WorldWideScience

Sample records for prostate radiotherapy comparison

  1. Can the prostate brachytherapy by permanent implants represent an alternative to external radiotherapy for the localised prostate cancers with intermediary risk?

    International Nuclear Information System (INIS)

    Farnault, B.; Duberge, T.; Salem, N.; Boher, J.M.; Gravis, G.; Bladou, F.; Jochen, W.; Resbeut, M.

    2009-01-01

    Purpose: the prostate brachytherapy stands out as treatment of low risk prostate cancers, but the data concerning its use as exclusive treatment of intermediary risk prostate cancer are rare. We present a retrospective analysis of intermediary risk prostate cancers which treatment was either an external conformal radiotherapy or an exclusive brachytherapy. conclusion: In this mono centric series, the brachytherapy brings excellent results in comparison with external conformal radiotherapy with dose escalation and could be proposed as alternative to patients suffering of intermediary risk prostate cancer. (N.C.)

  2. [Radiotherapy in node-positive prostate cancer].

    Science.gov (United States)

    Bottke, D; Bartkowiak, D; Bolenz, C; Wiegel, T

    2016-03-01

    There are numerous randomized trials to guide the management of patients with localized (and metastatic) prostate cancer, but only a few (mostly retrospective) studies have specifically addressed node-positive patients. Therefore, there is uncertainty regarding optimal treatment in this situation. Current guidelines recommend long-term androgen deprivation therapy (ADT) alone or radiotherapy plus long-term ADT as treatment options. This overview summarizes the existing literature on the use of radiotherapy for node-positive prostate cancer as definitive treatment and as adjuvant or salvage therapy after radical prostatectomy. In this context, we also discuss several PET tracers in the imaging evaluation of patients with biochemical recurrence of prostate cancer after radical prostatectomy. As for definitive treatment, retrospective studies suggest that ADT plus radiotherapy improves overall survival compared with ADT alone. These studies also consistently demonstrated that many patients with node-positive prostate cancer can achieve long-term survival - and are likely curable - with aggressive therapy. The beneficial impact of adjuvant radiotherapy on survival in patients with pN1 prostate cancer seems to be highly influenced by tumor characteristics. Men with ≤ 2 positive lymph nodes in the presence of intermediate- to high-grade disease, or positive margins, and those with 3 or 4 positive lymph nodes are the ideal candidates for adjuvant radiotherapy (plus long-term ADT) after surgery. There is a need for randomized trials to further examine the potential role of radiotherapy as either definitive or adjuvant treatment, for patients with node-positive prostate cancer.

  3. Elevation of PSA after prostate radiotherapy: Rebound or biochemical recurrence?

    International Nuclear Information System (INIS)

    Toledano, A.; Kanoui, A.; Chiche, R.; Lamallem, H.; Beley, S.; Thibault, F.; Sebe, P.

    2008-01-01

    The fact that external beam radiotherapy and brachytherapy are now considered to be curative techniques has led to major review of the modalities of follow-up after radiotherapy for prostate cancer. The problem concerns both the diagnosis of recurrence, rapidly announced by elevation of prostatic-specific antigen (PSA), usually at a subclinical stage, and the validity of criteria of biochemical recurrence to allow comparison of various study. Physicians involved in follow-up should be aware of the potential of bounce in PSA follow-up after external beam radiotherapy or brachytherapy. The PSA bounce phenomenon was defined by a rise of PSA values (+ 0.1 -0.8 ng/ml) with a subsequent fall. Biochemical failure after external beam radiotherapy or brachytherapy (with or without hormonotherapy) was defined by Phoenix criteria by a rise of 2 ng/ml above an initial PSA nadir. This definition was more correlated to PSA bounce phenomenon. (authors)

  4. Daily-diary evaluated side-effects of conformal versus conventional prostatic cancer radiotherapy technique

    International Nuclear Information System (INIS)

    Widmark, A.; Fransson, P.; Franzen, L.; Littbrand, B.; Henriksson, R.

