Skip to main content
SpringerLink
Log in

Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this planning study was to develop an acceptable technique for highly hypofractionated intensity-modulated radiation therapy using simultaneous integrated boost technique (SIB-hHF-RT) for nonmetastatic National Comprehensive Cancer Network high-risk prostate cancer.

Materials and methods

We created SIB-hHF-RT plans for 14 nonmetastatic prostate cancer patients with MRI-detectable intraprostatic lesions (IPLs) and without intestines locating close to the seminal vesicle and prostate. We prescribed 57 Gy for IPLs and 54 Gy for the remainder of planning target volume (PTV) in 15 fractions. The IPLs were contoured based on magnetic resonance imaging, and PTV was generated by adding 6–8-mm margins to the clinical target volume. For the dose-volume constraints of organs at risk (OARs), the same constraints as 54 Gy plans were used so as not to increase the toxicity.

Results

All created plans fulfilled the dose-volume constraints of all targets and OARs. The median estimated beam-on time was 108.5 s. For patient-specific quality assurance, the global gamma passing rates (3%/2 mm) with 10% dose threshold criteria were greater than 93% in all cases and greater than 95% in 11 cases.

Conclusion

SIB-hHF-RT plans were developed that fulfill the acceptable dose-volume constraints and pass patient-specific quality assurance. We believe these plans can be applied to selected patients with nonmetastatic prostate cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Center for Cancer Control and Information Services (2018) National Cancer Center. Projected cancer statistics. http://ganjoho.jp/en/public/statistics/short_pred.html. Accessed Mar 2021

  2. Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, et al. Prostate cancer radiation dose response: results of the M.D. anderson phase III randomized trial. Int J Radiat Oncol Biol Phys. 2002;53:1097–105.

    Article  Google Scholar 

  3. Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF, et al. Dose-response in radiotherapy for localized prostate cancer: results of the dutch multicenter randomized phase iii trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24:1990–6.

    Article  Google Scholar 

  4. Dearnaley DP, Jovic G, Syndikus I, Khoo V, Cowan RA, Graham JD, et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the Mrc Rt01 randomised controlled trial. Lancet Oncol. 2014;15:464–73.

    Article  Google Scholar 

  5. Aizawa R, Takayama K, Nakamura K, Inoue T, Yamasaki T, Kobayashi T, et al. Ten-year outcomes of high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer with unfavorable risk: early initiation of salvage therapy may replace long-term adjuvant androgen deprivation. Int J Clin Oncol. 2019;24:1247–55.

    Article  CAS  Google Scholar 

  6. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43:1095–101.

    Article  CAS  Google Scholar 

  7. Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, et al. Hypofractionated radiation therapy for localized prostate cancer: an astro, asco, and aua evidence-based guideline. J Clin Oncol. 2018. https://doi.org/10.1016/j.juro.2018.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nakamura K, Ikeda I, Inokuchi H, Takayama K, Inoue T, Kamba T, et al. A pilot study of highly hypofractionated intensity-modulated radiation therapy over 3 weeks for localized prostate cancer. J Radiat Res. 2018;59:656–63.

    Article  CAS  Google Scholar 

  9. Zaorsky NG, Palmer JD, Hurwitz MD, Keith SW, Dicker AP, Den RB. What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiother Oncol. 2015;115:295–300.

    Article  Google Scholar 

  10. von Eyben FE, Kiljunen T, Kangasmaki A, Kairemo K, von Eyben R, Joensuu T. Radiotherapy boost for the dominant intraprostatic cancer lesion-a systematic review and meta-analysis. Clin Genitourin Cancer. 2016;14:189–97.

    Article  Google Scholar 

  11. Aluwini S, Pos F, Schimmel E, van Lin E, Krol S, van der Toorn PP, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (Hypro): acute toxicity results from a randomised non-inferiority phase 3 trial. Lancet Oncol. 2015;16:274–83.

