scholarly journals Dosimetric Impact of Inter-Fraction Anatomical Changes in Carbon Ion Boost Treatment for High-Risk Prostate Cancer (AIRC IG 14300)

2021 ◽  
Vol 11 ◽  
Author(s):  
Stefania Russo ◽  
Rosalinda Ricotti ◽  
Silvia Molinelli ◽  
Filippo Patti ◽  
Amelia Barcellini ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
High Risk ◽  
Dose Distribution ◽  
Organs At Risk ◽  
Particle Therapy ◽  
Image Guided Radiotherapy ◽  
Carbon Ion ◽  
Significant Difference ◽  
Mixed Beam

Rectum and bladder volumes play an important role in the dose distribution reproducibility in prostate cancer adenocarcinoma (PCa) radiotherapy, especially for particle therapy, where density variation can strongly affect the dose distribution. We investigated the reliability and reproducibility of our image-guided radiotherapy (IGRT) and treatment planning protocol for carbon ion radiotherapy (CIRT) within the phase II mixed beam study (AIRC IG 14300) for the treatment of high-risk PCa. In order to calculate the daily dose distribution, a set of synthetic computed tomography (sCT) images was generated from the cone beam computed tomography (CBCT) images acquired in each treatment session. Planning target volume (PTV) together with rectum and bladder volume variation was evaluated with sCT dose-volume histogram (DVH) metric deviations from the planning values. The correlations between the bladder and rectum volumes, and the corresponding DVH metrics, were also assessed. No significant difference in the bladder, rectum, and PTV median volumes between the planning computed tomography (pCT) and the sCT was found. In addition, no significant difference was assessed when comparing the average DVHs and median DVH metrics between pCT and sCT. Dose deviations determined by bladder and rectum filling variations demonstrated that dose distributions were reproducible in terms of both target coverage and organs at risk (OARs) sparing.

A biopsy-based genomic classifier to predict biochemical failure after definitive radiation without hormone therapy in a prospective cohort of intermediate risk prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 68-68
Author(s):  
Melvin Chua ◽  
Jure Murgic ◽  
Ali Hosni ◽  
Adriana Salcedo ◽  
Suzanne Kamel-Reid ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Rna Extraction ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Image Guided Radiotherapy ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
Tumor Involvement

68 Background: Recently, NCCN adopted the Zumsteg-Spratt subclassification to define NCCN favorable and unfavorable intermediate-risk prostate cancer (IR-PCa). NCCN unfavorable disease is recommended to receive combination androgen deprivation therapy (ADT) and radiotherapy. To determine if genomics could help identify a subset who may safely avoid ADT, we evaluated the Decipher genomic classifier (GC) in IR-PCa treated with dose-escalated image-guided radiotherapy (DE-IGRT) alone. Methods: Our cohort comprised of 121 patients with NCCN favorable (N = 49, 40%) and unfavorable (N = 74, 60%) IR-PCa, who received 78 Gy without ADT. Diagnostic needle biopsies with the highest Gleason score (GS) and %tumor involvement were macrodissected for RNA extraction. GC scores were determined from the Decipher prostate cancer classifier assay (GenomeDx Biosciences, San Diego, CA). Primary clinical endpoint was biochemical relapse ([BCR], PSA nadir + 2ng/ml) post-DE-IGRT. We compared association with BCR against known clinicopathologic prognostic indices and the NCCN risk strata. Results: With a median follow up of 7.5y, 24 (19%) patients experienced BCR. Individual clinical indices did not predict BCR-free survival rate (BFS). NCCN risk strata was however associated with a small but significant difference in BFS (5-y 93%, favorable vs 88%, unfavourable, P = 0.046). GC scores stratified 85 (70%), 19 (16%), and 17 (14%) men into low, intermediate, and high risk of recurrence; 5-y BFS were 95%, 89%, and 59%, respectively (P < 0.001). On multivariable analysis, a hazard ratio of 4.71 (95% CI 1.81-12.28, P = 0.0015) for BCR was observed for the GC high risk group compared to low/intermediate; NCCN risk strata and intraductal variant did not achieve significance. Conclusions: In IR-PCa men treated with DE-IGRT monotherapy, Decipher GC was an independent predictor of BCR. While most men in this our cohort were stratified as NCCN unfavorable IR-PCa, the majority were GC low risk with excellent outcomes from DE-IGRT alone. In contrast, a minority with GC high risk had suboptimal outcomes, and may benefit from ADT intensification.

