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Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control

Authors: Per Munck af Rosenschold, Michael J. Zelefsky, Aditya P. Apte, Andrew Jackson, Jung Hun Oh, Elliot Shulman, Neil Desai, Margie Hunt, Pirus Ghadjar, Ellen Yorke, Joseph O. Deasy

Published in: Radiation Oncology | Issue 1/2018

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Abstract

Background

To determine if reduced dose delivery uncertainty is associated with daily image-guidance (IG) and Prostate Specific Antigen Relapse Free Survival (PRFS) in intensity-modulated radiotherapy (IMRT) of high-risk prostate cancer (PCa).

Methods

Planning data for consecutive PCa patients treated with IMRT (n = 67) and IG-IMRT (n = 35) was retrieved. Using computer simulations of setup errors, we estimated the patient-specific uncertainty in accumulated treatment dose distributions for the prostate and for posterolateral aspects of the gland that are at highest risk for extra-capsular disease. Multivariate Cox regression for PRFS considering Gleason score, T-stage, pre-treatment PSA, number of elevated clinical risk factors (T2c+, GS7+ and PSA10+), nomogram-predicted risk of extra-capsular disease (ECD), and dose metrics was performed.

Results

For IMRT vs. IG-IMRT, plan dosimetry values were similar, but simulations revealed uncertainty in delivered dose external to the prostate was significantly different, due to positioning uncertainties. A patient-specific interaction term of the risk of ECD and risk of low dose to the ECD (p = 0.005), and the number of elevated clinical risk factors (p = 0.008), correlate with reduced PRFS.

Conclusions

Improvements in PSA outcomes for high-risk PCa using IG-IMRT vs. IMRT without IG may be due to improved dosimetry for ECD.
Appendix
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Metadata
Title
Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control
Authors
Per Munck af Rosenschold
Michael J. Zelefsky
Aditya P. Apte
Andrew Jackson
Jung Hun Oh
Elliot Shulman
Neil Desai
Margie Hunt
Pirus Ghadjar
Ellen Yorke
Joseph O. Deasy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-0978-1

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