Phase I/II Study of a Five-fraction Hypofractionated Accelerated Radiotherapy Treatment for Low-risk Localised Prostate Cancer: Early Results of pHART3

Tang, Colin; Loblaw, D.A.; Cheung, Patrick; Holden, Lori; Morton, Gerard; Basran, Parminder S.; Tirona, R.; Cardoso, Marlene; Pang, G.; Gardner, Sandra; Cesta, Angela

doi:10.1016/j.clon.2008.08.006

Cited by 75 publications

(34 citation statements)

References 43 publications

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“…When the similarity between two images is based on intensity levels, several metrics can be considered [39] These can be computed via their voxel-wise differences, for example with the sum of squared differences (SSD), or via the cross correlation (CC) or the mutual information (MI). These metrics are computed as follows:…”

Section: Image Similarity Metricsmentioning

confidence: 99%

Multi-Atlas-Based Segmentation of Pelvic Structures from CT Scans for Planning in Prostate Cancer Radiotherapy

Acosta

Dowling

Dréan

et al. 2013

Abdomen and Thoracic Imaging

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In prostate cancer radiotherapy, the accurate identification of the prostate and organs at risk in planning computer tomography (CT) images is an important part of the therapy planning and optimization. Manually contouring these organs can be a time consuming process and subject to intra-and inter-expert variability. Automatic identification of organ boundaries from these images is challenging due to the poor soft tissue contrast. Atlas-based approaches may provide a priori structural information by propagating manual expert delineations to a new individual space; however the inter-individual variability and registration errors may lead to biased results. Multiatlas approaches can partly overcome some of these difficulties by selecting the most similar atlases among a large data base but the definition of similarity measure between the available atlases and the query individual has still to be addressed. The purpose of this chapter is to explain atlas-based segmentation approaches and the evaluation of different atlas-based strategies to simultaneously segment prostate, bladder and rectum from CT images. A comparison between single and multiple atlases is performed. Experiments on atlas ranking, selection strategies and fusion decision rules are carried out to illustrate the presented methodology. Propagation of labels using two registration strategies are applied and the results of the comparison with manual delineations are reported.

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Section: Image Similarity Metricsmentioning

confidence: 99%

Multi-Atlas-Based Segmentation of Pelvic Structures from CT Scans for Planning in Prostate Cancer Radiotherapy

Acosta

Dowling

Dréan

et al. 2013

Abdomen and Thoracic Imaging

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“…About a third (37%) of patients were low-risk patients and the remaining two thirds were high-risk patients (63%) (there were two hypofractionation research protocols requiring gold seed fiducial marker implantation at the time of this study). [12][13] Seventeen percent of patients were on pain-modifying medications in the week prior to the procedure. One patient was on methocarbamolacetaminophen combination for back pain.…”

Section: Resultsmentioning

confidence: 99%

A prospective study on pain score with transperineal prostatic gold seed fiducial implantation under local anesthetic alone

Tang

Sethukavalan

Cheung

et al. 2012

CUAJ

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Background: The purpose of this study was to monitor patient pain score with transperineal prostatic gold seed implantation in the absence of conscious sedation. Methods: All patients who were scheduled for image-guided external beam radiation (IGRT) and referred for gold seed fiducials were eligible to participate. Gold seed implants were performed by two radiation oncologists between December 2007 and April 2008. Patients received only local and deep anesthetic. No patients had prophylactic IV cannulation for the procedure. Three gold seeds were inserted transperineally into the prostate. A visual analogue scale from 0 to 10 was used to assess the pain at baseline, local and deep anesthetic infiltration, with each seed drop, and after the completion of the procedure. Results: A total of 30 patients were accrued to this study. The highest recorded increase in pain score was at the time point of deep local anesthesia, at which the mean pain score was 3.8. The mean pain scores at each seed drop were 0.8 (standard deviation [SD]=1.24), 1 (SD=1.26), and 0.5 (SD=0.90), respectively. All gold seed insertion procedures were well-tolerated, with no patients having significant pain post-procedure, and no significant procedural complications. There were only slight increases in dysuria, urinary frequency, constipation, urinary retention and flatulence in 7 patients -none of which required intervention. Interpretation: Transperineal ultrasound-guided gold seed implantation without conscious sedation is well-tolerated and associated with a low complication rate. It is a convenient outpatient procedure obviating the need for resource intensive postoperative monitoring. IntroductionModern prostate radiotherapy is trending towards higher biological doses. [1][2][3][4] There is a greater need for better accuracy in radiation treatment delivery if toxicities are not to increase. For patients undergoing image-guided external beam prostate radiotherapy (IGRT), gold seed fiducial implantation in the prostate is common. These gold seeds are usually small (typically about 1 × 3 mm) and are chemically inert.Being radio-opaque, gold seeds are easily identified on kilovoltage and megavoltage x-rays. This allows for daily online imaging and position adjustment before treatment. Daily online imaging based on fiducials reduces systematic and random errors, and is superior to offline imaging based on bony anatomy.5-9 As a result, studies have established that with the use of fiducials, clinical target volume and planning target volume margins can be reduced, allowing for more sparing of normal tissues without geographical miss. 9,10The Odette Cancer Centre (OCC) has been using fiducials for prostate radiotherapy since 2001. Initially, conscious sedation with intravenous midazolam and fentanyl was administered to all patients prior to fiducial implantation. This required the patient to remain at the OCC for about 1 hour after the procedure for monitoring in the recovery room before discharge. Furthermore, patients were not permitted...

