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Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer

BACKGROUND: This is the final report of a prospective phase I study which evaluated the feasibility, toxicities, and biochemical control in prostate cancer patients treated with a hypofractionated boost utilizing a fiducial marker-based daily image guidance strategy and small patient-specific PTV ma...

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Autores principales: Chu, William, Loblaw, D Andrew, Chan, Kelvin, Morton, Gerard, Choo, Richard, Szumacher, Ewa, Danjoux, Cyril, Pignol, Jean-Philippe, Cheung, Patrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407385/
https://www.ncbi.nlm.nih.gov/pubmed/25903934
http://dx.doi.org/10.1186/s13014-015-0400-1
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author Chu, William
Loblaw, D Andrew
Chan, Kelvin
Morton, Gerard
Choo, Richard
Szumacher, Ewa
Danjoux, Cyril
Pignol, Jean-Philippe
Cheung, Patrick
author_facet Chu, William
Loblaw, D Andrew
Chan, Kelvin
Morton, Gerard
Choo, Richard
Szumacher, Ewa
Danjoux, Cyril
Pignol, Jean-Philippe
Cheung, Patrick
author_sort Chu, William
collection PubMed
description BACKGROUND: This is the final report of a prospective phase I study which evaluated the feasibility, toxicities, and biochemical control in prostate cancer patients treated with a hypofractionated boost utilizing a fiducial marker-based daily image guidance strategy and small patient-specific PTV margins. METHODS: Low- and intermediate-risk prostate cancer patients underwent transperineal ultrasound-guided implantation of three gold fiducial markers and were treated with three-dimensional conformal radiotherapy to 42 Gy (2 Gy/day). During the first nine fractions of treatment, pre- and post-treatment electronic portal imaging was performed to calculate intrafraction prostate motion. Patient-specific PTV margins were derived and a 30 Gy (3 Gy/day) intensity modulated radiotherapy boost was delivered (Total dose = 72 Gy in 31 fractions; EQD2 = 81 Gy, α/β = 1.4). RESULTS: Thirty-three patients completed treatment and were followed for a median of 7.2 years (range, 1.2 – 9.5). Seven patients (21%) developed Radiation Therapy Oncology Group (RTOG) late grade 2 GI toxicity and 1 patient (3%) developed late grade 2 GU toxicity. No patients developed late grade 3 GI or GU toxicity. To date, nine patients developed PSA relapse according to the Phoenix criteria. The actuarial five, seven and nine year biochemical control (BC) rates were 87% (95% confidence interval: 69–95), 77% (95% confidence interval: 56–89) and 66% (95% confidence interval: 42–82). CONCLUSIONS: Our study demonstrates that the use of prostate fiducial markers in combination with a daily online image guidance protocol permits reduced, patient-specific PTV margins in a hypofractionated treatment scheme. This treatment planning and delivery strategy was well tolerated in the intermediate time frame. The use of very small PTV margins did not result in excessive failures when compared to other radiation regimens of similar radiobiological intensity.
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spelling pubmed-44073852015-04-24 Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer Chu, William Loblaw, D Andrew Chan, Kelvin Morton, Gerard Choo, Richard Szumacher, Ewa Danjoux, Cyril Pignol, Jean-Philippe Cheung, Patrick Radiat Oncol Research BACKGROUND: This is the final report of a prospective phase I study which evaluated the feasibility, toxicities, and biochemical control in prostate cancer patients treated with a hypofractionated boost utilizing a fiducial marker-based daily image guidance strategy and small patient-specific PTV margins. METHODS: Low- and intermediate-risk prostate cancer patients underwent transperineal ultrasound-guided implantation of three gold fiducial markers and were treated with three-dimensional conformal radiotherapy to 42 Gy (2 Gy/day). During the first nine fractions of treatment, pre- and post-treatment electronic portal imaging was performed to calculate intrafraction prostate motion. Patient-specific PTV margins were derived and a 30 Gy (3 Gy/day) intensity modulated radiotherapy boost was delivered (Total dose = 72 Gy in 31 fractions; EQD2 = 81 Gy, α/β = 1.4). RESULTS: Thirty-three patients completed treatment and were followed for a median of 7.2 years (range, 1.2 – 9.5). Seven patients (21%) developed Radiation Therapy Oncology Group (RTOG) late grade 2 GI toxicity and 1 patient (3%) developed late grade 2 GU toxicity. No patients developed late grade 3 GI or GU toxicity. To date, nine patients developed PSA relapse according to the Phoenix criteria. The actuarial five, seven and nine year biochemical control (BC) rates were 87% (95% confidence interval: 69–95), 77% (95% confidence interval: 56–89) and 66% (95% confidence interval: 42–82). CONCLUSIONS: Our study demonstrates that the use of prostate fiducial markers in combination with a daily online image guidance protocol permits reduced, patient-specific PTV margins in a hypofractionated treatment scheme. This treatment planning and delivery strategy was well tolerated in the intermediate time frame. The use of very small PTV margins did not result in excessive failures when compared to other radiation regimens of similar radiobiological intensity. BioMed Central 2015-04-18 /pmc/articles/PMC4407385/ /pubmed/25903934 http://dx.doi.org/10.1186/s13014-015-0400-1 Text en © Chu et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Chu, William
Loblaw, D Andrew
Chan, Kelvin
Morton, Gerard
Choo, Richard
Szumacher, Ewa
Danjoux, Cyril
Pignol, Jean-Philippe
Cheung, Patrick
Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title_full Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title_fullStr Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title_full_unstemmed Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title_short Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
title_sort long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407385/
https://www.ncbi.nlm.nih.gov/pubmed/25903934
http://dx.doi.org/10.1186/s13014-015-0400-1
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