Phase II Multi-institutional Clinical Trial on a New Mixed Beam RT Scheme of IMRT on Pelvis Combined with a Carbon Ion Boost for High-risk Prostate Cancer Patients

2016 ◽  
Vol 103 (3) ◽  
pp. 314-318 ◽  
Author(s):  
Giulia Marvaso ◽  
Barbara A. Jereczek-Fossa ◽  
Barbara Vischioni ◽  
Delia Ciardo ◽  
Tommaso Giandini ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trial ◽  
High Risk ◽  
Phase Ii ◽  
Carbon Ions ◽  
Carbon Ion ◽  
High Risk Prostate Cancer ◽  
Mixed Beam ◽  
Risk Prostate Cancer

Purpose Definition of the optimal treatment schedule for high-risk prostate cancer is under debate. A combination of photon intensity modulated radiotherapy (IMRT) on pelvis with a carbon ion boost might be the optimal treatment scheme to escalate the dose on prostate and deliver curative dose with respect to normal tissue and quality of dose distributions. In fact, carbon ion beams offer the advantage to deliver hypofractionated radiotherapy (RT) using a significantly smaller number of fractions compared to conventional RT without increasing risks of late effects. Methods This study is a prospective phase II clinical trial exploring safety and feasibility of a mixed beam scheme of carbon ion prostate boost followed by photon IMRT on pelvis. The study is designed to enroll 65 patients with localized high-risk prostate cancer at 3 different oncologic hospitals: Istituto Europeo di Oncologia, Fondazione IRCCS Istituto Nazionale dei Tumori, and Centro Nazionale di Adroterapia Oncologica. The primary endpoint is the evaluation of safety and feasibility with acute toxicity scored up to 1 month after the end of RT. Secondary endpoints are treatment early (3 months after the end of RT) and long-term tolerability, quality of life, and efficacy. Results The study is not yet recruiting; in silico studies are ongoing and we expect to start recruitment by 2017. Conclusions The present clinical trial aims at improving the current treatment for high-risk prostate cancer, evaluating safety and feasibility of a new RT mixed-beam scheme including photons and carbon ions. Encouraging results are coming from carbon ion facilities worldwide on the treatment of different tumors including prostate cancers. Carbon ions combine physical properties allowing for high dose conformity and advantageous radiobiological characteristics. The proposed mixed beam treatment has the advantage to combine a photon high conformity standard of care IMRT phase with a hypofractionated carbon ion RT boost delivered in a short overall treatment time.

scholarly journals Consistency Study of Multiparametric Magnetic Resonance and Computed Tomography Targeting in Targeted Radiotherapy for Prostate Cancer

2020 ◽  
Author(s):  
Zhen Xu ◽  
Xiao-Dong Li ◽  
Lu Fu ◽  
Yong-Hua Yu
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Organs At Risk ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Target Area ◽  
Target Delineation ◽  
Significant Difference

Abstract Background: To compare the difference of location by computed tomography (CT) and multiparametric magnetic resonance imaging (mpMRI) on the target delineation and volume for organs at risk (OARs) among patients with prostate cancer. Methods: T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and CT were performed among 11 patients who received radiotherapy for prostate cancer at our center between August 2018 and December 2019. The target areas were delineated using the Eclipse system, and the radiotherapy plans were made based on the treatment planning system (TPS) to compare target volume and dose-volume histogram (DVH) relative to rectum and bladder. Results: The clinical target volume (CTV) of T1WI and T2WI decreased by 18.8% (P=0.001) and 22.72% (P=0.003), respectively, compared with CT. The planning target volume (PTV) on T1WI and T2WI were 20.45% (P=0.015) and 22.31% (P= 0.008) smaller than that defined by CT. There was no significant difference in either CTV or PTV between the areas outlined on T1WI and T2WI. The DVH resulting from CT and MRI comparisons showed that the rectum and bladder dose levels were lower with MRI images compared with CT. It should be noted that at the lateral directions, the range of outlining on T2WI sequence were significantly smaller than others. Conclusion: Target planning based on mpMRI (T1WI, T2WI) is more precise than CT, which can significantly reduce the range of the target area and the volume of rectum and bladder exposed to high levels of radiation, improve the fitness and radiographic accuracy of the target area, especially on T2WI.

The role of pre-biopsy mpMRI in lymph node staging for prostate cancer

2021 ◽  
pp. 039156032110168
Author(s):  
Nassib Abou Heidar ◽  
Robert El-Doueihi ◽  
Ali Merhe ◽  
Paul Ramia ◽  
Gerges Bustros ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Gleason Score ◽  
Gold Standard ◽  
Cross Sectional ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Kappa Agreement

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

Bony-based and prostate-based image guidance for lo-calized prostate cancer radiotherapy

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Saulo Santos Fortes ◽  
Luiz Antonio Ribeiro Da Rosa
Keyword(s):  
Prostate Cancer ◽  
Normal Tissue ◽  
Bone Structure ◽  
Absorbed Dose ◽  
Target Volume ◽  
Image Guided Radiotherapy ◽  
Beam Modulation ◽  
Significant Difference ◽  
Treatment Volume ◽  
Treatment Plans

