Predictors of Rectal Tolerance Observed in a Dose-Escalated Phase 1-2 Trial of Stereotactic Body Radiation Therapy for Prostate Cancer

Kim, D. W Nathan; Cho, L. Chinsoo; Straka, Christopher; Christie, Alana; Lotan, Yair; Pistenmaa, David; Kavanagh, Brian D.; Nanda, Akash; Kueplian, Patrick; Brindle, Jeffrey; Cooley, Susan; Perkins, Alida; Raben, David; Xie, Xian Jin; Timmerman, Robert

doi:10.1016/j.ijrobp.2014.03.012

Cited by 183 publications

(141 citation statements)

References 29 publications

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“…One study treated with 5 fractions of 7 Gy; two studies used 9-10 Gy per fraction. Most recently, results of a dose-escalation study noted a 2-yr actuarial rate of 8% high-grade GI toxicity in 61 patients receiving 50 Gy in 5 fractions [35]. Five patients required a diverting colostomy at a median time of 9.5 mo.…”

Section: Evidence For Extreme Hypofractionationmentioning

confidence: 99%

A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer

Koontz¹,

Bossi²,

Cozzarini³

et al. 2015

European Urology

102

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Section: Evidence For Extreme Hypofractionationmentioning

confidence: 99%

A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer

Koontz¹,

Bossi²,

Cozzarini³

et al. 2015

European Urology

102

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“…With regards to dosimetric correlations with GI toxicity, King et al reported that bowel QOL was decreased significantly among patients in the top 25th percentile of rectal V 90% and V 100% . 43 Kim et al 45 found that late CTCAE grade $3 rectal toxicity was correlated with rectal wall dosimetry (V 50Gy .3 cm 3 or V 39Gy . 35%).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

Kishan

Park

King

et al. 2015

BJR

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Objective: Compared with standard, whole-gland (WG) therapies for prostate cancer, focal approaches may provide equivalent oncologic outcomes with fewer adverse effects. The purpose of this study was to compare organ-at-risk (OAR) dosimetry between hemigland (HG) and WG stereotactic body radiotherapy (SBRT) plans. Methods: Volumetric-modulated arc radiotherapy-based SBRT plans were designed to treat the left HG, right HG and WG in eight patients, using five fractions of 8 Gy. OARs of interest included the contralateral HG, rectum, urinary bladder, urethra, penile bulb and contralateral neurovascular bundle. Results: Rectal V 80% (the percentage of a normal structure receiving a dose of 80%) and V 90% were significantly lower with HG plans than with WG plans (median values of 4.4 vs 2.5 cm 3 and 2.1 vs 1.1 cm 3 , respectively, p , 0.05 by Student's t-test). Bladder V 50% was also reduced significantly in HG plans (32.3 vs 17.4 cm 3 , p , 0.05), with a trend towards reduction of V 100% (3.4 vs 1.3 cm 3

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“…Thus, it seems possible that heterogeneous SBRT plans including simultaneous boosts to dominant lesions could be created, but great caution must be taken to limit rectal dose. This concern is underscored by the recent report of unexpectedly high grade three rectal toxicity in patients treated with 50 Gy in five fractions via SBRT (24). Although it appears unlikely that SBRT can truly mimic the heterogeneity of HDR, it is important to consider whether this is actually a necessary prerequisite for pursuing SBRT.…”

Section: Discussionmentioning

confidence: 99%

A sector-based dosimetric analysis of dose heterogeneity in high-dose-rate prostate brachytherapy

et al. 2015

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PURPOSE: High-dose-rate (HDR) prostate brachytherapy delivers a heterogeneous dose distribution throughout the prostate gland. There is however limited information regarding the spatial distribution of this dose heterogeneity. To this end, we analyzed the magnitude and location of intraprostatic dose heterogeneity in HDR prostate brachytherapy. METHODS AND MATERIALS:Five consecutive prostate cancer patients treated with HDR were analyzed. Based on CT-simulation images, each prostate was divided into three sections (apex, base, and mid-gland). These were further subdivided into eight symmetrical sections to give a total of 24 sections. Doseevolume histograms were analyzed from V100eV200% for these 24 sections comparing the means of individual regions, left vs right, apex vs base vs mid-gland, lateral vs medial, and anterior vs posterior. A separate analysis on dose as a function of individual region volume was also performed. RESULTS: Analyses comparing the 24 regions showed a maximum 62% difference (range, 21.9e83.9%) at V130% and 19.9% (1.9e20.8%) at V200%. Seven regions were significantly decreased and one significantly elevated from V130eV180% when compared with the mean. The means for lateral sections were 1.57-fold higher than medial sections from V110eV200% ( p ! 0.0001). The dose at the base was significantly higher than the rest of the gland from V120eV200 (V150, 35.6 AE 16.2% vs 20.9 AE 13.1%, p ! 0.0001). CONCLUSIONS: There is significant intra-prostatic dose heterogeneity in prostate HDR brachytherapy. This is most notable in the increased dose to base and lateral portions of the gland. Further studies are needed to determine the impact of heterogeneity on clinical outcomes. Ó

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Predictors of Rectal Tolerance Observed in a Dose-Escalated Phase 1-2 Trial of Stereotactic Body Radiation Therapy for Prostate Cancer

Cited by 183 publications

References 29 publications

A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer

A Systematic Review of Hypofractionation for Primary Management of Prostate Cancer

Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

A sector-based dosimetric analysis of dose heterogeneity in high-dose-rate prostate brachytherapy

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