Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

Kishan, Amar U.; Park, Sang J; King, Christopher R.; Roberts, Karen; Kupelian, Patrick A.; Steinberg, Michael L.; Kamrava, Mitchell

doi:10.1259/bjr.20150658

Cited by 6 publications

(5 citation statements)

References 51 publications

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“…A potential over-dosage of healthy prostatic tissue should not necessarily lead to increased toxicity. A recent study could prove that even a hemigland irradiation has good dosimetric results 10 .…”

Section: Introductionmentioning

confidence: 99%

⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

Zamboglou¹,

Schiller²,

Fechter³

et al. 2016

Theranostics

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Purpose: We performed a voxel-wise comparison of 68Ga-HBED-CC-PSMA PET/CT with prostate histopathology to evaluate the performance of 68Ga-HBED-CC-PSMA for the detection and delineation of primary prostate cancer (PCa).Methodology: Nine patients with histopathological proven primary PCa underwent 68Ga-HBED-CC-PSMA PET/CT followed by radical prostatectomy. Resected prostates were scanned by ex-vivo CT in a special localizer and histopathologically prepared. Histopathological information was matched to ex-vivo CT. PCa volume (PCa-histo) and non-PCa tissue in the prostate (NPCa-histo) were processed to obtain a PCa-model, which was adjusted to PET-resolution (histo-PET). Each histo-PET was coregistered to in-vivo PSMA-PET/CT data.Results: Analysis of spatial overlap between histo-PET and PSMA PET revealed highly significant correlations (p < 10-5) in nine patients and moderate to high coefficients of determination (R²) from 42 to 82 % with an average of 60 ± 14 % in eight patients (in one patient R2 = 7 %). Mean SUVmean in PCa-histo and NPCa-histo was 5.6 ± 6.1 and 3.3 ± 2.5 (p = 0.012). Voxel-wise receiver-operating characteristic (ROC) analyses comparing the prediction by PSMA-PET with the non-smoothed tumor distribution from histopathology yielded an average area under the curve of 0.83 ± 0.12. Absolute and relative SUV (normalized to SUVmax) thresholds for achieving at least 90 % sensitivity were 3.19 ± 3.35 and 0.28 ± 0.09, respectively.Conclusions: Voxel-wise analyses revealed good correlations of 68Ga-HBED-CC-PSMA PET/CT and histopathology in eight out of nine patients. Thus, PSMA-PET allows a reliable detection and delineation of PCa as basis for PET-guided focal therapies.

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Section: Introductionmentioning

confidence: 99%

⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

Zamboglou¹,

Schiller²,

Fechter³

et al. 2016

Theranostics

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“…Kishan et al. designed five-fraction comparison plans and quantified the expected dosimetric advantage ( 7 ). They specifically noted favoring a “focused” hemigland vs .…”

Section: Discussionmentioning

confidence: 99%

“…Amini et al demonstrated theoretical feasibility of delivering hemiglandsparing radiation with predicted dosimetric improvements (36). Kishan et al designed five-fraction comparison plans and quantified the expected dosimetric advantage (7). They specifically noted favoring a "focused" hemigland vs. "ultrafocal" targeted which did not necessitate precise image fusion and rigorous radiologicalpathological correlation.…”

Section: Discussionmentioning

confidence: 99%

“…Advances in multiparametric MRI (mpMRI) and prostate-specific positron emission tomography (PET), combining anatomic and functional imaging, can more accurately identify high-grade and poorly differentiated foci within the prostate, characterizing their aggressiveness and malignant potential (1)(2)(3)(4)(5). As a result, there has arisen the possibility of partial gland therapy and image-guided focal dose escalation, with the goal of further sparing the normal tissues to reduce treatment-related toxicity (6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning

