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dc.contributor.authorSanmamed, N.
dc.contributor.authorLee, J.
dc.contributor.authorBerlin, A.
dc.contributor.authorCraig, T.
dc.contributor.authorLao, B.
dc.contributor.authorRink, A.
dc.contributor.authorBayley, A.
dc.contributor.authorCatton, C.
dc.contributor.authorSundaramurthy, A.
dc.contributor.authorFoltz, W.
dc.contributor.authorMcPartlin, Andrew J
dc.contributor.authorGhai, S.
dc.contributor.authorAstenafu, E.
dc.contributor.authorGospodarowicz, M.
dc.contributor.authorWarde, P.
dc.contributor.authorMenard, C.
dc.contributor.authorChung, P.
dc.date.accessioned2020-10-06T13:33:45Z
dc.date.available2020-10-06T13:33:45Z
dc.date.issued2020en
dc.identifier.citationSanmamed N, Lee J, Berlin A, Craig T, Lao B, Rink A, et al. Tumor-targeted dose escalation for localized prostate cancer using MR-guided HDR brachytherapy (HDR) or integrated VMAT (IB-VMAT) boost: Dosimetry, toxicity and health related quality of life. Radiother Oncol. 2020;149:240-5.en
dc.identifier.pmid32447033en
dc.identifier.doi10.1016/j.radonc.2020.05.029en
dc.identifier.urihttp://hdl.handle.net/10541/623324
dc.description.abstractPurpose: To report dosimetry, preliminary toxicity and health-related quality of life (HRQoL) outcomes of tumor-targeted dose-escalation delivered by integrated boost volumetric arc therapy (IB-VMAT) or MR-guided HDR brachytherapy (HDR) boost for prostate cancer. Materials and methods: Patients diagnosed with localized prostate cancer, with at least 1 identifiable intraprostatic lesion on multiparametric MRI (mpMRI) were enrolled in a prospective non-randomized phase II study. All patients received VMAT to the prostate alone (76 Gy in 38 fractions) plus a GTV boost: IB-VMAT (95 Gy in 38 fractions) or MR-guided HDR (10 Gy single fraction). GTV was delineated on mpMRI and deformably registered to planning CT scans. Comparative dosimetry using EQD2 assuming α/β 3 Gy was performed. Toxicity and health-related quality of life data (HRQoL) data were collected using CTCAE v.4.0, International Prostate Symptom Score (IPSS) and the Expanded Prostate Index Composite (EPIC). Results: Forty patients received IB-VMAT and 40 HDR boost. Organs at risk and target minimal doses were comparable between the two arms. HDR achieved higher mean and maximal tumor doses (p < 0.05). Median follow-up was 31 months (range 25-48); Acute grade G2 genitourinary (GU) toxicity was 30% and 37.5% in IB-VMAT and HDR boost, while gastrointestinal (GI) toxicity was 7.5% and 10%, respectively. Three patients developed acute G3 events, two GU toxicity (one IB-VMAT and one HDR boost) and one GI (IB-VMAT). Late G2 GU toxicity was 25% and 17.5% in the IB-VMAT and HDR boost arm and G2 GI was 5% and 7.5%, respectively. Two patients, both on the IB-VMAT arm, developed late G3 toxicity: one GI and one GU. No statistically significant difference was found in HRQoL between radiotherapy techniques (p > 0.2). Urinary and bowel HRQoL domains in both groups declined significantly by week 6 of treatment in both arms (p < 0.05) and recovered baseline scores at 6 months. Conclusion: Intraprostatic tumor dose escalation using IB-VMAT or MR-guided HDR boost achieved comparable OAR dosimetry, toxicity and HRQOL outcomes, but higher mean and maximal tumor dose were achieved with the HDR technique. Further follow-up will determine long-term outcomes including disease control.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1016/j.radonc.2020.05.029en
dc.titleTumor-targeted dose escalation for localized prostate cancer using MR-guided HDR brachytherapy (HDR) or integrated VMAT (IB-VMAT) boost: Dosimetry, toxicity and health related quality of lifeen
dc.typeArticleen
dc.contributor.departmentPrincess Margaret Cancer Center, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Hospital Clinico San Carlos, Madrid, Spain.en
dc.identifier.journalRadiotherapy and Oncologyen
dc.description.noteen]


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