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Gao Y, Yoon S, Ma TM, Yang Y, Sheng K, Low DA, Ballas L, Steinberg ML, Kishan AU, Cao M. Intra-fractional geometric and dose/volume metric variations of magnetic resonance imaging-guided stereotactic radiotherapy of prostate bed after radical prostatectomy. Phys Imaging Radiat Oncol 2024; 30:100573. [PMID: 38585371 PMCID: PMC10997948 DOI: 10.1016/j.phro.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background and purpose Magnetic Resonance Imaging (MRI)-guided Stereotactic body radiotherapy (SBRT) treatment to prostate bed after radical prostatectomy has garnered growing interests. The aim of this study is to evaluate intra-fractional anatomic and dose/volume metric variations for patients receiving this treatment. Materials and methods Nineteen patients who received 30-34 Gy in 5 fractions on a 0.35T MR-Linac were included. Pre- and post-treatment MRIs were acquired for each fraction (total of 75 fractions). The Clinical Target Volume (CTV), bladder, rectum, and rectal wall were contoured on all images. Volumetric changes, Hausdorff distance, Mean Distance to Agreement (MDA), and Dice similarity coefficient (DSC) for each structure were calculated. Median value and Interquartile range (IQR) were recorded. Changes in target coverage and Organ at Risk (OAR) constraints were compared and evaluated using Wilcoxon rank sum tests at a significant level of 0.05. Results Bladder had the largest volumetric changes, with a median volume increase of 48.9 % (IQR 28.9-76.8 %) and a median MDA of 5.1 mm (IQR 3.4-7.1 mm). Intra-fractional CTV volume remained stable with a median volume change of 1.2 % (0.0-4.8 %). DSC was 0.97 (IQR 0.94-0.99). For the dose/volume metrics, there were no statistically significant changes observed except for an increase in bladder hotspot and a decrease of bladder V32.5 Gy and mean dose. The CTV V95% changed from 99.9 % (IQR 98.8-100 %) to 99.6 % (IQR 93.9-100 %). Conclusion Despite intra-fractional variations of OARs, CTV coverage remained stable during MRI-guided SBRT treatments for the prostate bed.
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Affiliation(s)
- Yu Gao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Stephanie Yoon
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Shanghai Ruijin Hospital, China
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel A. Low
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
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Cao M, Gao Y, Yoon SM, Yang Y, Sheng K, Ballas LK, Basehart V, Sachdeva A, Felix C, Low DA, Steinberg ML, Kishan AU. Interfractional Geometric Variations and Dosimetric Benefits of Stereotactic MRI Guided Online Adaptive Radiotherapy (SMART) of Prostate Bed after Radical Prostatectomy: Post-Hoc Analysis of a Phase II Trial. Cancers (Basel) 2021; 13:cancers13112802. [PMID: 34199881 PMCID: PMC8200117 DOI: 10.3390/cancers13112802] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate geometric variations of patients receiving stereotactic body radiotherapy (SBRT) after radical prostatectomy and the dosimetric benefits of stereotactic MRI guided adaptive radiotherapy (SMART) to compensate for these variations. MATERIALS/METHODS The CTV and OAR were contoured on 55 MRI setup scans of 11 patients treated with an MR-LINAC and enrolled in a phase II trial of post-prostatectomy SBRT. All patients followed institutional bladder and rectum preparation protocols and received five fractions of 6-6.8 Gy to the prostate bed. Interfractional changes in volume were calculated and shape deformation was quantified by the Dice similar coefficient (DSC). Changes in CTV-V95%, bladder and rectum maximum dose, V32.5Gy and V27.5Gy were predicted by recalculating the initial plan on daily MRI. SMART was retrospectively simulated if the predicted dose exceeded pre-set criteria. RESULTS The CTV volume and shape remained stable with a median volumetric change of 3.0% (IQR -3.0% to 11.5%) and DSC of 0.83 (IQR 0.79 to 0.88). Relatively large volumetric changes in bladder (median -24.5%, IQR -34.6% to 14.5%) and rectum (median 5.4%, IQR - 9.7% to 20.7%) were observed while shape changes were moderate (median DSC of 0.79 and 0.73, respectively). The median CTV-V95% was 98.4% (IQR 94.9% to 99.6%) for the predicted doses. However, SMART would have been deemed beneficial for 78.2% of the 55 fractions based on target undercoverage (16.4%), exceeding OAR constraints (50.9%), or both (10.9%). Simulated SMART improved the dosimetry and met dosimetric criteria in all fractions. Moderate correlations were observed between the CTV-V95% and target DSC (R2 = 0.73) and bladder mean dose versus volumetric changes (R2 = 0.61). CONCLUSIONS Interfractional dosimetric variations resulting from anatomic deformation are commonly encountered with post-prostatectomy RT and can be mitigated with SMART.
