Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

Geier, Michael; Astner, Sabrina T.; Duma, Marciana Nona; Jacob, V.; Nieder, Carsten; Putzhammer, J.; Winkler, Cornelia; Molls, M.; Geinitz, Hans

doi:10.1007/s00066-012-0081-8

Cited by 25 publications

(13 citation statements)

References 38 publications

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“…De Meerleer There are few clinical studies assessing acute toxicity in patients treated with dose escalated SIB plans. 5,29 Fonteyne et al 5 did not find increased severity or incidence of acute toxicity in a group of 118 prostate cancer patients after dose escalation with SIB to an MRI/MRS-detected IPL (76 Gy median dose to PTV and 80 Gy median dose to gross tumour volume prescribed). In another study by Geier et al, 29 acute side effects and dose-volume histogram data were evaluated in 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy.…”

Section: Discussionmentioning

confidence: 94%

“…3 Therefore, selectively boosting radiation to these lesions to a very high dose has been hypothesized to be a more effective method to improve the therapeutic ratio than a homogeneous, but more modest, dose escalation to the entire prostate. 29 The accuracy of MRI and MRS in localizing prostate cancer was 82-85%, and the authors emphasized the importance of incorporating functional imaging techniques such as MRS for prostate cancer RT planning. 30,31 Although MRI with endorectal coil has higher sensitivity for staging, this coil can distort the prostate.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

Onal¹,

Sonmez²,

Erbay³

et al. 2014

BJR

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Objective: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels. Methods: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy. Results: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V 30 -V 50 ) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V 60 -V 80 ) were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6, 10, and 15 MV energy levels both in plans with and those without SIB. Conclusion: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT. Advances in knowledge: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed.Randomized trials have shown a gain in biochemical relapse-free survival using dose escalation for prostate cancer.1 However, isolated local failure is still reported in nearly one-third of patients, even with higher radiotherapy (RT) doses.1 Local recurrence is of clinical importance because a relationship has been suggested between local control, distant metastasis and survival.2 It has also been demonstrated that intraprostatic failure mainly originates at the initial tumour location as a result of intrinsic resistance of a fraction of the tumour clones, which implies that selective dose escalation to the dominant intraprostatic lesion using simultaneous integrated boost (SIB) might be beneficial. With new RT techniques, such as intensity-modulated RT (IMRT) and volumetric-arc therapy (VMAT), SIB could be delivered without increasing acute toxicity.4-7 Several recent studies have performed dosimetric comparison of IMRT and VMAT plans in prostate cancer; 8-10 however, dosimetric evaluation of IMRT and VMAT plans delivering SIB is rare. In these studies, target volume and organs at risk (OARs) doses may vary with different treatment planning systems. Another aspect not often addressed in these planning studies is the photon energy level. 4,8,9,11 Although higher energy photons have the potential advantage of reduced attenuation with depth, this may in turn increase the risk of secondary malignancies because of the presence of neutron...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

Onal¹,

Sonmez²,

Erbay³

et al. 2014

BJR

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“…In this study, all patients were treated with HT, a special form of IMRT which can produce a well-distributed dose in the PTV with effective sparing of OARs and can, therefore, reduce the incidence of side effects, as shown by a number of studies. [13][14][15][16] However, the sharp gradient of dose at the margin of the PTV can be a double-edged sword. The deviations that may happen in daily treatments require a certain expansion of CTV to guarantee effective target coverage.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer

Liu

Wang

et al. 2016

Technol Cancer Res Treat

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In our center, the feasibility and related acute toxicities of hypofractionated helical tomotherapy have been evaluated in older aged patients with prostate cancer . Between February 2009 and February 2014, 67 patients (older than 65 years) were enrolled in a prospective phase I-II study (registered number, ChiCTR-ONC-13004037). Patients in cohort 1 (n ¼ 33) and cohort 2 (n ¼ 34) received 76 Gy in 34 fractions (2.25 Gy/F) and 71.6 Gy in 28 fractions (2.65 Gy/F), respectively, to the prostate and seminal vesicles, while 25 patients in cohort 2 also received integrated elective lymph node irradiation (50.4 Gy). All patients were treated with helical tomotherapy, and daily image guidance was performed before each treatment. Acute toxicities were assessed with Radiation Therapy Oncology Group (RTOG)/European Organization for Research on Treatment of Cancer (EORTC) criteria. No significant difference was detected between the 2 cohorts in the incidence of acute toxicities. In cohort 1, the incidences of grade 1 and 2 genitourinary and gastrointestinal toxicities were 45.5% and 45.4%, respectively, and without grade 3 and 4 toxicities. In cohort 2, the incidences of acute grade 1 and 2 genitourinary and gastrointestinal toxicities were 47.1% and 55.9%, respectively, and grade 3 genitourinary toxicity (hematuria) was noted only in 1 patient. No significant difference was detected in the incidence of acute toxicities between the patients receiving integrated elective lymph node irradiation and those receiving irradiation to prostate and seminal vesicle in cohort 2. Univariate and multivariate analyses were performed with clinical parameters. Only the baseline weight was found negatively correlated with genitourinary toxicities at a weak level (relative risk ¼ 0.946, 95% confidence interval 0.896-0.998], P ¼ .043). This study shows that 2 hypofractionation regimens (76 Gy/34F and 71.6 Gy/28F) delivered with HT are well tolerated in older aged patients having prostate cancer without significant difference for acute toxicities between the 2 cohorts. Late toxicities and treatment outcomes for these patients are under investigation.

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“…In another randomized study for patients with T3-T4 esophageal cancer undergoing chemoradiation to a total dose up to 65 Gy, loco-regional control was achieved in only 30% of the patients [6]. The simultaneous integrated boost (SIB) technique allows delivery of a high dose of radiation to the gross tumor volume and sparing of radiosensitive organs such as the rectum in patients with prostate cancer [15]. The adaptive radiotherapy technique by taking advantage of the tumor shrinkage may spare the adjacent normal tissues while still delivering a high radiation dose to the PTV [16,17].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer

et al. 2014

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BackgroundIn this study the feasibility of intensity-modulated radiotherapy (IMRT) and tomotherapy-based image-guided radiotherapy (IGRT) for locally advanced esophageal cancer was assessed.MethodsA retrospective study of ten patients with locally advanced esophageal cancer who underwent concurrent chemotherapy with IMRT (1) and IGRT (9) was conducted. The gross tumor volume was treated to a median dose of 70 Gy (62.4-75 Gy).ResultsAt a median follow-up of 14 months (1-39 months), three patients developed local failures, six patients developed distant metastases, and complications occurred in two patients (1 tracheoesophageal fistula, 1 esophageal stricture requiring repeated dilatations). No patients developed grade 3-4 pneumonitis or cardiac complications.ConclusionsIMRT and IGRT may be effective for the treatment of locally advanced esophageal cancer with acceptable complications.

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Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

Abstract: This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity.

Cited by 25 publications

References 38 publications

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer

Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer

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