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Zapatero A, Castro P, Roch M, Carnero PR, Carroceda S, Rosciupchin AES, Hernández SH, Cogorno L, Iturriaga AG, García DB. Functional imaging guided stereotactic ablative body radiotherapy (SABR) with focal dose escalation and bladder trigone sparing for intermediate and high-risk prostate cancer: study protocol for phase II safo trial. Radiat Oncol 2024; 19:54. [PMID: 38702761 PMCID: PMC11069220 DOI: 10.1186/s13014-024-02440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is an emerging treatment alternative for patients with localized low and intermediate risk prostate cancer patients. As already explored by some authors in the context of conventional moderate hypofractionated radiotherapy, focal boost of the index lesion defined by magnetic resonance imaging (MRI) is associated with an improved biochemical outcome. The objective of this phase II trial is to determine the effectiveness (in terms of biochemical, morphological and functional control), the safety and impact on quality of life, of prostate SABR with MRI guided focal dose intensification in males with intermediate and high-risk localized prostate cancer. METHODS Patients with intermediate and high-risk prostate cancer according to NCCN definition will be treated with SABR 36.25 Gy in 5 fractions to the whole prostate gland with MRI guided simultaneous integrated focal boost (SIB) to the index lesion (IL) up to 50 Gy in 5 fractions, using a protocol of bladder trigone and urethra sparing. Intra-fractional motion will be monitored with daily cone beam computed tomography (CBCT) and intra-fractional tracking with intraprostatic gold fiducials. Androgen deprivation therapy (ADT) will be allowed. The primary endpoint will be efficacy in terms of biochemical and local control assessed by Phoenix criteria and post-treatment MRI respectively. The secondary endpoints will encompass acute and late toxicity, quality of life (QoL) and progression-free survival. Finally, the subgroup of high-risk patients will be involved in a prospective study focused on immuno-phenotyping. DISCUSSION To the best of our knowledge, this is the first trial to evaluate the impact of post-treatment MRI on local control among patients with intermediate and high-risk prostate cancer undergoing SABR and MRI guided focal intensification. The results of this trial will enhance our understanding of treatment focal intensification through the employment of the SABR technique within this specific patient subgroup, particularly among those with high-risk disease, and will help to clarify the significance of MRI in monitoring local responses. Hopefully will also help to design more personalized biomarker-based phase III trials in this specific context. Additionally, this trial is expected to be incorporated into a prospective radiomics study focused on localized prostate cancer treated with radiotherapy. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05919524; Registered 17 July 2023. TRIAL SPONSOR IRAD/SEOR (Instituto de Investigación de Oncología Radioterápica / Sociedad Española de Oncología Radioterápica). STUDY SETTING Clinicaltrials.gov identifier: NCT05919524; Registered 17 July 2023. TRIAL STATUS Protocol version number and date: v. 5/ 17 May-2023. Date of recruitment start: August 8, 2023. Date of recruitment completion: July 1, 2024.
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Affiliation(s)
- Almudena Zapatero
- Radiation Oncology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Diego de León 62, 28006, Madrid, Spain.
