Top

Published in:

Open Access 01-12-2010 | Research

Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy

Authors: Gianfranco A Pesce, Alessandro Clivio, Luca Cozzi, Giorgia Nicolini, Antonella Richetti, Emanuela Salati, Mariacarla Valli, Eugenio Vanetti, Antonella Fogliata

Published in: Radiation Oncology | Issue 1/2010

Abstract

Background

To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology.

Methods

Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0 ± 3.0 ng/mL, were treated with RapidArc in a feasibility study. All patients were treated with single arc using 6MV photons. Dose prescription ranged between 76 (7 patients) and 78 Gy (38 patients) in 2Gy/fraction. Plan quality was assessed by means of Dose Volume Histogram (DVH) analysis. Technical parameters of arcs and pre-treatment quality assurance results (Gamma Agreement Index, GAI) are reported to describe delivery features. Early toxicity was scored (according to the Common Terminology Criteria of Adverse Effects scale, CTCAE, scale) at the end of treatment together with biochemical outcome (PSA).

Results

From DVH data, target coverage was fulfilling planning objectives: V_95% was in average higher than 98% and V_107%~0.0% (D_2%~104.0% in average). Homogeneity D_5%-D_95% ranged between 6.2 ± 1.0% to 6.7 ± 1.3%. For rectum, all planning objectives were largely met (e.g. V_70Gy = 10.7 ± 5.5% against an objective of < 25%) similarly for bladder (e.g. D_2% = 79.4 ± 1.2Gy against an objective of 80.0Gy). Maximum dose to femurs was D_2% = 36.7 ± 5.4Gy against an objective of 47Gy. Monitor Units resulted: MU/Gy = 239 ± 37. Average beam on time was 1.24 ± 0.0 minutes. Pre-treatment GAI resulted in 98.1 ± 1.1%. Clinical data were recorded as PSA at 6 weeks after RT, with median values of 0.4 ± 0.4 ng/mL. Concerning acute toxicity, no patient showed grade 2-3 rectal toxicity; 5/42 (12%) patients experienced grade 2 dysuria; 18/41 (44%) patients preserved complete or partial erectile function.

Conclusion

RapidArc proved to be a safe, qualitative and advantageous treatment modality for prostate cancer.

Available only for authorised users

NICER and FSO Statistics of Cancer Incidence: Switzerland 1983-2006[http://www.ti.ch/tumori]

Otto K: Volumetric Modulated Arc Therapy: IMRT in a single arc. Med Phys 2008, 35: 310-317. 10.1118/1.2818738CrossRefPubMed

Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 118-124. 10.1016/j.radonc.2008.12.020CrossRefPubMed

Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89: 180-191. 10.1016/j.radonc.2008.06.013CrossRefPubMed

Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L: Intensity modulation with photons for benign intracranial tumours: a planning comparison of volumetric single arc, helical arc and fixed gantry techniques. Radiother Oncol 2008, 89: 254-262. 10.1016/j.radonc.2008.07.021CrossRefPubMed

Kjær-Kristoffersen F, Ohlhues L, Medin J, Korreman S: RapidArc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol 2008, 48: 227-232. 10.1080/02841860802266748CrossRef

Lagerwaard F, Meijer O, van del Hoorn E, Verbakel W, Slotman B, Senan S: Volumetric modulated arc radiotherapy for vestibular schwannomas. Int J Radiat Oncol Biol Phys 2009, 74: 610-615. 10.1016/j.ijrobp.2008.12.076CrossRefPubMed

Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 111-117. 10.1016/j.radonc.2008.12.008CrossRefPubMed

Verbakel W, Cuijpers J, Hoffmans D, Bieker M, Slotman B: Volumetric intensity modulated arc therapy versus conventional IMRT in head and neck cancer: A comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys 2009, 74: 252-259. 10.1016/j.ijrobp.2008.12.033CrossRefPubMed

10.

Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, McKenzie M, Morris J, Otto K: Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity modulated radiotherapy and three dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2009, 72: 996-1001.CrossRef

11.

Shaffer R, Morris WJ, Moiseenko V, Welsh M, Crumley C, Nakano S, Schmuland M, Pickles T, Otto K: Volumetric modulated Arc therapy and conventional intensity-modulated radiotherapy for simultaneous maximal intraprostatic boost: a planning comparison study. Clin Oncol 2009, 21: 401-407. 10.1016/j.clon.2009.01.014CrossRef

12.

Yoo S, Wu J, Lee R, Yin FF: Radiotherapy treatment plans with rapidarc for prostate cancer involving seminal vesicles and lymph nodes. Int J Radiat Oncol Biol Phys 2010, 76: 935-942. 10.1016/j.ijrobp.2009.07.1677CrossRefPubMed

13.

Zhang P, Happersett L, Hunt M, Jackson A, Zelefsky M, Mageras G: Volumetric Modulated Arc Therapy: Planning and Evaluation for Prostate Cancer Cases. Int J Radiat Oncol Biol Phys 2010, 76: 1456-1462. 10.1016/j.ijrobp.2009.03.033CrossRefPubMed

14.

Kestin L, Goldstein N, Vicini F, Yan D, Korman H, Martinez A: Treatment of prostate cancer with radiotherapy: should the entire seminal vesicles be included in the clinical target volume? Int J Radiat Oncol Biol Phys 2002, 54: 686-697. 10.1016/S0360-3016(02)03011-0CrossRefPubMed

15.

