Top

Published in:

Open Access 01-12-2019 | Prostate Cancer | Research

A treatment planning study comparing IMRT techniques and cyber knife for stereotactic body radiotherapy of low-risk prostate carcinoma

Authors: Sergiu Scobioala, Christopher Kittel, Khaled Elsayad, Kai Kroeger, Michael Oertel, Laith Samhouri, Uwe Haverkamp, Hans Theodor Eich

Published in: Radiation Oncology | Issue 1/2019

Abstract

Purpose

Comparing radiation treatment plans by using the same safety margins and dose objectives for all techniques, to ascertain the optimal radiation technique for the stereotactic body radiotherapy (SBRT) of low-risk prostate cancer.

Material and methods

Treatment plans for 27 randomly selected patients were compared using intensity-modulated (IMRT) techniques as Sliding Window (SW), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT), as well as Cyber Knife (CK) system. The target dose was calculated to 36.25 Gy delivered in five fractions over 1 week. Dosimetric indices for target volume and organs at risk (OAR) as well as normal tissue complication probability (NTCP) of late rectal and urinary bladder toxicities were analyzed.

Results

The CK provided lower homogeneity in the target volume, but higher values for most of the conformity indices compared to the IMRT approaches. The SW demonstrated superior rectum sparing at medium-to-high dose range (V18 Gy - V32.6 Gy) compared to other techniques (p < 0.05). The whole urinary bladder experienced the best shielding by SW and VMAT at the medium dose (V18 Gy, p < 0.05 versus CK), however we obtained no relevant differences between techniques at the high dose. Generally, the CK demonstrated significantly superior rectum and bladder exposure at V18 Gy as compared to HT, SW, and VMAT. For the rectum, mean NTCP values were significantly superior for HT (NTCP = 2.3%, p < 0.05), and for urinary bladder, the NTCP showed no significant advantages for any technique.

Conclusion

No absolute dosimetric advantage was revealed to choose between CK or IMRT techniques for the SBRT of low-grade prostate cancer. Using the same safety margins and dose objectives, IMRT techniques demonstrated superior sparing of the rectum and bladder at a medium dose compared to CK. Comparing different IMRT approaches SW displayed superior rectum sparing at a medium-to-high dose range, whereas both SW and RA revealed superior bladder sparing compared to HT. HT demonstrated a significantly lower NTCP outcome compared to CK or IMRT techniques regarding the rectum. Radiation plans can be optimized further by an individual modification of dose objectives independent of the treatment plan strategy.

Available only for authorised users

Miralbell R, Roberts SA, Zubizarreta E, Hendry JH. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: α/β = 1.4 (0.9–2.2) Gy. Int J Radiat Oncol Biol Phys. 2012;82:17–24. https://doi.org/10.1016/j.ijrobp.2010.10.075.CrossRef

Ju AW, Wang H, Oermann EK, Sherer BA, Uhm S, Chen VJ, Pendharkar AV, Hanscom HN, Kim JS, Lei S, Suy S, Lynch JH, Dritschilo A, Collins SP. Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer. Radiat Oncol. 2013;31:8–30. https://doi.org/10.1186/1748-717X-8-30.CrossRef

Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50:1021–31. https://doi.org/10.1016/S0360-3016(01)01607-8.CrossRefPubMed

Wang JZ, Guerrero M, Li XA. How low is the alpha/beta ratio for prostate cancer? Int J Radiat Oncol Biol Phys. 2003;55:194–203. https://doi.org/10.1016/S0360-3016(02)03828-2.CrossRefPubMed

Yeoh EE, Botten RJ, Butters J, Di Matteo AC, Holloway RH, Fowler J. Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys. 2010;81:1271–8. https://doi.org/10.1016/j.ijrobp.2010.07.1984.CrossRefPubMed

Lukka H, Hayter C, Julian JA, Warde P, Morris WJ, Gospodarowicz M, Levine M, Sathya J, Choo R, Prichard H, Brundage M, Kwan W. Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol. 2005;23:6132–8. https://doi.org/10.1200/JCO.2005.06.153.CrossRefPubMed

Arcangeli G, Saracino B, Gomellini S, Petrongari MG, Arcangeli S, Sentinelli S, Marzi S, Landoni V, Fowler J, Strigari L. A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2010;78:11–8. https://doi.org/10.1016/j.ijrobp.2009.07.1691.CrossRefPubMed

Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, Hanscom HN, Laing S, Kim JS, Lei S, Batipps GP, Kowalczyk K, Bandi G, Pahira J, McGeagh KG, Collins BT, Krishnan P, Dawson NA, Taylor KL, Dritschilo A, Lynch JH, Collins SP. Stereotactic Body Radiation Therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol. 2013;8:58. https://doi.org/10.1186/1748-717X-8-58.CrossRefPubMedPubMedCentral

King CR, Brooks JD, Gill H, Presti JC Jr. Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82:877–82. https://doi.org/10.1016/j.ijrobp.2010.11.054.CrossRefPubMed

10.

Bolzicco G, Favretto MS, Scremin E, Tambone C, Tasca A, Guglielmi R. Image-guided stereotactic body radiation therapy for clinically localized prostate cancer: preliminary clinical results. Technol Cancer Res Treat. 2010;9:473–7. https://doi.org/10.1177/153303461000900505.CrossRefPubMed

11.

Jabbari S, Weinberg VK, Kaprealian T, Hsu IC, Ma L, Chuang C, Descovich M, Shiao S, Shinohara K, Roach M 3rd, Gottschalk A. RStereotactic body radiotherapy as monotherapy or post-external beam radiotherapy boost for prostate cancer: technique, early toxicity, and PSA response. Int J Radiat Oncol Biol Phys. 2012;82:228–34. https://doi.org/10.1016/j.ijrobp.2010.10.026.CrossRefPubMed

12.

McBride SM, Wong DS, Dombrowski JJ, Harkins B, Tapella P, Hanscom HN, Collins SP, Kaplan ID. Hypofractionated stereotactic body radiotherapy in low-risk prostate adenocarcinoma: preliminary results of a multi-institutional phase 1 feasibility trial. Cancer. 2012;118:3681–90. https://doi.org/10.1002/cncr.26699.CrossRefPubMed

13.

Macdougall ND, Dean C, Muirhead R. Stereotactic body radiotherapy in prostate cancer: is Rapidarc a better solution than Cyberknife? Clin Oncol (R Coll Radiol). 2013;26:4–9. https://doi.org/10.1016/j.clon.2013.08.008.CrossRef

14.

Lin YW, Lin KH, Ho HW, Lin HM, Lin LC, Lee SP, Chui CS. Treatment plan comparison between stereotactic body radiation therapy techniques for prostate cancer: non-isocentric CyberKnife versus isocentric RapidArc. Phys Med. 2014;30:654–61. https://doi.org/10.1016/j.ejmp.2014.03.008.CrossRefPubMed

15.

Dong P, Nguyen BS, Ruan D, King C, Long T, Romeijn E, Low DA, Kupelian P, Steinberg M, Yang Y, Sheng K. Feasibility of prostate robotic radiation therapy on conventional C-arm linacs. Pract Radiat Oncol. 2014;4:254–60. https://doi.org/10.1016/j.prro.2013.10.009.CrossRefPubMed

16.

Rossi L, Breedveld S, Aluwini S, Heijmen B. Noncoplanar beam angle class solutions to replace time-consuming patient-specific beam angle optimization in robotic prostate stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2014;92:762–70. https://doi.org/10.1016/j.ijrobp.2015.03.013.CrossRef

17.

Rossi L, Sharfo AW, Aluwini S, Dirkx M, Breedveld S, Heijmen B. First fully automated planning solution for robotic radiosurgery – comparison with automatically planned volumetric arc therapy for prostate cancer. Acta Oncol. 2018;57:1490–8. https://doi.org/10.1080/0284186X.2018.1479068.CrossRefPubMed

18.

Network NCCN (2017) Clinical practise guidelines for oncology, prostate cancer, version 01.2016.

19.

Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys. 2010;76:123–9. https://doi.org/10.1016/j.ijrobp.2009.03.078.CrossRef

20.

Viswanathan AN, Yorke ED, Marks LB, Eifel PJ, Shipley WU. Radiation dose-volume effects of the urinary bladder. Int J Radiat Oncol Biol Phys. 2010;76:116–22. https://doi.org/10.1016/j.ijrobp.2009.02.090.CrossRef

21.

ICRU, Report 83. Prescribing, recording, and reporting intensity-modulated photon-beam. Bethesda: International Commission on Radiation Units and Measurements; 2010.

