The impact of androgen deprivation therapy on setup errors during external beam radiation therapy for prostate cancer

Onal, Cem; Dolek, Yemliha; Özdemir, Yurday

doi:10.1007/s00066-017-1131-z

Cited by 7 publications

(8 citation statements)

References 52 publications

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“…In low‐risk patients, the clinical target volume (CTV) encompasses only the prostate, whereas, in intermediate‐ and high‐risk patients, it includes the prostate and the proximal two‐thirds of the seminal vesicles. The planning target volume (PTV) is the CTV with a 5‐mm posterior margin and 8‐mm margins in all other directions 6,15 . All the patients received 78 Gy for their prostate ± seminal vesicles and 86 Gy for the IPL using the SIB technique.…”

Section: Methodsmentioning

confidence: 99%

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Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

et al. 2023

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Background To evaluate the treatment outcomes and toxicity of definitive radiotherapy (RT) for prostate cancer (PC) patients using the simultaneous integrated boost (SIB) technique, which delivered 78 Gy to the entire prostate and 86 Gy to the intraprostatic lesion (IPL) in 39 fractions. Materials and Methods Univariable and multivariable analyses were conducted of the prognostic factors for freedom from biochemical failure (FFBF), progression‐free survival (PFS), and PC‐specific survival (PCSS) of 619 PC patients who received definitive RT between September 2012 and August 2021. Predictors of late Grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicities were also identified using logistic regression. Results The median follow‐up for entire cohort was 68.5 months. The 5‐year FFBF, PFS, and PCSS rates were 93.2%, 83.2%, and 98.6%, respectively. They were predicted by the serum prostate‐specific antigen, Gleason score (GS), clinical nodal stage, and D'Amico risk group. Only 45 patients (7.3%) developed disease recurrence 41.9 months after RT. The 5‐year FFBF rates for low‐, intermediate‐, and high‐risk disease were 98.0%, 93.1%, and 88.5%, respectively (p < 0.001). The 5‐year PFS and PCSS rates according to risk groups were 91.0%, 82.1%, and 77.4% (p < 0.001), and 99.2%, 96.4%, and 95.9% (p = 0.03), and, respectively. GS > 7 and lymph node metastasis negatively predicted FFBF and PCSS in multivariable analysis. Ninety (14.6%) and 44 (7.1%) patients had acute Grade ≥2 GU and GI toxicities, respectively, and 42 (6.8%) and 27 (4.4%) patients had late Grade ≥2 GU and GI toxicities, respectively. Diabetes and transurethral resection independently predicted late Grade 2 GU toxicity, but no significant predictor of late Grade ≥2 GI toxicity was found. Conclusions Localized PC was effectively and safely treated with definitive RT using the SIB technique to deliver 86 Gy to the IPL in 39 fractions without severe late toxicity. This finding must be validated with long‐term results.

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Section: Methodsmentioning

confidence: 99%

“…The planning target volume (PTV) is the CTV with a 5-mm posterior margin and 8-mm margins in all other directions. 6,15 All the patients received 78 Gy for their prostate ± seminal vesicles and 86 Gy for the IPL using the SIB technique. High-risk patients received pelvic nodal irradiation.…”

Section: Patient Selectionmentioning

confidence: 99%

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

et al. 2023

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“…The planning target volume (PTV) is created by adding a 5‐mm posterior margin and 8‐mm margins in all other directions to the prostate and seminal vesicle 15,16 . The PTV for SIB was created by expanding IPL by 4 mm in all directions 13 .…”

Section: Methodsmentioning

confidence: 99%

“…The planning target volume (PTV) is created by adding a 5-mm posterior margin and 8-mm margins in all other directions to the prostate and seminal vesicle. 15,16 The PTV for SIB was created by expanding IPL by 4 mm in all directions. 13 The treatment plans were formulated utilizing the Monte Carlo algorithm in the Monaco Treatment Planning System (Elekta Ltd.) and radiation was delivered using Versa-HD linear accelerator (Elekta AB).…”

Section: Treatmentmentioning

confidence: 99%

The effect of dose‐escalation radiotherapy with simultaneous‐integrated‐boost on the use of short‐term androgen deprivation therapy in patients with intermediate risk prostate cancer

