Feasibility of dominant intraprostatic lesion boosting using advanced photon-, proton- or brachytherapy

Andrzejewski, Piotr; Kueß, Peter; Knäusl, B.; Pinker, Katja; Georg, Petra; Knoth, Johannes; Berger, Daniel; Kirisits, Christian; Goldner, Gregor; Helbich, Thomas H.; Pötter, Richard; Georg, Dietmar

doi:10.1016/j.radonc.2015.07.028

Cited by 26 publications

(21 citation statements)

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“…Recently, the FLAME trial [ 1 , 2 ] focused on the evaluation of 5‑year freedom from biochemical failure as well as toxicity when applying a boosting method. Also, several other studies investigated the feasibility of boosting the dominant intraprostatic lesion with various methods in patients with advanced prostate cancer, which indicated superior local control [ 3 – 7 ]. The presented results suggest that the implementation of this approach in intermediate and high-risk prostate cancer patients improves tumor control while keeping side effects at a reasonable level.…”

Section: Introductionmentioning

confidence: 99%

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

et al. 2018

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Purpose Accurate prostate cancer (PCa) detection is essential for planning focal external beam radiotherapy (EBRT). While biparametric MRI (bpMRI) including T2-weighted (T2w) and diffusion-weighted images (DWI) is an accurate tool to localize PCa, its value is less clear in the case of additional androgen deprivation therapy (ADT). The aim of this study was to investigate the value of a textural feature (TF) approach on bpMRI analysis in prostate cancer patients with and without neoadjuvant ADT with respect to future dose-painting applications. Methods 28 PCa patients (54–80 years) with ( n = 14) and without ( n = 14) ADT who underwent bpMRI with T2w and DWI were analyzed retrospectively. Lesions, central gland (CG), and peripheral zone (PZ) were delineated by an experienced urogenital radiologist based on localized pre-therapeutic histopathology. Histogram parameters and 20 Haralick TF were calculated. Regional differences (i. e., tumor vs. PZ, tumor vs. CG) were analyzed for all imaging parameters. Receiver-operating characteristic (ROC) analysis was performed to measure diagnostic performance to distinguish PCa from benign prostate tissue and to identify the features with best discriminative power in both patient groups. Results The obtained sensitivities were equivalent or superior when utilizing the TF in the no-ADT group, while specificity was higher for the histogram parameters. However, in the ADT group, TF outperformed the conventional histogram parameters in both specificity and sensitivity. Rule-in and rule-out criteria for ADT patients could exclusively be defined with the aid of TF. Conclusions The TF approach has the potential for quantitative image-assisted boost volume delineation in PCa patients even if they are undergoing neoadjuvant ADT. Electronic supplementary material The online version of this article (10.1007/s00066-018-1402-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

et al. 2018

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“…Previous planning studies (not accounting for inter-fractional motion) have also compared IMPT to VMAT for focal tumour boosting [14] and sparing of normal tissues/OARs [12][13][14] and found a similar performance for both modalities. Furthermore, other studies have shown that PT to the prostate alone can be robust towards inter-fractional changes, which was also what was seen in our study [17,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Recent treatment planning studies have compared the feasibility of focal boosting in different RT modalities such as volumetric modulated arc therapy (VMAT), intensity-modulated proton therapy (IMPT) and brachytherapy, and found that this was equally feasible for all modalities up to a certain dose. Andrzejewski et al found that although OAR doses were higher using focal boosting than for standard treatment, the risk levels were reasonably low for all these three modalities [14]. Kuang et al investigated focal boosting with VMAT and concluded that planning objectives and dose constraints could be met in the 30 included prostate patients [15].…”

Section: Introductionmentioning

confidence: 99%

“…Internal anatomical variations can have a large impact on the delivered proton dose distributions [16,17], in particular for focal boost treatments, shifting the high dose volumes away from the tumour and possibly into the normal tissues and ORs [11,14,15]. However, none of the previous focal boosting planning studies investigated the robustness towards inter-fractional motion for VMAT or IMPT [11,14,15]. Furthermore, biological models might be particularly useful when evaluating the potential clinical implications of dose re-distributions.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Pinkawa et al [15] used the above mentioned UDC method to estimate doses from TT and engaged physical BT doses only. Andrzejewski et al [16] compared different advanced radiotherapy methods for boosting dominant intraprostatic lesion. They calculated biological equivalent doses for comparison but did not examine combined therapies.…”

Section: Purposementioning

confidence: 99%

Biological dose summation of intensity-modulated arc therapy and image-guided high-dose-rate interstitial brachytherapy in intermediate- and high-risk prostate cancer

Fröhlich

Ágoston

Jorgo

et al. 2020

jcb

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Purpose: To present an alternative method for summing biologically effective doses of intensity-modulated arc therapy (IMAT) as teletherapy (TT), with interstitial high-dose-rate (HDR) brachytherapy (BT) boost in prostate cancer. Total doses using IMAT boost was compared with BT boost using our method. Material and methods: Initially, 25 IMAT TT plus interstitial HDR-BT plans were included, and additional plans using IMAT TT boost were created. The prescribed dose was 2/44 Gy to the whole pelvis, 2/60 Gy to the prostate and seminal vesicles, and 1 × 10 Gy BT or 2/18 Gy IMAT TT to the prostate. Teletherapy computed tomography (CT) was registered with ultrasound (US) of BT, and the most exposed volume of critical organs in BT were identified on these CT images. The minimal dose of these from IMAT TT was summed with their BT dose, and these EQD 2 doses were compared using BT vs. IMAT TT boost. This method was compared with uniform dose conception (UDC). Results: D 90 of the prostate was significantly higher with BT than with IMAT TT boost: 99.3 Gy vs. 77.9 Gy, p = 0.0034. The D 2 to rectum, bladder, and hips were 50.3 Gy vs. 76.8 Gy (p = 0.0117), 64.7 Gy vs. 78.3 Gy (p = 0.0117), and 41.9 Gy vs. 50.6 Gy (p = 0.0044), while D 0.1 to urethra was 96.1 Gy vs. 79.3 Gy (p = 0.0180), respectively. UDC overestimated D 2 (rectum) by 37% (p = 0.0117), D 2 (bladder) by 5% (p = 0.0214), and underestimated D 0.1 (urethra) by 1% (p = 0.0277). Conclusions: Based on our biological dose summation method, the total dose of prostate is higher using BT boost than the IMAT. BT boost yields lower rectum, bladder, and hips doses, but higher dose to urethra. UDC overestimates rectum and bladder dose and underestimates the dose to urethra.

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Feasibility of dominant intraprostatic lesion boosting using advanced photon-, proton- or brachytherapy

Cited by 26 publications

References 42 publications

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

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

Biological dose summation of intensity-modulated arc therapy and image-guided high-dose-rate interstitial brachytherapy in intermediate- and high-risk prostate cancer

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