Long-Term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation on Biochemical Tumor Control and Distant Metastases-Free Survival Outcomes

Zeléfsky, Michael J.; Yamada, Yoshiya; Fuks, Zvi; Zhang, Zhigang; Hunt, Margie; Cahlon, Oren; Park, Jessica; Shippy, Alison M.

doi:10.1016/j.ijrobp.2007.11.066

Cited by 300 publications

(182 citation statements)

References 19 publications

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“…( 1 ) By virtue of this capability, IMRT has enabled the delivery of conformal doses to the target while sparing the surrounding normal tissues, which can furthermore allow dose escalation — which is beneficial for the outcomes of radiotherapy. ( 2 – 5 ) …”

Section: Introductionmentioning

confidence: 99%

The dosimetric effect of mixed‐energy IMRT plans for prostate cancer

Park

Choi

et al. 2011

J Applied Clin Med Phys

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We investigated the effect of mixing high‐ and low‐energy photon beams on the quality of intensity‐modulated radiation therapy (IMRT) plans for patients with prostate cancer. Three different plans for each of twenty patients were generated using either 6 MV or 15 MV alone, and both 6 and 15 MV beams. All the planning parameters, goals, and constraints were set to be identical except beam energy. The dose distributions were similar in terms of target coverage, conformity, and homogeneity regardless of beam energy. The normalV70Gy of rectal wall in 6 MV, 15 MV and mixed‐energy plans was 16.7%, 17.9%, and 16.3%, respectively, while normalV40Gy was 55.6%, 53.2%, and 50%. The mean dose to femoral heads in 6 MV, 15 MV, and mixed‐energy plans were 31.7 Gy, 26.3 Gy, and 26.2 Gy, respectively. The integral dose of 6 MV plans was 7% larger than those of 15 MV or mixed‐energy plans. These results indicated that mixed‐energy IMRT plans could take advantage of the dosimetric characteristics of low‐ and high‐energy beams. Even though the reduction of dose to the organs at risk may not be clinically relevant, mixing energy in an IMRT plan for deep‐seated tumors can improve the overall plan quality.PACS number: 87.55.ne

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Section: Introductionmentioning

confidence: 99%

The dosimetric effect of mixed‐energy IMRT plans for prostate cancer

Park

Choi

et al. 2011

J Applied Clin Med Phys

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“…15 Although dose intensification and improved technologies of RT improve outcomes, almost 1 in 3 patients still experience treatment failure. 16 In a proportion of these men, recurrent or persistent disease is isolated to the prostate gland only. In a series of 4839 patients, Kuban and colleagues reported 416 (8.6%) cases of isolated intra-prostatic failure after RT.…”

Section: Discussionmentioning

confidence: 99%

Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer

Siddiqui

Billia

Williams

et al. 2015

CUAJ

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“…Dose‐escalated external beam radiation therapy (EBRT) (≥ 78 Gy) has replaced the previous standard dose of ~70 Gy as the new “standard of care” for the treatment of prostate cancer 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Dose‐escalated EBRT significantly improves biochemical progression‐free survival in most patients, and also overall survival in patients with intermediate‐ or high‐risk disease 7, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

Chung

Polf

Badiyan

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to evaluate whether a spacer inserted in the prerectal space could reduce modeled rectal dose and toxicity rates for patients with prostate cancer treated in silico with pencil beam scanning (PBS) proton therapy. A total of 20 patients were included in this study who received photon therapy (12 with rectal spacer (DuraSeal™ gel) and 8 without). Two PBS treatment plans were retrospectively created for each patient using the following beam arrangements: (1) lateral‐opposed (LAT) fields and (2) left and right anterior oblique (LAO/RAO) fields. Dose volume histograms (DVH) were generated for the prostate, rectum, bladder, and right and left femoral heads. The normal tissue complication probability (NTCP) for ≥grade 2 rectal toxicity was calculated using the Lyman–Kutcher–Burman model and compared between patients with and without the rectal spacer. A significantly lower mean rectal DVH was achieved in patients with rectal spacer compared to those without. For LAT plans, the mean rectal V70 with and without rectal spacer was 4.19 and 13.5%, respectively. For LAO/RAO plans, the mean rectal V70 with and without rectal spacer was 5.07 and 13.5%, respectively. No significant differences were found in any rectal dosimetric parameters between the LAT and the LAO/RAO plans generated with the rectal spacers. We found that ≥ 9 mm space resulted in a significant decrease in NTCP modeled for ≥grade 2 rectal toxicity. Rectal spacers can significantly decrease modeled rectal dose and predicted ≥grade 2 rectal toxicity in prostate cancer patients treated in silico with PBS. A minimum of 9 mm separation between the prostate and anterior rectal wall yields the largest benefit.

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Long-Term Results of Conformal Radiotherapy for Prostate Cancer: Impact of Dose Escalation on Biochemical Tumor Control and Distant Metastases-Free Survival Outcomes

Cited by 300 publications

References 19 publications

The dosimetric effect of mixed‐energy IMRT plans for prostate cancer

The dosimetric effect of mixed‐energy IMRT plans for prostate cancer

Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer

Rectal dose to prostate cancer patients treated with proton therapy with or without rectal spacer

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