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Journal of Radiation Oncology

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01-12-2017 | Original Research

Stereotactic ablative radiotherapy with targeted MRI-defined gross tumor dose escalation for prostate cancer: dosimetric feasibility and interfraction robustness

Authors: Ali Hosni, Vickie Kong, Tara Rosewall, Andrew Bayley, Cynthia Ménard, Peter Chung, Alejandro Berlin

Published in: Journal of Radiation Oncology | Issue 4/2017

Abstract

Objectives

The purpose of this study was to determine the dosimetric feasibility and reproducibility of stereotactic body radiotherapy (SBRT) with selective dose escalation for gross tumor volume (GTV) in prostate cancer.

Methods

Radiotherapy plans of previously treated patients with dose-escalated radiotherapy multiparametric MRI (mpMRI)-defined prostate and GTV were retrieved. Margins were re-created for prostate planning target volume (PTV) (PTV_36.25) and GTV-PTV (PTV₄₅), and two five-fraction SBRT VMAT plans were generated: (1) standard plan ([Sp], 36.25Gy/5Fx; V36.25 Gy-PTV_36.25 ≥95% and V40 Gy-prostate ≥95%) and (2) dose-escalated plan [DEp] with additional goal V45 Gy-PTV₄₅ ≥95%, while the same organs-at-risk (OAR) constraints. Delivered doses to targets and OAR were calculated from alternate days deformably registered cone beam computed tomography.

Results

In 23 patients (single GTV), all planned and delivered doses to targets and OAR in both Sp and DEp were within the ideal/acceptable criteria. No difference (p > 0.05) was observed in the proportion of Sp and DEp patients achieving ideal criteria either in planned or delivered doses except for prostatic urethra constraint. Differences between planned and delivered doses in DEp were not clinically relevant (i.e., mean differences lesser than 1 Gy).

Conclusion

Selective high-precision (i.e., mpMRI-defined targets, daily volumetric image guidance, intraprostatic fiducials) SBRT with GTV dose escalation seems feasible, without incremental dose to OAR. Prospective studies to determine its clinical benefit are warranted.

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Title: Stereotactic ablative radiotherapy with targeted MRI-defined gross tumor dose escalation for prostate cancer: dosimetric feasibility and interfraction robustness
Authors: Ali Hosni
Vickie Kong
Tara Rosewall
Andrew Bayley
Cynthia Ménard
Peter Chung
Alejandro Berlin
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 4/2017
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-017-0321-8

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Abstract

Objectives

Methods

Results

Conclusion

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