Evaluation of intensity modulated radiation therapy dose painting for localized prostate cancer using 68 Ga-HBED-CC PSMA-PET/CT: A planning study based on histopathology reference

Zamboglou, Constantinos; Sachpazidis, Ilias; Koubar, Khodor; Drendel, Vanessa; Wiehle, R.; Kirste, Simon; Mix, Michael; Schiller, Florian; Mavroidis, Panayiotis; Meyer, Philipp T.; Werner, Martin; Grosu, Anca L.; Baltas, Dimos

doi:10.1016/j.radonc.2017.04.021

Cited by 41 publications

(34 citation statements)

References 52 publications

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“…A considerably higher TCP was found for the boost arm, for both IMPT and VMAT, compared to plans without boost. Similar results were also seen in the paper by Kuang et al [15] and Zamboglou et al [24] in the case of VMAT, using a different TCP model than ours. In our case, the large difference between the boost arms and non-boost arms might be due to the inclusion of tumour-index information together with ADC maps-based cell density, which increases the inter-patient tumour response differentiation, resulting in TCP curves with a larger range in D 50% across the cohort compared with those based on uniform cell densities [18].…”

Section: Discussionsupporting

confidence: 92%

A biological modelling based comparison of radiotherapy plan robustness using photons vs protons for focal prostate boosting

Pedersen

Casares-Magaz

Petersen

et al. 2018

Physics and Imaging in Radiation Oncology

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Background and purpose: Focal tumour boosting is currently explored in radiotherapy of prostate cancer to increase tumour control. In this study we applied dose response models for both tumour control and normal tissue complications to explore the benefit of proton therapy (PT) combined with focal tumour boosting, also when accounting for inter-fractional motion. Materials and methods: CT scans of seven patients fused with MRI-based index volumes were used. Two volumetric modulated arc therapy (VMAT) plans were created for each patient; one with conventional dose (77 Gy) to the entire prostate, and one with an additional integrated boost (total dose of 95 Gy) to the index lesion. Two corresponding intensity modulated PT (IMPT) plans were created using two lateral opposing spot scanning beams. All plans were evaluated using an MRI-based tumour control probability (TCP) model and normal tissue complication probability (NTCP) models for the rectum and bladder. Plan robustness was evaluated using dose re-calculations on repeat cone-beam CTs. Results: Across all plans, median TCP increased from 86% (range: 59-98%) without boost to 97% (range: 96-99%) with boost. IMPT plans had lower rectum NTCPs (e.g. 3% vs. 4% for boost plans) but higher bladder NTCPs (20% vs. 18% for boost plans), yet only the bladder NTCPs remained different in the cone beam CT-based re-calculations. Conclusions: Focal tumour boosting can be delivered with either VMAT or protons, and increases the predicted TCP. The small benefit of IMPT when assessing the planned dose distributions was lost when accounting for inter-fractional motion.

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Section: Discussionsupporting

confidence: 92%

A biological modelling based comparison of radiotherapy plan robustness using photons vs protons for focal prostate boosting

Pedersen

Casares-Magaz

Petersen

et al. 2018

Physics and Imaging in Radiation Oncology

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“…8,9 Current advances in positron emission tomography (PET) imaging with the use of prostate-specific membrane antigen (PSMA)-PET/ computed tomography (CT) have been shown to be accurate in detecting segments containing intermediate-grade intraprostatic prostate cancer (International Society of Urological Pathology grade !2). 10 Studies have shown the feasibility of these techniques in DIL identification, 11 with ongoing studies investigating whether this additional information for radiation therapy planning is clinically meaningful.…”

Section: Introductionmentioning

confidence: 99%

Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial

Murray

Tree

Alexander

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To report a planned analysis of the efficacy and toxicity of dose escalation to the intraprostatic dominant nodule identified on multiparametric magnetic resonance imaging using standard and hypofractionated external beam radiation therapy. Methods and Materials: DELINEATE is a single centre prospective phase 2 multicohort study including standard (cohort A: 74 Gy in 37 fractions) and moderately hypofractionated (cohort B: 60 Gy in 20 fractions) prostate image guided intensity modulated radiation therapy in patients with National Comprehensive Cancer Network intermediate-and high-risk disease. Patients received an integrated boost of 82 Gy (cohort A) and 67 Gy (cohort B) to lesions visible on multiparametric magnetic

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“…We could demonstrate that PSMA PET guided RT dose escalation considering the FLAME trial protocol [89] was feasible in ten of ten patients. Furthermore, TCP-histo was significant higher in the dose escalation arm compared to the conventionally fractionated arm (70% vs. 96%, p < 0.01) without increased risk of normal tissue toxicity [90].…”

Section: Psma Pet/ctmentioning

confidence: 89%

Multimodal imaging for radiation therapy planning in patients with primary prostate cancer

Zamboglou

Eiber

Fassbender

et al. 2018

Physics and Imaging in Radiation Oncology

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Implementation of advanced imaging techniques like multiparametric magnetic resonance imaging (mpMRI) or Positron Emission Tomography (PET) in radiation therapy (RT) planning of patients with primary prostate cancer demands several preconditions: accurate staging of the extraprostatic and intraprostatic tumor mass, robust delineation of the intraprostatic gross tumor volume (GTV) and a reproducible characterization of the prostate cancer's biological properties. In the current review we searched for the currently available imaging techniques and we discussed their ability to fulfill these preconditions. We found that current pretreatment imaging was mainly performed with mpMRI and/or Prostate-specific membrane antigen PET imaging. Both techniques offered an accurate detection of the extraprostatic and intraprostatic tumor burden and had a major impact on RT concepts. However, some studies postulated that mpMRI and PSMA PET had complementary information for intraprostatic GTV detection. Moreover, interobserver differences for intraprostatic tumor delineation based on mpMRI were observed. It is currently unclear whether PET based GTV delineation underlies also interobserver heterogeneity. Further research is warranted to answer whether multimodal imaging is able to visualize biological processes related to prostate cancer pathophysiology and radiation resistance.

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Evaluation of intensity modulated radiation therapy dose painting for localized prostate cancer using 68 Ga-HBED-CC PSMA-PET/CT: A planning study based on histopathology reference

Abstract: IMRT dose painting using PSMA PET/CT was technically feasible and resulted in significantly higher TCPs without higher NTCPs.

Cited by 41 publications

References 52 publications

A biological modelling based comparison of radiotherapy plan robustness using photons vs protons for focal prostate boosting

A biological modelling based comparison of radiotherapy plan robustness using photons vs protons for focal prostate boosting

Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial

Multimodal imaging for radiation therapy planning in patients with primary prostate cancer

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