Top

Published in:

Open Access 01-12-2014 | Research

Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines

Authors: Jennifer Croke, Jillian Maclean, Balazs Nyiri, Yan Li, Kyle Malone, Leonard Avruch, Cathleen Kayser, Shawn Malone

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Recurrence rates following radiotherapy for prostate cancer in the post-operative adjuvant or salvage setting remain substantial. Previous work from our institution demonstrated that published prostate bed CTV guidelines frequently do not cover the pre-operative MRI defined prostate. Inadequate target delineation may contribute to the high recurrence rates, but increasing target volumes may increase dose to organs at risk.

Methods

We propose guidelines for delineating post-prostatectomy target volumes based upon an individual’s co-registered pre-operative MRI. MRI-based CTVs and PTVs were compared to those created using the RTOG guidelines in 30 patients. Contours were analysed in terms of absolute volume, intersection volume (Jaccard Index) and the ability to meet the RADICALS and QUANTEC rectal and bladder constraints (tomotherapy IMRT plans with PTV coverage of V98% ≥98%).

Results

CTV MRI was a mean of 18.6% larger than CTV RTOG: CTV MRI mean 138 cc (range 72.3 - 222.2 cc), CTV RTOG mean 116.3 cc (range 62.1 - 176.6 cc), (p < 0.0001). The difference in mean PTV was only 4.6%: PTV MRI mean 386.9 cc (range 254.4 – 551.2), PTV RTOG mean 370 cc (range 232.3 - 501.6) (p = 0.05). The mean Jaccard Index representing intersection volume between CTVs was 0.72 and 0.84 for PTVs. Both criteria had a similar ability to meet rectal and bladder constraints. Rectal DVH: 77% of CTV RTOG cases passed all RADICALS criteria and 37% all QUANTEC criteria; versus 73% and 40% for CTV MRI (p = 1.0 for both). Bladder DVH; 47% of CTV RTOG cases passed all RADICALS criteria and 67% all QUANTEC criteria, versus 57% and 60% for CTV MRI (p = 0.61for RADICALS, p = 0.79 for QUANTEC). CTV MRI spares more of the lower anterior bladder wall than CTV RTOG but increases coverage of the superior lateral bladder walls.

Conclusion

CTV contours based upon the patient’s co-registered pre-operative MRI in the post-prostatectomy setting may improve coverage of the individual’s prostate bed without substantially increasing the PTV size or dose to bladder/ rectum compared to RTOG CTV guidelines. Further evaluation of whether the use of pre-operative MRI improves local control rates is warranted.

Available only for authorised users

Moul JW: Prostate specific antigen only progression of prostate cancer. J Urol 2000,163(6):1632-42. 10.1016/S0022-5347(05)67511-8CrossRefPubMed

Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, Fearn PA, Kattan MW: Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006,98(10):715-7. 10.1093/jnci/djj190PubMedCentralCrossRefPubMed

Zietman AL, Coen JJ, Shipley WU, Willett CG, Efird JT: Radical radiation therapy in the management of prostatic adenocarcinoma: the initial prostate specific antigen value as a predictor of treatment outcome. J Urol 1994,151(3):640-5.PubMed

Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, Colombel M, van de Beek C, Verhagen P, van den Bergh A, Sternberg C, Gasser T, van Tienhoven G, Scalliet P, Haustermans K, Collette L: European Organisation for R, Treatment of Cancer RO, Genito-Urinary G: Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 2012,380(9858):2018-27. 10.1016/S0140-6736(12)61253-7CrossRefPubMed

Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E, Crawford ED: Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 2009,181(3):956-62. 10.1016/j.juro.2008.11.032PubMedCentralCrossRefPubMed

Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, Golz R, Storkel S, Willich N, Semjonow A, Stockle M, Rube C, Rebmann U, Kalble T, Feldmann HJ, Wirth M, Hofmann R, Engenhart-Cabillic R, Hinke A, Hinkelbein W, Miller K. Adjuvant Radiotherapy Versus Wait-and-See After Radical Prostatectomy: 10-year Follow-up of the ARO 96-02/AUO AP 09/95 Trial. European urology. 2014.

