Experimental assessments of intrafractional prostate motion on sequential and simultaneous boost to a dominant intraprostatic lesion

Abdellatif, Ady; Craig, J; Jensen, Michael D.; Mulligan, Michael J.; Mosalaei, H; Chen, Jeff; Wong, Eugene

doi:10.1118/1.3685586

Cited by 15 publications

(5 citation statements)

References 43 publications

(46 reference statements)

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“…First, we used T2WI and DWI to determine IPLs but did not use PET images. To determine IPLs, some studies have used 11 C choline PET [28][29][30][31] or prostate-specific membrane antigen-targeted PET [32] images. However, a combination of T2WI and DWI was used in PI-RADS version 2 to improve the detectability of prostate cancer [33,34].…”

Section: Discussionmentioning

confidence: 99%

Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study

et al. 2021

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“…In a previous experimental investigation, we showed that DIL boosts can be safely achieved in the presence of intrafraction motion when using a PTV margin of 7 mm. 31 More recent studies have shown that tracking intraprostatic fiducial markers and accounting for 6 degrees of freedom in prostate motion can reliably monitor prostate position during delivery with an accuracy of 0.2 AE 1.3 and 0.1 AE 0.5 mm for rotation and translation, respectively. 32 Fiducial tracking has been associated with lower toxicity.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Evaluation of PSMA PET-Delineated Dominant Intraprostatic Lesion Simultaneous Infield Boosts

Goodman

Fakir

Pautler

et al. 2020

Advances in Radiation Oncology

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Prostate cancer is multifocal. However, there often exists a single dominant focus in the gland responsible for driving the biology of the disease. Dose escalation to the dominant lesion is a proposed strategy to increase tumor control. We applied radiobiological modeling to evaluate the dosimetric feasibility and benefit of dominant intraprostatic lesion simultaneous in-field boosts (DIL-SIB) to the gross tumor volume (GTV), defined using a novel molecular positron emission tomography (PET) probe (18F-DCFPyL) directed against prostate specific membrane antigen (PSMA). Methods and Materials: Patients with clinically localized, biopsy-proven prostate cancer underwent preoperative [ 18 F]-DCFPyL PET/computed tomography (CT). DIL-SIB plans were generated by importing the PET/CT into the RayStation treatment planning system. GTV-PET for the DIL-SIB was defined by the highest %SUVmax (percentage of maximum standardized uptake value) that generated a biologically plausible volume. Volumetric arcebased plans incorporating prostate plus DIL-SIB treatment were generated. Tumor control probability (TCP) and normal tissue complication probability (NTCP) with fractionation schemes and boost doses specified in the FLAME (Investigate the Benefit of a Focal Lesion Ablative Microboost in Prostate Cancer; NCT01168479), PROFIT (Prostate Fractionated Irradiation Trial; NCT00304759), PACE (Prostate Advances in Comparative Evidence; NCT01584258), and hypoFLAME (Hypofractionated Focal Lesion Ablative Microboost in prostatE Cancer 2.0; NCT02853110) protocols were compared. Results: Comparative DIL-SIB plans for 6 men were generated from preoperative [ 18 F]-DCFPyL PET/CT. Median boost GTV volume was 1.015 cm 3 (0.42-1.83 cm 3 ). Median minimum (D99%) DIL-SIB dose for F35 BS , F20 BS , F5 BS , and F5 BSH were 97.3 Gy, 80.8 Gy, 46.5 Gy, and 51.5Gy. TCP within the GTV ranged from 84% to 88% for the standard plan and 95% to 96% for the DIL-SIB plans. Within the rest of the prostate, TCP ranged from 89% to 91% for the standard plans and 90% to 92% for the DIL-SIB plans. NTCP for the rectum NTCP was similar for the DIL-SIB plans (0.3%-2.7%) compared with standard plans (0.7%-2.6%). Overall, DIL-SIB plans yielded higher uncomplicated TCP (NTCP, 90%-94%) versus standard plans (NTCP, 83%-85%). Conclusions: PSMA PET provides a novel approach to define GTV for SIB-DIL dose escalation. Work is ongoing to validate PSMA PET-delineated GTV through correlation to coregistered postprostatectomy digitized histopathology.

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“…In a planning study with and without simulated intrafraction motion [10] a safety margin of 7 mm was found to make both sequential or simultaneous boosts feasible. This is in agreement with our simulation showing that already a safety margin of 5 mm will yield 97% of the dose to 100% of the IPL volume.…”

Section: Discussionmentioning

confidence: 99%

“…A simultaneous integrated boost (SIB) to the dominant IPL is a strategy to fight such recurrences [1–4]. Toxicity seems to be less of a problem [5–8], however it has been suggested that intrafraction motion requires either intrafraction motion tracking in case of small margins [9] or substantial margins [10].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric impact of intrafraction motion on boosts on intraprostatic lesions: a simulation based on actual motion data from real time ultrasound tracking

Ballhausen

Reiner

et al. 2019

Radiat Oncol

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Background Intrafraction motion is particularly problematic in case of small target volumes and narrow margins. Here we simulate the dose coverage of intraprostatic lesions (IPL) by simultaneous integrated boosts (SIB). For this purpose, we use a large sample of actual intrafraction motion data. Methods Fifty-three h of intra-fraction motion of the prostate were recorded in real-time by 4D ultrasound (4DUS) during 720 fractions in 28 patients. We simulate spherical IPLs with 3, 5, and 7 mm radius and matching spherical SIBs with 0, 2, and 5 mm safety margins. The volumetric overlap between IPLs and SIBs is calculated. Dose volume histograms (DVH) are estimated by Monte Carlo simulation. Results On average, the distance of the prostate was 1.3 mm from its initial position over all fractions and patients. Average volumetric overlap was 73, 82, and 87% of IPL volume in case of 3, 5, and 7 mm IPLs and SIBs without safety margins. These improved to 95% or more in case of 2 mm safety margins and 98% or more in case of 5 mm safety margins. DVHs showed that 80% of the IPL volume received 60, 72, and 79% of maximum dose in case of 3, 5, and 7 mm IPLs and SIBs without safety margins. These improved to 94% or more given moderately sized safety margins of 2 mm. Conclusions On average over all fractions and patients, the dose coverage would have been acceptable even for small target volumes such as IPLs of radius 3 to 7 mm and narrow fields. Moderate safety margins of 2 mm could have ensured a delivery of 90% or more of the SIB dose to the IPL. In this case, SIB volume would have been considerably larger than IPL volume, but still considerably smaller than the overall PTV of the prostate. Electronic supplementary material The online version of this article (10.1186/s13014-019-1285-1) contains supplementary material, which is available to authorized users.

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Experimental assessments of intrafractional prostate motion on sequential and simultaneous boost to a dominant intraprostatic lesion

Cited by 15 publications

References 43 publications

Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study

Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study

Dosimetric Evaluation of PSMA PET-Delineated Dominant Intraprostatic Lesion Simultaneous Infield Boosts

Dosimetric impact of intrafraction motion on boosts on intraprostatic lesions: a simulation based on actual motion data from real time ultrasound tracking

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