A randomised assessment of image guided radiotherapy within a phase 3 trial of conventional or hypofractionated high dose intensity modulated radiotherapy for prostate cancer

Murray, Julia; Griffin, Clare; Gulliford, S.; Syndikus, Isabel; Staffurth, John; Panades, Miguel; Scrase, Christopher; Parker, Chris; Khoo, Vincent; Dean, Jamie; Mayles, Helen; Mayles, Philip; Thomas, Simon; Naismith, O.; Baker, Angela; Mossop, Helen; Cruickshank, Clare; Hall, Emma; Dearnaley, David P.

doi:10.1016/j.radonc.2019.10.017

Cited by 37 publications

(29 citation statements)

References 33 publications

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“…Similarly, delivering RT without image guidance appears to double the risk (OR = 2.57, 95% CI 1.70–3.86, p < 0.0001) of developing impairment in terms of BB. The role of new RT technologies is still debated, but the majority of the papers published on this issue seems to provide evidence of an advantage for the use of IGRT, in particular when the increased accuracy in dose delivery has been exploited to reduce CTV-PTV margins, independently from the use of fiducial markers [ 21 , 22 , 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Gastrointestinal Side Effects on Patients’ Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study

Noale

Bruni²,

Triggiani

et al. 2021

Cancers

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Radiotherapy (RT) represents an important therapeutic option for the treatment of localized prostate cancer. The aim of the current study is to examine trajectories in patients’ reported quality of life (QoL) aspects related to bowel function and bother, considering data from the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study, analyzed with growth mixture models. Data for patients who underwent RT, either associated or not associated with androgen deprivation therapy, were considered. QoL outcomes were assessed over a 2-year period from the diagnosis, using the Italian version of the University of California Los Angeles-Prostate Cancer Index (Italian-UCLA-PCI). Three trajectories were identified for the bowel function; having three or more comorbidities and the use of 3D-CRT technique for RT were associated with the worst trajectory (OR = 3.80, 95% CI 2.04–7.08; OR = 2.17, 95% CI 1.22–3.87, respectively). Two trajectories were identified for the bowel bother scores; diabetes and the non-Image guided RT method were associated with being in the worst bowel bother trajectory group (OR = 1.69, 95% CI 1.06–2.67; OR = 2.57, 95% CI 1.70–3.86, respectively). The findings from this study suggest that the absence of comorbidities and the use of intensity modulated RT techniques with image guidance are related with a better tolerance to RT in terms of bowel side effects.

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Section: Discussionmentioning

confidence: 99%

Impact of Gastrointestinal Side Effects on Patients’ Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study

Noale

Bruni²,

Triggiani

et al. 2021

Cancers

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“…Dosimetric deviations in prostate radiotherapy resulting from intra- and interfractional anatomic variability have been incompletely understood, and an in-depth comprehension about the dosimetric impact of position verification imaging becomes more important as individual fraction dose are increasing for hypofractionated or even stereotactic treatment approaches ( 18 , 19 , 30 ). Previous analyses have generally been limited by the insufficient quality or frequency of position verification imaging and the lacking availability of elastic image registration tools.…”

Section: Discussionmentioning

confidence: 99%

“…For hypofractionated radiotherapy, it is conceivable that due to the increases in single doses, anatomy-related dosimetric deviations for individual treatment fractions may have a higher impact and may therefore warrant more frequent imaging as compared to normofractionation concepts. A substudy within the CHHiP trial analyzed the relevance of image guidance and PTV margin reduction for hypofractionated prostate radiotherapy and reported a borderline improvement of grade ≥2 late rectal toxicities only for image guidance and margin reduction, while standard-margin image-guided and non-image-guided therapies produced highly comparable results; bladder toxicities or patient outcomes appeared comparable in all three subgroups ( 18 ). The vast majority of patients in the CHHiP trial received 2D image guidance based on implanted fiducial markers, and the utilization of these markers may impact deviations of the applied doses from the treatment plan.…”

Section: Discussionmentioning

confidence: 99%

“…So far, very few data are available comparing planned and applied doses for prostate radiotherapy based on daily imaging and deformable imaging registration, and no information is available for hypofractionated treatment concepts ( 16 , 17 ). Additionally, while many guidelines recommend daily positional imaging for hypofractionated prostate radiotherapy, the majority of patients in the randomized trials did not receive image-guided treatment ( 18 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric Impact of the Positional Imaging Frequency for Hypofractionated Prostate Radiotherapy – A Voxel-by-Voxel Analysis

et al. 2020

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Background To investigate deviations between planned and applied treatment doses for hypofractionated prostate radiotherapy and to quantify dosimetric accuracy in dependence of the image guidance frequency. Methods Daily diagnostic in-room CTs were carried out in 10 patients in treatment position as image guidance for hypofractionated prostate radiotherapy. Fraction doses were mapped to the planning CTs and recalculated, and applied doses were accumulated voxel-wise using deformable registration. Non-daily imaging schedules were simulated by deriving position correction vectors from individual scans and used to rigidly register the following scans until the next repositioning before dose recalculation and accumulation. Planned and applied doses were compared regarding dose-volume indices and TCP and NTCP values in dependence of the imaging and repositioning frequency. Results Daily image-guided repositioning was associated with only negligible deviations of analyzed dose-volume parameters and conformity/homogeneity indices for the prostate, bladder and rectum. Average CTV T did not significantly deviate from the plan values, and rectum NTCPs were highly comparable, while bladder NTCPs were reduced. For non-daily image-guided repositioning, there were significant deviations in the high-dose range from the planned values. Similarly, CTV dose conformity and homogeneity were reduced. While TCPs and rectal NTCPs did not significantly deteriorate for non-daily repositioning, bladder NTCPs appeared falsely diminished in dependence of the imaging frequency. Conclusion Using voxel-by-voxel dose accumulation, we showed for the first time that daily image-guided repositioning resulted in only negligible dosimetric deviations for hypofractionated prostate radiotherapy. Regarding dosimetric aberrations for non-daily imaging, daily imaging is required to adequately deliver treatment.

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“…Chen et al similarly found a dose-progression relationship in the obturator region 10 . One study from the 'Trial-C' trial has reported, however, no significant difference of treatment efficacy in reduced margins IGRT treatments 11 .…”

Section: Introductionmentioning

confidence: 99%

Reduced Dose Posterior to Prostate Correlates With Increased PSA Progression in Voxel-Based Analysis of 3 Randomized Phase 3 Trials

Marcello

Denham

Kennedy

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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A randomised assessment of image guided radiotherapy within a phase 3 trial of conventional or hypofractionated high dose intensity modulated radiotherapy for prostate cancer

Cited by 37 publications

References 33 publications

Impact of Gastrointestinal Side Effects on Patients’ Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study

Impact of Gastrointestinal Side Effects on Patients’ Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study

Dosimetric Impact of the Positional Imaging Frequency for Hypofractionated Prostate Radiotherapy – A Voxel-by-Voxel Analysis

Reduced Dose Posterior to Prostate Correlates With Increased PSA Progression in Voxel-Based Analysis of 3 Randomized Phase 3 Trials

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