Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15/ NCT01982786)

Vigneault, Éric; Morton, Gerard; Parulekar, Wendy R.; Niazi, Tamim; Springer, Colvin; Barkati, Maroie; Chung, Peter; Koll, W; Kamran, Asim; Monreal, M.; Ding, Keyue; Loblaw, Andrew

doi:10.1016/j.clon.2018.05.007

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…A common treatment regime for prostate cancer patients may include interstitial HDR brachytherapy (28,29). Interstitial HDR brachytherapy may be used as monotherapy (without EBRT) for definitive or salvage (treating cancer recurrence following previous radiation) treatments (30,31) or as a boost in combination with EBRT (32). The typical prostate HDR workflow involves the use of Trans-rectal ultrasound (TRUS) to guide the procedure.…”

Section: Prostate Cancermentioning

confidence: 99%

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Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Shaaer

2023

Preprint

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Interstitial high dose rate (HDR) brachytherapy is a well-established treatment for prostate and gynecological cancers. HDR brachytherapy involves delivery of a high dose of radiation to the target with minimum dose to the surrounding tissue. Magnetic resonance imaging (MRI) has been explored as a main imaging modality for accurate target identification. Superior soft tissue resolution has been reported with MRI, increasing the accuracy of brachytherapy procedure. Clinical HDR brachytherapy workflows employing MRI are seeing increases in adoption. However, these require additional resources and patient transfers, which increases the planning time and the risk of catheters displacement. In addition, interstitial catheter reconstruction during interstitial brachytherapy procedure is challenging. Thus, accurate and efficient methods of incorporating the MRI imaging in interstitial HDR brachytherapy procedures need to be considered. In this thesis, a robust MRI-based algorithm and workflow were developed for treatment planning of interstitial HDR brachytherapy for prostate and gynecological cancers. An in-house MRI-to Ultrasound image registration algorithm was developed and evaluated for accurate identification of dominant intraprostatic lesions. The dosimetric impact of the registration was also assessed. Furthermore, an in-house MR-line marker was used in evaluating the feasibility of MR-only interstitial gynecological HDR brachytherapy workflow. The impact of the MR-only workflow on the target coverage and normal tissue sparing was evaluated. The dosimetric difference between the conventional approach and the proposed MR-only approaches was also compared and reported. Finally, a deep learning-assisted algorithm was developed for robust catheter reconstruction. The algorithm was benchmarked against the manual reconstruction and their efficiency was evaluated. Based on the results, the MRI-based innovations developed in this work are feasible for implementation in clinical brachytherapy workflows for treatment planning of prostate and gynecological cancers.

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Section: Prostate Cancermentioning

confidence: 99%

“…Interstitial high dose rate (HDR) brachytherapy is a crucial form of brachytherapy for improving the overall survival while limiting treatment toxicity in patients with larger tumours or asymmetric tumour morphology (32,(327)(328)(329).…”

Section: Introductionmentioning

confidence: 99%

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Shaaer

2023

Preprint

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“…Despite providing randomized evidence, criticisms of this trial include a low EBRT alone radiation dose (55 Gy/20 fractions) compared to current standards of 60 Gy in 20 fractions or 78-80 Gy in standard fractionation. A randomized feasibility study was conducted by Vigneault et al to assess the ability to randomize patients between dose escalated image-guided radiation therapy (IGRT) (78 Gy/39 fractions or 60 Gy/20 fractions) and IGRT plus HDR brachytherapy boost (37.5 Gy/15 fractions + 15 Gy HDR boost) with good compliance although small numbers (57 patients randomized) (26). Rates of protocol deviations and acute toxicities were low in both arms, but no biochemical control rates are reported as data matures (26).…”

Section: Hdr Boostmentioning

confidence: 99%

A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

et al. 2019

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For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LDR) or high-dose rate (HDR) brachytherapy to EBRT, although only ASCENDE-RT compared brachytherapy to dose-escalated EBRT but did report an over 50% improvement in biochemical failure with a LDR boost. Multiple single institution and comparative research series also support the use of a brachytherapy boost in the DE-EBRT era and demonstrate excellent prostate cancer specific outcomes. Despite improved oncologic outcomes with a brachytherapy boost in the high-risk setting, the utilization of both LDR, and HDR brachytherapy use is declining. The acute genitourinary toxicities when brachytherapy boost is combined with EBRT, particularly a LDR boost, are of concern in comparison to EBRT alone. HDR brachytherapy boost has many physical properties inherent to its rapid delivery of a large dose which may reduce acute toxicities and also appeal to the radiobiology of prostate cancer. We herein review the evidence for use of either LDR or HDR brachytherapy boost for high-risk prostate cancer and summarize comparisons between the two treatment modalities.

