Two versus five stereotactic ablative radiotherapy treatments for localized prostate cancer: A quality of life analysis of two prospective clinical trials

Alayed, Yasir; Quon, Harvey; Cheung, Patrick; Chu, William; Chung, Hans T.; Vesprini, Danny; Ong, Aldrich; Chowdhury, Anirban; Panjwani, D.; Helou, Joelle; Pang, G.; Korol, Renée; Davidson, Melanie; Ravi, Ananth; McCurdy, Boyd; Zhang, Liying; Mamedov, Alexandre; Deabreu, Andrea; Commisso, Angela; Commisso, Kristina; Loblaw, Andrew

doi:10.1016/j.radonc.2019.06.018

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…Although early studies showed that this increased dose also increased grade 2 gastrointestinal and genitourinary toxicity [31], dosimetric toxicity correlative studies have revealed how better planning can reduce toxicities [Loblaw DA personal communication, 2019]. Moreover, focal magnetic resonance imaging boosting (as in FLAME or HYPO-FLAME), biodegradable spacers [32] and pelvic immobilisation [33] all allow these higher biological doses to be delivered with less dose to organs at risk, therefore reducing toxicities and QOL detriment [34].…”

Section: Resultsmentioning

confidence: 99%

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Loblaw

2020

Clinical Oncology

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Section: Resultsmentioning

confidence: 99%

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Loblaw

2020

Clinical Oncology

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“…In response to the limited clinical OAR toxicity data associated with UHF prostate radiotherapy available, the most conservative planning constraints utilised in HDR brachytherapy monotherapy studies [7,8,[24][25][26][27][28], along with one UHF SBRT study [10] were applied. Gastrointestinal and genitourinary toxicities in these studies were generally mild, with toxicities greater than grade 2 (variously according to RTOG and CTCAE criteria) very rarely observed.…”

Section: Discussionmentioning

confidence: 99%

“…Abbreviations: high dose-rate brachytherapy (HDR), stereotactic body radiotherapy (SBRT), planning target volume (PTV), clinical target volume (CTV), gross tumour volume (GTV). Region of interest Hoskin et al [7] , [24] (HDR) Ghilezan et al [25] (HDR) Jawad et al [26] (HDR) Morton et al [8] (HDR) Alayed et al [10] (SBRT) Present study (SBRT) PTV Prostate Constraints min peripheral dose = 26 Gy* V27 Gy > 97%* V33.75 Gy < 60% V40.5 Gy < 30% V27 Gy > 95%* V33.75 Gy < 60% V40.5 Gy < 30% V27 Gy > 95%* V40.5 Gy < 35% V54 Gy < 12% D99% (CTV) = 26 Gy* D95% ≥ 24 Gy* D98% ≥ 22.8 Gy D2% < 29.7 Gy max dose (excl. GTV) < 30 Gy Volume definition CTV + 3 mm uniform expansion, clipped at rectum CTV, no expansion CTV, no expansion CTV, no expansion CTV + 3 mm uniform expansion CTV + 2 mm uniform expansion GTV Prostate_Boost Constraints – – – – – D95% ≥ 27 Gy* max dose < 33.75 Gy Volume definition – – – – – Dominant intraprostatic lesion, no expansion Rectum Constraints D0.25 cc < 25 Gy D2 cc < 20 Gy max dose < 19.58 Gy V20.25 Gy < 1% max dose < 24.3 Gy V21.6 Gy < 0.2 cc V20.8 Gy < 1 cc V17.6 Gy < 4 cc V13 Gy < 7 cc V20.8 Gy < 1 cc V17.6 Gy < 4 cc V13 Gy < 7 cc Bladder Constraints – – – – V20.8 Gy < 5 cc V14.6 Gy < 15 cc V20.8 Gy < 5 cc V14.6 Gy < 15 cc Urethra …”

Section: Methodsmentioning

confidence: 99%

“…More extreme hypofractionation has been tested with high dose rate (HDR) brachytherapy, down to 3, 2 or even a single fraction [7][8][9] with limited experience with similar fractionations delivered with external beam radiotherapy [10]. However, recently reported poor PSA control rates with single fraction HDR have significantly tempered enthusiasm for this approach [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Mohajer

Dunlop

Mitchell

et al. 2021

Clinical and Translational Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Recent evidence demonstrates the efficacy of hypofractionated and stereotactic IGRT, demanding increased accuracy for both interfraction and intrafraction verification [9] , [10] , [11] , [12] , [13] . Clinical adoption of hypofractionation is increasingly common, driven in part by the COVID-19 pandemic [14] .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting accuracy and precision in ultrasound guided radiotherapy

Grimwood

Thomas

Kember

et al. 2021

Physics and Imaging in Radiation Oncology

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Background and purpose Transperineal ultrasound (TPUS) is used clinically for directly assessing prostate motion. Factors affecting accuracy and precision in TPUS motion estimation must be assessed to realise its full potential. Methods and materials Patients were imaged using volumetric TPUS during the Clarity-Pro trial (NCT02388308). Prostate motion was measured online at patient set-up and offline by experienced observers. Cone beam CT with markers was used as a comparator and observer performance was also quantified. The influence of different clinical factors was examined to establish specific recommendations towards efficacious ultrasound guided radiotherapy. Results From 330 fractions in 22 patients, offline observer random errors were 1.5 mm, 1.3 mm, 1.9 mm (left–right, superior-inferior, anteroposterior respectively). Errors increased in fractions exhibiting poor image quality to 3.3 mm, 3.3 mm and 6.8 mm. Poor image quality was associated with inconsistent probe placement, large anatomical changes and unfavourable imaging conditions within the patient. Online matching exhibited increased observer errors of: 3.2 mm, 2.9 mm and 4.7 mm. Four patients exhibited large systematic residual errors, of which three had poor quality images. Patient habitus showed no correlation with observer error, residual error, or image quality. Conclusions TPUS offers the unique potential to directly assess inter- and intra-fraction motion on conventional linacs. Inconsistent image quality, inexperienced operators and the pressures of the clinical environment may degrade precision and accuracy. Experienced operators are essential and cross-centre standards for training and QA should be established that build upon current guidance. Greater use of automation technologies may further minimise uncertainties.

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Two versus five stereotactic ablative radiotherapy treatments for localized prostate cancer: A quality of life analysis of two prospective clinical trials

Cited by 13 publications

References 20 publications

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Feasibility of MR-guided ultrahypofractionated radiotherapy in 5, 2 or 1 fractions for prostate cancer

Factors affecting accuracy and precision in ultrasound guided radiotherapy

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