| | - Pablo Castro
- Medical Physics Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Madrid, Spain
| | - María Roch
- Medical Physics Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Madrid, Spain
| | - Pablo Rodríguez Carnero
- Radiology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Madrid, Spain
| | - Sara Carroceda
- Radiation Oncology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Diego de León 62, 28006, Madrid, Spain
| | - Alexandra Elena Stoica Rosciupchin
- Radiation Oncology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Diego de León 62, 28006, Madrid, Spain
| | - Sergio Honorato Hernández
- Medical Physics Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Madrid, Spain
| | - Leopoldo Cogorno
- Urology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Madrid, Spain
| | - Alfonso Gómez Iturriaga
- Department of Surgery and Radiology and Physical Medicine, Hospital Universitario Cruces, University of the Basque Country UPV/EHU, Biobizkaia Health Research Institute, Bizkaia, Spain
| | - David Büchser García
- Radiation Oncology Department, Hospital Universitario de la Princesa, Health Research Institute IIS- IP, Diego de León 62, 28006, Madrid, Spain
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Marvaso G, Corrao G, Repetti I, Lorubbio C, Bellerba F, Zaffaroni M, Vincini MG, Zerini D, Alessi S, Luzzago S, Mistretta FA, Fodor C, Cambria R, Cattani F, Ceci F, Musi G, De Cobelli O, Zilli T, Gandini S, Orecchia R, Petralia G, Jereczek-Fossa BA. Extreme-hypofractionated RT with concomitant boost to the DIL in PCa: a 5-year update on oncological and patient-reported outcomes for the phase II trial "GIVE ME FIVE". World J Urol 2024; 42:169. [PMID: 38492078 DOI: 10.1007/s00345-024-04876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/09/2024] [Indexed: 03/18/2024] Open
Abstract
AIM The present work reports updated oncological results and patients-reported outcomes at 5 years of phase II trial "Short-term high precision RT for early prostate cancer with SIB to the dominant intraprostatic lesion (DIL) for patients with early-stage PCa". METHODS Data from patients enrolled within AIRC IG-13218 (NCT01913717) trial were analyzed. Clinical and GU/GI toxicity assessment and PSA measurements were performed every 3 months for at least 2 years after RT end. QoL of enrolled patients was assessed by IPSS, EORTC QLQ-C30, EORTC QLQ-PR25, and IIEF-5. Patients' score changes were calculated at the end of RT and at 1, 12, and 60 months after RT. RESULTS A total of 65 patients were included. At a median follow-up of 5 years, OS resulted 86%. Biochemical and clinical progression-free survival at 5 years were 95%. The median PSA at baseline was 6.07 ng/ml, while at last follow-up resulted 0.25 ng/ml. IPSS showed a statistically significant variation in urinary function from baseline (p = 0.002), with the most relevant deterioration 1 month after RT, with a recovery toward baseline at 12 months (p ≤ 0.0001). A numerical improvement in QoL according to the EORTC QLQ-C30 has been reported although not statistically significant. No change in sexual activity was recorded after RT. CONCLUSIONS The study confirms that extreme hypofractionation with a DIL boost is safe and effective, with no severe effects on the QoL. The increasing dose to the DIL does not worsen the RT toxicity, thus opening the possibility of an even more escalated treatment.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ilaria Repetti
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Raffaella Cambria
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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3
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Zhao Y, Haworth A, Rowshanfarzad P, Ebert MA. Focal Boost in Prostate Cancer Radiotherapy: A Review of Planning Studies and Clinical Trials. Cancers (Basel) 2023; 15:4888. [PMID: 37835581 PMCID: PMC10572027 DOI: 10.3390/cancers15194888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Focal boost radiotherapy was developed to deliver elevated doses to functional sub-volumes within a target. Such a technique was hypothesized to improve treatment outcomes without increasing toxicity in prostate cancer treatment. PURPOSE To summarize and evaluate the efficacy and variability of focal boost radiotherapy by reviewing focal boost planning studies and clinical trials that have been published in the last ten years. METHODS Published reports of focal boost radiotherapy, that specifically incorporate dose escalation to intra-prostatic lesions (IPLs), were reviewed and summarized. Correlations between acute/late ≥G2 genitourinary (GU) or gastrointestinal (GI) toxicity and clinical factors were determined by a meta-analysis. RESULTS By reviewing and summarizing 34 planning studies and 35 trials, a significant dose escalation to the GTV and thus higher tumor control of focal boost radiotherapy were reported consistently by all reviewed studies. Reviewed trials reported a not significant difference in toxicity between focal boost and conventional radiotherapy. Acute ≥G2 GU and late ≥G2 GI toxicities were reported the most and least prevalent, respectively, and a negative correlation was found between the rate of toxicity and proportion of low-risk or intermediate-risk patients in the cohort. CONCLUSION Focal boost prostate cancer radiotherapy has the potential to be a new standard of care.
