Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?

Chao, K.; Goldstein, Neal S.; Yan, Di; Vargas, Carlos; Ghilezan, Michel; Korman, Howard; Kernen, Kenneth; Hollander, Jay B.; Gonzalez, Jose A.; Martínez, Álvaro; Vicini, Frank A.; Kestin, Larry L.

doi:10.1016/j.ijrobp.2006.02.039

Cited by 77 publications

(28 citation statements)

References 40 publications

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“…Intermediate-risk patients had a 5-mm dorsolateral prostate-to-PTV expansion (limited to the side of the prostate harboring the intermediate-risk lesion) and ≥1 cm of contiguous seminal vesicle inclusion in the PTV to more effectively cover their increased risk and potential distance of extracapsular extension near the neurovascular bundle (NVB) (22). Typically, the 2-mm margin expansion used in favorable prognosis patients split the NVB as defined on T1-weighted, gadolinium-enhanced MRI, while the 5-mm expansion used for intermediate-prognosis patients fully encompassed it (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Virtual HDR CyberKnife SBRT for Localized Prostatic Carcinoma: 5-Year Disease-Free Survival and Toxicity Observations

2014

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Purpose: Prostate stereotactic body radiotherapy (SBRT) may substantially recapitulate the dose distribution of high-dose-rate (HDR) brachytherapy, representing an externally delivered “Virtual HDR” treatment method. Herein, we present 5-year outcomes from a cohort of consecutively treated virtual HDR SBRT prostate cancer patients.Methods: Seventy-nine patients were treated from 2006 to 2009, 40 low-risk, and 39 intermediate-risk, under IRB-approved clinical trial, to 38 Gy in four fractions. The planning target volume (PTV) included prostate plus a 2-mm volume expansion in all directions, with selective use of a 5-mm prostate-to-PTV expansion and proximal seminal vesicle coverage in intermediate-risk patients, to better cover potential extraprostatic disease; rectal PTV margin reduced to zero in all cases. The prescription dose covered >95% of the PTV (V100 ≥95%), with a minimum 150% PTV dose escalation to create “HDR-like” PTV dose distribution.Results: Median pre-SBRT PSA level of 5.6 ng/mL decreased to 0.05 ng/mL 5 years out and 0.02 ng/mL 6 years out. At least one PSA bounce was seen in 55 patients (70%) but only 3 of them subsequently relapsed, biochemical-relapse-free survival was 100 and 92% for low-risk and intermediate-risk patients, respectively, by ASTRO definition (98 and 92% by Phoenix definition). Local relapse did not occur, distant metastasis-free survival was 100 and 95% by risk-group, and disease-specific survival was 100%. Acute and late grade 2 GU toxicity incidence was 10 and 9%, respectively; with 6% late grade 3 GU toxicity. Acute urinary retention did not occur. Acute and late grade 2 GI toxicity was 0 and 1%, respectively, with no grade 3 or higher toxicity. Of patient’s potent pre-SBRT, 65% remained so at 5 years.Conclusion: Virtual HDR prostate SBRT creates a very low PSA nadir, a high rate of 5-year disease-free survival and an acceptable toxicity incidence, with results closely resembling those reported post-HDR brachytherapy.

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Section: Methodsmentioning

confidence: 99%

Virtual HDR CyberKnife SBRT for Localized Prostatic Carcinoma: 5-Year Disease-Free Survival and Toxicity Observations

2014

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“…in a pathologic review of prostatectomy specimens correlated clinical features with the linear extent of ECE to determine the appropriate margin to include in the clinical target volume (CTV) when there is a significant risk of ECE. They demonstrated that the majority of all ECE occur primarily along the postero-lateral region and that approximately 20% of patients who have PSA > 10 ng/ml and biopsy Gleason score > 7 are at risk for ECE extending 4 to 5 mm beyond the prostate capsule [33]. In the present study, only 2 out of 9 patients were found to have ECE greater than 5 mm.…”

Section: Discussionmentioning

confidence: 47%

Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy

Gómez-Iturriaga

Crook

Casquero

et al. 2014

jcb

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PurposeThe purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy.Material and methodsProstate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans.ResultsMean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively).ConclusionsTRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.

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“…It has also been shown that the microscopic spread of tumour cells in the NVB is dependent on the differentiation of the tumour (16).…”

Section: Discussionmentioning

confidence: 99%

“…The NVBs were segmented separately and not included in the CTV, thus the NVBs did not affect the PTV. The NVB-CTV was defined as a circle of 7 mm ( Figure 1) in order to cover 90% of microscopic spread in tumours with Gleason score 7 (16). The rectum, the bladder and the femoral heads were segmented as OAR.…”

Section: Methodsmentioning

confidence: 99%

Neurovascular Bundle Infiltration Can Explain Local Relapses Using Conformal Radiotherapy of Prostate Cancer

Johansson

Lennernäs

Isacsson

2017

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Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?

Cited by 77 publications

References 40 publications

Virtual HDR CyberKnife SBRT for Localized Prostatic Carcinoma: 5-Year Disease-Free Survival and Toxicity Observations

Virtual HDR CyberKnife SBRT for Localized Prostatic Carcinoma: 5-Year Disease-Free Survival and Toxicity Observations

Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy

Neurovascular Bundle Infiltration Can Explain Local Relapses Using Conformal Radiotherapy of Prostate Cancer

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