22.

Boehmer D, Maingon P, Poortmans P, Baron MH, Miralbell R, Remouchamps V, Scrase C, Bossi A. Bolla M; EORTC radiation oncology group. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol. 2006;79:259–69. https://doi.org/10.1016/j.radonc.2006.05.012.CrossRefPubMed

23.

Haverkamp U, Norkus D, Kriz J, Müller MM, Prott FJ, Eich HT. Optimization by visualization of indices. Strahlenther Onkol. 2014;190:1053–9. https://doi.org/10.1007/s00066-014-0688-z.CrossRefPubMed

24.

Van't Riet A, Mak AC, Moerland MA, Elders LH, van der Zee W. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: application to the prostate. Int J Radiat Oncol Biol Phys. 1997;37:731–6. https://doi.org/10.1016/S0360-3016(96)00601-3.CrossRef

25.

ICRU, Report 62. Prescribing, recording and reporting photon beam therapy (supplement to ICRU report 50). Bethesda: International Commission on Radiation Units and Measurements; 1999.

26.

Van Gellekom MP, Moerland MA, Battermann JJ, Lagendijk JJ. MRI-guided prostate brachytherapy with single needle method--a planning study. Radiother Oncol. 2004;71:327–32. https://doi.org/10.1016/j.radonc.2004.03.002.CrossRefPubMed

27.

Das IJ, Cheng CW, Healey GA. Optimum field size and choice of isodose lines in electron beam treatment. Int J Radiat Oncol Biol Phys. 1995;31:157–63.CrossRef

28.

Burman C, Kutcher GJ, Emami B, Goitein M. Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys. 1991;21:123–35. https://doi.org/10.1016/0360-3016(91)90172-Z.CrossRefPubMed

29.

Buyyounouski MK, Price RA Jr, Harris EE, Miller R, Tomé W, Schefter T, Parsai EI, Konski AA, Wallner PE. Stereotactic body radiotherapy for primary management of early-stage, low- to intermediate-risk prostate cancer: report of the American Society for Therapeutic Radiology and Oncology Emerging Technology Committee. Int J Radiat Oncol Biol Phys. 2010;76:1297–304. https://doi.org/10.1016/j.ijrobp.2009.09.078.CrossRefPubMed

30.

Dale E, Hellebust TP, Skjonsberg A, Hogberg T, Olsen DR. Modeling normal tissue complication probability from repetitive computed tomography scans during fractionated high-dose-rate brachytherapy and external beam radiotherapy of the uterine cervix. Int J Radiat Oncol Biol Phys. 2000;47:963–71. https://doi.org/10.1016/S0360-3016(00)00510-1.CrossRefPubMed

31.

Stavrev P, Hristov D. Prostate IMRT fractionation strategies: two-phase treatment versus simultaneous integrated boost. Radiol Oncol. 2003;37:115–26.

32.

Boike TP, Lotan Y, Cho LC, Brindle J, DeRose P, Xie XJ, Yan J, Foster R, Pistenmaa D, Perkins A, Cooley S, Timmerman R. Phase I dose-escalation study of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer. J Clin Oncol. 2011;29:2020–6. https://doi.org/10.1200/JCO.2010.31.4377.CrossRefPubMedPubMedCentral

33.

Madsen BL, His RA, Pham HT, Fowler JF, Esagui L, Corman J. Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: first clinical trial results. Int J Radiat Oncol Biol Phys. 2007;67:1099–105. https://doi.org/10.1016/j.ijrobp.2006.10.050.CrossRefPubMed

34.

Aluwini S, van Rooij P, Hoogeman M, Bangma C, Kirkels WJ, Incrocci L, Kolkman-Deurloo IK. CyberKnife stereotactic radiotherapy as monotherapy for low- to intermediate-stage prostate cancer: early experience, feasibility, and tolerance. J Endourol. 2010;24:865–9. https://doi.org/10.1089/end.2009.0438.CrossRefPubMed

35.

Freeman DE, King CR. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes. Radiat Oncol. 2011;6:13. https://doi.org/10.1186/1748-717X-6-3.CrossRef

36.