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Affiliation(s)
- Yutong Zhao
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA 6000, Australia
| | - Martin A. Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- 5D Clinics, Claremont, WA 6010, Australia
- School of Medicine and Population Health, University of Wisconsin, Madison WI 53706, USA
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Spohn SKB, Adebahr S, Huber M, Jenkner C, Wiehle R, Nagavci B, Schmucker C, Carl EG, Chen RC, Weber WA, Mix M, Rühle A, Sprave T, Nicolay NH, Gratzke C, Benndorf M, Wiegel T, Weis J, Baltas D, Grosu AL, Zamboglou C. Feasibility, pitfalls and results of a structured concept-development phase for a randomized controlled phase III trial on radiotherapy in primary prostate cancer patients. BMC Cancer 2022; 22:337. [PMID: 35351058 PMCID: PMC8960686 DOI: 10.1186/s12885-022-09434-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Failure rate in randomized controlled trials (RCTs) is > 50%, includes safety-problems, underpowered statistics, lack of efficacy, lack of funding or insufficient patient recruitment and is even more pronounced in oncology trials. We present results of a structured concept-development phase (CDP) for a phase III RCT on personalized radiotherapy (RT) in primary prostate cancer (PCa) patients implementing prostate specific membrane antigen targeting positron emission tomography (PSMA-PET). Materials and methods The 1 yr process of the CDP contained five main working packages: (i) literature search and scoping review, (ii) involvement of individual patients, patients’ representatives and patients’ self-help groups addressing the patients’ willingness to participate in the preparation process and the conduct of RCTs as well as the patient informed consent (PIC), (iii) involvement of national and international experts and expert panels (iv) a phase II pilot study investigating the safety of implementation of PSMA-PET for focal dose escalation RT and (v) in-silico RT planning studies assessing feasibility of envisaged dose regimens and effects of urethral sparing in focal dose escalation. Results (i) Systematic literature searches confirmed the high clinical relevance for more evidence on advanced RT approaches, in particular stereotactic body RT, in high-risk PCa patients. (ii) Involvement of patients, patient representatives and randomly selected males relevantly changed the PIC and initiated a patient empowerment project for training of bladder preparation. (iii) Discussion with national and international experts led to adaptions of inclusion and exclusion criteria. (iv) Fifty patients were treated in the pilot trial and in- and exclusion criteria as well as enrollment calculations were adapted accordingly. Parallel conduction of the pilot trial revealed pitfalls on practicability and broadened the horizon for translational projects. (v) In-silico planning studies confirmed feasibility of envisaged dose prescription. Despite large prostate- and boost-volumes of up to 66% of the prostate, adherence to stringent anorectal dose constraints was feasible. Urethral sparing increased the therapeutic ratio. Conclusion The dynamic framework of interdisciplinary working programs in CDPs enhances robustness of RCT protocols and may be associated with decreased failure rates. Structured recommendations are warranted to further define the process of such CDPs in radiation oncology trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09434-2.