Swanson GP, Hussey MA, Tangen CM, Chin J, Messing E, Canby-Hagino E, Forman JD, Thompson IM, Crawford ED: Swog. Predominant treatment failure in postprostatectomy patients is local: analysis of patterns of treatment failure in SWOG 8794. J Clin Oncol Off J Am Soc Clin Oncol 2007,25(16):2225-9. 10.1200/JCO.2006.09.6495CrossRef

Sella T, Schwartz LH, Swindle PW, Onyebuchi CN, Scardino PT, Scher HI, Hricak H: Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 2004,231(2):379-85. 10.1148/radiol.2312030011CrossRefPubMed

Kassabian VS, Bottles K, Weaver R, Williams RD, Paulson DF, Scardino PT: Possible mechanism for seeding of tumor during radical prostatectomy. J Urol 1993,150(4):1169-71.PubMed

10.

Connolly JA, Shinohara K, Presti JC Jr, Carroll PR: Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins. Urology 1996,47(2):225-31. 10.1016/S0090-4295(99)80421-XCrossRefPubMed

11.

Poortmans P, Bossi A, Vandeputte K, Bosset M, Miralbell R, Maingon P, Boehmer D, Budiharto T, Symon Z, van den Bergh AC, Scrase C, Van Poppel H, Bolla M, Group ERO: Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol 2007,84(2):121-7. 10.1016/j.radonc.2007.07.017CrossRefPubMed

12.

Sidhom MA, Kneebone AB, Lehman M, Wiltshire KL, Millar JL, Mukherjee RK, Shakespeare TP, Tai KH: Post-prostatectomy radiation therapy: consensus guidelines of the Australian and New Zealand Radiation Oncology Genito-Urinary Group. Radiother Oncol 2008,88(1):10-9. 10.1016/j.radonc.2008.05.006CrossRefPubMed

13.

Wiltshire KL, Brock KK, Haider MA, Zwahlen D, Kong V, Chan E, Moseley J, Bayley A, Catton C, Chung PW, Gospodarowicz M, Milosevic M, Kneebone A, Warde P, Menard C: Anatomic boundaries of the clinical target volume (prostate bed) after radical prostatectomy. Int J Radiat Oncol Biol Phys 2007,69(4):1090-9. 10.1016/j.ijrobp.2007.04.068CrossRefPubMed

14.

Michalski JM, Lawton C, El Naqa I, Ritter M, O'Meara E, Seider MJ, Lee WR, Rosenthal SA, Pisansky T, Catton C, Valicenti RK, Zietman AL, Bosch WR, Sandler H, Buyyounouski MK, Menard C: Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010,76(2):361-8. 10.1016/j.ijrobp.2009.02.006PubMedCentralCrossRefPubMed

15.

Croke J, Malone S, Roustan Delatour N, Belanger E, Avruch L, Morash C, Kayser C, Underhill K, Spaans J: Postoperative radiotherapy in prostate cancer: the case of the missing target. Int J Radiat Oncol Biol Phys 2012,83(4):1160-8. 10.1016/j.ijrobp.2011.09.039CrossRefPubMed

16.

Parker C, Sydes MR, Catton C, Kynaston H, Logue J, Murphy C, Morgan RC, Mellon K, Morash C, Parulekar W, Parmar MK, Payne H, Savage C, Stansfeld J, Clarke NW: Radiotherapy and androgen deprivation in combination after local surgery (RADICALS): a new Medical Research Council/National Cancer Institute of Canada phase III trial of adjuvant treatment after radical prostatectomy. BJU Int 2007,99(6):1376-9. 10.1111/j.1464-410X.2007.06844.xCrossRefPubMed

17.

Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, Bentzen SM, Nam J, Deasy JO: Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010,76(3 Suppl):S10-9. 10.1016/j.ijrobp.2009.07.1754PubMedCentralCrossRefPubMed

18.

Davis BJ, Pisansky TM, Wilson TM, Rothenberg HJ, Pacelli A, Hillman DW, Sargent DJ, Bostwick DG: The radial distance of extraprostatic extension of prostate carcinoma: implications for prostate brachytherapy. Cancer 1999,85(12):2630-7. 10.1002/(SICI)1097-0142(19990615)85:12<2630::AID-CNCR20>3.0.CO;2-LCrossRefPubMed

19.

Sohayda C, Kupelian PA, Levin HS, Klein EA: Extent of extracapsular extension in localized prostate cancer. Urology 2000,55(3):382-6. 10.1016/S0090-4295(99)00458-6CrossRefPubMed

20.

