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Laughlin BS, Silva AC, Vora SA, Keole SR, Wong WW, Schild MH, Schild SE. Long-term outcomes of prostate intensity-modulated radiation therapy incorporating a simultaneous intra-prostatic MRI-directed boost. Front Oncol 2022; 12:921465. [PMID: 36033460 PMCID: PMC9399820 DOI: 10.3389/fonc.2022.921465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose/objectives This retrospective study demonstrates the long-term outcomes of treating prostate cancer using intensity modulated (IMRT) with incorporation of MRI-directed boost. Materials/methods From February 2009 to February 2013, 78 men received image-guided IMRT delivering 77.4 Gy in 44 fractions with simultaneously integrated boost to 81–83 Gy to an MRI-identified lesion. Patients with intermediate-risk or high-risk prostate cancer were recommended to receive 6 and 24–36 months of adjuvant hormonal therapy, respectively. Results Median follow-up was 113 months (11–147). There were 18 low-risk, 43 intermediate-risk, and 17 high-risk patients per NCCN risk stratification included in this study. Adjuvant hormonal therapy was utilized in 32 patients (41%). The 10-year biochemical control rate for all patients was 77%. The 10-year biochemical control rates for low-risk, intermediate-risk, and high-risk diseases were 94%, 81%, and 88%, respectively (p = 0.35). The 10-year rates of local control, distant control, and survival were 99%, 88%, and 66%, respectively. Of 25 patients who died, only four (5%) died of prostate cancer. On univariate analysis, T-category and pretreatment PSA level were associated with distant failure rate (p = 0.02). There was no grade =3 genitourinary and gastrointestinal toxicities that persisted at the last follow-up. Conclusions This study demonstrated the long-term efficacy of using MRI to define an intra-prostatic lesion for SIB to 81–83Gy while treating the entire prostate gland to 77.4 Gy with IMRT. Our study confirms that modern MRI can be used to locally intensify dose to prostate tumors providing high long-term disease control while maintaining favorable long-term toxicity.
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Affiliation(s)
- Brady S. Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Alvin C. Silva
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Sujay A. Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | | | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
- *Correspondence: Steven E. Schild,
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Kahokehr AA, Boysen WR, Schild MH, Nosé BD, Huang J, Eward W, Peterson AC. Urinary Pubic Symphysis Fistula Leads to Histopathologic Osteomyelitis in Prostate Cancer Survivors. Urology 2020; 148:297-301. [PMID: 32763316 DOI: 10.1016/j.urology.2020.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the histologic findings in the pubic bone resected during extirpative surgery for urinary pubic symphysis fistula (UPF). The concurrent presence of osteomyelitis and the need for bone resection at time of extirpative surgery for UPF has been debated. We hypothesized that UPF results in histopathologically confirmed osteomyelitis, underscoring the importance of bone resection at the time of surgery. METHODS An IRB-approved retrospective review of all patients undergoing surgery for UPF from 2012 to 2019 was performed. Demographic data were recorded. A single pathologist performed histopathologic examination of bone tissue in each case. Logistic regression and Fisher exact test were used to assess association of osteomyelitis with clinical factors. RESULTS We identified 36 patients who underwent major extirpative surgery for UPF with bone pathology available for review. Bone histopathology findings confirmed presence of osteomyelitis in the majority (n = 32, 88.9%). This was characterized as chronic osteomyelitis in 15 (41.7%), acute osteomyelitis only in 1 (2.8%) and combined chronic, and acute osteomyelitis in 16 (44.4%). Osteonecrosis was seen in 11 cases (33.6%). There was no correlation between presence of osteomyelitis and age, timing from radiotherapy to diagnosis of UPF, type of radiotherapy, or history of endoscopic bladder outlet procedures. CONCLUSION Osteomyelitis is present on histology of the pubic bone resected during surgery for UPF in the majority of cases (88.9%). Osteonecrosis is also common. These findings underscore the critical importance of pubic bone resection at time of UPF surgery to adequately treat the diseased bone.
