scholarly journals Impact on Late Toxicity of using Transabdominal Ultrasound for Prostate Cancer Patients Treated with Intensity Modulated Radiotherapy

2005 ◽  
Vol 4 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Ashesh B. Jani ◽  
John Gratzle ◽  
Emil Muresan ◽  
Mary K. Martel
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
External Beam Radiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Late Toxicity ◽  
Institutional Setting ◽  
Regression Analyses ◽  
Intensity Modulated ◽  
Gu Toxicity ◽  
Gi Toxicity

An analysis of the effects of using the B-mode ultrasound Acquisition and Targeting (BAT) system for positioning of prostate cancer patients receiving external beam radiotherapy (EBRT) on late gastrointestinal (GI) and genitourinary (GU) toxicity is provided. The records of 49 consecutive patients treated using the BAT were reviewed; additionally, a comparison (No-BAT) group treated in a similar manner was identified, consisting of 49 patients treated immediately prior to this BAT group. There were no other fundamental differences between the two groups. The daily BAT movements were charted and late toxicity was scored for all patients using established toxicity scales. The results demonstrated similar GU toxicity rates between the two groups, but slightly lower rates of GI toxicity in the BAT group vs. the No-BAT group. However, regression analyses revealed that no factors, including BAT use, were significantly correlated with late GI or GU toxicity. Further efforts, perhaps better undertaken in a multi-institutional setting, are needed to determine whether BAT use can significantly reduce late GI toxicity.

scholarly journals Magnetic resonance image-guided adaptive stereotactic body radiotherapy for prostate cancer: preliminary results of outcome and toxicity

2021 ◽  
Vol 94 (1117) ◽  
pp. 20200696
Author(s):  
Gamze Ugurluer ◽  
Banu Atalar ◽  
Teuta Zoto Mustafayev ◽  
Gorkem Gungor ◽  
Gokhan Aydin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Late Toxicity ◽  
Toxicity Profile ◽  
Adaptive Planning ◽  
Gu Toxicity ◽  
Psa Response ◽  
Gi Toxicity ◽  
Real Time Tracking

Objective: Using moderate or ultra-hypofractionation, which is also known as stereotactic body radiotherapy (SBRT) for treatment of localized prostate cancer patients has been increased. We present our preliminary results on the clinical utilization of MRI-guided adaptive radiotherapy (MRgRT) for prostate cancer patients with the workflow, dosimetric parameters, toxicities and prostate-specific antigen (PSA) response. Methods: 50 prostate cancer patients treated with ultra-hypofractionation were included in the study. Treatment was performed with intensity-modulated radiation therapy (step and shoot) technique and daily plan adaptation using MRgRT. The SBRT consisted of 36.25 Gy in 5 fractions with a 7.25 Gy fraction size. The time for workflow steps was documented. Patients were followed for the acute and late toxicities and PSA response. Results: The median follow-up for our cohort was 10 months (range between 3 and 29 months). The median age was 73.5 years (range between 50 and 84 years). MRgRT was well tolerated by all patients. Acute genitourinary (GU) toxicity rate of Grade 1 and Grade 2 was 28 and 36%, respectively. Only 6% of patients had acute Grade 1 gastrointestinal (GI) toxicity and there was no Grade ≥ 2 GI toxicity. To date, late Grade 1 GU toxicity was experienced by 24% of patients, 2% of patients experienced Grade 2 GU toxicity and 6% of patients reported Grade 2 GI toxicity. Due to the short follow-up, PSA nadir has not been reached yet in our cohort. Conclusion: In conclusion, MRgRT represents a new method for delivering SBRT with markerless soft tissue visualization, online adaptive planning and real-time tracking. Our study suggests that ultra-hypofractionation has an acceptable acute and very low late toxicity profile. Advances in knowledge: MRgRT represents a new markerless method for delivering SBRT for localized prostate cancer providing online adaptive planning and real-time tracking and acute and late toxicity profile is acceptable.

