Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control
Munck af Rosenschold, Per LU
; Zelefsky, Michael J.
; Apte, Aditya P.
; Jackson, Andrew
LU
; Oh, Jung Hun
; Shulman, Elliot
; Desai, Neil
; Hunt, Margie
; Ghadjar, Pirus
and Yorke, Ellen
, et al.
(2018)
In Radiation Oncology
13(1).
- 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... (More)
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.
(Less)
- author
- Munck af Rosenschold, Per
LU
; Zelefsky, Michael J.
; Apte, Aditya P.
; Jackson, Andrew
LU
; Oh, Jung Hun
; Shulman, Elliot
; Desai, Neil
; Hunt, Margie
; Ghadjar, Pirus
and Yorke, Ellen
, et al. (More)
- Munck af Rosenschold, Per
LU
; Zelefsky, Michael J.
; Apte, Aditya P.
; Jackson, Andrew
LU
; Oh, Jung Hun
; Shulman, Elliot
; Desai, Neil
; Hunt, Margie
; Ghadjar, Pirus
; Yorke, Ellen
and Deasy, Joseph O.
(Less)
- publishing date
- 2018-04-12
- type
- Contribution to journal
- publication status
- published
- keywords
- High risk disease, Image-guided, IMRT, Prostate cancer, Radiotherapy, Tumor control probability
- in
- Radiation Oncology
- volume
- 13
- issue
- 1
- article number
- 64
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:29650035
- scopus:85045397647
- ISSN
- 1748-717X
- DOI
- 10.1186/s13014-018-0978-1
- language
- English
- LU publication?
- no
- id
- 551bde80-0045-4f05-984f-4b962e1ab818
- date added to LUP
- 2020-07-28 08:39:06
- date last changed
- 2024-04-17 14:21:06
@article{551bde80-0045-4f05-984f-4b962e1ab818,
abstract = {{<p>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.</p>}},
author = {{Munck af Rosenschold, Per and Zelefsky, Michael J. and Apte, Aditya P. and Jackson, Andrew and Oh, Jung Hun and Shulman, Elliot and Desai, Neil and Hunt, Margie and Ghadjar, Pirus and Yorke, Ellen and Deasy, Joseph O.}},
issn = {{1748-717X}},
keywords = {{High risk disease; Image-guided; IMRT; Prostate cancer; Radiotherapy; Tumor control probability}},
language = {{eng}},
month = {{04}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Radiation Oncology}},
title = {{Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control}},
url = {{http://dx.doi.org/10.1186/s13014-018-0978-1}},
doi = {{10.1186/s13014-018-0978-1}},
volume = {{13}},
year = {{2018}},
}