Prostate Dose-painting Radiotherapy and Radiobiological Guided Optimisation Enhances the Therapeutic Ratio

Uzan, J.; Nahum, Alan E.; Syndikus, Isabel

doi:10.1016/j.clon.2015.09.006

Cited by 22 publications

(28 citation statements)

References 30 publications

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“…The analyzed literature 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 included 323 (23%) patients with National Comprehensive Cancer Network low-risk disease, 509 (37%) patients with intermediate-risk disease, and 517 (38%) patients with high-risk disease. Three studies did not specify the risk group (29 patients, 2.1%).…”

Section: Resultsmentioning

confidence: 99%

“…In 976 patients (70.8%; n = 17 studies), an MRI was used to identify the IDN. From those series, five (488 patients, 35.4%) used magnetic resonance spectroscopy imaging (Choline/creatine-to-citrate ratios >1.4–2) to define the tumor 28 , 29 , 32 , 33 , 45 , three series (116 patients, 8.4%) used 3T MRI, and nine series (438 patients, 31.7%) used mpMRI (with sequences T2W + dynamic contrast enhancement + diffusion-weighted imaging) 31 , 33 , 34 , 35 , 43 , 44 , 46 , 49 , 48 , of which two studies used open MRI 33 , 35 .…”

Section: Resultsmentioning

confidence: 99%

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Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review

Feutren

Herrera

2018

Prostate International

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Radiation therapy (RT) is a curative treatment option for localized prostate cancer. Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule (IDN) is an emerging treatment option that involves the prophylactic irradiation of the whole prostate while increasing RT doses to the visible prostatic tumor. Because of the lack of large multicentre trials, a systematic review was performed in an attempt to get an overview on the feasibility and efficacy of focal dose escalation to the IDN.A bibliographic search for articles in English, which were listed in MEDLINE from 2000 to 2016 to identify publications on RT with focal directed boost to the IDN, was performed. The review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Twenty-two articles describing 1,378 patients treated with RT using focal boost were identified and fulfilled the selection criteria. Intensity-modulated radiation therapy (IMRT) was used in 720 patients (52.3%), volumetric modulated arc therapy was used in 45 patients (3.3%), stereotactic body radiation therapy (SBRT) in 113 patients (8.2%), and low–dose rate and high–dose rate brachytherapy (BT) were used in 305 patients (22.1%) and 195 patients (14.1%), respectively. Use of androgen deprivation therapy varied substantially among series. Biochemical disease-free survival at 5 years was reported for a cohort of 812 (58.9%) patients. The combined median biochemical disease-free survival for this group of patients was 85% (range: 78.8–100%; 95% confidence interval: 77.1–82.7%).The average occurrence of grade III or worse gastrointestinal and genitourinary late toxicity was, respectively, 2.5% and 3.1% for intensity-modulated RT boost, 10% and 6% for stereotactic body RT, 6% and 2% for low–dose rate BT, and 4% and 4.3% for high–dose rate BT.This review shows encouraging results for focal dose escalation to the IDN with acceptable short- to medium-term side effects and biochemical disease control rates. However, owing to the heterogeneity of patient population and the short follow-up, the results should be interpreted with caution. Considering that the clinical endpoint in the studies was biochemical recurrence, the use and duration of androgen deprivation therapy administration should be carefully considered before driving definitive conclusions. Randomized trials with long-term follow-up are needed before this technique can be generally recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review

Feutren

Herrera

2018

Prostate International

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“…For all subvolume geometries investigated, the biological optimisation was feasible without a significant increase in NTCP compared to conventional uniform-dose plans. Uzan et al [54] maximised the TCP of the DIL, identified on quantitative MRI, while satisfying the NTCP limits for grade 2-3 rectal bleeding and grade 3 faecal incontinence. For TCP modeling, it was assumed that all clonogens are located uniformly inside the DIL with a constant clonogen density and any clonogens outside the DIL can be controlled by the dose to the clinical target volume (CTV).…”

Section: Biological Optimisation Of Prostate Imrt Using Population-bamentioning

confidence: 99%

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Her

Haworth

Rowshanfarzad

et al. 2020

Cancers

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Advances in imaging have enabled the identification of prostate cancer foci with an initial application to focal dose escalation, with subvolumes created with image intensity thresholds. Through quantitative imaging techniques, correlations between image parameters and tumour characteristics have been identified. Mathematical functions are typically used to relate image parameters to prescription dose to improve the clinical relevance of the resulting dose distribution. However, these relationships have remained speculative or invalidated. In contrast, the use of radiobiological models during treatment planning optimisation, termed biological optimisation, has the advantage of directly considering the biological effect of the resulting dose distribution. This has led to an increased interest in the accurate derivation of radiobiological parameters from quantitative imaging to inform the models. This article reviews the progress in treatment planning using image-informed tumour biology, from focal dose escalation to the current trend of individualised biological treatment planning using image-derived radiobiological parameters, with the focus on prostate intensity-modulated radiotherapy (IMRT).

