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Stereotactic ablative radiotherapy with targeted MRI-defined gross tumor dose escalation for prostate cancer: dosimetric feasibility and interfraction robustness

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

The purpose of this study was to determine the dosimetric feasibility and reproducibility of stereotactic body radiotherapy (SBRT) with selective dose escalation for gross tumor volume (GTV) in prostate cancer.

Methods

Radiotherapy plans of previously treated patients with dose-escalated radiotherapy multiparametric MRI (mpMRI)-defined prostate and GTV were retrieved. Margins were re-created for prostate planning target volume (PTV) (PTV36.25) and GTV-PTV (PTV45), and two five-fraction SBRT VMAT plans were generated: (1) standard plan ([Sp], 36.25Gy/5Fx; V36.25 Gy-PTV36.25 ≥95% and V40 Gy-prostate ≥95%) and (2) dose-escalated plan [DEp] with additional goal V45 Gy-PTV45 ≥95%, while the same organs-at-risk (OAR) constraints. Delivered doses to targets and OAR were calculated from alternate days deformably registered cone beam computed tomography.

Results

In 23 patients (single GTV), all planned and delivered doses to targets and OAR in both Sp and DEp were within the ideal/acceptable criteria. No difference (p > 0.05) was observed in the proportion of Sp and DEp patients achieving ideal criteria either in planned or delivered doses except for prostatic urethra constraint. Differences between planned and delivered doses in DEp were not clinically relevant (i.e., mean differences lesser than 1 Gy).

Conclusion

Selective high-precision (i.e., mpMRI-defined targets, daily volumetric image guidance, intraprostatic fiducials) SBRT with GTV dose escalation seems feasible, without incremental dose to OAR. Prospective studies to determine its clinical benefit are warranted.

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Authors and Affiliations

  1. Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University Health Network, University of Toronto, 700 University Ave, Office 7-317, Toronto, ON, M5G 1Z5, Canada

    Ali Hosni, Vickie Kong, Tara Rosewall, Andrew Bayley, Peter Chung & Alejandro Berlin

  2. Département de radio-oncologie, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

    Cynthia Ménard

Authors
  1. Ali Hosni
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  2. Vickie Kong
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  3. Tara Rosewall
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  4. Andrew Bayley
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  5. Cynthia Ménard
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  6. Peter Chung
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  7. Alejandro Berlin
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Corresponding author

Correspondence to Alejandro Berlin.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hosni, A., Kong, V., Rosewall, T. et al. Stereotactic ablative radiotherapy with targeted MRI-defined gross tumor dose escalation for prostate cancer: dosimetric feasibility and interfraction robustness. J Radiat Oncol 6, 397–404 (2017). https://doi.org/10.1007/s13566-017-0321-8

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  • DOI: https://doi.org/10.1007/s13566-017-0321-8

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