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[11C]-Choline PET/CT-guided simultaneous integrated boost to dominant intraprostatic lesions using intensity-modulated radiation therapy with helical tomotherapy technique for dose escalation

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective of the study is to demonstrate the feasibility of using [11C]-choline positron-emission tomography (PET)/CT to deliver helical tomotherapy (HT) to the prostate with a simultaneous integrated boost to dominant intraprostatic lesions as a biological target volume for dose escalation.

Methods

Eleven patients with intermediate-risk prostate cancer were included in this virtual planning study. Pretreatment baseline [11C]-choline PET/CT scans were acquired with a PET/CT scanner dynamically in 2-min frames from injection to 40 min post injection. PET data was reconstructed using the RAMLA 3D algorithm and analyzed to identify dominant intraprostatic lesion(s). Dominant lesions were defined as biological target volume(s) (BTV) including all voxels with a standardized uptake value of 75 % or above relative to the maximum standard uptake value (SUV) within the prostate gland. Three target volumes for optimization included the following: PTV78 (BTV + 5 mm margin), PTV68 (prostate + 5 mm posteriorly and 10 mm in all other dimensions), and PTV50 (prostate gland and proximal seminal vesicles + 7 mm margin posteriorly and 10 mm in all other dimensions). Dose constraints on organs at risk were implemented based on a published data using hypofractionated IMRT with long-term follow-up. Helical tomotherapy plans were generated to deliver hypofractionated radiation therapy to these volumes using simultaneous integrated boost in 25 fractions.

Results

Eight patients had one identifiable contiguous BTV, and the other three patients had two noncontiguous BTVs. The mean BTV ratio to prostate volume ratio was 6.03 % (minimum 0.80 %, maximum 13.44 %). Target volume and normal tissue constraints were met in seven of the 11 patients enrolled in the study. Targets and structures in the four patients that did not meet constraints were the bladder (3 patients), peritoneal cavity (2 patients), rectum (1 patient), PTV68 (1 patient), and PTV50 (1 patient).

Conclusion

It is feasible in selected patients to use [11C]-choline PET/CT to deliver hypofractionated dose-escalated helical tomotherapy to dominant intraprostatic lesions with simultaneous integrated boost using clinically established normal tissue constraints.

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Acknowledgments

We thank Lai Schrader for her expertise and invaluable assistance in the accrual and data management of this study, Merlita Lamadrid for the data management, and Heidi Borchers for the administrative assistance in preparing this manuscript.

Conflict of interest

The authors John Amanie, M.D.; Jans Hans-Sonke, Ph.D.; Melinda Wuest, PhD; Colin Field; Nadeem Pervez, M.D.; Albert Murtha, M.D.; Nawaid Usmani, M.D.; Don Yee, M.D.; Brita Danielson, M.D.; Samir Patel, M.D.; Rob Macewan, M.D.; Don Robinson, Ph.D.; John Wilson, Ph.D.; Dyann Lewis, R.T.T.; Matthew Parliament, M.D.; and Alexander J.B. McEwan, M.D. do not have a conflict of interest with respect to this article in accordance with the standards set by the International Committee of Medical Journal Editors (ICMJE).

Ethical statement

All persons gave their informed consent prior to their inclusion in the study.

This study was approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Division of Radiation Oncology, Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada

    John Amanie, Nadeem Pervez, Albert Murtha, Nawaid Usmani, Don Yee, Brita Danielson, Samir Patel, Dyann Lewis & Matthew Parliament

  2. Division of Oncologic Imaging, Cross Cancer Institute, Edmonton, AB, Canada

    Melinda Wuest, Rob Macewan & Alexander J. B. McEwan

  3. Division of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada

    Jans Hans-Sonke, Colin Field & Don Robinson

  4. Division of Experimental Oncology, Cross Cancer Institute, Edmonton, AB, Canada

    John Wilson

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  1. John Amanie
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Correspondence to John Amanie.

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Amanie, J., Hans-Sonke, J., Wuest, M. et al. [11C]-Choline PET/CT-guided simultaneous integrated boost to dominant intraprostatic lesions using intensity-modulated radiation therapy with helical tomotherapy technique for dose escalation. J Radiat Oncol 4, 87–93 (2015). https://doi.org/10.1007/s13566-014-0176-1

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