Trade-off between the conflicting planning goals in correlation with patient’s anatomical parameters for intensity-modulated radiotherapy of prostate cancer patients

Banaei, Amin; Hashemi, Bijan; Bakhshandeh, Mohsen; Mofid, Bahram

doi:10.1017/s1460396919000025

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…This is contrary to the findings of Banaei et al who conducted a study based on 15 prostate cancer patients that were delivered IMRT treatment. 27 Researchers reported inverse exponential relationships between the OAR sparing and HI, which might be the case due to the differences in dose delivery techniques. Banaei et al used nine static IMRT beams, while this study utilized VMAT techniques with two arcs.…”

Section: Discussionmentioning

confidence: 99%

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Adaptive radiation therapy strategies in the treatment of prostate cancer patients using hypofractionated VMAT

Siciarz

McCurdy

Hanumanthappa

et al. 2021

J Applied Clin Med Phys

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To perform a comprehensive evaluation of eight adaptive radiation therapy strategies in the treatment of prostate cancer patients who underwent hypofractionated volumetric modulated arc therapy (VMAT) treatment. Material and methods:The retrospective study included 20 prostate cancer patients treated with 40 Gy total dose over five fractions (8 Gy/fraction) using VMAT. Daily cone beam computed tomography images were acquired before the delivery of every fraction and then, with the application of deformable image registration used for the estimation of daily dose, contouring and plan re-optimization. Dosimetric benefits of the various ART strategies were quantified by the comparison of dose and dose-volume metrics derived from treatment planning objectives for original treatment plan and adapted plans with the consideration of target volumes (PTV and CTV) as well as critical structures (bladder, rectum, left, and right femoral heads). Results: Percentage difference (ΔD) between planning objectives and delivered dose in the D 99% > 4000cGy (CTV) metric was −3.9% for the non-ART plan and 2.1% to 4.1% for ART plans. For D 99% > 3800cGy and D max < 4280cGy (PTV), ΔD was −11.2% and −6.5% for the non-ART plan as well as −3.9% to −1.6% and −0.2% to 1.8% for ART plans, respectively. For D 15% < 3200 cGy and D 20% < 2800 cGy (bladder), ΔD was −62.4% and −68.8% for the non-ART plan as well as −60.0% to −57.4% and −67.0% to −64.0% for ART plans. For D 15% < 3200 cGy and D 20% < 2800 cGy (rectum), ΔD was −11.4% and −8.15% for non-ART plan as well as −14.9% to −9.0% and −11.8% to −5.1% for ART plans. Conclusions: Daily on-line adaptation approaches were the most advantageous, although strategies adapting every other fraction were also impactful while reducing relative workload as well. Offline treatment adaptations were shown to be less beneficial due to increased dose delivered to bladder and rectum compared toother ART strategies.

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Section: Discussionmentioning

confidence: 99%

“…who conducted a study based on 15 prostate cancer patients that were delivered IMRT treatment. 27 Researchers reported inverse exponential relationships between the OAR sparing and HI, which might be the case due to the differences in dose delivery techniques. Banaei et al.…”

Section: Discussionmentioning

confidence: 99%

Adaptive radiation therapy strategies in the treatment of prostate cancer patients using hypofractionated VMAT

Siciarz

McCurdy

Hanumanthappa

et al. 2021

J Applied Clin Med Phys

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“…The upper limit for the prescribed dose for DIL was considered 70 Gy in 27 fractions for high risk DILs. This hypofractionated dose escalation was used and evaluated in many studies (35)(36)(37)(38)(39)(40)(41)(42). According to a study by Onjukka et al (43), this hypofractionated dose was equivalent to 86 Gy in 37 sessions (used in the study of Uzan et al (44).…”

Section: Methodsmentioning

confidence: 99%

Introducing new plan evaluation indices for prostate dose painting IMRT plans based on apparent diffusion coefficient images

