Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer

Millender, L.E.; Aubin, Michèle; Pouliot, Jean; Shinohara, Katsuto; Roach, Mack

doi:10.1016/j.ijrobp.2003.12.027

Cited by 111 publications

(64 citation statements)

References 11 publications

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“…11,14,22 Similarly, greater organ motion and set-up error may interfere with accurate delivery of RT to obese men. 53,54 Notably, these technical problems may be of even greater concern in the very obese.…”

Section: Discussionmentioning

confidence: 99%

Obesity and mortality in men with locally advanced prostate cancer

Efstathiou

Bae

Shipley

et al. 2007

Cancer

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BACKGROUND.Greater body mass index (BMI) is associated with shorter time to prostate‐specific antigen (PSA) failure following radical prostatectomy and radiation therapy (RT). Whether BMI is associated with prostate cancer‐specific mortality (PCSM) was investigated in a large randomized trial of men treated with RT and androgen deprivation therapy (ADT) for locally advanced prostate cancer.METHODS.Between 1987 and 1992, 945 eligible men with locally advanced prostate cancer were enrolled in a phase 3 trial (RTOG 85‐31) and randomized to RT and immediate goserelin or RT alone followed by goserelin at recurrence. Height and weight data were available at baseline for 788 (83%) subjects. Cox regression analyses were performed to evaluate the relations between BMI and all‐cause mortality, PCSM, and nonprostate cancer mortality. Covariates included age, race, treatment arm, history of prostatectomy, nodal involvement, Gleason score, clinical stage, and BMI.RESULTS.The 5‐year PCSM rate for men with BMI <25 kg/m2 was 6.5%, compared with 13.1% and 12.2% in men with BMI ≥25 to <30 and BMI ≥30, respectively (Gray's P = .005). In multivariate analyses, greater BMI was significantly associated with higher PCSM (for BMI ≥25 to <30, hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.02–2.27, P = .04; for BMI ≥30, HR 1.64, 95% CI, 1.01–2.66, P = .04). BMI was not associated with nonprostate cancer or all‐cause mortality.CONCLUSIONS.Greater baseline BMI is independently associated with higher PCSM in men with locally advanced prostate cancer. Further studies are warranted to evaluate the mechanism(s) for increased cancer‐specific mortality and to assess whether weight loss after prostate cancer diagnosis alters disease course. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Obesity and mortality in men with locally advanced prostate cancer

Efstathiou

Bae

Shipley

et al. 2007

Cancer

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“…Obesity has been identified as an independent risk factor for increased biochemical relapse after EBRT [6][7][8][9] but not after permanent low-dose-rate BT. [12][13][14] This might be because accurate dose delivery can be compromised in obese patients by spatial shifts in prostate position and setup errors greater than 10 mm 29,30 whereas similar problems are not present in BT.…”

Section: à2mentioning

confidence: 99%

Prognostic impact of abdominal adiposity, waist circumference and body mass index in patients with intermediate-risk prostate cancer treated with radiotherapy

Zilli

Nguyễn

et al. 2011

Int J Obes

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Objective: We tested the potential role of abdominal visceral (VAT) and subcutaneous (SAT) adipose tissues, waist circumference (WC) and body mass index (BMI) as prognostic factors in patients with intermediate-risk prostate cancer (clinical stage T1b-2b, and Gleason Score (GS) ¼ 7 and prostate-specific antigen PSA level o15 ng ml À1 , or GS p6 and PSA between 10 and 20 ng ml À1 ) treated with ultrasound-based image-guided radiotherapy. Methods: VAT, SAT and WC (measured from planning abdominal computed tomography) and BMI were compared with clinical and pathologic factors using univariate analyses. Cox regression analyses were performed to evaluate whether obesity indices significantly predicted biochemical disease free-survival (bDFS). Results: Of the 112 eligible patients, 30 (27%) were obese. Median BMI at baseline was 27.5 kg m À2 (range, 19.2-51.5 kg m À2 ). Greater abdominal adiposity, WC and BMI were significantly associated with younger age at diagnosis and increased prostate volume (P ¼ 0.003 and P ¼ 0.002, respectively). No significant correlation between obesity measures and T-stage, GS, PSA or percentage of positive cores at biopsy was found. On Cox regression analyses, none of the obesity measures predicted for bDFS. No association was observed between obesity indices and surrogate markers of biochemical failure as PSA nadir (nPSA) or time to nPSA. Conclusions: Abdominal adiposity, WC and BMI are associated with younger age at diagnosis and greater prostate volume but not with an increased risk of biochemical failure in patients with intermediate-risk prostate cancer.

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“…[42][43][44][45] Investigators at the University of California San Francisco (UCSF) have shown that the gold marker seeds can be placed into the prostate for routine daily monitoring using an electronic portal imaging device (EPID) and can provide an accurate guide such that treatments can be delivered within ϳ2 mm. Implanted seeds don't migrate significantly if properly placed.…”

Section: D Igrt To Reduce Toxicitymentioning

confidence: 99%

“…Intraprostate markers appear to be particularly critical to the accurate treatment of obese patients who are at a very high risk for setup errors because of inconsistencies associated with using skin marks in these patients. 45 An example of how gold marker seeds can be used to accurately target small volume is shown in Figure 4A-D. This patient had a biopsy-proven recurrence after radical prostatectomy, and his tumor was marked with two gold seeds as shown in the AP and lateral port films ( Figure 4A,B).…”

Section: D Igrt To Reduce Toxicitymentioning

confidence: 99%

Advances in Radiation Therapy: Conventional to 3D, to IMRT, to 4D, and Beyond

Bucci

Bevan

Roach

2005

CA: A Cancer Journal for Clinicians

291

182

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Modern advances in computers have fueled parallel advances in imaging technologies. The improvements in imaging have in turn allowed a higher level of complexity to be incorporated into radiotherapy treatment planning systems. As a result of these changes, the delivery of radiotherapy evolved from therapy designed based primarily on plain (two dimensional) x-ray images and hand calculations to three-dimensional x-ray based images incorporating increasingly complex computer algorithms. More recently, biologic variables based on differences between tumor metabolism, tumor antigens, and normal tissues have been incorporated into the treatment process. In addition, greater awareness of the challenges to the accuracy of the treatment planning process, such as problems with set-error and organ movement, have begun to be systematically addressed, ushering in an era of so-called FourDimensional Radiotherapy. This review article discusses how these advances have changed the way the most common neoplasms are treated now and will be treated in the near future. (CA Cancer J Clin 2005;55:117-134.)

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Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer

Cited by 111 publications

References 11 publications

Obesity and mortality in men with locally advanced prostate cancer

Obesity and mortality in men with locally advanced prostate cancer

Prognostic impact of abdominal adiposity, waist circumference and body mass index in patients with intermediate-risk prostate cancer treated with radiotherapy

Advances in Radiation Therapy: Conventional to 3D, to IMRT, to 4D, and Beyond

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