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
dc.contributor.author | Sanmamed, N. | |
dc.contributor.author | Lee, J. | |
dc.contributor.author | Berlin, A. | |
dc.contributor.author | Craig, T. | |
dc.contributor.author | Lao, B. | |
dc.contributor.author | Rink, A. | |
dc.contributor.author | Bayley, A. | |
dc.contributor.author | Catton, C. | |
dc.contributor.author | Sundaramurthy, A. | |
dc.contributor.author | Foltz, W. | |
dc.contributor.author | McPartlin, Andrew J | |
dc.contributor.author | Ghai, S. | |
dc.contributor.author | Astenafu, E. | |
dc.contributor.author | Gospodarowicz, M. | |
dc.contributor.author | Warde, P. | |
dc.contributor.author | Menard, C. | |
dc.contributor.author | Chung, P. | |
dc.date.accessioned | 2020-10-06T13:33:45Z | |
dc.date.available | 2020-10-06T13:33:45Z | |
dc.date.issued | 2020 | en |
dc.identifier.citation | Sanmamed 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.pmid | 32447033 | en |
dc.identifier.doi | 10.1016/j.radonc.2020.05.029 | en |
dc.identifier.uri | http://hdl.handle.net/10541/623324 | |
dc.description.abstract | Purpose: 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.iso | en | en |
dc.relation.url | https://dx.doi.org/10.1016/j.radonc.2020.05.029 | en |
dc.title | 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 | en |
dc.type | Article | en |
dc.contributor.department | Princess 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.journal | Radiotherapy and Oncology | en |
dc.description.note | en] |