Prospective Phase II Study of Image-guided Local Boost Using a Real-time Tumor-tracking Radiotherapy (RTRT) System for Locally Advanced Bladder Cancer

Nishioka, Kentaro; Shimizu, Satoru; Shinohara, Nobuo; Ito, Yoichi M.; Abe, Takashige; Maruyama, Satoru; Kinoshita, Rumiko; Harada, Kiyoshi; Nishikawa, Noboru; Miyamoto, Naoki; Onimaru, Rikiya; Shirato, Hiroki

doi:10.1093/jjco/hyt182

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…First, the fiducial markers implanted around the tumor bed were surrogates of the bladder wall and may be different from the motion of the bladder wall itself. Based on our published clinical results using the same registration technique, we believe that the markers represented bladder wall positions well [ 34 ]. Second, the number of markers implanted and the registration method was changed in February 2002.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were treated using three-dimensional conformal radiotherapy. We have reported details of the methods and results elsewhere [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…Real-time tumor-tracking radiotherapy (RTRT) systems have the advantage that they enable corrections of the target location and also make it possible to observe the location of the target using the fiducial markers during the beam delivery [ 32 ]. We have previously reported about intrafractional prostate motion in prostate cancer radiotherapy [ 33 ], and have applied the same technique to treat locally advanced bladder cancers with encouraging results [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

et al. 2017

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BackgroundCurrent adaptive and dose escalating radiotherapy for muscle invasive bladder cancer requires knowledge of both inter-fractional and intra-fractional motion of the bladder wall involved. The purpose of this study is to characterize inter- and intra-fractional movement of the partial bladder wall using implanted fiducial markers and a real-time tumor-tracking radiotherapy system.MethodsTwo hundred fifty one sessions with 29 patients were analysed. After maximal transurethral bladder tumor resection and 40 Gy of whole bladder irradiation, up to six gold markers were implanted transurethrally into the bladder wall around the tumor bed and used for positional registration. We compared the systematic and random uncertainty of positions between cranial vs. caudal, left vs. right, and anterior vs. posterior tumor groups. The variance in intrafractional movement and the percentage of sessions where 3 mm and 5 mm or more of intrafractional wall movement occurring at 2, 4, 6, 8, 10, and at more than 10 min until the end of a session were determined.ResultsThe cranial and anterior tumor group showed larger interfractional uncertainties in the position than the opposite side tumor group in the CC and AP directions respectively, but these differences did not reach significance. Among the intrafractional uncertainty of position, the cranial and anterior tumor group showed significantly larger systematic uncertainty of position than the groups on the opposite side in the CC direction. The variance of intrafractional movement increased over time; the percentage of sessions where intrafractional wall movement was larger than 3 mm within 2 min of the start of a radiation session or larger than 5 mm within 10 min was less than 5%, but this percentage was increasing further during the session, especially in the cranial and anterior tumor group.ConclusionsMore attention for intrafractional uncertainty of position is required in the treatment of cranial and anterior bladder tumors especially in the CC direction. The optimal internal margins in each direction should be chosen or a precise intrafractional target localization system is required depending on the tumor location and treatment delivery time in the setting of partial bladder radiotherapy.

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Section: Discussionmentioning

confidence: 99%

“…All patients were treated using three-dimensional conformal radiotherapy. We have reported details of the methods and results elsewhere [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

et al. 2017

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“…An alternative means to identify the GTV is fiducial markers, which were successfully placed around the tumour bed in nine of our patients. Elsewhere, the use of fiducial markers has been reported with few complications and excellent visibility on CBCT [ 34 – 36 ]. However, in our experience, the implementation of a fiducial marker program for bladder radiation proved to be a challenging process and did not always aid in tumour delineation.…”

Section: Discussionmentioning

confidence: 99%

Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer

et al. 2015

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AimTo describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer.MethodsTwenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment.ResultsThe median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed.Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone.ConclusionIG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity.

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Alternative Verfahren bei Urothelkarzinom

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et al. 2016

Alternative Operative Therapien in Der Uroonkologie

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Prospective Phase II Study of Image-guided Local Boost Using a Real-time Tumor-tracking Radiotherapy (RTRT) System for Locally Advanced Bladder Cancer

Cited by 6 publications

References 32 publications

Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer

Alternative Verfahren bei Urothelkarzinom

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