    Article  Google Scholar 

  12. Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn PP, de Jager H, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (Hypro): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol. 2016;17:464–74.

    Article  Google Scholar 

  13. Arrayeh E, Westphalen AC, Kurhanewicz J, Roach M 3rd, Jung AJ, Carroll PR, et al. Does local recurrence of prostate cancer after radiation therapy occur at the site of primary tumor? Results of a longitudinal Mri and Mrsi study. Int J Radiat Oncol Biol Phys. 2012;82:e787–93.

    Article  Google Scholar 

  14. Ling CC, Humm J, Larson S, Amols H, Fuks Z, Leibel S, et al. Towards multidimensional radiotherapy (Md-Crt): biological imaging and biological conformality. Int J Radiat Oncol Biol Phys. 2000;47:551–60.

    Article  CAS  Google Scholar 

  15. Feutren T, Herrera FG. Prostate irradiation with focal dose escalation to the intraprostatic dominant nodule: a systematic review. Prostate Int. 2018;6:75–87.

    Article  Google Scholar 

  16. Rossi L, Breedveld S, Heijmen BJ, Voet PW, Lanconelli N, Aluwini S. On the beam direction search space in computerized non-coplanar beam angle optimization for Imrt-Prostate Sbrt. Phys Med Biol. 2012;57:5441–58.

    Article  Google Scholar 

  17. Price RA, Hanks GE, McNeeley SW, Horwitz EM, Pinover WH. Advantages of using noncoplanar vs. axial beam arrangements when treating prostate cancer with intensity-modulated radiation therapy and the step-and-shoot delivery method. Int J Radiat Oncol Biol Phys. 2002;53:236–43.

    Article  Google Scholar 

  18. Norihisa Y, Mizowaki T, Takayama K, Miyabe Y, Matsugi K, Matsuo Y, et al. Detailed dosimetric evaluation of intensity-modulated radiation therapy plans created for stage C prostate cancer based on a planning protocol. Int J Clin Oncol. 2012;17:505–11.

    Article  Google Scholar 

  19. Mizowaki T, Cohen GN, Fung AY, Zaider M. Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the Mr spectroscopy imaging to ultrasound/Ct images and its implementation in treatment planning. Int J Radiat Oncol Biol Phys. 2002;54:1558–64.

    Article  Google Scholar 

  20. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969–74.

    Article  CAS  Google Scholar 

  21. Tong X, Chen X, Li J, Xu Q, Lin MH, Chen L, et al. Intrafractional prostate motion during external beam radiotherapy monitored by a real-time target localization system. J Appl Clin Med Phys. 2015;16:5013.

    Article  Google Scholar 

  22. Mizowaki T, Takayama K, Nagano K, Miyabe Y, Matsuo Y, Kaneko S, et al. Feasibility evaluation of a new irradiation technique: three-dimensional unicursal irradiation with the Vero4drt (Mhi-Tm2000). J Radiat Res. 2013;54:330–6.

    Article  Google Scholar 

  23. Hirashima H, Nakamura M, Miyabe Y, Mukumoto N, Uto M, Nakamura K, et al. Geometric and dosimetric quality assurance using logfiles and a 3d helical diode detector for dynamic wavearc. Phys Med. 2017;43:107–13.

    Article  Google Scholar 

  24. Ikeda I, Mizowaki T, Sawada Y, Nakata M, Norihisa Y, Ogura M, et al. Assessment of interfractional prostate motion in patients immobilized in the prone position using a thermoplastic shell. J Radiat Res. 2014;55:168–74.

    Article  Google Scholar 

  25. Langen KM, Willoughby TR, Meeks SL, Santhanam A, Cunningham A, Levine L, et al. Observations on real-time prostate gland motion using electromagnetic tracking. Int J Radiat Oncol Biol Phys. 2008;71:1084–90.

    Article  Google Scholar 

  26. Abe E, Mizowaki T, Norihisa Y, Narita Y, Matsuo Y, Narabayashi M, et al. Impact of multileaf collimator width on intraprostatic dose painting plans for dominant intraprostatic lesion of prostate cancer. J Appl Clin Med Phys. 2010;11:3193.

