The radial distance of extraprostatic extension of prostate carcinoma

Davis, Brian J.; Pisansky, Thomas M.; Wilson, Timothy O.; Rothenberg, Harold J.; Pacelli, Anna; Hillman, David W.; Sargent, Daniel J.; Bostwick, David G.

doi:10.1002/(sici)1097-0142(19990615)85:12<2630::aid-cncr20>3.0.co;2-l

Cited by 145 publications

(42 citation statements)

References 44 publications

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“…The clinical target volume (CTV) comprised the whole prostate gland plus 5 mm in all directions to cover possible extracapsular extensions [11], except for the posterior (rectal) margin. The posterior margin varied from 2 to 5 mm depending on the distance from the rectal wall.…”

Section: Methodsmentioning

confidence: 99%

Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife

Fukuda

Seo

Shiomi

et al. 2014

Journal of Radiation Research

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The purpose of this study was to perform dosimetry analyses comparing high-dose-rate brachytherapy (HDR-BT) with simulated stereotactic body radiotherapy (SBRT). We selected six consecutive patients treated with HDR-BT monotherapy in 2010, and a CyberKnife SBRT plan was simulated for each patient using computed tomography images and the contouring set used in the HDR-BT plan for the actual treatment, but adding appropriate planning target volume (PTV) margins for SBRT. Then, dosimetric profiles for PTVs of the rectum, bladder and urethra were compared between the two modalities. The SBRT plan was more homogenous and provided lower dose concentration but better coverage for the PTV. The maximum doses in the rectum were higher in the HDR-BT plans. However, the HDR-BT plan provided a sharper dose fall-off around the PTV, resulting in a significant and considerable difference in volume sparing of the rectum with the appropriate PTV margins added for SBRT. While the rectum D5cm3 for HDR-BT and SBRT was 30.7 and 38.3 Gy (P < 0.01) and V40 was 16.3 and 20.8 cm3 (P < 0.01), respectively, SBRT was significantly superior in almost all dosimetric profiles for the bladder and urethra. These results suggest that SBRT as an alternative to HDR-BT in hypofractionated radiotherapy for prostate cancer might have an advantage for bladder and urethra dose sparing, but for the rectum only when proper PTV margins for SBRT are adopted.

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Section: Methodsmentioning

confidence: 99%

Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife

Fukuda

Seo

Shiomi

et al. 2014

Journal of Radiation Research

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“…Data suggests that periprostatic dose impacts the likelihood of treatment success [5, 6, 9, 16]. Choi et al .…”

Section: Discussionmentioning

confidence: 99%

“…However, treatment margins can vary markedly between patients with comparable intra-prostatic dose distributions [5]. Because brachytherapy dose decreases by as much as 20 Gy per millimeter at the periphery of the target volume, as many as 50% of patients with a pre-treatment prostate specific antigen (PSA) < 10 ng/mL manifest extracapsular extension (EPE), and the radial extent of EPE is usually in the range of 2-5 mm [7–9], periprostatic treatment margins accomplished by either monotherapeutic brachytherapy and/or the addition of supplemental external beam radiation therapy (XRT) are necessary to ensure geographic coverage of potential sites of EPE.…”

Section: Purposementioning

confidence: 99%

Permanent prostate brachytherapy extracapsular radiation dose distributions: analysis of a multi-institutional database

Merrick

Butler²,

Grimm³

et al. 2013

jcb

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PurposePeriprostatic brachytherapy doses impact biochemical control. In this study, we evaluate extracapsular volumetric dosimetry following permanent prostate brachytherapy in patients entered in a multi-institutional community database.Material and methodsIn the database, 4547 patients underwent brachytherapy (3094 – 125I, 1437 – 103Pd and 16 – 131Cs). Using the originally determined prostate volume, a 5 mm, 3-dimensional peri-prostatic anulus was constructed around the prostate (except for a 2 mm posterior margin), and evaluated in its entirety and in 90° segments. Prostate dosimetric parameters consisted of a V100 and D90 while the annular dosimetry was reported as a V100.ResultsThe intraprostatic V100 and D90 for 103Pd, and 125I were statistically comparable when stratified by isotope and/or monotherapy vs. boost. The overall mean V100 for the periprostatic annulus was 62.8%. The mean V100 at the base (51.6%) was substantially less than the apex (73.5%) and midgland (65.9%). In addition, for all patients, the anterior V100 (45.7%) was less than the lateral (68.8%) and the posterior (75.0%). The geometric V100 annular differences were consistent when evaluated by isotope. Overall, the V100 was higher in the 125I cohort.ConclusionsThe optimal extracapsular brachytherapy dose and radial extent remains unknown, but will prove increasingly important with reductions and/or elimination of supplemental external beam radiation therapy. The large multi-institutional community database demonstrates periprostatic annular doses that are not as robust as those in selected high volume brachytherapy centers, and may be inadequate for optimal biochemical control following monotherapeutic brachytherapy, especially in higher risk patients.

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“…In the first study, Davis et al examined 376 prostatectomy specimens; 28% of the patients had EPE, the median radial distance of EPE was only 0.5 mm, and only 4% of the patients had EPE > 2.5 mm (33). A second cohort of men treated at the Mayo Clinic, inclusive of 404 prostatectomy specimens, was published in 2007 (36); 30% of the patients had EPE, the median radial distance of EPE was 0.6 mm; and <1% of patients had EPE beyond 5 mm.…”

Section: Discussionmentioning

confidence: 99%

Endorectal magnetic resonance imaging for predicting pathologic T3 disease in Gleason score 7 prostate cancer: Implications for prostate brachytherapy

et al. 2013

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The radial distance of extraprostatic extension of prostate carcinoma

Cited by 145 publications

References 44 publications

Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife

Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife

Permanent prostate brachytherapy extracapsular radiation dose distributions: analysis of a multi-institutional database

Endorectal magnetic resonance imaging for predicting pathologic T3 disease in Gleason score 7 prostate cancer: Implications for prostate brachytherapy

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