ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II

Zaorsky, Nicholas G.; Showalter, Timothy N.; Ezzell, Gary A.; Nguyen, Paul L.; Assimos, Dean G.; D’Amico, Anthony V.; Gottschalk, Alexander; Gustafson, Gary; Keole, Sameer R.; Liauw, Stanley L.; Lloyd, Shane; McLaughlin, Patrick W.; Movsas, Benjamin; Prestidge, Bradley R.; Taira, Al V.; Vapiwala, Neha; Davis, Brian J.

doi:10.1016/j.adro.2016.10.002

Cited by 35 publications

(20 citation statements)

References 215 publications

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“…Computed tomography-based simulation and radiation therapy planning were in accordance with recommendations published by the American College of Radiology. 13 All men were treated with intensity modulated radiation therapy (IMRT). Prostate bed volumes were contoured according to anatomy-based interdisciplinary consensus guidelines, 14 with a 0.5 to 1 cm planning target volume margin.…”

Section: Methodsmentioning

confidence: 99%

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Akthar

Wong

Parekh

et al. 2018

Advances in Radiation Oncology

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PurposeDose-volume histogram (DVH) toxicity relationships are poorly defined in men who receive radiation after radical prostatectomy (RP). We evaluated Radiation Therapy Oncology Group (RTOG) study 0534 and institutional intact normal-tissue sparing guidelines, as well as dose to bladder trigone, for ability to minimize late toxicity.Methods and materials164 men received intensity modulated radiation therapy (RT) to a median prostate bed dose of 66.6 Gy at a median of 22 months after RP. 46% of men were prescribed androgen deprivation therapy and pelvic lymph node irradiation to a median dose of 50.4 Gy. DVH relationships for the rectum, bladder, trigone, and bladder excluding the clinical target volume (bladder-CTV) were analyzed against the Common Terminology Criteria for Adverse Events late grade 2 + (G2+) gastrointestinal (GI) and genitourinary (GU) toxicity by log-rank test. RTOG 0534 (rectum V65, 40 Gy ≤35, 55%, and bladder-CTV V65, 40 ≤50, 70%) and intact prostate RT institutional guidelines (rectum V70, 65, 40 ≤20, 40, 80% and bladder V70, 65, 40 ≤30, 60, 80%, respectively) guidelines were evaluated.ResultsWith a median follow-up time of of 33 months, the 4-year freedom from G2 + GI and GU toxicity were both 91%. G2 + GI (n = 12) and GU (n = 15) toxicity included 4% diarrhea (n = 6), 4% hemorrhage (n = 6), 1% proctitis (n = 1), and 4% urinary frequency (n = 7), 1% obstructive (n = 2), 2% cystitis (n = 3), and 3% incontinence (n = 5), respectively. RTOG 0534 rectum and bladder goals were not achieved in 65% and 41% of cases, while the institutional intact prostate goals were not achieved in 21% and 25% of cases, respectively. Neither dose to the bladder trigone nor any of the proposed normal tissue goals were associated with late toxicity (P > .1). In the univariate analysis, age, pelvic RT, RT dose, anticoagulation use, androgen deprivation therapy, time from RP to RT, and tobacco history were not associated with toxicity.ConclusionsMore than 90% of men were free from late G2 + toxicity 4 years after post-RP intensity modulated RT. No tested parameters were associated with late toxicity. In the absence of established normal-tissue DVH guidelines in the postoperative setting, the use of intact guidelines is reasonable.

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Section: Methodsmentioning

confidence: 99%

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Akthar

Wong

Parekh

et al. 2018

Advances in Radiation Oncology

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“…Current dose calculation in photon and proton radiotherapy is based on computed tomography (CT) as the primary imaging modality [1,2]. The CT provides density information on patients' anatomy [3] in terms of Hounsfield units (HU), which, in turn, can…”

Section: Introductionmentioning

confidence: 99%

MRI-Based Proton Treatment Planning for Base of Skull Tumors

Shafai-Erfani

Lei

Liu

et al. 2019

International Journal of Particle Therapy

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Purpose: To introduce a novel, deep-learning method to generate synthetic computed tomography (SCT) scans for proton treatment planning and evaluate its efficacy. Materials and Methods: 50 Patients with base of skull tumors were divided into 2 nonoverlapping training and study cohorts. Computed tomography and magnetic resonance imaging pairs for patients in the training cohort were used for training our novel 3-dimensional generative adversarial network (cycleGAN) algorithm. Upon completion of the training phase, SCT scans for patients in the study cohort were predicted based on their magnetic resonance images only. The SCT scans obtained were compared against the corresponding original planning computed tomography scans as the ground truth, and mean absolute errors (in Hounsfield units [HU]) and normalized cross-correlations were calculated. Proton plans of 45 Gy in 25 fractions with 2 beams per plan were generated for the patients based on their planning computed tomographies and recalculated on SCT scans. Dose-volume histogram endpoints were compared. A γ-index analysis along 3 cardinal planes intercepting at the isocenter was performed. Proton distal range along each beam was calculated. Results: Image quality metrics show agreement between the generated SCT scans and the ground truth with mean absolute error values ranging from 38.65 to 65.12 HU and an average of 54.55 ± 6.81 HU and a normalized cross-correlation average of 0.96 ± 0.01. The dosimetric evaluation showed no statistically significant differences (p > 0.05) within planning target volumes for dose-volume histogram endpoints and other metrics studied, with the exception of the dose covering 95% of the target volume, with a relative difference of 0.47%. The γ-index analysis showed an average passing rate of 98% with a 10% threshold and 2% and 2-mm criteria. Proton ranges of 48 of 50 beams (96%) in this study were within clinical tolerance adopted by 4 institutions. Conclusions: This study shows our method is capable of generating SCT scans with acceptable image quality, dose distribution agreement, and proton distal range compared with the ground truth. Our results set a promising approach for magnetic resonance imaging–based proton treatment planning.

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“…Magnetic resonance imaging (MRI) has been used for more than two decades as an important tool of radiation therapy (RT) target definition [1][2][3], as the availability of MRI has greatly improved and the treatment planning workstations have become capable of handling 3D multimodal image data. Especially as, MRI has superior properties over computed tomography (CT) in imaging of most soft tissue targets and normal tissues, it has been included in the prostate RT target definition guideline as the most accurate modality [4].…”

Section: Introductionmentioning

confidence: 99%

MRI-only based radiation therapy of prostate cancer: workflow and early clinical experience

et al. 2018

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ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II

Cited by 35 publications

References 215 publications

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

MRI-Based Proton Treatment Planning for Base of Skull Tumors

MRI-only based radiation therapy of prostate cancer: workflow and early clinical experience

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