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“…Prostate cancer is the most prevalent non‐skin cancer among men with over 190,000 new cases expected in the United States in 2020 1 . Multi‐fraction high‐dose‐rate brachytherapy (HDR‐BT) is a localized prostate cancer treatment technique with high biochemical control rates and low toxicity, 2,3 which can be offered as either a monotherapy or as a boost to external beam radiotherapy (EBRT), depending on patient disease stage and risk category 4–7 …”

Section: Introductionmentioning

confidence: 99%

“…1 Multi-fraction high-dose-rate brachytherapy (HDR-BT) is a localized prostate cancer treatment technique with high biochemical control rates and low toxicity, 2,3 which can be offered as either a monotherapy or as a boost to external beam radiotherapy (EBRT), depending on patient disease stage and risk category. [4][5][6][7] As a monotherapy, recent HDR-BT clinical trials have been conducted which have demonstrated that single-fraction HDR-BT is a low-toxicity treatment [8][9][10][11][12] that can be delivered as an outpatient procedure, improving convenience for the patient relative to multi-fraction HDR-BT, shortening the overall length of treatment, decreasing total anesthesia time, and reducing the total cost of treatment. 13 Hoskin et al, 9 Siddiqui et al, 14 Morton et al, 11 and Prada et al 15 have reported comparable or lower late-term side effects with single fraction HDR-BT regimens than with multiple fraction schedules.…”

Section: Introductionmentioning

confidence: 99%

¹⁶⁹Yb‐based rotating shield brachytherapy for prostate cancer

et al. 2020

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Purpose To present a system for the treatment of prostate cancer in a single‐fraction regimen using 169Yb‐based rotating shield brachytherapy (RSBT) with a single‐catheter robotic delivery system. The proposed system is innovative because it can deliver RSBT through multiple implanted needles independently, in serial, using flexible catheters, with no inter‐needle shielding effects and without the need to rotate multiple shielded catheters inside the needles simultaneously, resulting in a simple, mechanically robust, delivery approach. RSBT was compared to conventional 192Ir‐based high‐dose‐rate brachytherapy (HDR‐BT) in a treatment planning study with dose escalation and urethral sparing goals, representing single‐fraction brachytherapy monotherapy and brachytherapy as a boost to external beam radiotherapy, respectively. A prototype mechanical delivery system was constructed and quantitatively evaluated as a proof of concept. Methods Treatment plans for twenty‐six patients with single fraction prescriptions of 20.5 and 15 Gy, were created for dose escalation and urethral sparing, respectively. The RSBT and HDR‐BT delivery systems were modeled with one partially shielded 999 GBq (27 Ci) 169Yb source and one 370 GBq (10 Ci) 192Ir source, respectively. A prototype angular drive system for helical source delivery was constructed. Mechanical accuracy measurements of source translational position and angular orientation in a simulated treatment delivery setup were obtained using the prototype system. Results For dose escalation, with equivalent urethra D10%, PTV D90% for RSBT vs HDR‐BT increased from 22.6 ± 0.0 Gy (average ± standard deviation) to 29.3 ± 0.9 Gy, or 29.9 % ± 3.0%, with treatment times of 51.4 ± 6.1 min for RSBT and 15.8 ± 2.3 min for 10 Ci 192Ir‐based HDR‐BT. For urethra sparing, with equivalent PTV D90%, urethra D10% for RSBT vs HDR‐BT decreased for RSBT vs HDR‐BT from 15.6 ± 0.4 Gy to 12.0 ± 0.4 Gy, or 23.1% ± 3.5%, with treatment times of 30.0 ± 3.7 min for RSBT and 12.3 ± 1.8 min for HDR‐BT. Differences between measured vs predicted rotating catheter positions (corresponding to source position) were within 0.18 mm ± 0.12 mm longitudinally and 0.07° ± 0.78°. Conclusion 169Yb‐based RSBT can increase PTV D90% or decrease urethral D10% relative to HDR‐BT with treatment times of less than 1 h using a single‐source robotic delivery system with treatment delivered in a single fraction. The prototype helical delivery system was able to demonstrate adequate mechanical accuracy.

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Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15/ NCT01982786)

Cited by 8 publications

References 22 publications

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

¹⁶⁹Yb‐based rotating shield brachytherapy for prostate cancer

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Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15/ NCT01982786)

Cited by 8 publications

References 22 publications

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

A Brief Review of Low-Dose Rate (LDR) and High-Dose Rate (HDR) Brachytherapy Boost for High-Risk Prostate

169Yb‐based rotating shield brachytherapy for prostate cancer

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Resources

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¹⁶⁹Yb‐based rotating shield brachytherapy for prostate cancer