierens H. Investigation of geometrical and scoring grid resolution for Monte Carlo dose calculations for IMRT. Phys Med Biol 2005; 50:4005-19. [PMID: 16177526 DOI: 10.1088/0031-9155/50/17/006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Monte Carlo based treatment planning of two different patient groups treated with step-and-shoot IMRT (head-and-neck and lung treatments) with different CT resolutions and scoring methods is performed to determine the effect of geometrical and scoring voxel sizes on DVHs and calculation times. Dose scoring is performed in two different ways: directly into geometrical voxels (or in a number of grouped geometrical voxels) or into scoring voxels defined by a separate scoring grid superimposed on the geometrical grid. For the head-and-neck cancer patients, more than 2% difference is noted in the right optical nerve when using voxel dimensions of 4 x 4 x 4 mm3 compared to the reference calculation with 1 x 1 x 2 mm3 voxel dimensions. For the lung cancer patients, 2% difference is noted in the spinal cord when using voxel dimensions of 4 x 4 x 10 mm3 compared to the 1 x 1 x 5 mm3 calculation. An independent scoring grid introduces several advantages. In cases where a relatively high geometrical resolution is required and where the scoring resolution is less important, the number of scoring voxels can be limited while maintaining a high geometrical resolution. This can be achieved either by grouping several geometrical voxels together into scoring voxels or by superimposing a separate scoring grid of spherical voxels with a user-defined radius on the geometrical grid. For the studied lung cancer cases, both methods produce accurate results and introduce a speed increase by a factor of 10-36. In cases where a low geometrical resolution is allowed, but where a high scoring resolution is required, superimposing a separate scoring grid on the geometrical grid allows a reduction in geometrical voxels while maintaining a high scoring resolution. For the studied head-and-neck cancer cases, calculations performed with a geometrical resolution of 2 x 2 x 2 mm3 and a separate scoring grid containing spherical scoring voxels with a radius of 2 mm produce accurate results and introduce a speed increase by a factor of 13. The scoring grid provides an additional degree of freedom for limiting calculation time and memory requirements by selecting optimized scoring and geometrical voxel dimensions in an independent way.
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Affiliation(s)
- B De Smedt
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium
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Reynaert N, Coghe M, De Smedt B, Paelinck L, Vanderstraeten B, De Gersem W, Van Duyse B, De Wagter C, De Neve W, Thierens H. The importance of accurate linear accelerator head modelling for IMRT Monte Carlo calculations. Phys Med Biol 2005; 50:831-46. [PMID: 15798258 DOI: 10.1088/0031-9155/50/5/008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Two Monte Carlo dose engines for radiotherapy treatment planning, namely a beta release of Peregrine and MCDE (Monte Carlo dose engine), were compared with Helax-TMS (collapsed cone superposition convolution) for a head and neck patient for the Elekta SLi plus linear accelerator. Deviations between the beta release of Peregrine and MCDE up to 10% were obtained in the dose volume histogram of the optical chiasm. It was illustrated that the differences are not caused by the particle transport in the patient, but by the modelling of the Elekta SLi plus accelerator head and more specifically the multileaf collimator (MLC). In MCDE two MLC modules (MLCQ and MLCE) were introduced to study the influence of the tongue-and-groove geometry, leaf bank tilt and leakage on the actual dose volume histograms. Differences in integral dose in the optical chiasm up to 3% between the two modules have been obtained. For single small offset beams though the FWHM of lateral profiles obtained with MLCE can differ by more than 1.5 mm from profiles obtained with MLCQ. Therefore, and because the recent version of MLCE is as fast as MLCQ, we advise to use MLCE for modelling the Elekta MLC. Nevertheless there still remains a large difference (up to 10%) between Peregrine and MCDE. By studying small offset beams we have shown that the profiles obtained with Peregrine are shifted, too wide and too flat compared with MCDE and phantom measurements. The overestimated integral doses for small beam segments explain the deviations observed in the dose volume histograms. The Helax-TMS results are in better agreement with MCDE, although deviations exceeding 5% have been observed in the optical chiasm. Monte Carlo dose deviations of more than 10% as found with Peregrine are unacceptable as an influence on the clinical outcome is possible and as the purpose of Monte Carlo treatment planning is to obtain an accuracy of 2%. We would like to emphasize that only the Elekta MLC has been tested in this work, so it is certainly possible that alpha releases of Peregrine provide more accurate results for other accelerators.
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Affiliation(s)
- N Reynaert
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium
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Goethals M, Vanderstraeten B, Berghmans J, De Smedt G, Vliegen S, Van't Oost E. Experimental study of the flammability limits of toluene-air mixtures at elevated pressure and temperature. J Hazard Mater 1999; 70:93-104. [PMID: 10631350 DOI: 10.1016/s0304-3894(99)00164-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The flammability limits of toluene-air mixtures are experimentally determined at pressures up to 500 kPa and temperatures up to 250 degrees C in a closed spherical vessel. The results at atmospheric pressure are compared with the results obtained in a glass tube. The flammability limits depend linearly upon temperature. A twilight zone characterized by weak pressure rises is observed for toluene at all pressures, while soot is formed at elevated pressures only. The explosion characteristics of toluene are compared with those of methane. Despite their chemical differences, the explosion characteristics of toluene and methane are similar.
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Affiliation(s)
- M Goethals
- K.U. Leuven, Department of Mechanical Engineering Celestijnenlaan 300A, B-3001 Leuven-Heverlee, Belgium
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