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“…5 In the study development phase, patients had PET/CT imaging at planning whilst on ADT ("ADT group"). As visual tracer uptake was noted to be low for the first 10 patients, subsequent patients had PET/CT imaging at staging before ADT ("ADT-naïve group").…”

Section: Introductionmentioning

confidence: 99%

“…Cohort studies have demonstrated outcomes without increased toxicity. [2][3][4][5] These DILs have been contoured using a co-registered multiparametric MRI (mpMRI) in several studies such as Dose EscaLation to Intraprostatic tumour Nodules in localised prostate Cancer (DELINEATE) (ISRCTN04483921), Hypofractionated External beam Image-Guided Highly Targeted radiotherapy (HEIGHT) (NCT01411332) and Focal Lesion Ablation Microboost In Prostate Cancer (FLAME) trials. 6 An alternative imaging modality for identifying lesions is the positron emission tomography CT scan (PET/CT).…”

Section: Introductionmentioning

confidence: 99%

Effect of androgen deprivation therapy on intraprostatic tumour volume identified on 18F choline PET/CT for prostate dose painting radiotherapy

Chan

Carver

Brunt

et al. 2017

The British Journal of Radiology

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Objective: Prostate dose painting radiotherapy requires the accurate identification of dominant intraprostatic lesions (DILs) to be used as boost volumes; these can be identified on multiparametric MRI (mpMRI) or choline positron emission tomography (PET)/CT. Planning scans are usually performed after 2-3 months of androgen deprivation therapy (ADT). We examine the effect of ADT on choline tracer uptake and boost volumes identified on choline PET/CT. Methods: Fluoroethylcholine ( 18 F choline) PET/CT was performed for dose painting radiotherapy planning in patients with intermediate-to high-risk prostate cancer. Initially, they were performed at planning. Owing to low visual tracer uptake, PET/CT for subsequent patients was performed at staging. We compared these two approaches on intraprostatic lesions obtained on PET using both visual and automatic threshold methods [prostate maximum standardized uptake value (SUV max ) 60%] when compared with mpMRI. Results: PET/CT was performed during ADT in 11 patients (median duration of 85 days) and before ADT in 29 patients. ADT significantly reduced overall prostate volume by 17%. During ADT, prostate SUV max was lower although it did not reach statistical significance (4.2 vs 6.6, p 5 0.06); three patients had no visually identifiable PET DIL; and visually defined PET DILs were significantly smaller than corresponding mpMRI DILs (p 5 0.03). However, all patients scanned before ADT had at least one visually identifiable PET DIL, with no significant size difference between MRI and visually defined PET DILs. In both groups, threshold PET produced larger DILs than visual PET. Both PET methods have moderate sensitivity (0.50-0.68) and high specificity (0.85-0.98) for identifying MRI-defined disease. Conclusion: For visual contouring of boost volumes in prostate dose painting radiotherapy, 18 F choline PET/CT should be performed before ADT. For threshold contouring of boost volumes using our PET/CT scanning protocol, threshold levels of above 60% prostate SUV max may be more suitable. Additional use of PET with MRI for radiotherapy planning can significantly change the overall boost volumes compared with using MRI alone. Advances in knowledge: For prostate dose painting radiotherapy, the additional use of 18 F choline PET with MRI can significantly change the overall boost volumes, and PET should be performed before hormone therapy, especially if boost volumes are visually identified.

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Prostate Dose-painting Radiotherapy and Radiobiological Guided Optimisation Enhances the Therapeutic Ratio

Abstract: The toxicity for this radiobiological guided dose-painting protocol was low, but we have only treated a small cohort with limited follow-up time. The advantages of this treatment approach should be established in a clinical trial.

Cited by 22 publications

References 30 publications

Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review

Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review

Progress towards Patient-Specific, Spatially-Continuous Radiobiological Dose Prescription and Planning in Prostate Cancer IMRT: An Overview

Effect of androgen deprivation therapy on intraprostatic tumour volume identified on 18F choline PET/CT for prostate dose painting radiotherapy

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