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Radiation Oncology
Published in: Radiation Oncology 1/2020

01-12-2020 | Magnetic Resonance Imaging | Research

Voxel-level biological optimisation of prostate IMRT using patient-specific tumour location and clonogen density derived from mpMRI

Authors: E. J. Her, A. Haworth, H. M. Reynolds, Y. Sun, A. Kennedy, V. Panettieri, M. Bangert, S. Williams, M. A. Ebert

Published in: Radiation Oncology | Issue 1/2020

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Abstract

Aims

This study aimed to develop a framework for optimising prostate intensity-modulated radiotherapy (IMRT) based on patient-specific tumour biology, derived from multiparametric MRI (mpMRI). The framework included a probabilistic treatment planning technique in the effort to yield dose distributions with an improved expected treatment outcome compared with uniform-dose planning approaches.

Methods

IMRT plans were generated for five prostate cancer patients using two inverse planning methods: uniform-dose to the planning target volume and probabilistic biological optimisation for clinical target volume tumour control probability (TCP) maximisation. Patient-specific tumour location and clonogen density information were derived from mpMRI and geometric uncertainties were incorporated in the TCP calculation. Potential reduction in dose to sensitive structures was assessed by comparing dose metrics of uniform-dose plans with biologically-optimised plans of an equivalent level of expected tumour control.

Results

The planning study demonstrated biological optimisation has the potential to reduce expected normal tissue toxicity without sacrificing local control by shaping the dose distribution to the spatial distribution of tumour characteristics. On average, biologically-optimised plans achieved 38.6% (p-value: < 0.01) and 51.2% (p-value: < 0.01) reduction in expected rectum and bladder equivalent uniform dose, respectively, when compared with uniform-dose planning.

Conclusions

It was concluded that varying the dose distribution within the prostate to take account for each patient’s clonogen distribution was feasible. Lower doses to normal structures compared to uniform-dose plans was possible whilst providing robust plans against geometric uncertainties. Further validation in a larger cohort is warranted along with considerations for adaptive therapy and limiting urethral dose.
Appendix
Available only for authorised users
Footnotes
1
International Electrochemical Commission definitions
 
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Metadata
Title
Voxel-level biological optimisation of prostate IMRT using patient-specific tumour location and clonogen density derived from mpMRI
Authors
E. J. Her
A. Haworth
H. M. Reynolds
Y. Sun
A. Kennedy
V. Panettieri
M. Bangert
S. Williams
M. A. Ebert
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-020-01568-6

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