Moradi

Hashemi

Bakhshandeh

et al. 2022

Preprint

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Background: Dose painting planning would be more complicated due to different levels of prescribed doses and more complex evaluation with conventional plan quality indices considering uniform dose prescription. Therefore, we tried to introduce new indices for evaluating the dose distribution conformity and homogeneity of treatment volumes based on the tumoral cell density and relative volumes of each lesion in prostate IMRT. Methods: CT and MRI scans of 20 male patients having local prostate cancer were used for IMRT DP planning. Apparent diffusion coefficient (ADC) images were imported to a MATLAB program to identify lesion regions based on ADC values automatically. Regions with ADC values lower than 750 mm2/s and regions with ADC values higher than 750 and less than 1500 mm2/s were considered CTV70Gy (clinical tumor volume with 70Gy prescribed dose), and CTV60Gy, respectively. Other regions of the prostate were considered as CTV53Gy. New plan evaluation indices based on evaluating the homogeneity (IOE(H)), and conformity (IOE(C)) were introduced, considering the relative volume of each lesion and cellular density obtained from ADC images. These indices were compared with conventional homogeneity and conformity indices and IOEs without considering cellular density. Furthermore, tumor control probability (TCP) was calculated for each patient, and the relationship of the assessed indices were evaluated with TCP values.Results: IOE (H) and IOE (C) with considering cellular density had significantly lower values compared to conventional indices and IOEs without considering cellular density. (P<0.05). TCP values had a stronger relationship with IOE(H) considering cell density (R2=-0.415), and IOE(C) without considering cell density (R2=0.624). Conclusion: IOE plan evaluation indices proposed in this study can be used for evaluating prostate IMRT dose painting plans. We suggested to consider cell densities in the IOE(H) calculation formula and it’s appropriate to calculate IOE(C) without considering cell density vaqlues.

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“…Concerning patients in the hypofractionated group, for better delineation of the target, T2-weighted magnetic resonance images (using a Siemens Avanto 1.5 Tesla Magnetic resonance imaging (MRI) scanner, Erlangen, Germany) were fused with CT scans (using the Siemens Emotion System spiral 16-slice, Erlangen, Germany). The patients' position, bowel and bladder preparation protocol, segmentation, and target volumes were defined the same as the conventional group, except for an 8 mm posterior margin of PTV (18). In contrast to the conventional group, none of the patients in the hypofractionated group received radiation to the pelvic lymph nodes.…”

Section: Treatmentmentioning

confidence: 99%

Comparison of Survival Between Hypofractionated and Conventional Radiotherapy in Clinically Localized Prostate Cancer: A Single-Center Retrospective Cohort

et al. 2020

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Background: Prostate cancer (pCa) is the most frequently diagnosed visceral cancer among men. The main role of radical prostatectomy and external-beam radiation therapy (EBRT) in the management of patients with localized pCa has been established. Objectives: This study aims at comparing the clinical outcomes of hypofractionated versus conventional EBRT in the definitive management of patients with localized pCa. Methods: From 2013 to 2019, a consecutive series of patients with localized pCa was treated with conventional (74 Gy at 2 Gy fractions) or hypofractionated (70.2 Gy at 2.7 Gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), respectively. The impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-RFS) and overall survival (OS) was assessed. Results: The median follow-up was 42 months (range: 8 - 81 months). Among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. The patient characteristics between groups were comparable. The mean bc-RFS of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (CI) 95%: 34.5 - 35.7, P = 0.25). Accordingly, the mean OS of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (CI 95%: 37.3 - 38.6, P = 0.04). The sub-analysis showed that the OS benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (CI 95%: 0.02 - 1.46, P = 0.054). Conclusions: Hypofractionation had OS benefit over the conventional schedule for definitive radiotherapy of localized pCa. This benefit was limited to patients with intermediate- and high-risk pCa.

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Trade-off between the conflicting planning goals in correlation with patient’s anatomical parameters for intensity-modulated radiotherapy of prostate cancer patients

Cited by 11 publications

References 21 publications

Adaptive radiation therapy strategies in the treatment of prostate cancer patients using hypofractionated VMAT

Adaptive radiation therapy strategies in the treatment of prostate cancer patients using hypofractionated VMAT

Introducing new plan evaluation indices for prostate dose painting IMRT plans based on apparent diffusion coefficient images

Comparison of Survival Between Hypofractionated and Conventional Radiotherapy in Clinically Localized Prostate Cancer: A Single-Center Retrospective Cohort

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