Onal,

Guler,

Erbay

et al. 2024

The Prostate

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PurposeTo compare the biochemical failure (FFBF) and prostate cancer specific survival (PCSS) rates of patients with intermediate‐risk prostate cancer (IR‐PC) who were treated with 6 months of androgen deprivation therapy (ADT) with 78 Gy to the prostate, those treated with ADT and focal boost (FB) of 86 Gy to intraprostatic lesion (IPL) using the simultaneous‐integrated boost (SIB) technique, and those treated with SIB alone.Materials and MethodsA retrospective analysis of 320 IR‐PC patients treated between January 2012 and April 2021 was performed. Patients were divided into three groups based on their treatment arm: 78 + ADT (109 patients, 34.1%), 78/86 (102 patients, 31.8%), and 78/86 + ADT. Univariable and multivariable analyses were used to determine prognostic factors for FFBF and PCSS.ResultsMedian follow‐up was 8.8 years. The 8‐year FFBF and PCSS rates were 88.6% and 99.0%. Patients who received ADT had significantly higher pretreatment PSA levels and clinical tumor stage. Disease progression occurred in 45 patients (7.3%) at a median of 41.9 months after definitive radiotherapy (RT). Younger age, positive core biopsy (PCB) ≥ 50%, and the absence of ADT were all independent predictors of poor FFBF in multivariate analysis, whereas patients with PCB < 50% who were also given ADT had better PCSS. Patients treated with 78/86 Gy alone had worse FFBF than those treated with 78 Gy and ADT (Hazard ratio [HR] = 3.39 [95% CI = 1.46–7.88]; p = 0.005), as well as than those treated with 78/86 Gy and ADT (HR = 3.21 [95% CI = 1.23–6.46]; p = 0.009). However, FB to IPL has no effect on PCSS in multivariable analysis. There was no significant difference between treatment groups in terms of acute and late Grade ≥2 genitourinary or gastrointestinal toxicity.ConclusionsOur findings demonstrated that patients who received 78/86 alone did worse than patients who received ADT with either 78 or 78/86 Gy. However, because IR‐PC patients are so diverse, additional prospective trials are needed to validate our findings.

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“…The patients underwent a computed tomography (CT) scan to determine dose distribution and a diagnostic MRI, which included diffusion‐weighted imaging (DWI), dynamic contrast‐enhanced (DCE), and high spatial resolution T2‐weighted (T2W) images. The patients were instructed to have an empty bowel and a full bladder during simulation and treatment 9 . The diagnostic MRI and the planning CT images were registered using a deformable registration technique.…”

Section: Methodsmentioning

confidence: 99%

The impact of margin reduction on radiation dose distribution of ultra‐hypofractionated prostate radiotherapy utilizing a 1.5‐T MR‐Linac

Onal,

Efe,

Bozca

et al. 2023

J Applied Clin Med Phys

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BackgroundWe examined the effects of reducing the planning target volume (PTV) margin in MR‐guided radiotherapy (MRgRT) on the distribution of radiation dose to target volumes and organs‐at‐risk (OARs). Thus, we compared MR‐Linac (MRL) plans with and without reduced margin and intensity‐modulated radiotherapy (IMRT) plan with conventional linac for low‐risk prostate cancer patients receiving 36.25 Gy in five fractions of ultra‐hypofractionated radiation therapy.Materials and MethodsTwenty low‐risk prostate cancer patients treated with 1.5 T MR‐Linac were evaluated. The same planning CT images were used for four plans: the MRL‐R plan with reduced margin planning target volume (PTV‐R) and the MRL‐N plan with normal margin PTV (PTV‐N), which is also used for IMRT plan. In four plans, PTV doses, organs‐at‐risk (OARs) doses, the homogeneity index (HI), and monitor units were compared.ResultsAll plans met the criteria for PTV coverage and OARs dose constraints. The maximum and mean PTV doses were significantly higher in the MRL‐R and MRL‐N plans compared to the IMRT plan. The HI was lowest in the IMRT plan (0.040 ± 0.013) and highest in the MRL‐N plan (0.055 ± 0.012; p < 0.001). There was no significant difference in the PTV dosimetric parameters between the MRL‐R and the MRL‐N plans. The high doses in the rectum was significantly lower in the MRL‐R compared to other plans. The bladder V36.25 Gy was significantly lower in the MRL‐R plan (2.43 ± 1.87 Gy) compared to MRL‐N (4.50 ± 2.42 Gy; p < 0.001), and IMRT plans (4.76 ± 2.77 Gy; p < 0.001). There was no significant difference in the low‐dose volumes of the body, maximum femur doses, or monitor units across each plan.ConclusionsUltra‐hypofractionated MR‐guided RT with 1.5 T MRL is dosimetrically feasible for patients with prostate cancer. The improved soft tissue contrast and the online adaptive plan for 1.5 T MR‐Linac allows for PTV margin reduction resulted in a significant dose reduction in OARs.

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The impact of androgen deprivation therapy on setup errors during external beam radiation therapy for prostate cancer

Abstract: Hormone therapy given concurrently with RT was not found to significantly impact setup errors. Prostate volume was significantly correlated with shifts in the anterior-posterior direction only.

Cited by 7 publications

References 52 publications

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

The effect of dose‐escalation radiotherapy with simultaneous‐integrated‐boost on the use of short‐term androgen deprivation therapy in patients with intermediate risk prostate cancer

The impact of margin reduction on radiation dose distribution of ultra‐hypofractionated prostate radiotherapy utilizing a 1.5‐T MR‐Linac

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