Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus

Draulans, Cédric; Roover, Robin De; Heide, Uulke A. van der; Haustermans, Karin; Pos, Floris J.; Smeenk, Robert Jan; Boer, H. de; Depuydt, Tom; Kunze-Busch, Martina; Isebaert, Sofie; Kerkmeijer, Linda G.W.

doi:10.1016/j.radonc.2019.06.023

Cited by 27 publications

(35 citation statements)

References 146 publications

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“…In radiotherapy, there is a clear increase of the use of stereotactic body radiotherapy (SBRT), 1 which may be planned with inhomogeneous target doses for focal lesion ablation and organ at risk sparing 2 . This makes accurate treatment delivery at each fraction of paramount importance, which is unfortunately challenged by intrafractional motion and anatomical changes 3–7 .…”

Section: Introductionmentioning

confidence: 99%

Six degrees of freedom dynamic motion‐including dose reconstruction in a commercial treatment planning system

et al. 2021

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Purpose Intrafractional motion during radiotherapy delivery can deteriorate the delivered dose. Dynamic rotational motion of up to 38 degrees has been reported during prostate cancer radiotherapy, but methods to determine the dosimetric consequences of such rotations are lacking. Here, we create and experimentally validate a dose reconstruction method that accounts for dynamic rotations and translations in a commercial treatment planning system (TPS). Interplay effects are quantified by comparing dose reconstructions with dynamic and constant rotations. Methods The dose reconstruction accumulates the dose in points of interest while the points are moved in six degrees of freedom (6DoF) in a precalculated time‐resolved four‐dimensional (4D) dose matrix to emulate dynamic motion in a patient. The required 4D dose matrix was generated by splitting the original treatment plan into multiple sub‐beams, each representing 0.4 s dose delivery, and recalculating the dose of the split plan in the TPS (Eclipse). The dose accumulation was performed via TPS scripting by querying the dose of each sub‐beam in dynamically moving points, allowing dose reconstruction with any dynamic motion. The dose reconstruction was validated with film dosimetry for two prostate dual arc VMAT plans with intra‐prostatic lesion boosts. The plans were delivered to a pelvis phantom with internal dynamic rotational motion of a film stack (21 films with 2.5 mm separation). Each plan was delivered without motion and with three prostate motion traces. Motion‐including dose reconstruction was performed for each motion experiment using the actual dynamic rotation as well as a constant rotation equal to the mean rotation during the experiment. For each experiment, the 3%/2 mm γ failure rate of the TPS dose reconstruction was calculated with the film measurement being the reference. For each motion experiment, the motion‐induced 3%/2 mm γ failure rate was calculated using the static delivery as the reference and compared between film measurements and TPS dose reconstruction. DVH metrics for RT structures fully contained in the film volume were also compared between film and TPS. Results The mean γ failure rate of the TPS dose reconstructions when compared to film doses was 0.8% (two static experiments) and 1.7% (six dynamic experiments). The mean (range) of the motion‐induced γ failure rate in film measurements was 35.4% (21.3–59.2%). The TPS dose reconstruction agreed with these experimental γ failure rates with root‐mean‐square errors of 2.1% (dynamic rotation dose reconstruction) and 17.1% (dose reconstruction assuming constant rotation). By DVH metrics, the mean (range) difference between dose reconstructions with dynamic and constant rotation was 4.3% (−0.3–10.6%) (urethra D2%), −0.6% (−5.6%–2.5%) (urethra D99%), 1.1% (−7.1–7.7%) (GTV D2%), −1.4% (−17.4–7.1%) (GTV D95%), −1.2% (−17.1–5.7%) (GTV D99%), and −0.1% (−3.2–7.6%) (GTV mean dose). Dose reconstructions with dynamic motion revealed large interplay effects (cold and hot spots). Conclusions A meth...

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Section: Introductionmentioning

confidence: 99%

Six degrees of freedom dynamic motion‐including dose reconstruction in a commercial treatment planning system

et al. 2021

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“…A small rise in median PSA was observed at 18 months but this did not meet the definition of PSA bounce. Benign PSA bounces are described in up to 30% of patients undergoing prostate SABR and are defined as a PSA rise of at least 0.2 ng/mL above its previous nadir with a subsequent decline to that nadir or lower [28] . This phenomenon can occur up to 30 months from treatment.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiotherapy with focal boost for intermediate and high-risk prostate cancer: Initial results of the SPARC trial

Nicholls¹,

Suh²,

Chapman³

et al. 2020

Clinical and Translational Radiation Oncology

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“…However, a planning study must be preceded clinical study for the safety of the patients. Several on-going phase II studies are evaluating SIB to DIL in SBRT settings 26 , including hypo-FLAME study (NCT02853110) investigating the feasibility of 35 Gy in 5 fractions to the whole prostate with an additional boost to DIL up to 50 Gy. As the patient accrual was completed in 2018, it will take some time for maturing the data.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous integrated boost with stereotactic radiotherapy for dominant intraprostatic lesion of localized prostate cancer: a dosimetric planning study

Kim

Yoon

Kim

2020

Sci Rep

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Dominant intraprostatic lesion (DIL) has been known as the most common local recurrence site of prostate cancer. We evaluated the feasibility of simultaneous integrated boost (SIB) to DIL with CyberKnife stereotactic body radiotherapy (CK-SBRT). We selected 15 patients with prostate cancer and visible DIL and compared 3 plans for each patient: 1) No boost plan of 35 Gy to prostate, 2) DIL_40 plan of SIB 40 Gy to DIL and 35 Gy to prostate, and 3) DIL_45 plan with 45 Gy to DIL and 35 Gy to the prostate in 5 fractions. All targets satisfied with the prescription coverage per protocol. However, some patients failed to meet the Dmax of the rectum in DIL_40 plans (n = 4), and DIL_45 plans (n = 6). Violations of bladder constraints occurred in four DIL_45 plans. Consequently, the DIL boost with SBRT was possible in 73% of patients with DIL_40 plans, and 60% of patients with DIL_45 plans without any violation of normal organ constraints. All patients who experienced constraint violations had DILs in posterior segments. DIL boost using CK-SBRT could be an option for localized prostate cancer patients. For patients who had DIL in posterior segments, a moderate dose escalation of 40 Gy seemed appropriate.

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Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus

Cited by 27 publications

References 146 publications

Six degrees of freedom dynamic motion‐including dose reconstruction in a commercial treatment planning system

Six degrees of freedom dynamic motion‐including dose reconstruction in a commercial treatment planning system

Stereotactic radiotherapy with focal boost for intermediate and high-risk prostate cancer: Initial results of the SPARC trial

Simultaneous integrated boost with stereotactic radiotherapy for dominant intraprostatic lesion of localized prostate cancer: a dosimetric planning study

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