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5
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Augugliaro M, Marvaso G, Cambria R, Pepa M, Bagnardi V, Frassoni S, Pansini F, Patricia Rojas D, Colombo F, Iuliana Fodor C, Musi G, Petralia G, De Cobelli O, Cattani F, Orecchia R, Zerini D, Jereczek-Fossa BA. Finding safe dose-volume constraints for re-irradiation with SBRT of patients with prostate cancer relapse: The IEO experience. Phys Med 2021; 92:62-68. [PMID: 34871888 DOI: 10.1016/j.ejmp.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
AIM The primary aim of this study is to provide preliminary indications for safe constraints of rectum and bladder in patients re-irradiated with stereotactic body RT (SBRT). METHODS Data from patients treated for prostate cancer (PCa) and intraprostatic relapse, from 1998 to 2016, were retrospectively collected. First RT course was delivered with 3D conformal RT techniques, SBRT or volumetric modulated arc therapy (VMAT). All patients underwent re-irradiation with SBRT with heavy hypofractionated schedules. Cumulative dose-volume values to organs at risk (OARs) were computed and possible correlation with developed toxicities was investigated. RESULTS Twenty-six patients were included. Median age at re-irradiation was 75 years, mean interval between the two RT courses was 5.6 years and the median follow-up was 47.7 months (13.4-114.3 months). After re-irradiation, acute and late G ≥ 2 GU toxicity events were reported in 3 (12%) and 10 (38%) patients, respectively, while late G ≥ 2 GI events were reported in 4 (15%) patients. No acute G ≥ 2 GI side effects were registered. Patients receiving an equivalent uniform dose of the two RT treatments < 131 Gy appeared to be at higher risk of progression (4-yr b-PFS: 19% vs 33%, p = 0.145). Cumulative re-irradiation constraints that appear to be safe are D30% < 57.9 Gy for bladder and D30% < 66.0 Gy, D60% < 38.0 Gy and V122.1 Gy < 5% for rectum. CONCLUSION Preliminary re-irradiation constraints for bladder and rectum have been reported. Our preliminary investigation may serve to clear some grey areas of PCa re-irradiation.
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Affiliation(s)
- Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Francesca Colombo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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6
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Cambria R, Ciardo D, Bazani A, Pansini F, Rondi E, Maestri D, Zerini D, Marvaso G, Romanelli P, Timon G, Fodor C, Petralia G, Alessi S, Pricolo P, Vischioni B, Fossati P, Molinelli S, Russo S, Ciocca M, De Cobelli O, Renne G, Orecchia R, Cattani F, Jereczek-Fossa BA. Ultrahypofractionated radiotherapy for localized prostate cancer with simultaneous boost to the dominant intraprostatic lesion: a plan comparison. TUMORI JOURNAL 2021; 108:263-269. [PMID: 33896239 DOI: 10.1177/03008916211011667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare different stereotactic body techniques-intensity-modulated radiotherapy with photons and protons, applied to radiotherapy of prostatic cancer-with simultaneous integrated boost (SIB) on the dominant intraprostatic lesion (DIL). METHODS Ten patients were selected for this planning study. Dosimetric results were compared between volumetric modulated arc therapy, intensity-modulated radiation therapy (IMRT), and intensity-modulated proton therapy both with two (IMPT 2F) and five fields (IMPT 5F) planning while applying the prescription schemes of 7.25 Gy/fraction to the prostate gland and 7.5 Gy/fraction to the DIL in 5 fractions. RESULTS Comparison of the coverages of the planning target volumes showed that small differences exist. The IMPT-2F-5F techniques allowed higher doses in the targets; conformal indexes resulted similar; homogeneity was better in the photon techniques (2%-5%). Regarding the organs at risk, all the techniques were able to maintain the dose well below the prescribed constraints: in the rectum, the IMPT-2F-5F and IMRT were more efficient in lowering the intermediate doses; in the bladder, the median dose was significantly better in the case of IMPT (2F-5F). In the urethra, the best sparing was achieved only by IMPT-5F. CONCLUSIONS Stereotactic radiotherapy with SIB for localized prostate cancer is feasible with all the investigated techniques. Concerning IMPT, the two-beam technique does not seem to have a greater advantage compared to the standard techniques; the 5-beam technique seems more promising also accounting for the range uncertainty.