Tang CI, Loblaw DA, Cheung P, Holden L, Morton G, Basran PS, Tirona R, Cardoso M, Pang G, Gardner S, Cesta A. Phase I/II study of a five-fraction hypofractionated accelerated radiotherapy treatment for low-risk localised prostate cancer: early results of pHART3. Clin Oncol. 2008;20:729–37. https://doi.org/10.1016/j.clon.2008.08.006.CrossRef

37.

Friedland JL, Freeman DE, Masterson-McGary ME, Spellberg DM. Stereotactic body radiotherapy: an emerging treatment approach for localized prostate cancer. Technol Cancer Res Treat. 2009;8:387–92. https://doi.org/10.1177/153303460900800509.CrossRefPubMed

38.

Katz AJ, Santoro M, Ashley R, Diblasio F, Witten M. Stereotactic body radiotherapy for organ-confined prostate cancer. BMC Urol. 2010;110:11. https://doi.org/10.1186/1471-2490-10-1.CrossRef

39.

van der Wielen GJ, Mutanga TF, Incrocci L, Kirkels WJ, Vasquez Osorio EM, Hoogeman MS, Heijmen BJ, de Boer HC. Deformation of prostate and seminal vesicles relative to intraprostatic fiducial markers. Int J Radiat Oncol Biol Phys. 2008;72:1604–11. https://doi.org/10.1016/j.ijrobp.2008.07.023.CrossRefPubMed

40.

Nichol AM, Brock KK, Lockwood GA, Moseley DJ, Rosewall T, Warde PR, Catton CN, Jaffray DA. A magnetic resonance imaging study of prostate deformation relative to implanted gold fiducial markers. Int J Radiat Oncol Biol Phys. 2007;67:48–56. https://doi.org/10.1016/j.ijrobp.2006.08.021.CrossRefPubMed

41.

Reggiori G, Mancosu P, Tozzi A, Cantone MC, Castiglioni S, Lattuada P, Lobefalo F, Cozzi L, Fogliata A, Navarria P, Scorsetti M. Cone beam CT pre- and post-daily treatment for assessing geometrical and dosimetric intrafraction variability during radiotherapy of prostate cancer. J App Clin Med Phys. 2011;12:141–52. https://doi.org/10.1120/jacmp.v12i1.3371.CrossRef

42.

Soete G, Arcangeli S, De Meerleer G, Landoni V, Fonteyne V, Arcangeli G, De Neve W, Storme G. Phase II study of a four-week hypofractionated external beam radiotherapy regimen for prostate cancer: report on acute toxicity. Radiother Oncol. 2006;80:78–81. https://doi.org/10.1016/j.radonc.2006.06.005.CrossRefPubMed

43.

Martin JM, Rosewall T, Bayley A, Bristow R, Chung P, Crook J, Gospodarowicz M, McLean M, Ménard C, Milosevic M, Warde P, Catton C. Phase II trial of hypofractionated image-guided intensity-modulated radiotherapy for localized prostate adenocarcinoma. Int J Radiat Oncol Biol Phys. 2007;69:1084–9. https://doi.org/10.1016/j.ijrobp.2007.04.049.CrossRefPubMed

44.

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 radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67:1088–98. https://doi.org/10.1016/j.ijrobp.2006.10.026.CrossRefPubMed

45.

Wilder RB, Chittenden L, Mesa AV, Bunyapanasarn J, Agustin J, Lizarde J, Ravera J, Tokita KM. A prospective study of intrafraction prostate motion in the prone vs. supine position. Int J Radiat Oncol Biol Phys. 2010;77:165–70. https://doi.org/10.1016/j.ijrobp.2009.04.041.CrossRefPubMed

46.

Mutanga TF, de Boer HC, Rajan V, Dirkx ML, Incrocci L, Heijmen BJ. Day-to-day reproducibility of prostate intrafraction motion assessed by multiple kV and MV imaging of implanted markers during treatment. Int J Radiat Oncol Biol Phys. 2012;83:400–7. https://doi.org/10.1016/j.ijrobp.2011.05.049.CrossRefPubMed

47.

Rosewall T, Chung P, Bayley A, Lockwood G, Alasti H, Bristow R, Kong V, Milosevic M, Catton C. A randomized comparison of interfraction and intrafraction prostate motion with and without abdominal compression. Radiother Oncol. 2008;88:88–94. https://doi.org/10.1016/j.radonc.2008.01.019.CrossRefPubMed

48.

