Conformal High Dose Rate Brachytherapy Improves Biochemical Control And Cause Specific Survival in Patients With Prostate Cancer And Poor Prognostic Factors

Phak

2015

Rep Radiother Oncol

Section: Discussionsupporting

confidence: 80%

Stereotactic Body Radiotherapy Using Cyberknife for Localized Prostate Cancer

Phak

2015

Rep Radiother Oncol

Prostate Cancer Prostatic Dis

“…[17][18][19][20] In brief, all patients received treatment with external beam radiation using megavoltage linear accelerators (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In all three institutions, the prostate gland was boosted using two interstitial brachytherapy procedures.…”

Section: Radiation Techniquementioning

confidence: 99%

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

Vargas

Martı́nez

Galalae

et al. 2006

The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) X10, Gleason Score (GS) X7, or T stage XT2b), 560 received no NAD (n ¼ 308) or NAD for p6 months (n ¼ 252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was 4100 Gy (a/b ¼ 1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on v 2 tables for all 560 patients treated with or without NAD including pretreatment PSA (P ¼ 0.11), GS (P ¼ 0.4), and clinical T stage (P ¼ 0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P ¼ 0.04); cause-specific survival (CSS), 93 vs 98% (P ¼ 0.005)).Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n ¼ 112 (P ¼ 0.03, P ¼ 0.02)), pretreatment PSAX15 (n ¼ 136 (P ¼ 0.03, P ¼ 0.008)), and palpable disease XT2a (n ¼ 434 (P ¼ 0.04, P ¼ 0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P ¼ 0.003, HR 2.8) and NAD (P ¼ 0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate-and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.

“…Advancements recently made in imaging technology have improved the accuracy and effectiveness of HDR prostate brachytherapy planning. The anatomical information obtained from computed [2,4,17,18,25,26]. In addition, the development of anatomy-based inverse planning dose optimization for HDR brachytherapy can produce a highly conformal dose profile within one minute, with more than 90% of the prostate volume covered with the prescribed dose and a clinically acceptable sparing of OAR [1,3,5,[13][14][15]28].…”

mentioning

confidence: 99%

“…The functional imaging information, MR spectroscopic imaging (MRSI) combined with MRI and translated into the planning CT or MRI, was introduced into HDR prostate brachytherapy in order to better identify dominant intra-prostatic malignant lesions (DILs) within the prostate and to escalate the dose on the DIL [22]. Several clinical follow-up studies demonstrated that improved biochemical control, a higher survival rate and a lower risk of complications are achieved by the dose escalation of prostate cancer with HDR brachytherapy [2,4,17,18,25,26]. In addition, the development of anatomy-based inverse planning dose optimization for HDR brachytherapy can produce a highly conformal dose profile within one minute, with more than 90% of the prostate volume covered with the prescribed dose and a clinically acceptable sparing of OAR [1,3,5,[13][14][15]28].…”

mentioning

confidence: 99%

Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

Radiotherapy and Oncology

Hsu

Lessard

et al. 2008

Purpose-To establish an inverse planning set of parameters (class solution) to boost dominant intra-prostatic lesion (DIL) defined by MRI/MRSI.Methods-For 15 patients, DIL were contoured on CT or MR images and a class solution was developed to boost the DIL under the dosimetric requirements of the RTOG-0321 protocol. To determine the maximum attainable level of boost for each patient, 5 different levels were considered, at least 110%, 120%, 130%, 140% and 150% of the prescribed dose. The maximum attainable level was compared to the plan without boost using cumulative dose volume histogram (DVH).Results-DIL dose escalation was feasible for 11/15 patients under the requirements. The planning target volume (PTV) dose was slightly increased, while the DIL dose was significantly increased without any violation of requirements. With slight adjustments of the dose constraint parameters, the dose escalation was feasible for 13/15 patients under requirements.Conclusion-Using a class solution, a dose escalation of the MRI/MRSI defined DIL up to 150% while complying with RTOG dosimetric requirements is feasible. This HDR brachytherapy approach to dose escalation allows a significant dose increase to the tumor while maintaining an acceptable risk of complications. KeywordsClass solution; Dominant intra-prostatic lesion; MR Spectroscopy imaging; Dose escalation; Inverse planned HDR brachytherapy High dose rate (HDR) brachytherapy can safely and accurately deliver radiation dose to prostate cancer with a single Ir-192 source. The HDR brachytherapy employs catheters inserted directly into the prostate, guided by transrectal ultrasound (TRUS), and adjusts source dwell times along the catheters with a remotely controlled afterloader. Advancements recently made in imaging technology have improved the accuracy and effectiveness of HDR prostate brachytherapy planning. The anatomical information obtained from computed [2,4,17,18,25,26]. In addition, the development of anatomy-based inverse planning dose optimization for HDR brachytherapy can produce a highly conformal dose profile within one minute, with more than 90% of the prostate volume covered with the prescribed dose and a clinically acceptable sparing of OAR [1,3,5,[13][14][15]28]. Furthermore, the concept of class solution commonly used in intensity modulated radiation therapy (IMRT) [8,20,21,24,27] is now available in brachytherapy. The class solution of an inverse planning routine can reduce the variation of treatment plan quality across different users and can dramatically decrease the treatment planning time. In this study we developed a class solution for boosting MRI/MRS defined DILs in inverse planned HDR brachytherapy of prostate cancer. HHS Public Access Methods and materials Patient cohortsWe used data from 15 HDR patients with MRI/MRSI de-fined DILs (patients A to O). The mean ± standard deviation value of their prostate volume was 43.7 ± 16.3 cc with a range from 28.1 to 86.0 cc. In general, 16 catheters (range from 15 to 18) were inserted using TRUS gu...