    1997-01-01

    Conventional 4-field box radiotherapy technique induces high morbidity for patients with localized prostatic cancer. Using a patient daily diary, the present study compared side-effects after conventional radiotherapy with conformal radiotherapy for prostate cancer. Fifty-eight patients treated with the conventional technique (with or without sucralfate) were compared with 72 patients treated with conformal technique. The patient groups were compared with an age-matched control population. Patients treated with conformal technique were also evaluated regarding acute and late urinary problems. Results showed that patients treated with conformal technique reported significantly fewer side-effects as compared with conventional technique. Patients treated with sucralfate also showed slightly decreased intestinal morbidity in comparison to non-sucralfate group. Acute and late morbidity evaluated by the patients was decreased after conformal radiotherapy as compared with the conventional technique. Sucralfate may be of value if conformal radiotherapy is used for dose escalation in prostatic cancer patients. (orig.)

  5. Comparison of manual and automatic MR-CT registration for radiotherapy of prostate cancer.

    Science.gov (United States)

    Korsager, Anne Sofie; Carl, Jesper; Riis Østergaard, Lasse

    2016-05-08

    In image-guided radiotherapy (IGRT) of prostate cancer, delineation of the clini-cal target volume (CTV) often relies on magnetic resonance (MR) because of its good soft-tissue visualization. Registration of MR and computed tomography (CT) is required in order to add this accurate delineation to the dose planning CT. An automatic approach for local MR-CT registration of the prostate has previously been developed using a voxel property-based registration as an alternative to a manual landmark-based registration. The aim of this study is to compare the two registration approaches and to investigate the clinical potential for replacing the manual registration with the automatic registration. Registrations and analysis were performed for 30 prostate cancer patients treated with IGRT using a Ni-Ti prostate stent as a fiducial marker. The comparison included computing translational and rotational differences between the approaches, visual inspection, and computing the overlap of the CTV. The computed mean translational difference was 1.65, 1.60, and 1.80mm and the computed mean rotational difference was 1.51°, 3.93°, and 2.09° in the superior/inferior, anterior/posterior, and medial/lateral direction, respectively. The sensitivity of overlap was 87%. The results demonstrate that the automatic registration approach performs registrations comparable to the manual registration.

  6. Palliative prostate radiotherapy for symptomatic advanced prostate cancer

    International Nuclear Information System (INIS)

    Din, Omar S.; Thanvi, Narottam; Ferguson, Catherine J.; Kirkbride, Peter

    2009-01-01

    Background and purpose: To report the results for the use of short-course palliative radiotherapy to the prostate for localised symptoms. Materials and methods: Fifty-eight patients were identified from radiotherapy records between 2003 and 2007. Data were collected retrospectively on patients' demographics, radiotherapy details and response. Symptoms and toxicity were scored, retrospectively, according to the following scale: 0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, and 3 = severe symptoms. Results: All the 58 patients had advanced prostate carcinoma. The median age at radiotherapy was 76.6 years (range 54-91). Fifty-six patients (97%) had hormone refractory disease. Twenty-seven patients (47%) had evidence of metastatic disease. 20Gy in 5 fractions was the most commonly used fractionation. The most frequent baseline symptom was haematuria (54%). Eighty-nine percent (31/35) of the patients had a complete or partial resolution of symptoms at 4 months. Response rates for individual symptoms (including unknown responses) were: rectal symptoms (75%), pelvic pain (69%), urinary obstruction (54%) and haematuria (42%). A >50% reduction in PSA occurred in five patients. Toxicity was mild to moderate only and was self-limiting. Conclusion: Palliative radiotherapy to the prostate gland for local symptoms appears to be an effective means of palliation with minimal toxic side effects. Prospective studies are now required to assess its benefits in more detail.

