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Adaptive sequential plan-on-plan optimization during prostate-specific antigen response guided radiotherapy of recurrent prostate cancer

Jóhannesson, Vilberg LU ; Wieslander, Elinore LU ; Nilsson, Per LU orcid ; Brun, Eva LU ; Bitzén, Ulrika LU ; Ahlgren, Göran LU ; Olsson, Tomas LU ; Bäck, Sven LU ; Kjellén, Elisabeth LU and Gunnlaugsson, Adalsteinn LU (2021) In Physics and imaging in radiation oncology 18. p.5-10
Abstract

Background: Treatment adaptation based on tumour biomarker response during radiotherapy of prostate cancer, could be used for both escalation and de-escalation of radiation doses and volumes. To execute an adaptation involving extension of treatment volumes during radiation can however be restricted by the doses already delivered. The aim of this work was to develop a treatment planning method that addresses this challenge. Material and methods: A volumetric-modulated-arc-therapy (VMAT) planning method with sequential plan-on-plan optimization was developed for a prospective phase II trial including 100 patients on salvage radiotherapy (SRT) for prostate cancer recurrence. A treatment adaptation was performed after five weeks of SRT... (More)

Background: Treatment adaptation based on tumour biomarker response during radiotherapy of prostate cancer, could be used for both escalation and de-escalation of radiation doses and volumes. To execute an adaptation involving extension of treatment volumes during radiation can however be restricted by the doses already delivered. The aim of this work was to develop a treatment planning method that addresses this challenge. Material and methods: A volumetric-modulated-arc-therapy (VMAT) planning method with sequential plan-on-plan optimization was developed for a prospective phase II trial including 100 patients on salvage radiotherapy (SRT) for prostate cancer recurrence. A treatment adaptation was performed after five weeks of SRT based on prostate-specific antigen response during this phase of the treatment. This involved extension of treatment volumes for non-responders (n = 64) to include pelvic lymph nodes and boost to 68Gallium-Prostate-Specific-Membrane-Antigen-Positron-Emission-Tomography positive lesions. This method was evolved by introducing an EQD2 (equivalent dose in 2.0 Gy fractions) correction of the base plan for improved dose coverage. Results: All dose-volume criteria for target coverage were met for the non-responders when based on physical dose. An EQD2 correction of the base plan for non-responders, implemented for the final 29 patients, led to a statistically significant improvement in dose coverage as compared to the 35 patients treated without EQD2 correction. Conclusions: This is to our knowledge the only study presented on biomarker-guided sequential VMAT radiotherapy using a plan-on-plan technique in the pelvis. By using a biologically adapted technique an improved target coverage was achieved without compromising doses to organs at risk.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Plan-on-plan, Prostate cancer, PSA response, PSA-guided radiotherapy, Salvage radiotherapy
in
Physics and imaging in radiation oncology
volume
18
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85103294833
  • pmid:34258401
ISSN
2405-6316
DOI
10.1016/j.phro.2021.03.001
language
English
LU publication?
yes
id
f8adb9cd-fed8-4f89-a708-8bed16ceaca4
date added to LUP
2021-04-07 08:25:35
date last changed
2024-06-15 09:21:04
@article{f8adb9cd-fed8-4f89-a708-8bed16ceaca4,
  abstract     = {{<p>Background: Treatment adaptation based on tumour biomarker response during radiotherapy of prostate cancer, could be used for both escalation and de-escalation of radiation doses and volumes. To execute an adaptation involving extension of treatment volumes during radiation can however be restricted by the doses already delivered. The aim of this work was to develop a treatment planning method that addresses this challenge. Material and methods: A volumetric-modulated-arc-therapy (VMAT) planning method with sequential plan-on-plan optimization was developed for a prospective phase II trial including 100 patients on salvage radiotherapy (SRT) for prostate cancer recurrence. A treatment adaptation was performed after five weeks of SRT based on prostate-specific antigen response during this phase of the treatment. This involved extension of treatment volumes for non-responders (n = 64) to include pelvic lymph nodes and boost to <sup>68</sup>Gallium-Prostate-Specific-Membrane-Antigen-Positron-Emission-Tomography positive lesions. This method was evolved by introducing an EQD2 (equivalent dose in 2.0 Gy fractions) correction of the base plan for improved dose coverage. Results: All dose-volume criteria for target coverage were met for the non-responders when based on physical dose. An EQD2 correction of the base plan for non-responders, implemented for the final 29 patients, led to a statistically significant improvement in dose coverage as compared to the 35 patients treated without EQD2 correction. Conclusions: This is to our knowledge the only study presented on biomarker-guided sequential VMAT radiotherapy using a plan-on-plan technique in the pelvis. By using a biologically adapted technique an improved target coverage was achieved without compromising doses to organs at risk.</p>}},
  author       = {{Jóhannesson, Vilberg and Wieslander, Elinore and Nilsson, Per and Brun, Eva and Bitzén, Ulrika and Ahlgren, Göran and Olsson, Tomas and Bäck, Sven and Kjellén, Elisabeth and Gunnlaugsson, Adalsteinn}},
  issn         = {{2405-6316}},
  keywords     = {{Plan-on-plan; Prostate cancer; PSA response; PSA-guided radiotherapy; Salvage radiotherapy}},
  language     = {{eng}},
  pages        = {{5--10}},
  publisher    = {{Elsevier}},
  series       = {{Physics and imaging in radiation oncology}},
  title        = {{Adaptive sequential plan-on-plan optimization during prostate-specific antigen response guided radiotherapy of recurrent prostate cancer}},
  url          = {{http://dx.doi.org/10.1016/j.phro.2021.03.001}},
  doi          = {{10.1016/j.phro.2021.03.001}},
  volume       = {{18}},
  year         = {{2021}},
}