Standard whole prostate gland radiotherapy with and without lesion boost in prostate cancer: Toxicity in the FLAME randomized controlled trial

Monninkhof, Evelyn M.; Loon, Juliette W. L. van; Vulpen, Marco van; Kerkmeijer, Linda G.W.; Pos, Floris J.; Haustermans, Karin; Bergh, Laura Van den; Isebaert, Sofie; McColl, G.; Smeenk, Robert Jan; Noteboom, J.L.; Walraven, Iris; Peeters, Petra H.M.; Heide, Uulke A. van der

doi:10.1016/j.radonc.2017.12.022

Cited by 104 publications

(77 citation statements)

References 24 publications

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“…Intermediateand high-risk PCa patients were randomised into the standard arm that delivered 77 Gy to the whole gland over 35 fractions or the experimental arm that received a focal boost to the DIL resulting in a total dose of 95 Gy. Focal dose escalation demonstrated comparable genitourinary (GU) and gastrointestinal (GI) toxicity to the standard arm up to two years post-treatment [15]. Murray et al recently reported on preliminary results from the DELINEATE trial that applied focal dose escalation to conventionally-fractionated and hypofractionated IMRT for intermediate-and high-risk PCa [16].…”

Section: Image-guided Focal Dose Escalation In Pca Imrtmentioning

confidence: 99%

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Her

Haworth

Rowshanfarzad

et al. 2020

Cancers

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Advances in imaging have enabled the identification of prostate cancer foci with an initial application to focal dose escalation, with subvolumes created with image intensity thresholds. Through quantitative imaging techniques, correlations between image parameters and tumour characteristics have been identified. Mathematical functions are typically used to relate image parameters to prescription dose to improve the clinical relevance of the resulting dose distribution. However, these relationships have remained speculative or invalidated. In contrast, the use of radiobiological models during treatment planning optimisation, termed biological optimisation, has the advantage of directly considering the biological effect of the resulting dose distribution. This has led to an increased interest in the accurate derivation of radiobiological parameters from quantitative imaging to inform the models. This article reviews the progress in treatment planning using image-informed tumour biology, from focal dose escalation to the current trend of individualised biological treatment planning using image-derived radiobiological parameters, with the focus on prostate intensity-modulated radiotherapy (IMRT).

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Section: Image-guided Focal Dose Escalation In Pca Imrtmentioning

confidence: 99%

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Her

Haworth

Rowshanfarzad

et al. 2020

Cancers

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“…Dose escalation on intraprostatic GTV was feasible in 14/15 patients and with a median follow-up of 18 months no patient developed gastrointestinal/genitourinary toxicities ≥3. Recently, a randomized, multicenter Phase III study (FLAME trial) reported toxicity outcomes after a median follow-up of 55 month in 571 patients [83]. The standard treatment arm received a dose to the entire prostate of 77 Gy in 35 fractions.…”

Section: Mpmrimentioning

confidence: 99%

Multimodal imaging for radiation therapy planning in patients with primary prostate cancer

Zamboglou

Eiber

Fassbender

et al. 2018

Physics and Imaging in Radiation Oncology

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Implementation of advanced imaging techniques like multiparametric magnetic resonance imaging (mpMRI) or Positron Emission Tomography (PET) in radiation therapy (RT) planning of patients with primary prostate cancer demands several preconditions: accurate staging of the extraprostatic and intraprostatic tumor mass, robust delineation of the intraprostatic gross tumor volume (GTV) and a reproducible characterization of the prostate cancer's biological properties. In the current review we searched for the currently available imaging techniques and we discussed their ability to fulfill these preconditions. We found that current pretreatment imaging was mainly performed with mpMRI and/or Prostate-specific membrane antigen PET imaging. Both techniques offered an accurate detection of the extraprostatic and intraprostatic tumor burden and had a major impact on RT concepts. However, some studies postulated that mpMRI and PSMA PET had complementary information for intraprostatic GTV detection. Moreover, interobserver differences for intraprostatic tumor delineation based on mpMRI were observed. It is currently unclear whether PET based GTV delineation underlies also interobserver heterogeneity. Further research is warranted to answer whether multimodal imaging is able to visualize biological processes related to prostate cancer pathophysiology and radiation resistance.

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“…Due to the last decade of research into standard fractionation we have also developed alternative methods of tipping the therapeutic ratio in our favour, such as increasing dose solely to the dominant tumour lesion seen on magnetic resonance imaging at diagnosis, rather than to the whole gland. The concept of a biological target volume, dose-escalated focally to improve PSA control rates [14], has been tested in the FLAME [15] and DELINEATE [16] trials. These trials, and others [17], suggest that focal boosting can be achieved with little/no penalty to toxicity; it remains to be seen whether focal boosting increases control or cure rates.…”

Section: Introductionmentioning

confidence: 99%

Seven or less Fractions is Not the Standard of Care for Intermediate-Risk Prostate Cancer

Tree

Dearnaley

2020

Clinical Oncology

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Standard whole prostate gland radiotherapy with and without lesion boost in prostate cancer: Toxicity in the FLAME randomized controlled trial

Cited by 104 publications

References 24 publications

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Multimodal imaging for radiation therapy planning in patients with primary prostate cancer

Seven or less Fractions is Not the Standard of Care for Intermediate-Risk Prostate Cancer

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