Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial

Dearnaley, David P.; Syndikus, Isabel; Sumo, Georges; Bidmead, M.; Bloomfield, David; Clark, Catharine H.; Gao, Annie; Hassan, Shama; Horwich, A.; Huddart, Robert; Khoo, Vincent; Kirkbride, Peter; Mayles, Helen; Mayles, Philip; Naismith, O.; Parker, Chris; Patterson, Helen; Russell, Martin; Scrase, Christopher; South, C.; Staffurth, John; Hall, Emma

doi:10.1016/s1470-2045(11)70293-5

Cited by 271 publications

(218 citation statements)

References 38 publications

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“…Any patient receiving radiation to the pelvis has a risk for this kind of complication. 15 In this study, we demonstrated that after a transperitoneal minimally invasive prostatectomy, patients will receive extra doses to a larger amount of the small bowel compared to patients who underwent conventional open prostatectomies. There is no effective way to displace the small bowel from the pelvis, although a full bladder could help and even a tissue expander was already tested to prevent small bowel from receiving excessive doses of radiation.…”

Section: Discussionmentioning

confidence: 78%

Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

Luz¹,

Pra²,

Tu³

et al. 2013

CUAJ

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Introduction: Transperitoneal minimally invasive radical prostatectomy (MIRP) has become first choice for several urologists and patients dealing with localized prostate cancer. We evaluate the effect of postoperative radiation on the small bowel in patients who underwent extraperitoneal open versus transperitoneal MIRP. Methods:We reviewed all patients who received postoperative radiation from 2006 to 2010. Planning target volume (PTV) and surrounding organs, including the small bowel, were delineated. The presence of the small bowel in PTV and its volume in receiving each dose level were analyzed. Results: A total of 122 patients were included: 26 underwent MIRP and 96 underwent open prostatectomy. The median age of patients was 66 years, with median body mass index 27 kg/m 2 . The total PTV dose was 66 Gy, with the minimum and maximum doses received by the small bowel 0.4 and 66.4 Gy, respectively. The maximum volume of small bowel that received the safe limit of 40 Gy was 569 cm 3 . Of the 26 patients who underwent MIRP, 12 (46%) had small bowel identified inside the PTV compared to 57 (59%) among patients who underwent open prostatectomy (p = 0.228). The mean volume of the small bowel receiving 40 Gy was 26 and 67 cm 3 in open and MIRP groups, respectively (p = 0.006); the incidence of acute complications was the same in both groups. Conclusions: Higher volumes of the small bowel are subjected to significant radiation after MIRP procedures compared to open procedures; however, we could not demonstrate any impact on acute complications. Whether there is a difference in late complications remains to be evaluated.

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Section: Discussionmentioning

confidence: 78%

Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

Luz¹,

Pra²,

Tu³

et al. 2013

CUAJ

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“…The beam energy was 10 MV and the final dose calculation was made using the adaptive collapsed cone convolution algorithm. A prescription of 57 Gy in 19 fractions to the prostate was set, with further dose levels covering the seminal vesicles, per group 3 of the CHHIP trial protocol (17) . The mean number of monitor units (and standard deviation) for the prostate patients was

465.1 \pm 25.5

MU.…”

Section: Methodsmentioning

confidence: 99%

The impact of continuously‐variable dose rate VMAT on beam stability, MLC positioning, and overall plan dosimetry

Boylan

McWilliam

Johnstone

et al. 2012

J Applied Clin Med Phys

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A recent control system update for Elekta linear accelerators includes the ability to deliver volumetric‐modulated arc therapy (VMAT) with continuously variable dose rate (CVDR), rather than a number of fixed binned dose rates (BDR). The capacity to select from a larger range of dose rates allows the linac to maintain higher gantry speeds, resulting in faster, smoother deliveries. The purpose of this study is to investigate two components of CVDR delivery — the increase in average dose rate and gantry speed, and a determination of their effects on beam stability, MLC positioning, and overall plan dosimetry. Initially, ten VMAT plans (5 prostate, 5 head and neck) were delivered to a Delta4 dosimetric phantom using both the BDR and CVDR systems. The plans were found to be dosimetrically robust using both delivery methods, although CVDR was observed to give higher gamma pass rates at the 2%/2 mm gamma level for prostates (p < 0.01). For the dual arc head‐and‐neck plans, CVDR delivery resulted in improved pass rates at all gamma levels (2%/2 mm to 4%/4 mm) for individual arc verifications (p < 0.01), but gave similar results to BDR when both arcs were combined. To investigate the impact of increased gantry speed on MLC positioning, a dynamic leaf‐tracking tool was developed using the electronic portal imaging device (EPID). Comparing the detected MLC positions to those expected from the plan, CVDR was observed to result in a larger mean error compared to BDR (0.13 cm and 0.06 cm, respectively, p < 0.01). The EPID images were also used to monitor beam stability during delivery. It was found that the CVDR deliveries had a lower standard deviation of the gun‐target (GT) and transverse (AB) profiles (p < 0.01). This study has determined that CVDR may offer a dosimetric advantage for VMAT plans. While the higher gantry speed of CVDR appears to increase deviations in MLC positioning, the relative effect on dosimetry is lower than the positive impact of a flatter and more stable beam profile.PACS numbers: 87.56.bd; 87.55.km; 87.55.Qr

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“…This is inevitable, given that the ProtecT trial is unique in comparing three prostate treatment modalities, probably was only achievable when it was done and in the UK -and so will never be repeated. There have been a several other landmark trials in the UK of radiotherapy for prostate cancer, including the Medical Research Council (MRC) RT01 and PR07 trials, the Cancer Research UK/NIHR Cancer Research Network CHHIP trial, and exploratory data from the MRC STAMPEDE trial [2][3][4][5]. This article aims to put these radiotherapy trials into their historical context as a backdrop when the first results of the ProtecT trial are unveiled in 2016.…”

Section: Introductionmentioning

confidence: 99%

“…Our analysis of a subset of the radiotherapy plans demonstrates good understanding and adherence to the ProtecT protocol. Since then, pre-specified QA has become a requisite component, and of recent UK prostate trials, the most detailed programme is in the CHHIP study with single phase forward planned three-field IMRT [4].…”

Section: The Impact Of Dose Escalation and The Introduction Of Qualitmentioning

confidence: 99%

“…RT01 and CHHIP) or the non-randomised comparisons recently published from the STAMPEDE trial [35]. As the trend moves inexorably towards higher total dose equivalents, and fewer fractions [4], the desirability of highest quality treatment delivery becomes an absolute imperative -with much to lose in terms of adverse effects for patients otherwise.…”

Section: The Impact Of Dose Escalation and The Introduction Of Qualitmentioning

confidence: 99%

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Radiotherapy for Prostate Cancer: is it ‘what you do’ or ‘the way that you do it’? A UK Perspective on Technique and Quality Assurance

et al. 2016

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Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial

Cited by 271 publications

References 38 publications

Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

The impact of continuously‐variable dose rate VMAT on beam stability, MLC positioning, and overall plan dosimetry

Radiotherapy for Prostate Cancer: is it ‘what you do’ or ‘the way that you do it’? A UK Perspective on Technique and Quality Assurance

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