  7. Comparison of manual and automatic MR‐CT registration for radiotherapy of prostate cancer

    Science.gov (United States)

    Carl, Jesper; Østergaard, Lasse Riis

    2016-01-01

    In image‐guided radiotherapy (IGRT) of prostate cancer, delineation of the clinical target volume (CTV) often relies on magnetic resonance (MR) because of its good soft‐tissue visualization. Registration of MR and computed tomography (CT) is required in order to add this accurate delineation to the dose planning CT. An automatic approach for local MR‐CT registration of the prostate has previously been developed using a voxel property‐based registration as an alternative to a manual landmark‐based registration. The aim of this study is to compare the two registration approaches and to investigate the clinical potential for replacing the manual registration with the automatic registration. Registrations and analysis were performed for 30 prostate cancer patients treated with IGRT using a Ni‐Ti prostate stent as a fiducial marker. The comparison included computing translational and rotational differences between the approaches, visual inspection, and computing the overlap of the CTV. The computed mean translational difference was 1.65, 1.60, and 1.80 mm and the computed mean rotational difference was 1.51°, 3.93°, and 2.09° in the superior/inferior, anterior/posterior, and medial/lateral direction, respectively. The sensitivity of overlap was 87%. The results demonstrate that the automatic registration approach performs registrations comparable to the manual registration. PACS number(s): 87.57.nj, 87.61.‐c, 87.57.Q‐, 87.56.J‐ PMID:27167285

  8. Postoperative high-dose pelvic radiotherapy for N+ prostate cancer: Toxicity and matched case comparison with postoperative prostate bed-only radiotherapy

    International Nuclear Information System (INIS)

    Van Praet, Charles; Ost, Piet; Lumen, Nicolaas; De Meerleer, Gert; Vandecasteele, Katrien; Villeirs, Geert; Decaestecker, Karel; Fonteyne, Valérie

    2013-01-01

    Purpose: To report on toxicity of postoperative high-dose whole-pelvis radiotherapy (WPRT) with androgen deprivation therapy for lymph node metastasized (N1) prostate cancer (PC). To perform a matched-case analysis to compare this toxicity profile to postoperative prostate bed-only radiotherapy (PBRT). Materials and methods: Forty-eight N1-PC patients were referred for WPRT and 239 node-negative patients for PBRT. Patients were matched 1:1 according to pre-treatment demographics, symptoms, treatment and tumor characteristics. Mean dose to the prostate bed was 75 Gy (WPRT–PBRT) and 54 Gy to the elective nodes (WPRT) in 36 or 37 fractions. End points are genito-urinary (GU) and gastro-intestinal (GI) toxicity. Results: After WPRT, 35% developed grade 2 (G2) and 4% G3 acute GU toxicity. Acute GI toxicity developed in 42% (G2). Late GU toxicity developed in 36% (G2) and 7% (G3). One patient had G4 incontinence. Recuperation occurred in 59%. Late GI toxicity developed in 25% (G2) with 100% recuperation. Incidence of acute and late GI toxicity was higher following WPRT compared to PBRT (p ⩽ 0.041). GU toxicity was similar. With WPRT mean dose to bladder and rectosigmoid were higher. Conclusions: Postoperative high-dose WPRT comes at the cost of a temporary increase in G2. GI toxicity compared to PBRT because larger volumes of rectosigmoid are irradiated

