Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

Hsu, I.; Bae, K.; Shinohara, K.; Pouliot, J.; Purdy, J.; Ibbott, G.; Speight, J.; Vigneault, E.; Ivker, R.; Sandler, H.

doi:10.1016/j.ijrobp.2008.06.442

Cited by 31 publications

(43 citation statements)

References 20 publications

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“…We developed a class solution that would comply with the dosimetric requirements used in the current RTOG-0321 protocol [6]. The RTOG protocol requires more than 90% of the planning target volume (PTV) to be covered by the prescription dose (9.5 Gy).…”

Section: Dosimetric Requirements For a Class Solutionmentioning

confidence: 99%

Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

Kim

Hsu

Lessard

et al. 2008

Radiotherapy and Oncology

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Purpose-To establish an inverse planning set of parameters (class solution) to boost dominant intra-prostatic lesion (DIL) defined by MRI/MRSI.Methods-For 15 patients, DIL were contoured on CT or MR images and a class solution was developed to boost the DIL under the dosimetric requirements of the RTOG-0321 protocol. To determine the maximum attainable level of boost for each patient, 5 different levels were considered, at least 110%, 120%, 130%, 140% and 150% of the prescribed dose. The maximum attainable level was compared to the plan without boost using cumulative dose volume histogram (DVH).Results-DIL dose escalation was feasible for 11/15 patients under the requirements. The planning target volume (PTV) dose was slightly increased, while the DIL dose was significantly increased without any violation of requirements. With slight adjustments of the dose constraint parameters, the dose escalation was feasible for 13/15 patients under requirements.Conclusion-Using a class solution, a dose escalation of the MRI/MRSI defined DIL up to 150% while complying with RTOG dosimetric requirements is feasible. This HDR brachytherapy approach to dose escalation allows a significant dose increase to the tumor while maintaining an acceptable risk of complications. KeywordsClass solution; Dominant intra-prostatic lesion; MR Spectroscopy imaging; Dose escalation; Inverse planned HDR brachytherapy High dose rate (HDR) brachytherapy can safely and accurately deliver radiation dose to prostate cancer with a single Ir-192 source. The HDR brachytherapy employs catheters inserted directly into the prostate, guided by transrectal ultrasound (TRUS), and adjusts source dwell times along the catheters with a remotely controlled afterloader. Advancements recently made in imaging technology have improved the accuracy and effectiveness of HDR prostate brachytherapy planning. The anatomical information obtained from computed [2,4,17,18,25,26]. In addition, the development of anatomy-based inverse planning dose optimization for HDR brachytherapy can produce a highly conformal dose profile within one minute, with more than 90% of the prostate volume covered with the prescribed dose and a clinically acceptable sparing of OAR [1,3,5,[13][14][15]28]. Furthermore, the concept of class solution commonly used in intensity modulated radiation therapy (IMRT) [8,20,21,24,27] is now available in brachytherapy. The class solution of an inverse planning routine can reduce the variation of treatment plan quality across different users and can dramatically decrease the treatment planning time. In this study we developed a class solution for boosting MRI/MRS defined DILs in inverse planned HDR brachytherapy of prostate cancer. HHS Public Access Methods and materials Patient cohortsWe used data from 15 HDR patients with MRI/MRSI de-fined DILs (patients A to O). The mean ± standard deviation value of their prostate volume was 43.7 ± 16.3 cc with a range from 28.1 to 86.0 cc. In general, 16 catheters (range from 15 to 18) were inserted using TRUS gu...

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Section: Dosimetric Requirements For a Class Solutionmentioning

confidence: 99%

Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

Kim

Hsu

Lessard

et al. 2008

Radiotherapy and Oncology

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“…[4][5][6][7] Until now, hypofractionation with high dose rate has been utilized by high dose rate brachytherapy (HDR-BRT), establishing itself as a viable and safe approach as monotherapy or boost after EBRT. [8][9][10][11][12][13][14][15] The HDR-BRT has the advantage of better accuracy to the dose delivered and avoidance of complications secondary to organ movement compared to EBRT. In intermediate-and high-risk disease, HDR-BRT alone may not deliver adequate dose to periprostatic tissues.…”

Section: Introductionmentioning

confidence: 99%

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Pontoriero

Iatì

Mondello

et al. 2015

Technol Cancer Res Treat

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Background: Stereotactic body radiotherapy (SBRT) can emulate high dose rate brachytherapy (HDR-BRT) dose fractionation. We report our preliminary results using SBRT in monotherapy or pre-external-beam radiotherapy (EBRT) boost in patients with localized prostate cancer (LpC). The primary end point was the evaluation of both acute and late toxicities; secondary end point was the observation of prostate-specific antigen (PSA) nadir. Patients and Methods: Patients with LpC having prostate volume 90 cm 3 were enrolled in the present study. Patients were treated with SBRT alone or in combined modality (SBRT þ EBRT). SBRT was performed using a CyberKnife System (Accuray Incorporated, Sunnyvale, California) and fiducial tracking system. Results: From February 2008 to July 2013, 21 patients for monotherapy (38 Gy/4 fractions) and 5 for combined modality (9.5 Gy/2 fractions plus 46 Gy/23 fractions EBRT) were enrolled. Androgen deprivation therapy (ADT) was administered in 16 of the 26 patients. The median pretreatment PSA was 9.4 (range, 4.5-14.3) ng/mL. All patients completed the planned therapy. Acute Grade 1 toxicity was observed in 18 patients, genitourinary (GU) in 12 / 26 patients, and gastrointestinal (GI) in 6 / 26 patients. Acute Grade 2 GU toxicity was reported in 1 / 26 patients, and Grade 2 GI toxicity was observed in 2 / 26 patients. The median PSA nadir was 0.15 (range, 0.02 ¼ 1.4) ng/mL. Late toxicities were observed in 5 / 26 patients: Grade 1 GU (3 of 26), Grade 2 GU (1 of 26), and Grade 1 GI (1 of 26). Median follow-up was 21.5 (range, 8-65) months. Conclusions: Our preliminary results of SBRT ''simulating'' HDR for LpC confirm a minimal toxicity and an optimal PSA response. The PSA nadirs appear comparable with HDR-BRT.

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“…These observations led to use of high dose rate brachytherapy (HDR), first as a boost [17][18][19], and then as definitive monotherapy [20][21][22][23]. Due to its superior conformality, HDR could deliver high bioequivalent doses while sparing neighboring critical structures.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

Anwar

Weinberg

Chang

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Background: Patients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcomes. The purpose of this study was to compare the PSA kinetics between CF-EBRT and SBRT in newly diagnosed localized prostate cancer. Materials/methods: 75 patients with low to low-intermediate risk prostate cancer (T1-T2; GS 3 + 3, PSA < 20 or 3 + 4, PSA < 15) treated without hormones with CF-EBRT (>70.2 Gy, <76 Gy) to the prostate only, were identified from a prospectively collected cohort of patients treated at the University of California, San Francisco (1997. Patients were excluded if they failed therapy by the Phoenix definition or had less than 1 year of follow-up or <3 PSAs. 43 patients who were treated with SBRT to the prostate to 38 Gy in 4 daily fractions also met the same criteria. PSA nadir and rate of change in PSA over time (slope) were calculated from the completion of RT to 1, 2 and 3 years post-RT.

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Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321

Cited by 31 publications

References 20 publications

Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Hypofractionated SBRT Versus Conventionally Fractionated EBRT for Prostate Cancer: Comparison of PSA Slope and Nadir

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