Virtual HDRSM CyberKnife Treatment for Localized Prostatic Carcinoma: Dosimetry Comparison With HDR Brachytherapy and Preliminary Clinical Observations

Fuller, Donald B.; Naitoh, John; Lee, Charles; Hardy, Steven; Jin, Haoran

doi:10.1016/j.ijrobp.2007.11.067

Cited by 192 publications

(145 citation statements)

References 24 publications

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“…33 Although our data show a low incidence of acute and late grade 2 to 3 toxicities, the data of the trials published on SBRT LpC have shown late grade 3 GI and GU toxicities within the 1% to 3% range. 18,25,[34][35][36] An exception was 1 SBRT trial 29 delivering 50 Gy in 5 fractions: In this study, 7% grade 3 GI and GU late toxicities were observed. Our data, of late toxicity, are, respectively, 1% for grade 2 GI toxicity and 4% for grade 2 GU toxicity.…”

Section: Discussionmentioning

confidence: 58%

“…16 Data from a systematic review have emphasized the advantages of the combination of EBRT and HDR-BRT in terms of biochemical control and overall survival versus HDR-BRT or EBRT alone. 12 Data for LpC, published by Fuller et al, 18 suggest the validity of stereotactic body radiotherapy (SBRT) emulating dosimetry, dose, and fractionation of HDR-BRT. Another experience for LpC, 19 with SBRT as monotherapy and post-EBRT boost, has reported prostatespecific antigen (PSA) nadir comparable with HDR-BRT.…”

Section: Introductionmentioning

confidence: 99%

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High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Pontoriero

Iatì

Mondello

et al. 2015

Technol Cancer Res Treat

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Background: Stereotactic body radiotherapy (SBRT) can emulate high dose rate brachytherapy (HDR-BRT) dose fractionation. We report our preliminary results using SBRT in monotherapy or pre-external-beam radiotherapy (EBRT) boost in patients with localized prostate cancer (LpC). The primary end point was the evaluation of both acute and late toxicities; secondary end point was the observation of prostate-specific antigen (PSA) nadir. Patients and Methods: Patients with LpC having prostate volume 90 cm 3 were enrolled in the present study. Patients were treated with SBRT alone or in combined modality (SBRT þ EBRT). SBRT was performed using a CyberKnife System (Accuray Incorporated, Sunnyvale, California) and fiducial tracking system. Results: From February 2008 to July 2013, 21 patients for monotherapy (38 Gy/4 fractions) and 5 for combined modality (9.5 Gy/2 fractions plus 46 Gy/23 fractions EBRT) were enrolled. Androgen deprivation therapy (ADT) was administered in 16 of the 26 patients. The median pretreatment PSA was 9.4 (range, 4.5-14.3) ng/mL. All patients completed the planned therapy. Acute Grade 1 toxicity was observed in 18 patients, genitourinary (GU) in 12 / 26 patients, and gastrointestinal (GI) in 6 / 26 patients. Acute Grade 2 GU toxicity was reported in 1 / 26 patients, and Grade 2 GI toxicity was observed in 2 / 26 patients. The median PSA nadir was 0.15 (range, 0.02 ¼ 1.4) ng/mL. Late toxicities were observed in 5 / 26 patients: Grade 1 GU (3 of 26), Grade 2 GU (1 of 26), and Grade 1 GI (1 of 26). Median follow-up was 21.5 (range, 8-65) months. Conclusions: Our preliminary results of SBRT ''simulating'' HDR for LpC confirm a minimal toxicity and an optimal PSA response. The PSA nadirs appear comparable with HDR-BRT.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Pontoriero

Iatì

Mondello

et al. 2015

Technol Cancer Res Treat

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“…Iris dynamic collimator has been used in many clinics to allow the planner to choose multiple collimator sizes to treat a tumor, which improves the planning quality and allows for a similar treatment delivery time with the single collimator plan. Multiple studies have reported

25 % \sim 50 %

of MU reductions using Iris comparing with single‐cone collimator plan 7 , 8 , 9 . However, based on our large cone selection in planning, we do not think the utilizations of Iris would affect the modulation factor in this study (7.43).…”

Section: Resultsmentioning

confidence: 78%

Radiation shielding evaluation based on five years of data from a busy CyberKnife center

Yang

Feng²

2014

J Applied Clin Med Phys

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We examined the adequacy of existing shielding guidelines using five‐year clinical data from a busy CyberKnife center. From June 2006 through July 2011, 1,370 patients were treated with a total of 4,900 fractions and 680,691 radiation beams using a G4 CyberKnife. Prescription dose and total monitor units (MU) were analyzed to estimate the shielding workload and modulation factor. In addition, based on the beam's radiation source position, targeting position, MU, and beam collimator size, the MATLAB program was used to project each beam toward the shielding barrier. The summation of the projections evaluates the distribution of the shielding load. On average, each patient received 3.6 fractions, with an average 9.1 Gy per fraction prescribed at the 71.1% isodose line, using 133.7 beams and 6,200 MU. Intracranial patients received an average of 2.7 fractions, with 8.6 Gy per fraction prescribed at the 71.4% isodose line, using 133 beams and 5,083 MU. Extracranial patients received an average of 3.94 fractions, with 9.2 Gy per fraction prescribed at the 71% isodose line, using 134 beams and 6,514 MU. Most‐used collimator sizes for intracranial patients were smaller (7.5 to 20 mm) than for extracranial patients (20 to 40 mm). Eighty‐five percent of the beams exited through the floor, and about 40% of the surrounding wall area received no direct beam. For the rest of the wall, we found “hot” areas that received above‐average MU. The locations of these areas were correlated with the projection of the nodes for extracranial treatments. In comparison, the beam projections on the wall were more spread for intracranial treatments. The maximum MU any area received from intracranial treatment was less than 0.25% of total MU used for intracranial treatments, and was less than 1.2% of total MU used for extracranial treatments. The combination of workload, modulation factor, and use factor in our practice are about tenfold less than recommendations in the existing CyberKnife shielding guidelines. The current guidelines were found to be adequate for shielding, even in a busy center. There may be a potential to reduce shielding in areas with no or few direct beams in the current G4 model. Since a newer model CyberKnife (M6) has recently been introduced, the patterns of usage reported here may be changed in the future. The uneven distribution of use factor we have found may, however, be considered in the vault design.PACS number: 87.55.N

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“…Stereotactic body radiotherapy (SBRT) has recently emerged as an alternative technique to deliver hypofractionated radiotherapy to the prostate, comparable in many respects to HDR brachytherapy, but with a noninvasive approach [8][9][10][11][12][13][14]. The concept is not entirely novel.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy for low-risk prostate cancer: Five-year outcomes.

Freeman

King

2011

JCO

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Purpose: Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Results: At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusion: Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach. Method and

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Virtual HDRSM CyberKnife Treatment for Localized Prostatic Carcinoma: Dosimetry Comparison With HDR Brachytherapy and Preliminary Clinical Observations

Cited by 192 publications

References 24 publications

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer

Radiation shielding evaluation based on five years of data from a busy CyberKnife center

Stereotactic body radiotherapy for low-risk prostate cancer: Five-year outcomes.

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