  9. Radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Krause, S.; Herfarth, K.

    2011-01-01

    With the development of modern radiation techniques, such as intensity-modulated radiotherapy (IMRT), a dose escalation in the definitive radiotherapy of prostate cancer and a consecutive improvement in biochemical recurrence-free survival (BFS) could be achieved. Among others, investigators at the Memorial Sloan-Kettering Cancer Center (MSKCC) saw 5-year BFS rates of up to 98%. A further gain in effectiveness and safety is expected of hypofractionation schedules, as suggested by data published by Kupelian et al., who saw a low 5-year rate of grade ≥2 rectal side-effects of 4.5%. However, randomized studies are just beginning to mature. Patients with intermediate or high-risk tumors should receive neoadjuvant (NHT) and adjuvant (AHT) androgen deprivation. Bolla et al. could show an increase in 5-year overall survival from 62-78%. The inclusion of the whole pelvis in the treatment field (WPRT) is still controversial. The RTOG 94-13 study showed a significant advantage in disease-free survival after 60 months but long-term data did not yield significant differences between WPRT and irradiation of the prostate alone. The German Society of Urology strongly recommends adjuvant radiotherapy of the prostate bed for pT3 N0 tumors with positive margins. In a pT3 N0 R0 or pT2 N0 R+ situation, adjuvant radiotherapy should at least be considered. So far, no randomized data on NHT and AHT have been published, so androgen deprivation remains an individual decision in the postoperative setting. In a retrospective analysis Spiotto et al. reported a positive effect for adjuvant WPRT and biochemical control. This article summarizes the essential publications on definitive and adjuvant radiotherapy and discusses the additional use of androgen deprivation and WPRT. (orig.) [de

  10. Long-term follow-up after modern radical prostate cancer radiotherapy

    DEFF Research Database (Denmark)

    Sander, Lotte

    that clinical target volumes are up to 30% smaller on MRI delineation compared to computer tomography delineation. The overall aim of the thesis was to explore the use of MRI target planning and a Nicle-Titanium prostate stent as fiducial marker for both MR-CT co-registration and image guided radiotherapy....... radiotherapy is a well established treatment modality for prostate cancer. Accuracy and precision are key words with regard to optimal survival and minimal toxicity in modern radiotherapy and are fundamentals in modern radiotherapy. Modern imaging has improved the ability to define radiotherapy target volumes......A significant increase in the prostate cancer incidence has made prostate cancer a major health problem in recent years. Because of the often but unfortunately not always indolent nature of the disease, over-diagnosis and over-treatment are relevant clinical and ethic dilemmas. External beam...

  11. Surveillance after prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Supiot, S.; Rio, E.; Clement-Colmou, K.; Bouchot, O.; Rigaud, J.

    2011-01-01

    Follow-up after prostate cancer radiotherapy aims at detecting local or metastatic relapse, as well as long-term toxicity, requiring adapted treatments. Several scientific societies have published guidelines including clinical, biological and imaging recommendations. More data suggest a role for aggressive salvage therapy in case of local failure following radiotherapy. An adequate follow-up is required for the sake of patients' safety, i.e. to a posteriori validate dose constraints and radiation technique in each radiotherapy department. (authors)

  12. Salvage radiotherapy for prostate-specific antigen relapse after radical prostatectomy for prostate cancer. A single-center experience

    International Nuclear Information System (INIS)

    Yoshida, Takahiro; Nakayama, Masashi; Suzuki, Osamu

    2011-01-01

    The aim of this study was to investigate the efficacy and prognostic factors of salvage radiotherapy for prostate-specific antigen relapse after radical prostatectomy for prostate cancer at a single center in Japan. A retrospective review of the medical records of 51 patients who underwent salvage radiotherapy for prostate-specific antigen relapse after radical prostatectomy was carried out. Salvage radiotherapy was undergone for the single indication of at least two consecutive prostate-specific antigen elevations >0.1 ng/ml. Salvage radiotherapy was delivered to the prostatic bed at a total dose of 60 or 64 Gy. Late toxicity was scored according to the Common Terminology Criteria for Adverse Events 3.0. A total dose of 60 and 64 Gy were administered to 26 and 25 patients, respectively. The median prostate-specific antigen level at the initiation of radiotherapy was 0.29 ng/ml (range, 0.11-1.10 ng/ml). With a median follow-up of 57.3 months (range, 9.9-134.0 months), the prostate-specific antigen relapse-free rate at 5 years was 50.7%. Multivariate analysis using Cox's proportional hazards regression model revealed that the Gleason score at radical prostatectomy ≥8 significantly predicted prostate-specific antigen relapse after salvage radiotherapy (hazard ratio 4.531; 95% confidence interval 1.413-14.535; P=0.011). The prostate-specific antigen relapse-free rate at 5 years in the Gleason score at radical prostatectomy ≤7 and at radical prostatectomy ≥8 was 62.7 and 15.4%, respectively. Salvage radiotherapy was effective for prostate-specific antigen relapse after radical prostatectomy with tolerable toxicities in Japanese patients. A high Gleason score seemed to be a poor prognostic factor. (author)