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Affiliation(s)
| | - William R Boysen
- Division of Urology, Duke University Medical Center, Durham, NC.
| | | | - Brent D Nosé
- Division of Urology, Duke University Medical Center, Durham, NC
| | - Jiaoti Huang
- Division of Urology, Duke University Medical Center, Durham, NC
| | - Will Eward
- Division of Urology, Duke University Medical Center, Durham, NC
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Schild MH, Leckey BD, Coulas A, McCall S. Incidental urothelial rest within the vermiform appendix of a paediatric male patient: an extremely rare entity. BMJ Case Rep 2020; 13:13/1/e233530. [PMID: 31919071 DOI: 10.1136/bcr-2019-233530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Michael H Schild
- Pathology, Duke University Hospital, Durham, North Carolina, USA
| | - Bruce D Leckey
- Pathology, Duke University Hospital, Durham, North Carolina, USA
| | - Aubrey Coulas
- Pathology, Duke University Hospital, Durham, North Carolina, USA
| | - Shannon McCall
- Pathology, Duke University Hospital, Durham, North Carolina, USA
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Liu X, Li J, Schild SE, Schild MH, Wong W, Vora S, Herman MG, Fatyga M. Modeling of Acute Rectal Toxicity to Compare Two Patient Positioning Methods for Prostate Cancer Radiotherapy: Can Toxicity Modeling be Used for Quality Assurance? ACTA ACUST UNITED AC 2019; 7. [PMID: 30775161 PMCID: PMC6376967 DOI: 10.4172/2167-7964.1000302] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: Intensity Modulated Radiation Therapy (IMRT) allows for significant dose reductions to organs at risk in prostate cancer patients. However, the accurate delivery of IMRT plans can be compromised by patient positioning errors. The purpose of this study was to determine if the modeling of grade ≥ 2 acute rectal toxicity could be used to monitor the quality of IMRT protocols. Materials and Methods: 79 patients treated with Image and Fiducial Markers Guided IMRT (FMIGRT) and 302 patients treated with trans-abdominal ultrasound guided IMRT (USGRT) was selected for this study. Treatment plans were available for the FMIGRT group, and hand recorded dosimetric indices were available for both groups. We modeled toxicity in the FMIGRT group using the Lyman Kutcher Burman (LKB) and Univariate Logistic Regression (ULR) models, and we modeled toxicity in USGRT group using the ULR model. We performed Receiver Operating Characteristics (ROC) analysis on all of the models and compared the Area under the ROC curve (AUC) for the FMIGRT and the USGRT groups. Results: The observed Incidence of grade ≥ 2 rectal toxicity was 20% in FMIGRT patients and 54% in USGRT patients. LKB model parameters in the FMIGRT group were TD50=56.8 Gy, slope m=0.093, and exponent n=0.131. The most predictive indices in the ULR model for the FMIGRT group were D25% and V50 Gy. AUC for both models in the FMIGRT group was similar (AUC=0.67). The FMIGRT URL model predicted less than a 37% incidence of grade ≥ 2 acute rectal toxicity in the USGRT group. A fit of the ULR model to USGRT data did not yield a predictive model (AUC=0.5). Conclusion: Modeling of acute rectal toxicity provided a quantitative measure of the correlation between planning dosimetry and this clinical endpoint. Our study suggests that an unusually weak correlation may indicate a persistent patient positioning error.
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Affiliation(s)
- X Liu
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - J Li
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M H Schild
- Department of Pathology, Duke University School of Medicine, USA
| | - W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - S Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M G Herman
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a major health concern and the prevalence continues to increase in many industrialized and developing countries around the world. NAFLD affects adults and children. NAFLD-related cirrhosis is expected to become the top indication for liver transplantation in the near future, and the incidence of NAFLD-related hepatocellular carcinoma is also increasing. Nonalcoholic steatohepatitis is the more severe form of NAFLD. The pathogenesis of NALFD/nonalcoholic steatohepatitis is complex and new concepts continue to evolve. The diagnosis and categorization of nonalcoholic steatohepatitis currently rests on hepatopathologists. Accurate morphologic interpretation is important for therapeutic, prognostic, and investigational purposes.
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Affiliation(s)
- Michael H Schild
- Department of Pathology, Duke University, DUHS, Box 3912, Durham, NC 27710, USA
| | - Cynthia D Guy
- Department of Pathology, Duke University, DUHS, Box 3912, Durham, NC 27710, USA.
