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Dose-volume relationships of planned versus estimated delivered radiation doses to pelvic organs at risk and side effects in patients treated with salvage radiotherapy for recurrent prostate cancer

Jóhannesson, Vilberg LU ; Gunnlaugsson, Adalsteinn LU ; Nilsson, Per LU orcid ; Brynolfsson, Patrik LU orcid ; Kjellén, Elisabeth LU and Wieslander, Elinore LU (2024) In Technical Innovations and Patient Support in Radiation Oncology 29.
Abstract

PURPOSE: To investigate estimated delivered dose distributions using weekly cone-beam computed tomography (CBCT) scans for pelvic organs at risk (OARs) in salvage radiotherapy (SRT) after radical prostatectomy. Furthermore, to compare them with the originally planned dose distributions and analyse associations with gastrointestinal (GI) and genitourinary (GU) side effects.

METHODS: This study is part of a phase II trial involving SRT for recurrent prostate cancer. Treatment was personalised based on PSA response during SRT, classifying patients as PSA responders or non-responders. Estimated radiation dose distributions were obtained using deformable image registration from weekly CBCT scans. GI and GU toxicities were assessed... (More)

PURPOSE: To investigate estimated delivered dose distributions using weekly cone-beam computed tomography (CBCT) scans for pelvic organs at risk (OARs) in salvage radiotherapy (SRT) after radical prostatectomy. Furthermore, to compare them with the originally planned dose distributions and analyse associations with gastrointestinal (GI) and genitourinary (GU) side effects.

METHODS: This study is part of a phase II trial involving SRT for recurrent prostate cancer. Treatment was personalised based on PSA response during SRT, classifying patients as PSA responders or non-responders. Estimated radiation dose distributions were obtained using deformable image registration from weekly CBCT scans. GI and GU toxicities were assessed using the RTOG toxicity scale, while patient-reported symptoms were monitored through self-assessment questionnaires.

RESULTS: The study included 100 patients, with similar treatment-related side effects observed in both responders and non-responders. Differences in dose-volume metrics between the planned and estimated delivered doses for the examined OARs were mostly modest, although generally statistically significant. We identified statistically significant associations between QUANTEC-recommended dose-volume constraints and acute bowel toxicity, as well as late urinary patient-reported symptoms, for both the estimated delivered and planned dose distributions.

CONCLUSION: We found small but statistically significant differences between estimated delivered and planned doses to OARs. These differences showed trends toward improved associations for estimated delivered dose distributions with side effects. Enhanced registration methods and imaging techniques could potentially further enhance the assessment of truly delivered doses and yield more reliable dose-volume constraints for future therapies.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Organs at risk, Prostate cancer, Volumetric-modulated arc therapy, Estimated delivered dose, Salvage radiotherapy
in
Technical Innovations and Patient Support in Radiation Oncology
volume
29
article number
100231
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85180563752
  • pmid:38192583
ISSN
2405-6324
DOI
10.1016/j.tipsro.2023.100231
language
English
LU publication?
yes
additional info
© 2023 The Author(s).
id
b5c0aabf-00da-49ea-aa11-7cb21d9f3614
date added to LUP
2024-01-10 11:25:26
date last changed
2024-11-08 21:14:01
@article{b5c0aabf-00da-49ea-aa11-7cb21d9f3614,
  abstract     = {{<p>PURPOSE: To investigate estimated delivered dose distributions using weekly cone-beam computed tomography (CBCT) scans for pelvic organs at risk (OARs) in salvage radiotherapy (SRT) after radical prostatectomy. Furthermore, to compare them with the originally planned dose distributions and analyse associations with gastrointestinal (GI) and genitourinary (GU) side effects.</p><p>METHODS: This study is part of a phase II trial involving SRT for recurrent prostate cancer. Treatment was personalised based on PSA response during SRT, classifying patients as PSA responders or non-responders. Estimated radiation dose distributions were obtained using deformable image registration from weekly CBCT scans. GI and GU toxicities were assessed using the RTOG toxicity scale, while patient-reported symptoms were monitored through self-assessment questionnaires.</p><p>RESULTS: The study included 100 patients, with similar treatment-related side effects observed in both responders and non-responders. Differences in dose-volume metrics between the planned and estimated delivered doses for the examined OARs were mostly modest, although generally statistically significant. We identified statistically significant associations between QUANTEC-recommended dose-volume constraints and acute bowel toxicity, as well as late urinary patient-reported symptoms, for both the estimated delivered and planned dose distributions.</p><p>CONCLUSION: We found small but statistically significant differences between estimated delivered and planned doses to OARs. These differences showed trends toward improved associations for estimated delivered dose distributions with side effects. Enhanced registration methods and imaging techniques could potentially further enhance the assessment of truly delivered doses and yield more reliable dose-volume constraints for future therapies.</p>}},
  author       = {{Jóhannesson, Vilberg and Gunnlaugsson, Adalsteinn and Nilsson, Per and Brynolfsson, Patrik and Kjellén, Elisabeth and Wieslander, Elinore}},
  issn         = {{2405-6324}},
  keywords     = {{Organs at risk; Prostate cancer; Volumetric-modulated arc therapy; Estimated delivered dose; Salvage radiotherapy}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Technical Innovations and Patient Support in Radiation Oncology}},
  title        = {{Dose-volume relationships of planned versus estimated delivered radiation doses to pelvic organs at risk and side effects in patients treated with salvage radiotherapy for recurrent prostate cancer}},
  url          = {{http://dx.doi.org/10.1016/j.tipsro.2023.100231}},
  doi          = {{10.1016/j.tipsro.2023.100231}},
  volume       = {{29}},
  year         = {{2024}},
}