Wang JK, R. Choi, S. Pettaway, C. Choi, H. Hobbs, B. Occena, M. McGuire, S. Pugh, T. Hoffman, K. Mahmood, U. Kuban, D. Local recurrence map to guide target volume delineation after radical prostatectomy. Practical Radiation Oncology. doi: http://dx.doi.org/10.1016/j.prro.2014.02.007

21.

Chang JH, Lim Joon D, Nguyen BT, Hiew CY, Esler S, Angus D, Chao M, Wada M, Quong G, Khoo V: MRI scans significantly change target coverage decisions in radical radiotherapy for prostate cancer. J Med Imaging Radiat Oncol 2014,58(2):237-43. 10.1111/1754-9485.12107CrossRefPubMed

22.

Tanaka H, Hayashi S, Ohtakara K, Hoshi H, Iida T: Usefulness of CT-MRI fusion in radiotherapy planning for localized prostate cancer. J Radiat Res 2011,52(6):782-8. 10.1269/jrr.11053CrossRefPubMed

23.

Ost P, De Meerleer G, Vercauteren T, De Gersem W, Veldeman L, Vandecasteele K, Fonteyne V, Villeirs G: Delineation of the postprostatectomy prostate bed using computed tomography: interobserver variability following the EORTC delineation guidelines. Int J Radiat Oncol Biol Phys 2011,81(3):e143-9. 10.1016/j.ijrobp.2010.12.057CrossRefPubMed

24.

Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V, Futterer JJ: European Society of Urogenital R: ESUR prostate MR guidelines 2012. Eur Radiol 2012,22(4):746-57. 10.1007/s00330-011-2377-yPubMedCentralCrossRefPubMed

25.

Mullerad M, Hricak H, Kuroiwa K, Pucar D, Chen HN, Kattan MW, Scardino PT: Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer. J Urol 2005,174(6):2158-63. 10.1097/01.ju.0000181224.95276.82CrossRefPubMed

26.

Khoo VS, Joon DL. New developments in MRI for target volume delineation in radiotherapy. The British journal of radiology. 2006;79 Spec No 1:S2-15.

27.

Jackson AS, Parker CC, Norman AR, Padhani AR, Huddart RA, Horwich A, Husband JE, Dearnaley DP: Tumour staging using magnetic resonance imaging in clinically localised prostate cancer: relationship to biochemical outcome after neo-adjuvant androgen deprivation and radical radiotherapy. Clin Oncol 2005,17(3):167-71. 10.1016/j.clon.2004.08.007CrossRef

28.

Khoo EL, Schick K, Plank AW, Poulsen M, Wong WW, Middleton M, Martin JM: Prostate contouring variation: can it be fixed? Int J Radiat Oncol Biol Phys 2012,82(5):1923-9. 10.1016/j.ijrobp.2011.02.050CrossRefPubMed

29.

Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P: USANZ: The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 2013,112(Suppl 2):6-20. 10.1111/bju.12381CrossRefPubMed

30.

Tan N, Margolis DJ, McClure TD, Thomas A, Finley DS, Reiter RE, Huang J, Raman SS: Radical prostatectomy: value of prostate MRI in surgical planning. Abdom Imaging 2012,37(4):664-74. 10.1007/s00261-011-9805-yCrossRefPubMed

31.

Prostate Cancer: Diagnosis and Treatment. 2014. NICE guidelines [CG175], https://www.nice.org.uk/guidance/cg175. Accessed May 2014 2014.

32.

Eberhardt SC, Carter S, Casalino DD, Merrick G, Frank SJ, Gottschalk AR, Leyendecker JR, Nguyen PL, Oto A, Porter C, Remer EM, Rosenthal SA: ACR Appropriateness Criteria prostate cancer-pretreatment detection, staging, and surveillance. J Am Coll Radiol 2013,10(2):83-92. 10.1016/j.jacr.2012.10.021CrossRefPubMed

Title: Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines
Authors: Jennifer Croke
Jillian Maclean
Balazs Nyiri
Yan Li
Kyle Malone
Leonard Avruch
Cathleen Kayser
Shawn Malone
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-014-0303-6

At a glance: The STEP trials

Springer Medicine

Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Association between radiation pneumonitis and tumor response in patients with NSCLC treated with chemoradiation

Objective consensus from decision trees

Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

A clinical study of lung cancer dose calculation accuracy with Monte Carlo simulation

The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities

PTV margin definition in hypofractionated IGRT of localized prostate cancer using cone beam CT and orthogonal image pairs with fiducial markers