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Affiliation(s)
- Raffaella Cambria
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Alessia Bazani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Floriana Pansini
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Elena Rondi
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Davide Maestri
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Pola Romanelli
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo di Oncologia IRCCS, via Ripamonti 435, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Sarah Alessi
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Paola Pricolo
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | | | - Piero Fossati
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | | | - Stefania Russo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Giuseppe Renne
- Uropathology and Intraoperative Diagnostic Division, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
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7
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Delgadillo R, Ford JC, Abramowitz MC, Dal Pra A, Pollack A, Stoyanova R. The role of radiomics in prostate cancer radiotherapy. Strahlenther Onkol 2020; 196:900-912. [PMID: 32821953 PMCID: PMC7545508 DOI: 10.1007/s00066-020-01679-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
"Radiomics," as it refers to the extraction and analysis of a large number of advanced quantitative radiological features from medical images using high-throughput methods, is perfectly suited as an engine for effectively sifting through the multiple series of prostate images from before, during, and after radiotherapy (RT). Multiparametric (mp)MRI, planning CT, and cone beam CT (CBCT) routinely acquired throughout RT and the radiomics pipeline are developed for extraction of thousands of variables. Radiomics data are in a format that is appropriate for building descriptive and predictive models relating image features to diagnostic, prognostic, or predictive information. Prediction of Gleason score, the histopathologic cancer grade, has been the mainstay of the radiomic efforts in prostate cancer. While Gleason score (GS) is still the best predictor of treatment outcome, there are other novel applications of quantitative imaging that are tailored to RT. In this review, we summarize the radiomics efforts and discuss several promising concepts such as delta-radiomics and radiogenomics for utilizing image features for assessment of the aggressiveness of prostate cancer and its outcome. We also discuss opportunities for quantitative imaging with the advance of instrumentation in MRI-guided therapies.
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Affiliation(s)
- Rodrigo Delgadillo
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - John C Ford
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, 1121 NW 14th St, 33136, Miami, FL, USA.
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Gugliandolo SG, Pepa M, Isaksson LJ, Marvaso G, Raimondi S, Botta F, Gandini S, Ciardo D, Volpe S, Riva G, Rojas DP, Zerini D, Pricolo P, Alessi S, Petralia G, Summers PE, Mistretta FA, Luzzago S, Cattani F, De Cobelli O, Cassano E, Cremonesi M, Bellomi M, Orecchia R, Jereczek-Fossa BA. MRI-based radiomics signature for localized prostate cancer: a new clinical tool for cancer aggressiveness prediction? Sub-study of prospective phase II trial on ultra-hypofractionated radiotherapy (AIRC IG-13218). Eur Radiol 2020; 31:716-728. [PMID: 32852590 DOI: 10.1007/s00330-020-07105-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/18/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Radiomic involves testing the associations of a large number of quantitative imaging features with clinical characteristics. Our aim was to extract a radiomic signature from axial T2-weighted (T2-W) magnetic resonance imaging (MRI) of the whole prostate able to predict oncological and radiological scores in prostate cancer (PCa). METHODS This study included 65 patients with localized PCa treated with radiotherapy (RT) between 2014 and 2018. For each patient, the T2-W MRI images were normalized with the histogram intensity scale standardization method. Features were extracted with the IBEX software. The association of each radiomic feature with risk class, T-stage, Gleason score (GS), extracapsular extension (ECE) score, and Prostate Imaging Reporting and Data System (PI-RADS v2) score was assessed by univariate and multivariate analysis. RESULTS Forty-nine out of 65 patients were eligible. Among the 1702 features extracted, 3 to 6 features with the highest predictive power were selected for each outcome. This analysis showed that texture features were the most predictive for GS, PI-RADS v2 score, and risk class; intensity features were highly associated with T-stage, ECE score, and risk class, with areas under the receiver operating characteristic curve (ROC AUC) ranging from 0.74 to 0.94. CONCLUSIONS MRI-based radiomics is a promising tool for prediction of PCa characteristics. Although a significant association was found between the selected features and all the mentioned clinical/radiological scores, further validations on larger cohorts are needed before these findings can be applied in the clinical practice. KEY POINTS • A radiomic model was used to classify PCa aggressiveness. • Radiomic analysis was performed on T2-W magnetic resonance images of the whole prostate gland. • The most predictive features belong to the texture (57%) and intensity (43%) domains.