scholarly journals Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Salvina Barra ◽  
Stefano Vagge ◽  
Michela Marcenaro ◽  
Gladys Blandino ◽  
Giorgia Timon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Helical Tomotherapy ◽  
Late Toxicity ◽  
Conformal Radiotherapy ◽  
Conventional Fractionation ◽  
Gu Toxicity ◽  
Gi Toxicity ◽  
Low Toxicity ◽  
Primary Radiotherapy

Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT) of prostate cancer as well as the value of the nadir PSA (nPSA) and time to nadir PSA (tnPSA) as surrogate efficacy of treatment.Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT). A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy.Results. Most of patients (83%) did not develop acute gastrointestinal (GI) toxicity and 50% did not present genitourinary (GU) toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL) of the conventionally treated cohort (P=0.02).Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.

Trade-off between the conflicting planning goals in correlation with patient’s anatomical parameters for intensity-modulated radiotherapy of prostate cancer patients

2019 ◽  
Vol 18 (03) ◽  
pp. 232-238 ◽  
Author(s):  
Amin Banaei ◽  
Bijan Hashemi ◽  
Mohsen Bakhshandeh ◽  
Bahram Mofid
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Intensity Modulated Radiotherapy ◽  
Normal Tissue Complication Probability ◽  
Target Dose ◽  
Trade Off ◽  
Intensity Modulated ◽  
Dose Constraints ◽  
Anatomical Parameters

AbstractAimTo quantify the relationship between the planning target volume (PTV) dose homogeneity and organs at risk (OARs) sparing in correlation with anatomical parameters in prostate intensity-modulated radiotherapy (IMRT).Materials and methodsNine IMRT plans with various target dose constraints’ priorities were created for 15 prostate cancer patients. Selected PTV and OARs parameters were calculated for the patients. A trade-off was assessed between homogeneity index (HI) and OAR sparing. Several anatomical parameters were evaluated to investigate their effects on the OAR sparing and HI.ResultsInverse exponential relationships were found between the OAR sparing and HI (average R 2 of 0·983 and 0·994 for bladder and rectum, respectively). Decreasing the priority led to more OARs sparing (normal tissue complication probability reduction: 97·6 and 74·5%; mean dose reduction: 16·3 and 11·3% for bladder and rectum, respectively) and worsening of the HI (0·095–0·322) but with no significant effect on tumour control probability. Furthermore, OARs volumes, distances between OARs and PTV and their joint volumes had stronger correlations with OARs’ mean doses.ConclusionEnforcement of target dose constraints was more effective on the improvement of HIs for the patients with initial high HI values at low dose constraints’ priorities. Reducing the priority had more effects on the OARs sparing compared to HI, especially for the patients with high OAR doses in high priority plans. This can be attributed to smaller distances or greater joint volumes between the OARs and PTV.

The influence of daily localization during treatment of prostate cancer on acute toxicity.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 214-214
Author(s):  
Peter john Rossi ◽  
Sherrie Cooper ◽  
Ashesh B. Jani
Keyword(s):  
Prostate Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Definitive Treatment ◽  
Gleason Grade ◽  
Ordered Logit ◽  
Chi Square ◽  
Logit Regression ◽  
Gu Toxicity ◽  
Gi Toxicity ◽  
The Impact