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Affiliation(s)
- Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
- Correspondence:
| | - Yu Gao
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Stephanie M. Yoon
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Leslie K. Ballas
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90089, USA;
| | - Vincent Basehart
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Ankush Sachdeva
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Carol Felix
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Daniel A. Low
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (Y.G.); (S.M.Y.); (Y.Y.); (K.S.); (V.B.); (A.S.); (C.F.); (D.A.L.); (M.L.S.); (A.U.K.)
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Kaps B, Leapman M, An Y. Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer. Cancer Med 2020; 9:8754-8764. [PMID: 33128858 PMCID: PMC7724485 DOI: 10.1002/cam4.3482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
We aimed to determine patterns in frequency of radiotherapy for prostate cancer and definitive surgical management. There is prospective evidence indicating benefits of radiotherapy for some patients after radical prostatectomy (prostatectomy), with recent evidence suggesting benefit of early salvage radiotherapy. Trends in postoperative radiotherapy have not been elucidated. We analyzed the National Cancer Database for prostate cancer patients treated with curative‐intent therapy between 2004 and 2016. Patients were risk stratified according to NCCN treatment guidelines. Linear regression was utilized to examine trends in treatment with initial prostatectomy and trends in postoperative radiotherapy among treatment risk groups. Multivariable logistic regression was utilized to examine clinical‐demographic variables associated with prostatectomy and postoperative radiotherapy. From 2004 to 2016, 508,450 patients received prostatectomy and 370,314 received radiotherapy. Median age was 63.6 years. There was increased utilization of prostatectomy from 47.9% in 2004 to 61.3% in 2016 (ptrend <0.001). 24,466 cases received postoperative radiotherapy. Similarly, postoperative radiotherapy utilization increased from 2.2% in 2004 to 4.0% in 2016 (ptrend <0.001). The subgroup with the largest increase in postoperative radiotherapy was clinically high‐risk disease (5.3% in 2004 to 7.8% in 2016 (ptrend <0.001). Clinical high‐risk disease (OR 1.751), Gleason 9‐10 (OR 2.973), and PSA >20 ng/ml (OR 1.489) were factors predictive for postoperative radiotherapy. The proportion of prostate cancer patients who undergo definitive prostatectomy and postoperative radiotherapy is increasing. This increase is greatest in high‐risk cases. Overall, the proportion of patients who receive any radiotherapy is decreasing. Association with preclinical factors suggests optimization of patient selection should be considered.