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Affiliation(s)
| | - Matteo Pepa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Lars Johannes Isaksson
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- European School of Molecular Medicine, IFOM-IEO Campus, Via Adamello, 16, 20139, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Francesca Botta
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Delia Ciardo
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Stefania Volpe
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giulia Riva
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Damari Patricia Rojas
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Paul Eugene Summers
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Frnacesco Alessandro Mistretta
- Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Stefano Luzzago
- Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bellomi
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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Phase II prospective trial "Give Me Five" short-term high precision radiotherapy for early prostate cancer with simultaneous boost to the dominant intraprostatic lesion: the impact of toxicity on quality of life (AIRC IG-13218). Med Oncol 2020; 37:74. [PMID: 32725443 DOI: 10.1007/s12032-020-01397-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
As part of the AIRC IG-13218 (NCT01913717), we analyzed data from patients with low- and intermediate-risk prostate cancer treated with extreme hypofractionated radiotherapy (RT) and simultaneous boost to the intraprostatic lesion. The aim of the study is to identify clinically meaningful information through the analysis of validated questionnaires testing gastrointestinal (GI) and genitourinary (GU) RT-related toxicity and their impact on quality of life (QoL). At the end of RT treatment, clinical assessment and prostate-specific antigen (PSA) measurements were performed every 3 months for at least 2 years and GI and GU toxicities were evaluated contextually. QoL of enrolled patients was assessed by International Prostate Symptoms score (IPSS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), EORTC QLQ prostate specific (QLQ-PR25), and sexual activity by International Index of Erectile Function (IIEF-5). Patients' score changes were calculated at the end of RT, at one month after RT and at 12 and 24 months. Sixty-five prospectively enrolled patients were analyzed. Extensive analysis of different QoL assessments showed that patients' tolerance was satisfactory across all the considered time points, with no statistically significant change of QoL from baseline compared to that before RT. Overall survival and biochemical progression-free survival at 2-years were of 98% and 97%, respectively. Despite the toxicity of extreme hypofractionation was low and tumor control was encouraging, a longer follow-up is necessary to confirm our findings. The increasing dose to the dominant intraprostatic lesion does not worsen the RT toxicity and consequently does not affect patients' QoL, thus questioning the possibility of an even more escalated treatment.
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Ballhausen H, Li M, Reiner M, Belka C. Dosimetric impact of intrafraction motion on boosts on intraprostatic lesions: a simulation based on actual motion data from real time ultrasound tracking. Radiat Oncol 2019; 14:81. [PMID: 31096991 PMCID: PMC6524311 DOI: 10.1186/s13014-019-1285-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/25/2019] [Indexed: 01/24/2023] Open
Abstract
Background Intrafraction motion is particularly problematic in case of small target volumes and narrow margins. Here we simulate the dose coverage of intraprostatic lesions (IPL) by simultaneous integrated boosts (SIB). For this purpose, we use a large sample of actual intrafraction motion data. Methods Fifty-three h of intra-fraction motion of the prostate were recorded in real-time by 4D ultrasound (4DUS) during 720 fractions in 28 patients. We simulate spherical IPLs with 3, 5, and 7 mm radius and matching spherical SIBs with 0, 2, and 5 mm safety margins. The volumetric overlap between IPLs and SIBs is calculated. Dose volume histograms (DVH) are estimated by Monte Carlo simulation. Results On average, the distance of the prostate was 1.3 mm from its initial position over all fractions and patients. Average volumetric overlap was 73, 82, and 87% of IPL volume in case of 3, 5, and 7 mm IPLs and SIBs without safety margins. These improved to 95% or more in case of 2 mm safety margins and 98% or more in case of 5 mm safety margins. DVHs showed that 80% of the IPL volume received 60, 72, and 79% of maximum dose in case of 3, 5, and 7 mm IPLs and SIBs without safety margins. These improved to 94% or more given moderately sized safety margins of 2 mm. Conclusions On average over all fractions and patients, the dose coverage would have been acceptable even for small target volumes such as IPLs of radius 3 to 7 mm and narrow fields. Moderate safety margins of 2 mm could have ensured a delivery of 90% or more of the SIB dose to the IPL. In this case, SIB volume would have been considerably larger than IPL volume, but still considerably smaller than the overall PTV of the prostate. Electronic supplementary material The online version of this article (10.1186/s13014-019-1285-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik Ballhausen
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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