An important modality for the treatment of prostate cancer is teletherapy. The use of image-guided radiotherapy (IGRT) is a valuable tool in this treatment. This study retrospectively compared how repositioning the patient based on bone structure (B-ISO) and the prostate itself (P-ISO) affected the volumetric dose in the rectum, bladder, and clinical treatment volume (CTV). Additionally, the probability of normal tissue complication (NTCP) for the rectum was computed. We evaluated 155 cone-beam computed tomography (CBCT) from 8 patients. The treatment plans used beam modulation techniques. The planning target volume (PTV) margin adopted in both scenarios was 1 cm. The organs of interest were outlined over each CBCT and then treatment plans were applied so that the absorbed dose could be computed. NTCP values were calculated for the rectum. Analyzing dose-volume metrics published by the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC), there was no significant difference between the two repositioning strategies for the rectum and bladder. There was a slight degradation in CTV coverage for the B-ISO strategy, but still with adequate coverage. Analysis of the uniform equivalent dose (EUD) and NTCP for the rectum showed little sensitivity to the strategy used. The present study showed that the use of CBCT in radiotherapy for prostate cancer treatment did not significantly improve volumetric doses for the rectum, bladder, and CTV, as well as NTCP for the rectum.

scholarly journals Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy

2019 ◽  
Vol 17 (12) ◽  
pp. 1497-1504
Author(s):  
Lucas K. Vitzthum ◽  
Chris Straka ◽  
Reith R. Sarkar ◽  
Rana McKay ◽  
J. Michael Randall ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Short Term ◽  
Combined Androgen Blockade ◽  
Significant Difference ◽  
Androgen Blockade

Background: The addition of androgen deprivation therapy to radiation therapy (RT) improves survival in patients with intermediate- and high-risk prostate cancer (PCa), but it is not known whether combined androgen blockade (CAB) with a gonadotropin-releasing hormone agonist (GnRH-A) and a nonsteroidal antiandrogen improves survival over GnRH-A monotherapy. Methods: This study evaluated patients with intermediate- and high-risk PCa diagnosed in 2001 through 2015 who underwent RT with either GnRH-A alone or CAB using the Veterans Affairs Informatics and Computing Infrastructure. Associations between CAB and prostate cancer–specific mortality (PCSM) and overall survival (OS) were determined using multivariable regression with Fine-Gray and multivariable Cox proportional hazards models, respectively. For a positive control, the effect of long-term versus short-term GnRH-A therapy was tested. Results: The cohort included 8,423 men (GnRH-A, 4,529; CAB, 3,894) with a median follow-up of 5.9 years. There were 1,861 deaths, including 349 resulting from PCa. The unadjusted cumulative incidences of PCSM at 10 years were 5.9% and 6.9% for those receiving GnRH-A and CAB, respectively (P=.16). Compared with GnRH-A alone, CAB was not associated with a significant difference in covariate-adjusted PCSM (subdistribution hazard ratio [SHR], 1.05; 95% CI, 0.85–1.30) or OS (hazard ratio, 1.02; 95% CI, 0.93–1.12). For high-risk patients, long-term versus short-term GnRH-A therapy was associated with improved PCSM (SHR, 0.74; 95% CI, 0.57–0.95) and OS (SHR, 0.82; 95% CI, 0.73–0.93). Conclusions: In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone.

scholarly journals Efficacy of a hydrogel spacer in three-dimensional conformal radiation therapy for prostate cancer

2020 ◽  
Vol 50 (3) ◽  
pp. 303-309 ◽  
Author(s):  
Mami Ogita ◽  
Hideomi Yamashita ◽  
Subaru Sawayanagi ◽  
Wataru Takahashi ◽  
Keiichi Nakagawa
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
High Risk ◽  
Seminal Vesicle ◽  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Computed Tomography Scans ◽  
Before And After ◽  
Three Dimensional Conformal Radiotherapy ◽  
Dose Constraints

Abstract Objectives We aimed to compare the dose constraints fulfillment rate of the three-dimensional conformal radiotherapy treatment plan before and after a hydrogel spacer insertion. Methods The planning computed tomography scans of 39 patients who received stereotactic body radiotherapy for prostate cancer were used. All patients inserted a hydrogel spacer and underwent computed tomography scans before and after spacer insertion. The three-dimensional conformal radiotherapy plans according to NCCN classification, low-, intermediate- and high-risk, were made for each patient. Clinical target volume included prostate and seminal vesicle 2 cm for high risk, prostate and seminal vesicle 1 cm for intermediate risk and prostate only for low risk. Three-dimensional conformal radiotherapy including a seven-field conformal technique with 76 Gy in 38 fractions. Dose constraints for rectum and bladder were V70 Gy ≤ 15%, V65 Gy ≤ 30% and V40 Gy ≤ 60%. Results Among 39 patients, 35 (90%), 19 (49%) and 13 (33%) and 38 (97%), 38 (97%) and 34 (87%) patients before and after the spacer insertion fulfilled rectum dose constraints for low-, intermediate- and high-risk plans, respectively. A hydrogel spacer significantly reduced rectum dose and improved the rectum dose constraints fulfillment rate in intermediate (P &lt; 0.01) and high (P &lt; 0.01), but no difference was found in low-risk plan (P = 0.25). On multivariate analysis, spacer use was associated with the higher rectum dose constraints fulfillment rate. Conclusions A hydrogel spacer reduced rectum dose and improved the dose constraints fulfillment rate in three-dimensional conformal radiotherapy plan. Although IMRT is the standard treatment, 3D-CRT using a hydrogel spacer may be a treatment option.

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