Gluck I, Vineberg KA, Ten Haken RK, Sandler HM: Evaluating the relationships between rectal normal tissue complication probability and the portion of seminal vesicles included in the clinical target volume in intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2009, 73: 334-340. 10.1016/j.ijrobp.2008.09.025CrossRefPubMed

16.

Pinkawa M, Piroth MD, Fischedick K, Holy R, Klotz J, Nussen S, Krenkel B, Eble MJ: Impact of the target volume (prostate alone vs. prostate with seminal vesicles) and fraction dose (1.8 Gy vs. 2.0 Gy) on quality of life changes after external-beam radiotherapy for prostate cancer. Strahlenther Onkol 2009, 185: 724-730. 10.1007/s00066-009-2008-6CrossRefPubMed

17.

Guckenberger M, Baier K, Richter A, Vordermark D, Flentje M: Dose Intensity Modulated Radiation Therapy (IMRT) prevent additional toxicity of treating the pelvic lymph nodes compared to treatment of the prostate only? Radiat Oncol 2008, 3: 3. 10.1186/1748-717X-3-3PubMedCentralCrossRefPubMed

18.

Fonteyne V, Villeirs G, Lumen N, De Meerleer G: Urinary toxicity after high dose intensity modulated radiotherapy as primary therapy for prostate cancer. Radiother Oncol 2009, 92: 42-47. 10.1016/j.radonc.2009.03.013CrossRefPubMed

19.

Low DA, Harms WB, Mutic S, Purdy JA: A technique for quantitative evaluation of dose distributions. Med Phys 1998, 25: 656-661. 10.1118/1.598248CrossRefPubMed

20.

Nicolini G, Vanetti E, Clivio A, Fogliata A, Korreman S, Bocanek J, Cozzi L: The GLAaS algoritm for portal dosimetry and quality assurance of RapidArc, an intensity modulated rotational therapy. Radiat Oncol 2008, 3: 24. 10.1186/1748-717X-3-24PubMedCentralCrossRefPubMed

21.

Nicolini G, Fogliata A, Vanetti E, Clivio A, Cozzi L: GLAaS: an absolute dose calibration algorithm for an amorphous silicon portal imager. Applications to IMRT verifications. Med Phys 2006, 33: 2839-2851. 10.1118/1.2218314CrossRefPubMed

22.

National Cancer Institute: Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events. Version 3.0. DCTD, NCI, NIH, NHHS 2003. [http://ctep.cancer.gov]

23.

Fellin G, Fiorino C, Rancati T, Vavassori V, Baccolini M, Bianchi C, Cagna E, Gabriele P, Mauro F, Menegotti L, Monti AF, Stasi M, Valdagni R: Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: results of a large multicenter observational study. Radiother Oncol 2009, 93: 197-202. 10.1016/j.radonc.2009.09.004CrossRefPubMed

24.

Weber D, Wang H, Cozzi L, Dipasquale G, Khan H, Ratib O, Rouzaoud M, Vees H, Zaidi H, Miralbell R: RapidArc, intensity modulated photon and proton techniques for recurrent prostate cancer in previously irradiated patients: a treatment planning comparison study. Radiat Oncol 2009, 4: 34. 10.1186/1748-717X-4-34PubMedCentralCrossRefPubMed

25.

Richetti A, Fogliata A, Clivio A, Nicolini G, Pesce G, Salati E, Vanetti E, Cozzi L: Neo-adjuvant chemo-radiation of rectal cancer with volumetric modulated arc therapy: summary of technical and dosimetric features and early clinical experience. Radiat Oncol 2010, 5: 14. 10.1186/1748-717X-5-14PubMedCentralCrossRefPubMed

26.

Kupelian P, Willoughby T, Mahadevan A, Djemil T, Weinstein G, Jani S, Enke C, Solberg T, Flores N, Liu D, Beyer D, Levine L: Multi institutional clinical experience with the calypso system in localization and continuous real time monitoring of the prostate gland during external ragiotherapy. Int J Radiat Oncol Biol Phys 2007, 67: 1088-1098. 10.1016/j.ijrobp.2006.10.026CrossRefPubMed

27.

Langen K, Willoughby T, Meeks S, Santhanam A, Cunningham A, Levine L, Kupelian P: Observations on real time prostate gland motion using electromagnetic tracking. Int J Radiat Oncol Biol Phys 2008, 72: 1084-1090.CrossRef

Title: Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy
Authors: Gianfranco A Pesce
Alessandro Clivio
Luca Cozzi
Giorgia Nicolini
Antonella Richetti
Emanuela Salati
Mariacarla Valli
Eugenio Vanetti
Antonella Fogliata
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2010
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-5-54

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2010

Comparison of T2 and FLAIR imaging for target delineation in high grade gliomas

Accelerated Partial Breast Irradiation (APBI): A review of available techniques

Proposing the lymphatic target volume for elective radiation therapy for pancreatic cancer: a pooled analysis of clinical evidence

Reduction of radiation pneumonitis by V20-constraints in breast cancer

Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

Stereotactic radiosurgery may contribute to overall survival for patients with recurrent head and neck carcinoma