et al. 2021

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IntroductionAdvances in multiparametric MRI (mpMRI) combining anatomic and functional imaging can accurately identify foci of adenocarcinoma within the prostate, offering the possibility of partial gland therapy. We performed tandem prospective pilot trials to investigate the feasibility of focal prostate SBRT (f-SBRT) based on correlating diagnostic mpMRI and biopsies with confirmatory pathology in treatment planning.Materials and MethodsPatients with pathologic focal Gleason 6–7 disease and a corresponding PIRADS 4–5 lesion on mpMRI underwent targeted and comprehensive biopsies using MRI/ultrasound fusion under electromagnetic sensor navigation. After rigorous analysis for imaging biopsy concordance, five of 18 patients were eligible to proceed to f-SBRT. Chi-squared test was used for differences from expected outcomes, and concordance was estimated with binomial distribution theory and Wilson’s method.ResultsSix patients had Gleason 6 and 12 had Gleason 3 + 4 disease (mean PSA: 5.8 ng/ml, range: 2.2–8.4). Absolute concordance was 43.8% (95% CI: 0.20, 0.64). Patterns of discordance included additional sites of ipsilateral disease, bilateral disease, and negative target. Five were upstaged to a new NCCN risk category necessitating treatment escalation. The five patients with concordant pathology completed three-fraction f-SBRT with sparing of the surrounding normal structures (including contralateral neurovascular bundle), with no reported grade 2+ toxicities and favorable PSA responses (mean: 41% decrease).ConclusionsOn our pilot trials of f-SBRT planning using rigorous imaging and pathology concordance, image-guided confirmatory biopsies frequently revealed additional disease, suggesting the need for caution in partial-gland therapy. For truly focal disease, f-SBRT provided excellent dosimetry, minimal toxicity, and encouraging biochemical response. Clinical Trial Registration: www.clinicaltrials.gov, NCT02681614; NCT02163317.

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“…The maximum dose delivered to the urethra was reduced from 43.0 Gy to 39.7 Gy, mean penile bulb dose decreased from 13.3 Gy to 9.2 Gy and the contralateral neurovascular bundle decreased from 40.2 Gy to 19.3 Gy. 33…”

Section: Focal Prostate Sbrtmentioning

confidence: 99%

Potential for focal magnetic resonance-guided stereotactic body radiotherapy for prostate cancer: A review

Nethercott¹,

Foroudi²,

Jack³

et al. 2021

IJRRT

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Prostate cancer is the most commonly diagnosed cancer among Australian men. Current whole gland radiotherapy treatment regimens are associated with known toxicities. The MR-Linac has the capability to deliver real-time visually guided radiation to enable focal therapy and reduce toxicity through decreasing radiation doses to organs at risk. This review article discusses the rationale, potential benefits and limitations of the MR-Linac in focal prostate stereotactic body radiotherapy (SBRT), in an effort to reduce toxicity-related side effects for men with low to favourable-intermediate risk prostate cancer. Pubmed was systemically for all published and ongoing trials using the search terms ‘Prostate’ and ‘MRI Linac or MR Linac’. 8 articles were reviewed, of those 1 was deemed relevant, additions were made and expert opinions in the field were sought regarding the most relevant research. Real-time MRI imaging during the delivery of each fraction with daily plan adaption is now a reality due to the development of the MR-Linac system. It is hoped that with improved real-time imaging, treatment accuracy can be improved, increasing the percentage of the planning target volume receiving the prescribed dose while reducing radiation to the surrounding organs at risk. Early results of prostate SBRT are promising but further research is needed into long term survival benefits and toxicity related outcomes. Focal stereotactic radiotherapy for low-risk intermediate prostate cancer using the MR-Linac has the potential to provide adequate tumour control while decreasing the toxicity and quality of life impact of whole gland treatment for men with localised prostate cancer.

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Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

Cited by 6 publications

References 51 publications

⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning

Potential for focal magnetic resonance-guided stereotactic body radiotherapy for prostate cancer: A review

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Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

Cited by 6 publications

References 51 publications

68Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

68Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning

Potential for focal magnetic resonance-guided stereotactic body radiotherapy for prostate cancer: A review

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⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison

⁶⁸Ga-HBED-CC-PSMA PET/CT Versus Histopathology In Primary Localized Prostate Cancer: A Voxel-Wise Comparison