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Schild SE, Schild MH, Wong WW, Vora SA, Keole SR, Vargas CE, Daniels TB, Ezzell GA, Nguyen BE, Roarke MC. (S018) A Prospective Trial of Intensity-Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer: Long-Term Outcomes Compared With Standard Image-Guided IMRT. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.054] [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: 10/19/2022]
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Liu X, Li J, Schild SE, Schild MH, Wong W, Vora S, Herman MG, Fatyga M. Statins and Metformin Use Is Associated with Lower PSA Levels in Prostate Cancer Patients Presenting for Radiation Therapy. ACTA ACUST UNITED AC 2017; 8:73-85. [PMID: 28239505 PMCID: PMC5325211 DOI: 10.4236/jct.2017.82007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background A possible association between the level of prostate specific antigen (PSA) and the use of some commonly prescribed medications has been reported in recent studies. Most of these studies were carried out in general populations of men who were screened for prostate cancer using the PSA test. We reported on the association between the initial PSA level and the use of statins, metformin and alpha-blockers in patients who were diagnosed with prostate cancer and presented for radiation therapy. Methods Three hundred and eighty one patients treated between the years of 2000-2005 and 2009-2012 were included in this retrospective study. The information about statin, metformin and alpha-blockers use was recorded immediately prior to treatment. Differences in PSA levels prior to treatment by medication status were estimated using univa-riate and multivariate linear regression on log PSA values. Results Compared with men who were not on these medications, the PSA level at presentation was 20% lower for statin users (p = 0.002) and 33% lower for metformin users (p = 0.004). We did not observe statistically significant associations between the use of statins or metformin and cancer stage, National Comprehensive Cancer Network (NCCN) risk score, or therapy outcome. A statistically significant association between the NCCN risk score and the use of alpha-blockers was observed (p = 0.002). Conclusions We found that statins and metformin were associated with lower PSA levels in prostate cancer patients to an extent that could influence management decisions. We found no statistically significant associations between the use of these medications and treatment outcomes.
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Affiliation(s)
- Xiaonan Liu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Jing Li
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Michael H Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sujay Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, AZ, USA
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Liu X, Li J, Wu T, Schild SE, Schild MH, Wong W, Vora S, Fatyga M. Patient Specific Characteristics Are an Important Factor That Determines the Risk of Acute Grade ≥ 2 Rectal Toxicity in Patients Treated for Prostate Cancer with IMRT and Daily Image Guidance Based on Implanted Gold Markers. ACTA ACUST UNITED AC 2016; 5. [PMID: 27478689 PMCID: PMC4966533 DOI: 10.4172/2167-7964.1000225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To model acute rectal toxicity in Intensity Modulated Radiation Therapy (IMRT) for prostate cancer using dosimetry and patient specific characteristics. METHODS A database of 79 prostate cancer patients treated with image guided IMRT was used to fit parameters of Lyman-Kutcher-Burman (LKB) and logistic regression Normal Tissue Complications Probability (NTCP) models to acute grade ≥ 2 rectal toxicities. We used a univariate regression model to find the dosimetric index which was most correlated with toxicity and a multivariate logistic regression model with machine learning algorithm to integrate dosimetry with patient specific characteristics. We used Receiver Operating Characteristics (ROC) analysis and the area under the ROC curve (AUC) to quantify the predictive power of models. RESULTS Sixteen patients (20.3%) developed acute grade≥2 rectal toxicity. Our best estimate (95% confidence interval) of LKB model parameters for acute rectal toxicity are exponent n=0.13 (0.1-0.16), slope m=0.09 (0.08-0.11), and threshold dose TD50=56.8 (53.7-59.9) Gy. The best dosimetric indices in the univariate logistic regression NTCP model were D25% and V50Gy. The best AUC of dosimetry only modeling was 0.67 (0.54, 0.8). In the multivariate logistic regression two patient specific variables were particularly strongly correlated with acute rectal toxicity, the use of statin drugs and PSA level prior to IMRT, while two additional variables, age and diabetes were weakly correlated. The AUC of the logistic regression NTCP model improved to 0.88 (0.8, 0.96) when patient specific characteristics were included. In a group of 79 patients, 40 took Statins and 39 did not. Among patients who took statins, (4/40)=10% developed acute grade ≥2 rectal toxicity, compared to (12/39)=30.8% who did not take statins (p=0.03). The average and standard deviation of PSA distribution for patients with acute rectal toxicity was PSAtox = 5.77 ± 2.27 and it was PSAnotox = 9.5 ± 7.8 for the remainder (p=0.01). CONCLUSIONS Patient specific characteristics strongly influence the likelihood of acute grade ≥ 2 rectal toxicity in radiation therapy for prostate cancer.