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“…8,23 In recent years several prospective trials were conducted in prostate and renal cell carcinoma, well known as being radioresistant to conventional irradiation, and early results were mainly successive without any significant increase in complication rates. [24][25][26] SBRS has also been used as a salvage treatment modality for patients with recurrent head-and-neck cancer. 27 Good local control was achieved with a relatively high rate of morbidity and related mortality in that study.…”

Section: Discussionmentioning

confidence: 99%

Salvage Stereotactic Body Radiosurgery in the Management of Recurrent Gynecological Cancer

Yazıcı¹

2013

UHOD

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Local tumor persistence in the pelvis is the major cause of death in patients with recurrent gynecological cancer. Pelvic exenteration has been the only treatment option providing a chance for cure in selected patients. The aim of this study is to analyze the efficacy of stereotactic body radiosurgery (SBRS) in patients with recurrent gynecological cancer. Sixteen patients treated with SBRS were analyzed retrospectively. The majority of the patients had cervical cancer. Eleven patients had a history of prior radiotherapy either as postoperative adjuvant external beam radiotherapy (EBRT) with a median dose of 50.4 Gy (range 45-60 Gy) or definitive chemoradiotherapy as EBRT and high dose rate brachytherapy with a dose of 85-90 Gy low dose rate equivalent to point A. The prescribed dose of SBRS was 15-40 Gy (mean 26.6 Gy) in 3-5 fractions. Five patients with no prior radiotherapy received additional EBRT before SBRS. The median follow-up in all patients is 12 months (range 3-36 months). Six patients (37.5%) showed complete radiological and functional response to salvage SBRS. Six patients (37.5%) showed partial response and 2 (12.5%) showed stable disease. One and 2 year overall survival rates are 60.3% and 40.2% respectively. Progression free survival is 59%. All patients with complete response after SBRS are alive with no evidence of disease with a median follow up time of 20 months. SBRS is a promising treatment modality with high local control and reasonable complication rates in selected patients with recurrent gynecological cancer.Keywords: Cyberknife, Radiotherapy, Recurrent gynecological cancer, Salvage, Stereotactic radiosurgery ÖZET Rekürren Jinekolojik Kanser Tedavisinde Kurtarma Amaçl› Stereotaktik Vücut RadyocerrahisiLokal-bölgesel yineleme gözlenen jinekolojik kanserli hastalarda ölüm nedeni ço¤unlukla bölgesel hastal›kt›r. Seçilmifl grup hastada pelvik ekzenterasyon kür için tek seçenek olmufltur. Bu çal›flman›n amac› stereotaktik vücut radyocerrahisinin (SVRC) reküren jinekolojik kanserli hastalarda etkinli¤ini araflt›rmakt›r. SVRC ile tedavi edilen 16 hasta retrospektif olarak de¤erlendirilmifltir. Hastalar›n bü-yük ço¤unlu¤unun tan›s› serviks kanseridir. On bir hastan›n ilk tedavisinde postoperatif ya da küratif radyoterapi uygulanm›flt›r. SVRC ile reçete edilen doz 15-45 Gy' dir (ortalama 26.6 Gy) ve 3-5 fraksiyonda uygulanm›flt›r. Daha önce radyoterapi uygulanmayan hastalara eksternal tedavi SVRC öncesinde uygulanm›flt›r. Ortanca takip 12 ayd›r (3-36 ay). Alt› hastada (%37.5) radyolojik olarak tam cevap elde edilmifltir. Alt› hastada parsiyel cevap (%37.5) ve iki hastada stabil hastal›k (%12.5) gözlenmifltir. Bir ve 2 y›ll›k genel sa¤ kal›m oranlar› s›ras› ile % 60.3 ve % 40.2' dir. Progresyonsuz sa¤ kal›m % 59' dur. Tam cevap al›nan hastalar›n tamam› ortanca 20 ayl›k takipte hastal›ks›z hayattad›r. SVRC yüksek lokal kontrol oranlar› ve nispeten düflük komplikasyon yüzdesi ile reküren jinekolojik kanserli hastalarda seçilmifl bir grupta iyi bir tedavi seçene¤idir.

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Phase I/II Study of a Five-fraction Hypofractionated Accelerated Radiotherapy Treatment for Low-risk Localised Prostate Cancer: Early Results of pHART3

Cited by 75 publications

References 43 publications

Multi-Atlas-Based Segmentation of Pelvic Structures from CT Scans for Planning in Prostate Cancer Radiotherapy

Multi-Atlas-Based Segmentation of Pelvic Structures from CT Scans for Planning in Prostate Cancer Radiotherapy

A prospective study on pain score with transperineal prostatic gold seed fiducial implantation under local anesthetic alone

Salvage Stereotactic Body Radiosurgery in the Management of Recurrent Gynecological Cancer

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