Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial

Keall, Paul J.; Nguyen, Doan Trang; O’Brien, Ricky; Hewson, Emily; Ball, Helen J.; Poulsen, Per Rugaard; Booth, Jeremy; Greer, Peter; Hunter, Perry; Wilton, Lee; Bromley, Regina; Kipritidis, John; Eade, Thomas; Kneebone, Andrew; Hruby, George; Moodie, T. B.; Hayden, Alix; Turner, Sandra; Arumugam, Sankar; Sidhom, Mark; Hardcastle, Nicholas; Siva, Shankar; Tai, Keen‐Hun; Gebski, Val; Martin, Jarad

doi:10.1016/j.ijrobp.2020.03.014

Cited by 38 publications

(36 citation statements)

References 33 publications

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“…The analysis of the MER plans which incorporated the effect of prostate residual intrafraction motion during dose delivery with beam gating and repositioning when necessary, showed that PTV coverage was slightly reduced and hotspots increased in accordance with prior reports [26][27][28]. However, the median CTV D 98% was 18.1 Gy (i.e., 95% of the prescribed dose) though in one patient (#6) dropped to 17.8 Gy (i.e.…”

Section: Discussionsupporting

confidence: 81%

“…PTV margins in combination with motion mitigation strategies allowed maintaining an adequate target coverage using a 3-mm gating threshold. These findings compare favorably with results of the TROG 15.01 SPARK trial, showing that with real-time kilovoltage-based IGRT intrafraction monitoring, no treatment had a prostate CTV D 98% dose 5% less than planned [28].…”

Section: Discussionsupporting

confidence: 69%

“…The latter probably gives a better estimate of the delivered dose by including interplay effects. This methodology was already employed in several studies to reconstruct the dose delivered to the liver or to the prostate with SBRT [26][27][28][31][32][33] or to validate other reconstruction methods [34,35]. Its main pitfall is that prostate motion is assimilated to EMT centroid position which may not be an optimal surrogate, especially when considering the seminal vesicle motion, and that intrafraction rotation are not taken into account (since not available from the Calypso data).…”

Section: Discussionmentioning

confidence: 99%

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Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking

Jaccard

Ehrbar

Miralbell

et al. 2021

Radiotherapy and Oncology

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To reconstruct the dose delivered during single-fraction urethra-sparing prostate stereotactic body radiotherapy (SBRT) accounting for intrafraction motion monitored by intraprostatic electromagnetic transponders (EMT). Methods: We analyzed data of 15 patients included in the phase I/II ''ONE SHOT" trial and treated with a single fraction of 19 Gy to the planning target volume (PTV) and 17 Gy to the urethra planning risk volume. During delivery, prostate motion was tracked with implanted EMT. SBRT was interrupted when a 3mm threshold was trespassed and corrected unless the offset was transient. Motion-encoded reconstructed (MER) plans were obtained by splitting the original plans into multiple sub-beams with isocenter shifts based on recorded EMT positions, mimicking prostate motion during treatment. We analyzed intrafraction motion and compared MER to planned doses. Results: The median EMT motion range (±SD) during delivery was 0.26 ± 0.09, 0.22 ± 0.14 and 0.18 ± 0. 10 cm in the antero-posterior, supero-inferior, and left-right axes, respectively. Treatment interruptions were needed for 8 patients because of target motion beyond limits in the antero-posterior (n = 6) and/or supero-inferior directions (n = 4). Comparing MER vs. original plan there was a median relative dose difference of À1.9% (range, À7.9 to À1.0%) and of +0.5% (À0.3-1.7%) for PTV D 98% and D 2% , respectively. The clinical target volume remained sufficiently covered with a median D 98% difference of À0.3% (À1.6-0.5%). Bladder and rectum dosimetric parameters showed significant differences between original and MER plans, but mostly remained within acceptable limits. Conclusions: The dosimetric impact of intrafraction prostate motion was minimal for target coverage for single-fraction prostate SBRT with real-time electromagnetic tracking combined with beam gating.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking

Jaccard

Ehrbar

Miralbell

et al. 2021

Radiotherapy and Oncology

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“…2 There has been huge progress in cancer treatment, including surgery, radiotherapy, chemotherapy, and immunotherapy. [3][4][5] Chemotherapy remains the most common therapeutic modality due to its high efficiency. However, clinical trials have proven that chemotherapy has many problems, such as poor targeting, systemic effects, and indiscriminate destruction of normal cells, resulting in various side effects.…”

Section: Introductionmentioning

confidence: 99%

Self-Monitoring and Self-Delivery of Self-Assembled Fluorescent Nanoparticles in Cancer Therapy

