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Impact of prostate position-based image-guidance in intensity-modulated radiation therapy for localized prostate cancer

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Abstract

Background/purpose

The long-term clinical impact of prostate position-based image-guided radiotherapy (IGRT) for localized prostate cancer remains unclear.

Materials and methods

We retrospectively compared clinical outcomes following intensity-modulated radiation therapy (IMRT) with cone-beam computed tomography-based prostate position-based IGRT (P-IGRT) or without P-IGRT (non-P-IGRT). From June 2011, we applied P-IGRT in IMRT for intermediate-risk (IR) prostate cancer (PCa) (D’Amico risk classification) (76 Gy in 38 fractions, with smaller margins). Clinical outcomes of patients who received P-IGRT between June 2011 and June 2019 were retrospectively compared with those of patients with IR PCa who received IMRT without P-IGRT between October 2002 and May 2011 in our institution (74 Gy in 37 fractions).

Results

A total of 222 consecutive patients were analyzed: 114 in the P-IGRT cohort and 108 in the non-P-IGRT cohort. The median follow-up period after IMRT was 7.1 years for the P-IGRT cohort and 10.8 years for the non-P-IGRT cohort. The biochemical failure-free rate was significantly better in the P-IGRT cohort (94.9% for the P-IGRT cohort vs 82.7% for the non-P-IGRT cohort at 10 years, p = 0.041). The rate of rectal bleeding which needs intervention including the use of suppositories was significantly lower in the P-IGRT cohort (p < 0.001).

Conclusions

The use of P-IGRT with higher doses and smaller margins was correlated with significantly better biochemical control, and a lower incidence of rectal bleeding in IMRT for intermediate-risk prostate cancer. The enhanced accuracy using P-IGRT has the potential to independently improve disease control and reduce late rectal bleeding.

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Abbreviations

IMRT:

Intensity-modulated radiation therapy

PCa:

Prostate cancer

IGRT:

Image-guided radiotherapy

EBRT:

External-beam radiotherapy

P-IGRT:

Prostate position-based image-guided radiotherapy

CBCT:

Cone-beam computed tomography

IR:

Intermediate-risk

ADT:

Androgen-deprivation therapy

CRPC:

Castration-resistant prostate cancer

CTV:

Clinical target volume

PTV:

Planning target volume

VMAT:

Volumetric-modulated arc therapy

DWA:

Dynamic WaveArc

PSA:

Prostate-specific antigen

BF:

Biochemical failure

GI:

Gastrointestinal

GU:

Genitourinary

UVA:

Univariate analysis

IQR:

Interquartile range

HR:

Hazard ratio

CI:

Confidence interval

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Acknowledgements

This work was partly supported by JSPS KAKENHI Grant No.22H03022. We would like to thank EIGOCLINIC (https://eigoclinic.com/) for English language editing.

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Authors and Affiliations

  1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Rihito Aizawa, Haruo Inokuchi, Itaru Ikeda, Kiyonao Nakamura, Takashi Ogata & Takashi Mizowaki

  2. Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Shusuke Akamatsu, Takayuki Goto, Kimihiko Masui, Takayuki Sumiyoshi, Yuki Kita & Takashi Kobayashi

Authors
  1. Rihito Aizawa
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  2. Haruo Inokuchi
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  3. Itaru Ikeda
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  4. Kiyonao Nakamura
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  5. Takashi Ogata
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  9. Takayuki Sumiyoshi
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  11. Takashi Kobayashi
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  12. Takashi Mizowaki
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Corresponding author

Correspondence to Takashi Mizowaki.

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Conflict of interest

RA, HI, II, KN, TO, SA, TG, KM, TS, and YK report no conflicts of interest related to the subject matter of this study. TK reported receiving honoraria for lectures from Astellas Pharma, Janssen Pharma, and Bayel Pharma. TM reported receiving funds for research or education and honoraria for lectures from Varian, Hitachi, and BrainLab; and consulting fees from Varian.

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Aizawa, R., Inokuchi, H., Ikeda, I. et al. Impact of prostate position-based image-guidance in intensity-modulated radiation therapy for localized prostate cancer. Int J Clin Oncol 29, 325–332 (2024). https://doi.org/10.1007/s10147-023-02456-1

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  • DOI: https://doi.org/10.1007/s10147-023-02456-1

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