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Affiliation(s)
- Xiaonan Liu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe Arizona, USA
| | - Jing Li
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe Arizona, USA
| | - Teresa Wu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe Arizona, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix Arizona, USA
| | - Michael H Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix Arizona, USA
| | - William Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix Arizona, USA
| | - Sujay Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix Arizona, USA
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix Arizona, USA
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Kaleem TA, Schild MH, Miller D, Jha A, Cortese C, Attia S, Miller RC. Langerhan's Cell Sarcoma: Two Case Reports. Rare Tumors 2016; 8:6140. [PMID: 27134713 PMCID: PMC4827650 DOI: 10.4081/rt.2016.6140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/10/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
Langerhan’s cell sarcoma (LCS) is a rare neoplasm with a poor prognosis. To our knowledge, only sixty-six cases have been published. We discuss two patients who presented very differently with LCS, as well as a recently published review of all sixty-six cases. Our first case had a complicated history of metastatic, high-grade myxofibrosarcomas and presented with a single skin lesion of LCS which was treated with resection to a positive margin and adjuvant radiotherapy. The LCS recurred locoregionally and was again resected. The patient is alive two years after initial diagnosis. The second case presented with bone marrow and splenic involvement, leukocytosis, and thrombocytopenia. This patient had an excellent response to etoposide, prednisone, oncovorin, cyclophosphamide, and adriamycin, with normalization of the complete blood count, negative bone marrow biopsy at follow up, and splenectomy without viable neoplasm. This patient is alive without signs of disease at 16 months after initial diagnosis.
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Affiliation(s)
- Tasneem A Kaleem
- Department of Radiation Oncology, Mayo Clinic Florida , Jacksonville, FL, USA
| | - Michael H Schild
- Department of Radiation Oncology, Mayo Clinic Florida , Jacksonville, FL, USA
| | - Daniel Miller
- Department of Radiation Oncology, Mayo Clinic Florida , Jacksonville, FL, USA
| | - Asit Jha
- Department of Oncology, Mayo Clinic Health System in Waycross , Waycross, GA, USA
| | - Cherise Cortese
- Department of Pathology, Mayo Clinic Florida , Jacksonville, FL, USA
| | - Steven Attia
- Department of Oncology, Mayo Clinic Florida , Jacksonville, FL, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic Florida , Jacksonville, FL, USA
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Schild MH, Wong WW, Valdez R, Leis JF. Primary pulmonary classical Hodgkin lymphoma: a case report. J Surg Oncol 2014; 110:341-4. [PMID: 24777934 DOI: 10.1002/jso.23624] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 03/22/2014] [Indexed: 11/07/2022]
Abstract
Primary pulmonary Hodgkin lymphoma (PPHL) is a rare entity. Most reported cases occurred before the availability of PET scan for accurate staging of the disease. We report a case of PPHL for which PET/CT scan was used and surgery was performed to confirm the diagnosis. A review of cases of PPHL since 1990 suggests that adjuvant chemotherapy and/or radiation therapy after surgical resection of the lung lesions achieve better disease control than surgical resection alone.
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Affiliation(s)
- Michael H Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
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11
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Schild MH, Schild SE, Wong WW, Vora SA, Silva AC, Silva AM, Daniels TB, Keole SR. Early Outcome of Prostate Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Intra-Prostatic MRI Directed Boost. ACTA ACUST UNITED AC 2014; 3. [PMID: 25717423 DOI: 10.4172/2167-7964.1000170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study assessed the feasibility and outcomes of treating prostate cancer with intensity modulated radiotherapy (IMRT) incorporating a Magnetic Resonance Imaging (MRI) directed boost. Seventy-eight men received IMRT for localized prostate cancer. The entire prostate received 77.4Gy in 43 fractions and simultaneous intra-prostatic boosts (SIB) of 83Gy were administered to increase the dose to the MRI identified malignancy. In 16 (21%) patients, the MRI didn't detect a neoplasm and these patients received an SIB of 81Gy to the posterior prostate. Androgen Deprivation Therapy (ADT) was also administered to 32 (41%) patients. The 3-year rates of biochemical control, local control, distant control, and survival were 92%, 98%, 95%, and 95% respectively. While grade 1-2 toxicities were common, there were only 2 patients who suffered grade 3 toxicity. These patients developed strictures which were dilated resulting in improvement in symptoms such that both had grade 1-2 toxicity at last follow up examination. The results of this program of IMRT incorporating a MRI directed intra-prostatic boost suggest this technique is feasible and well tolerated. This technique appears to shift the therapeutic index favorably by boosting the malignancy to the highest dose without increasing the doses administered to the bladder and rectum.
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Affiliation(s)
- Michael H Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Alvin C Silva
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Annelise M Silva
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Thomas B Daniels
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale 85259, USA
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Schild MH, Wong WW, Vora SA, Ward LD, Nguyen BD. Embolization of an iodine-125 radioactive seed from the prostate gland into the right ventricle: An unusual pattern of seed migration. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.11.008] [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: 10/21/2022]
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