Dose Escalation in Prostate Radiotherapy up to 82 Gy Using Simultaneous Integrated Boost

The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

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“…; Dolezel et al . ) and one abstract (Kirichenko et al . ) were identified, as shown in Table of Appendix .…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Zemplényi

Kaló

Kovács³

et al. 2016

Eur J Cancer Care

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“…Intensity-modulated radiotherapy (IMRT) techniques for prostate cancer facilitate safe dose escalation through maximization of the therapeutic ratio with proven benefits on local recurrence and biochemical control rates [1,2]. Given the very conformal nature of IMRT treatment plans, accurate patient positioning utilizing image-guidance systems is of the utmost importance [3].…”

Section: Introductionmentioning

confidence: 99%

Real-time prostate motion assessment: image-guidance and the temporal dependence of intra-fraction motion

et al. 2013

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BackgroundThe rapid adoption of image-guidance in prostate intensity-modulated radiotherapy (IMRT) results in longer treatment times, which may result in larger intrafraction motion, thereby negating the advantage of image-guidance. This study aims to qualify and quantify the contribution of image-guidance to the temporal dependence of intrafraction motion during prostate IMRT.MethodsOne-hundred and forty-three patients who underwent conventional IMRT (n=67) or intensity-modulated arc therapy (IMAT/RapidArc, n=76) for localized prostate cancer were evaluated. Intrafraction motion assessment was based on continuous RL (lateral), SI (longitudinal), and AP (vertical) positional detection of electromagnetic transponders at 10 Hz. Daily motion amplitudes were reported as session mean, median, and root-mean-square (RMS) displacements. Temporal effect was evaluated by categorizing treatment sessions into 4 different classes: IMRTc (transponder only localization), IMRTcc (transponder + CBCT localization), IMATc (transponder only localization), or IMATcc (transponder + CBCT localization).ResultsMean/median session times were 4.15/3.99 min (IMATc), 12.74/12.19 min (IMATcc), 5.99/5.77 min (IMRTc), and 12.98/12.39 min (IMRTcc), with significant pair-wise difference (p<0.0001) between all category combinations except for IMRTcc vs. IMATcc (p>0.05). Median intrafraction motion difference between CBCT and non-CBCT categories strongly correlated with time for RMS (t-value=17.29; p<0.0001), SI (t-value=−4.25; p<0.0001), and AP (t-value=2.76; p<0.0066), with a weak correlation for RL (t-value=1.67; p=0.0971). Treatment time reduction with non-CBCT treatment categories showed reductions in the observed intrafraction motion: systematic error (Σ)<0.6 mm and random error (σ)<1.2 mm compared with ≤0.8 mm and <1.6 mm, respectively, for CBCT-involved treatment categories.ConclusionsFor treatment durations >4-6 minutes, and without any intrafraction motion mitigation protocol in place, patient repositioning is recommended, with at least the acquisition of the lateral component of an orthogonal image pair in the absence of volumetric imaging.

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“…Several studies have shown the importance of dose escalation in the radiotherapeutic management for various prognostic groups of prostate cancer [2,7,8,11,33]. Intensity-modulated radiation therapy (IMRT) allows the delivery of the necessary high tumor total doses without increasing the dose to the organs at risk [13].…”

Section: Introductionmentioning

confidence: 99%

Definition of the CTV Prostate in CT and MRI by Using CT–MRI Image Fusion in IMRT Planning for Prostate Cancer

et al. 2011

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Dose Escalation in Prostate Radiotherapy up to 82 Gy Using Simultaneous Integrated Boost

Abstract: SIB enables dose escalation up to 82 Gy with a lower rate of gastrointestinal toxicity grade 3 in comparison with 3D-CRT up to 74 Gy.

Cited by 34 publications

References 35 publications

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Real-time prostate motion assessment: image-guidance and the temporal dependence of intra-fraction motion

Definition of the CTV Prostate in CT and MRI by Using CT–MRI Image Fusion in IMRT Planning for Prostate Cancer

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