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Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer

PURPOSE: Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporat...

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Autores principales: Hrinivich, William T., Phillips, Ryan, Da Silva, Angela J., Radwan, Noura, Gorin, Michael A., Rowe, Steven P., Pienta, Kenneth J., Pomper, Martin G., Wong, John, Tran, Phuoc T., Kang-Hsin Wang, Ken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136645/
https://www.ncbi.nlm.nih.gov/pubmed/32280826
http://dx.doi.org/10.1016/j.adro.2019.10.006
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author Hrinivich, William T.
Phillips, Ryan
Da Silva, Angela J.
Radwan, Noura
Gorin, Michael A.
Rowe, Steven P.
Pienta, Kenneth J.
Pomper, Martin G.
Wong, John
Tran, Phuoc T.
Kang-Hsin Wang, Ken
author_facet Hrinivich, William T.
Phillips, Ryan
Da Silva, Angela J.
Radwan, Noura
Gorin, Michael A.
Rowe, Steven P.
Pienta, Kenneth J.
Pomper, Martin G.
Wong, John
Tran, Phuoc T.
Kang-Hsin Wang, Ken
author_sort Hrinivich, William T.
collection PubMed
description PURPOSE: Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporating positron emission tomography (PET) detectors is being developed to use radiotracer uptake as a biologic fiducial for intrafraction tumor tracking to improve geometric accuracy. This study simulates prostate-specific membrane antigen (PSMA)-directed BgRT using a cohort from our phase II randomized trial of SABR in men with recurrent hormone sensitive OMPC and compares dose distributions to clinical SABR (CSABR). METHODS AND MATERIALS: A research treatment planning system (RTPS) was used to replan 15 patients imaged with PSMA-targeted (18)F-DCFPyL PET/computed tomography and previously treated with CSABR using conventional linear accelerators (linacs). The RTPS models a prototype ring-mounted linac incorporating PET and kilo-voltage computed tomography imaging subsystems and can be used to optimize BgRT plans, as well as research SABR (RSABR) plans, which use the prototype linac without radiotracer guidance. CSABR, RSABR, and BgRT plans were compared in terms of maximum planning target volume (PTV) dose (D(max)), mean dose to proximal organs at risk (D(OAR)), conformity index, as well as voxel-wise correlation of dose with PET specific uptake values to investigate possible dose-painting effects. RESULTS: RSABR and BgRT plans resulted in mean ± standard deviation increases in D(max) of 4 ± 11% (P = .21) and 18 ± 15% (P < .001) and reductions in D(OAR) of –20 ± 19% (P <.001) and –10 ± 19% (P = .02) compared with CSABR. Similar target coverage was maintained with conformity indices of 0.81 ± 0.04 (P < .001) and 0.72 ± 0.08 (P = .44) for RSABR and BgRT compared with 0.74 ± 0.08 for CSABR. Dose and log (specific uptake values) had Pearson correlation coefficients of 0.10 (CSABR), 0.16 (RSABR), and 0.31 (BgRT). CONCLUSIONS: BgRT plans provided similar PTV coverage and conformity compared with CSABR while incorporating underlying PET activity. These results demonstrate feasibility of BgRT optimization enabling online PSMA-targeted, PET-based tracked dose delivery for OMPC.
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spelling pubmed-71366452020-04-10 Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer Hrinivich, William T. Phillips, Ryan Da Silva, Angela J. Radwan, Noura Gorin, Michael A. Rowe, Steven P. Pienta, Kenneth J. Pomper, Martin G. Wong, John Tran, Phuoc T. Kang-Hsin Wang, Ken Adv Radiat Oncol Physics Contribution PURPOSE: Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporating positron emission tomography (PET) detectors is being developed to use radiotracer uptake as a biologic fiducial for intrafraction tumor tracking to improve geometric accuracy. This study simulates prostate-specific membrane antigen (PSMA)-directed BgRT using a cohort from our phase II randomized trial of SABR in men with recurrent hormone sensitive OMPC and compares dose distributions to clinical SABR (CSABR). METHODS AND MATERIALS: A research treatment planning system (RTPS) was used to replan 15 patients imaged with PSMA-targeted (18)F-DCFPyL PET/computed tomography and previously treated with CSABR using conventional linear accelerators (linacs). The RTPS models a prototype ring-mounted linac incorporating PET and kilo-voltage computed tomography imaging subsystems and can be used to optimize BgRT plans, as well as research SABR (RSABR) plans, which use the prototype linac without radiotracer guidance. CSABR, RSABR, and BgRT plans were compared in terms of maximum planning target volume (PTV) dose (D(max)), mean dose to proximal organs at risk (D(OAR)), conformity index, as well as voxel-wise correlation of dose with PET specific uptake values to investigate possible dose-painting effects. RESULTS: RSABR and BgRT plans resulted in mean ± standard deviation increases in D(max) of 4 ± 11% (P = .21) and 18 ± 15% (P < .001) and reductions in D(OAR) of –20 ± 19% (P <.001) and –10 ± 19% (P = .02) compared with CSABR. Similar target coverage was maintained with conformity indices of 0.81 ± 0.04 (P < .001) and 0.72 ± 0.08 (P = .44) for RSABR and BgRT compared with 0.74 ± 0.08 for CSABR. Dose and log (specific uptake values) had Pearson correlation coefficients of 0.10 (CSABR), 0.16 (RSABR), and 0.31 (BgRT). CONCLUSIONS: BgRT plans provided similar PTV coverage and conformity compared with CSABR while incorporating underlying PET activity. These results demonstrate feasibility of BgRT optimization enabling online PSMA-targeted, PET-based tracked dose delivery for OMPC. Elsevier 2019-11-06 /pmc/articles/PMC7136645/ /pubmed/32280826 http://dx.doi.org/10.1016/j.adro.2019.10.006 Text en © 2019 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Physics Contribution
Hrinivich, William T.
Phillips, Ryan
Da Silva, Angela J.
Radwan, Noura
Gorin, Michael A.
Rowe, Steven P.
Pienta, Kenneth J.
Pomper, Martin G.
Wong, John
Tran, Phuoc T.
Kang-Hsin Wang, Ken
Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title_full Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title_fullStr Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title_full_unstemmed Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title_short Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
title_sort online prostate-specific membrane antigen and positron emission tomography–guided radiation therapy for oligometastatic prostate cancer
topic Physics Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136645/
https://www.ncbi.nlm.nih.gov/pubmed/32280826
http://dx.doi.org/10.1016/j.adro.2019.10.006
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