Is it essential to use fiducial markers during cone-beam CT-based radiotherapy for prostate cancer patients?

Background To evaluate the treatment outcomes and toxicity of definitive radiotherapy (RT) for prostate cancer (PC) patients using the simultaneous integrated boost (SIB) technique, which delivered 78 Gy to the entire prostate and 86 Gy to the intraprostatic lesion (IPL) in 39 fractions. Materials and Methods Univariable and multivariable analyses were conducted of the prognostic factors for freedom from biochemical failure (FFBF), progression‐free survival (PFS), and PC‐specific survival (PCSS) of 619 PC patients who received definitive RT between September 2012 and August 2021. Predictors of late Grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicities were also identified using logistic regression. Results The median follow‐up for entire cohort was 68.5 months. The 5‐year FFBF, PFS, and PCSS rates were 93.2%, 83.2%, and 98.6%, respectively. They were predicted by the serum prostate‐specific antigen, Gleason score (GS), clinical nodal stage, and D'Amico risk group. Only 45 patients (7.3%) developed disease recurrence 41.9 months after RT. The 5‐year FFBF rates for low‐, intermediate‐, and high‐risk disease were 98.0%, 93.1%, and 88.5%, respectively (p < 0.001). The 5‐year PFS and PCSS rates according to risk groups were 91.0%, 82.1%, and 77.4% (p < 0.001), and 99.2%, 96.4%, and 95.9% (p = 0.03), and, respectively. GS > 7 and lymph node metastasis negatively predicted FFBF and PCSS in multivariable analysis. Ninety (14.6%) and 44 (7.1%) patients had acute Grade ≥2 GU and GI toxicities, respectively, and 42 (6.8%) and 27 (4.4%) patients had late Grade ≥2 GU and GI toxicities, respectively. Diabetes and transurethral resection independently predicted late Grade 2 GU toxicity, but no significant predictor of late Grade ≥2 GI toxicity was found. Conclusions Localized PC was effectively and safely treated with definitive RT using the SIB technique to deliver 86 Gy to the IPL in 39 fractions without severe late toxicity. This finding must be validated with long‐term results.

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“…One or more GTVs could be contoured per patient. Based on our previous findings, we did not routinely use gold fiducial markers 14 …”

Section: Methodsmentioning

confidence: 99%

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

et al. 2023

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“…I agree with Dr. Parker that FMs are not superior to noninvasive techniques such as CBCT in the initial setup alignment of prostate patients . Dr. Parker went further to present an argument for an alternative role for FMs whereby they are used to monitor prostate intrafraction motion.…”

Section: Against the Proposition: Brent C Parker Phdmentioning

confidence: 84%

“…This may lead one to conclude that fiducials are no longer needed in prostate radiotherapy. Indeed, studies have shown that the use of implanted fiducials imaged with orthogonal planar imaging is not superior to CBCT for patient positioning . Thus, there is intrinsically no “need” for fiducials in the traditional use of initial patient positioning.…”

Section: Against the Proposition: Brent C Parker Phdmentioning

confidence: 99%

Implanted fiducial markers are no longer needed for prostate cancer radiotherapy

2017

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“…In addition, VMAT (especially with FFF beam) has a shorter treatment time than CyberKnife [ 19 ]. VMAT can be performed without fiducial markers using cone-beam CT and other matching techniques [ 24 ]. These are significant advantages for patients who desire minimally invasive treatment and are sufficient reasons to perform SBRT with VMAT, regardless of whether the institution owns a CyberKnife.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiation therapy for prostate cancer: a study comparing 3-year genitourinary toxicity between CyberKnife and volumetric-modulated arc therapy by propensity score analysis

et al. 2023

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Background To investigate whether the rate of stereotactic body radiation therapy-related (SBRT-related) genitourinary (GU) toxicity is lower in patients with prostate cancer treated with CyberKnife. Methods We retrospectively reviewed the medical records of patients with nonmetastatic prostate cancer at two institutions between 2017 and 2020. We analyzed 70 patients who were extracted by propensity score matching based on age, pre-treatment International Prostate Symptom Score (IPSS), and prostate volume. The patients were treated with SBRT, with a total dose of 36.25 Gy in five fractions over five consecutive weekdays, using CyberKnife or volumetric-modulated arc therapy (VMAT). Results The low-, medium-, and high-risk patients were 2, 19, and 14, respectively, in the CyberKnife group and 4, 17, and 14, respectively, in the VMAT group. The median follow-up time in both groups was 3 years. One patient with CyberKnife died of unrelated causes. No biochemical or clinical recurrence, distant metastases, or death from prostate cancer was observed. The peak values of IPSS in the acute phase (< 3 months) were significantly lower in the CyberKnife than in the VMAT group (CyberKnife:16.2 vs VMAT:20.2, p = 0.025). In multiple regression analyses, the treatment modality (p = 0.03), age (p = 0.01), bladder medication pre-irradiation (p = 0.03), and neoadjuvant androgen deprivation therapy (p = 0.04) contributed to the peak value of the acute-phase IPSS. The incidence of treatment-related grade 2 acute GU toxicity tended to be lower in the CyberKnife than the VMAT group (CyberKnife: 22.9% vs. VMAT: 45.7%, p = 0.077). No difference was noted between the groups with regard to late IPSS or GU toxicity and gastrointestinal toxicity in all phases. Toxicities of grade ≥ 3 have not been observed to date. Conclusions Regardless of treatment modality, SBRT is effective in treating prostate cancer without serious toxicity. However, CyberKnife has an advantage over VMAT in terms of acute prostate symptoms.

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Is it essential to use fiducial markers during cone-beam CT-based radiotherapy for prostate cancer patients?

Abstract: Our study demonstrated that CBCT-FM was not superior to CBCT-P for image-guided radiotherapy in prostate cancer patients.

Cited by 14 publications

References 36 publications

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients

Implanted fiducial markers are no longer needed for prostate cancer radiotherapy

Stereotactic body radiation therapy for prostate cancer: a study comparing 3-year genitourinary toxicity between CyberKnife and volumetric-modulated arc therapy by propensity score analysis

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