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Affiliation(s)
- Bryan Kaps
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Yi An
- Yale Cancer Center, New Haven, CT, USA.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Kishan AU, Tendulkar RD, Tran PT, Parker CC, Nguyen PL, Stephenson AJ, Carrie C. Optimizing the Timing of Salvage Postprostatectomy Radiotherapy and the Use of Concurrent Hormonal Therapy for Prostate Cancer. Eur Urol Oncol 2018; 1:3-18. [PMID: 31100226 DOI: 10.1016/j.euo.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Currently, salvage radiotherapy (SRT) is the only known curative intervention for men with recurrent disease following prostatectomy. Critical issues in the optimal selection and management of men being considered for SRT include the threshold prostate-specific antigen (PSA) value at which to initiate treatment (ie, pre-SRT PSA) and the role of concurrent hormonal therapy (HT). OBJECTIVE To review the published evidence pertaining to the optimal timing for SRT and the role of concurrent HT. EVIDENCE ACQUISITION MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and guideline statements from professional organizations were queried from January 1, 2000 through January 10, 2018. EVIDENCE SYNTHESIS Thirty-three independent reports, including two randomized trials evaluating HT with SRT, were identified. Retrospective data suggest that SRT initiation at lower pre-SRT PSA levels is associated with better clinical outcomes. Prospective data suggest an overall survival benefit with concurrent HT that manifests during long-term follow-up, with the caveat that hypothesis-generating subgroup analyses suggest that this benefit may be limited to patients with higher pre-SRT PSA levels. Patients with adverse risk factors, such as Gleason grade group 4-5 disease, are likely to benefit the most from earlier SRT initiation and/or the use of HT. CONCLUSIONS Given the limitations of the available data, it is imperative that physicians participate in shared decision-making, with the recommendation tailored for each man's desire to maximize oncologic benefit (with a risk of overtreatment) versus potential quality-of-life optimization (with a risk of undertreatment). Within that framework, a significant body of retrospective data supports initiation of SRT at low pre-SRT PSA values, without an arbitrary absolute threshold. Prospective data suggest a benefit of HT, but this benefit may be greatest in patients with a pre-SRT PSA that is higher than the typical level in most patients receiving "early" SRT. Further research is necessary before absolute recommendations can be made. PATIENT SUMMARY Two ways to potentially improve outcomes following salvage radiotherapy for prostate cancer that recurs after prostatectomy are to start treatment at a lower prostate-specific antigen level and to use concurrent hormonal therapy. Our review suggests that the available evidence is imperfect, but highlights that both measures are likely to improve clinical outcomes in general, but perhaps not uniformly and/or consistently for all patients. Physician-patient shared decision-making and further research are critical.
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Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, USA.
| | | | - Phuoc T Tran
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher C Parker
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Chalieopanyarwong V, Attawettayanon W, Kanchanawanichkul W, Pripatnanont C. The Prognostic Factors of Biochemical Recurrence-Free Survival Following Radical Prostatectomy. Asian Pac J Cancer Prev 2017; 18:2555-2559. [PMID: 28952300 PMCID: PMC5720666 DOI: 10.22034/apjcp.2017.18.9.2555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate outcomes, biochemical recurrence-free survival (BCRFS) and to identify parameters
influencing BCRFS of radical prostatectomy (RP) and bilateral pelvic lymph node dissection in a single-institution.
Methods: A retrospective review of prostate cancer (PC) patients received RP was identified from the medical records.
Data was collected from 2007 to 2016. 178 patients received RP were enrolled in a study. These patients were evaluated
on efficacy of RP by using prostate-specific antigen (PSA) to analyze BCRFS and compared with Gleason score,
pathologic staging, margin status and lymph node status with BCRFS. Results: The median follow up was 32.5 months
(n = 178). Sixty-nine patients had extracapsular extension on pathologic results whereas 93 patients were classified as
a high risk group. The median time for biochemical recurrence (BCR) was 22.3 months. The 3-year BCRFS in patients
with a Gleason score 6, 3+4, 4+3, 8 and 9-10 were 85.8%, 84.6%, 78.7%, 53.3% and 35.8% . Multivariate analysis
showed that extracapsular extension was independently associated with BCRFS. Conclusions: New group grading
system indicates impact on BCRFS on univariate analysis but show negative impact on a multivariate Cox regression,
only pathologic staging was independently associated with the cancer control outcome.
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Affiliation(s)
- Virote Chalieopanyarwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University,
Songkhla, Thailand.
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