Li¹,

Yuan²,

Liu³

et al. 2021

IJN

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Due to the shortcomings of nanocarriers, the development of carrier-free nanodelivery systems has attracted more and more attention in cancer treatment. However, there are few studies on carrier-free nanosystems that can simultaneously achieve monitoring functions. Here a multifunctional carrier-free nanosystem loaded with curcumin and irinotecan hydrochloride was established for the treatment and monitoring of gastric cancer. Methods: In this study, an irinotecan hydrochloride-curcumin nanosystem in the early stage (the system is named SICN) was prepared. Based on the fluorescence of curcumin, flow cytometry, laser confocal microscopy, and zebrafish fluorescence imaging were used to study the monitoring function of SICN in vivo and in vitro. In addition, HGC-27 human gastric cancer cells were used to study SICN cytotoxicity. Results: Flow cytometry and zebrafish fluorescence imaging monitoring results showed that the uptake of SICN was significantly higher than free curcumin, and the excretion rate was lower. SICN had higher accumulation and retention in cells and zebrafish. Laser confocal microscopy monitoring results showed that SICN was internalized into HGC-27 cells through multiple pathways, including macropinocytosis, caveolin, and clathrin-mediated and clathrin -independent endocytosis, and distributed intracellularly throughout the whole cytoplasm, including lysosomes and Golgi apparatus. In vitro cell experiments showed that SICN nanoparticles were more toxic than single components, and HGC-27 cells had more absorption and higher toxicity to nanoparticles under slightly acidic conditions. Conclusion: SICN is a promising carrier-free nanoparticle, and the combination of two single-component therapies can exert a synergistic antitumor effect. When exposed to a tumor acidic environment, SICN showed stronger cytotoxicity due to charge conversion. More importantly, the nanoparticles' self-monitoring function has been developed, opening up new ideas for combined tumor therapy.

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“…Once the treatment beam was manually gated, the couch was shifted to reposition the patient such that the prostate was returned to its initial planned position. Gating was available for 171 fractions, but treatment was not completed using KIM for 5 fractions due to various technical issues [24]. A total of 166 gating fractions were included in this analysis, and 65 of these fractions observed prostate motion that exceeded the motion threshold, requiring intervention.…”

Section: Motion Adaptation Processmentioning

confidence: 99%

Is multileaf collimator tracking or gating a better intrafraction motion adaptation strategy? An analysis of the TROG 15.01 stereotactic prostate ablative radiotherapy with KIM (SPARK) trial

Hewson

Nguyen

O’Brien

et al. 2020

Radiotherapy and Oncology

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Purpose: Stereotactic Ablative Radiotherapy (SABR) has recently emerged as a favourable treatment option for prostate cancer patients. With higher doses delivered over fewer fractions, motion adaptation is a requirement for accurate delivery of SABR. This study compared the efficacy of multileaf collimator (MLC) tracking vs. gating as a real-time motion adaptation strategy for prostate cancer SABR patients enrolled in a clinical trial.Methods: Forty-four prostate patients treated over five fractions in the TROG 15.01 SPARK trial were analysed in this study. Forty-nine fractions were treated using MLC tracking and 166 fractions were treated using beam gating and couch shifts. A time-resolved motionencoded dose reconstruction method was used to evaluate the dose delivered using each motion adaptation strategy and compared to an estimation of what would have been delivered with no motion adaptation strategy implemented.Results: MLC tracking and gating both delivered doses closer to the plan compared to when no motion adaptation strategy was used. Differences between MLC tracking and gating were small with differences in the mean discrepancy from the plan of -0.3% (CTV D98%), 1.4% (CTV D2%), 0.4% (PTV D95%), 0.2% (rectum V30Gy) and 0.0% (bladder V30Gy). On average, 0.5 couch shifts were required per gated fractions with a mean interruption duration of 1.8 ± 2.6 minutes per fraction treated using gating. Conclusion:Both MLC tracking and gating were effective strategies at improving the accuracy of the dose delivered to the target and organs at risk. While dosimetric performance was comparable, gating resulted in interruptions to treatment.Clinical trial registration number: NCT02397317

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Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial

Cited by 38 publications

References 33 publications

Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking

Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking

Self-Monitoring and Self-Delivery of Self-Assembled Fluorescent Nanoparticles in Cancer Therapy

Is multileaf collimator tracking or gating a better intrafraction motion adaptation strategy? An analysis of the TROG 15.01 stereotactic prostate ablative radiotherapy with KIM (SPARK) trial

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