Kotte AN, Hofman P, Lagendijk JJ, van Vulpen M, van der Heide U. Intrafraction motion of the prostate during external-beam radiation therapy: analysis of 427 patients with implanted fiducial markers. Int J Radiat Oncol Biol Phys. 2007;69:419–25. https://doi.org/10.1016/j.ijrobp.2007.03.029.CrossRefPubMed

49.

Aubry JF, Beaulieu L, Girouard LM, Aubin S, Tremblay D, Laverdière J, Vigneault E. Measurements of intrafraction motion and interfraction and intrafraction rotation of prostate by three-dimensional analysis of daily portal imaging with radiopaque markers. Int J Radiat Oncol Biol Phys. 2004;60:30–9. https://doi.org/10.1016/j.ijrobp.2004.02.045.CrossRefPubMed

50.

Pontoriero A, Iatì G, Mondello S, Midili F, Siragusa C, Brogna A, Ielo I, Anastasi G, Magno C, Pergolizzi S, De Renzis C. High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer: Preliminary Results in 26 Patients. Technol Cancer Res Treat. 2016;15:179–85. https://doi.org/10.1177/1533034614566994.CrossRefPubMed

51.

Lee SW, Jang HS, Lee JH, Kim SH, Yoon SC. Stereotactic body radiation therapy for prostate cancer patients with old age or medical comorbidity: a 5-year follow-up of an investigational study. Medicine (Baltimore). 2014;93:e290. https://doi.org/10.1097/MD.0000000000000290.CrossRef

52.

Jiang P, Krockenberger K, Vonthein R, Tereszczuk J, Schreiber A, Liebau S, Huttenlocher S, Imhoff D, Balermpas P, Keller C, Dellas K, Baumann R, Rödel C, Hildebrandt G, Jünemann KP, Merseburger AS, Katz A, Ziegler A, Blanck O, Dunst J. Hypo-fractionated SBRT for localized prostate cancer: a German bi-center single treatment group feasibility trial. Radiat Oncol. 2017;12:138. https://doi.org/10.1186/s13014-017-0872-2.CrossRefPubMedPubMedCentral

53.

Nielsen TB, Wieslander E, Fogliata A, Nielsen M, Hansen O, Brink C. Influence of dose calculation algorithms on the predicted dose distributions and NTCP values for NSCLC patients. Med Phys. 2011;38:2412–8. https://doi.org/10.1118/1.3575418.CrossRefPubMed

54.

Hedin E, Bäck A. Influence of different dose calculation algorithms on the estimate of NTCP for lung complications. J Appl Clin Med Phys. 2013;14:127–39. https://doi.org/10.1120/jacmp.v14i5.4316.CrossRefPubMedPubMedCentral

55.

Liang X, Penagaricano J, Zheng D, Morrill S, Zhang X, Corry P, Griffin RJ, Han EY, Hardee M, Ratanatharathom V. Radiobiological impact of dose calculation algorithms on biologically optimized IMRT lung stereotactic body radiation therapy plans. Radiat Oncol. 2016;11:10. https://doi.org/10.1186/s13014-015-0578-2.CrossRefPubMedPubMedCentral

Title: A treatment planning study comparing IMRT techniques and cyber knife for stereotactic body radiotherapy of low-risk prostate carcinoma
Authors: Sergiu Scobioala
Christopher Kittel
Khaled Elsayad
Kai Kroeger
Michael Oertel
Laith Samhouri
Uwe Haverkamp
Hans Theodor Eich
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Prostate Cancer
Prostate Cancer
Radiotherapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1353-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A treatment planning study comparing IMRT techniques and cyber knife for stereotactic body radiotherapy of low-risk prostate carcinoma

Abstract

Purpose

Material and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Dose-volume relationship for laryngeal substructures and aspiration in patients with locally advanced head-and-neck cancer

Network meta-analysis comparing neoadjuvant chemoradiation, neoadjuvant chemotherapy and upfront surgery in patients with resectable, borderline resectable, and locally advanced pancreatic ductal adenocarcinoma

Risk factors to identify patients who may not benefit from whole brain irradiation for brain metastases - a single institution analysis

Novel rotatable tabletop for total-body irradiation using a linac-based VMAT technique

Five-year oncological outcome after a single fraction of accelerated partial breast irradiation in the elderly

Biophysical modeling and experimental validation of relative biological effectiveness (RBE) for 4He ion beam therapy