214 Background: Various localization techniques are used in clinical practice but little comparative effectivess data exists. The purpose of this investigation is to assess the impact of daily localization (L) of the prostate on toxicity during definitive treatment of prostate cancer with intensity modulated radiotherapy (IMRT). Methods: This study details an IRB approved retrospective review of three cohorts of patients treated for prostate cancer utilizing IMRT and different L technologies at four academic hospitals. Patients were treated with no technique (N), gold markers (G), or electromagnetic beacons [Calypso] (C) for daily L. Acute genitourinary (GU) and gastrointestinal (GI) toxicity was assessed according to RTOG toxicity criteria; toxicity rates between the groups were compared using the chi-square test. Ordered logit regression of all major demographic (age, race), disease (PSA, Gleason grade, and T-stage) and treatment (hormones, pelvic nodal treatment, total dose, and prior TURP) characteristics on GU and on GI toxicity were performed. Results: One hundred fifty four men who received definitive dose escalated IMRT (no brachytherapy or post-prostatectomy patients) for prostate cancer from 2006 to 2010 and were included (G: n=47; C: n=47; N: n=60). The cohorts were balanced except race (higher percentage of African Americans in the N group, due to hospital demographics) and higher grade and use of pelvic nodal treatment (which were more common in the G and C groups). Bladder V40 and V70 were higher in the N group (45.4%/24.3%) compared to C (27.9%/12.3%) and G (37.4%/18.4%) groups; however, rectal V40 and V70 were similar among all 3 groups. Toxicity results are shown in the Table; as shown the C and G groups had lower GU toxicity (p <0.001) respectively compared to the N group; no significant differences in GI toxicity were seen among the 3 groups. Ordered logit regression showed only daily L (p=0.041) reached significance in lowering GU toxicity, and only pelvic RT use (p =0.008) reached significance in increasing GI toxicity. Conclusions: In patients treated with IMRT, daily L was associated with lower acute GU toxicity but not acute GI toxicity.

Phase I/II study of hypofractionated intensity modulated radiotherapy (IMRT) for prostate cancer including simultaneously integrated boost (SIB).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 67-67
Author(s):  
Michael G. Chang ◽  
Siddharth Saraiya ◽  
Nitai Mukhopadhyay ◽  
Mitchell Anscher
Keyword(s):  
Prostate Cancer ◽  
Phase I ◽  
Prospective Trial ◽  
Intensity Modulated Radiotherapy ◽  
Chi Square ◽  
Gu Toxicity ◽  
Integrated Boost ◽  
Chi Square Test ◽  
Gi Toxicity ◽  
Moderate Hypofractionation

67 Background: The purpose of this study is to evaluate the toxicity of hypofractionationed H- IMRT treatment including SIB IMRT when pelvic nodes were covered. Additionally, we assessed early treatment efficacy through PSA control (biochemical failure defined as PSA more than nadir + 2 ng/mL). Methods: Men with localized prostate cancer were enrolled in a phase I/II trial to receive H-IMRT to the prostate, seminal vesicles)(SV) and pelvic lymph nodes (LN) using simultaneous integrated boost (SIB) method. Low risk (LR) patients received 69.4 Gy to the prostate only in 29 fractions. The intermediate (IR) and high risk (HR) patients received 72 Gy to the prostate, 54 Gy to the proximal 1 cm SV, and 50.4 Gy to the pelvic LN when risk of LN involvement >15% by Roach formula. Treatment was given in 30 fractions using intraprostatic fiducials and daily image guidance. PTV expansion for prostate and SV was 0.3 mm posteriorly and 0.7 cm in all other directions. The IR and HR patients received androgen deprivation therapy (3 years for HR patients, and 6 months for IR patients). Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively evaluated according to CTCAE v3.0. Results: 55 men (29 African American and 26 white) were enrolled on trial with 20% LR, 41% IR and 39% HR disease (NCCN criteria). The median age was 55 with median follow-up time of 37.9 months. 26 patients received pelvic nodal SIB-IMRT. Toxicity is reported in the table. The biochemical control rate for the cohort was 91% at 3 years. Patients with pelvic LN IMRT experienced grade 2+ acute GI toxicity 38% vs 21% in the non-nodal IMRT group. (p= 0.25 by chi-square test). Conclusions: Hypofractionated SIB-IMRT can be delivered safely. Late grade III GI and GU toxicity for our cohort were 0% and 3.6% respectively. Our prospective trial shows acceptable toxicity with moderate hypofractionation in treating prostate cancer while maintaining good PSA control. Clinical trial information: NCT01117935. [Table: see text]

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