    Article  Google Scholar 

  27. Miften M, Olch A, Mihailidis D, Moran J, Pawlicki T, Molineu A, et al. Tolerance limits and methodologies for imrt measurement-based verification Qa: recommendations of Aapm task group no. 218. Med Phys. 2018;45:e53–83.

    Article  Google Scholar 

  28. Muldermans JL, Romak LB, Kwon ED, Park SS, Olivier KR. Stereotactic body radiation therapy for oligometastatic prostate cancer. Int J Radiat Oncol Biol Phys. 2016;95:696–702.

    Article  Google Scholar 

  29. Kuang Y, Wu L, Hirata E, Miyazaki K, Sato M, Kwee SA. Volumetric modulated arc therapy planning for primary prostate cancer with selective intraprostatic boost determined by 18f-choline pet/Ct. Int J Radiat Oncol Biol Phys. 2015;91:1017–25.

    Article  Google Scholar 

  30. Chang JH, Lim Joon D, Davis ID, Lee ST, Hiew CY, Esler S, et al. Comparison of [(11)C]choline positron emission tomography with T2- and diffusion-weighted magnetic resonance imaging for delineating malignant intraprostatic lesions. Int J Radiat Oncol Biol Phys. 2015;92:438–45.

    Article  Google Scholar 

  31. Abdellatif A, Craig J, Jensen M, Mulligan M, Mosalaei H, Bauman G, et al. Experimental assessments of intrafractional prostate motion on sequential and simultaneous boost to a dominant intraprostatic lesion. Med Phys. 2012;39:1505–17.

    Article  Google Scholar 

  32. Schild MH, Schild SE, Wong WW, Vora SA, Keole SR, Vargas CE, et al. A prospective trial of intensity modulated radiation therapy (Imrt) incorporating a simultaneous integrated boost for prostate cancer: long-term outcomes compared with standard image guided Imrt. Int J Radiat Oncol Biol Phys. 2017;97:1021–5.

    Article  Google Scholar 

  33. Barrett T, Turkbey B, Choyke PL. Pi-Rads version 2: What you need to know. Clin Radiol. 2015;70:1165–76.

    Article  CAS  Google Scholar 

  34. Kajihara H, Hayashida Y, Murakami R, Katahira K, Nishimura R, Hamada Y, et al. Usefulness of diffusion-weighted imaging in the localization of prostate cancer. Int J Radiat Oncol Biol Phys. 2009;74:399–403.

    Article  Google Scholar 

Download references

Funding

This work was supported by JSPS KAKENHI Grant Number JP16K10390, and partially supported by the Practical Research for Innovative Cancer Control (Grant No. JP18ck0106427h0001) of the Japan Agency for Medical Research and Development.

Author information

Authors and Affiliations

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

    Ryo Ashida, Kiyonao Nakamura, Rihito Aizawa, Hiraku Iramina, Kenji Takayama, Mitsuhiro Nakamura & Takashi Mizowaki

  2. Division of Medical Physics, Department of Information Technology and Medical Engineering, Graduate School of Medicine, Human Health Sciences, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Mitsuhiro Nakamura

Authors
  1. Ryo Ashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiyonao Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rihito Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiraku Iramina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenji Takayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mitsuhiro Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Mizowaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RA and TM contributed to the study conception and design. RA, KN, RA, KT and TM collected the data. HI and MN performed patient-specific quality assurance. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takashi Mizowaki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ashida, R., Nakamura, K., Aizawa, R. et al. Highly hypofractionated intensity-modulated radiation therapy for nonmetastatic prostate cancer with a simultaneous integrated boost to intraprostatic lesions: a planning study. Jpn J Radiol 40, 210–218 (2022). https://doi.org/10.1007/s11604-021-01186-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-021-01186-6

Keywords

Search

Navigation