  13. Outcomes following negative prostate biopsy for patients with persistent disease after radiotherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Jacob H. Cohen

    2010-02-01

    Full Text Available PURPOSE: When faced with biochemical recurrence after definitive radiotherapy for prostate cancer, clinicians must determine whether the recurrence is local or systemic. Post radiotherapy prostate biopsies to detect persistent local disease are difficult to interpret histopathologically and are subject to sampling error. Our study examines outcomes for patients with a negative prostate biopsy performed for rising prostate-specific antigen (PSA levels after prostate radiation. MATERIALS AND METHODS: We performed a retrospective review of 238 prostate cancer patients with a negative biopsy following definitive radiotherapy. Seventy-five of these patients had biochemical recurrence at the time of biopsy. A negative biopsy was defined as the absence of prostate cancer without radiation-treatment effect in the specimen. RESULTS: Patients underwent biopsy at a mean of 41 months after the completion of radiation. They had a mean PSA of 6. Patients were followed for an average of 63 months. Thirty-two patients (43% developed metastasis, and 11 (15% died of prostate cancer despite a negative post-radiation biopsy. Five of nine patients (56% with sequential biopsies had a positive second biopsy. CONCLUSIONS: Patients with PSA recurrence and a negative post-radiation biopsy have a high chance of persistent local disease, progression, and death from prostate cancer. Furthermore, an initial negative biopsy does not rule-out local recurrence. Patients with biochemical recurrence after radiotherapy for prostate cancer need to be evaluated earlier for local recurrence.

  14. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    International Nuclear Information System (INIS)

    Geinitz, Hans

    2015-01-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  15. Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer. A population-based analysis

    International Nuclear Information System (INIS)

    Abdollah, F.; Schmitges, J.; Sun, M.

    2012-01-01

    The objectives of this study were to compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer. Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age. For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65-69 years, 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients aged 75-80 years (all P<0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P<0.001). Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories. (author)

  16. Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review

    International Nuclear Information System (INIS)

    Pieters, Bradley R.; Back, Djuna Z. de; Koning, Caro C.E.; Zwinderman, Aeilko H.

    2009-01-01

    Background and Purpose: For the radiation treatment of prostate cancer high dose should be delivered for optimal biochemical control. Treatment can be given by dose-escalated external beam radiotherapy (EBRT) or external beam radiotherapy combined with a radioactive seed implantation (EBSeeds) or high-dose rate (HDR) brachytherapy (EBTI). Differences in outcome between the modalities were assessed by a systematic review. Materials and methods: A systematic search was performed resulting in 40 articles to be used. Data were extracted on biochemical control and overall survival at 3, 5, and 8 years and other time points mentioned in the articles. Also known prognostic parameters were noted. Comparison of the modalities was done by a Weibull survival analysis and estimation of Hazard Ratio's (HR) was done with 95% confidence intervals (95% CIs). Results: The HR for biochemical recurrence was 1.40 (95% CI 1.31-1.51) for EBRT relative to EBTI, and was 1.37 (95% CI 1.26-1.49) for EBSeeds relative to EBTI. The HR for overall survival was 1.50 (95% CI 1.29-1.73) for EBRT relative to EBTI, and was 2.33 (95% CI 2.04-2.66) for EBSeeds relative to EBTI. Conclusion: The combination of external beam radiotherapy and HDR brachytherapy results in a superior biochemical control and overall survival found in a systematic review on radiotherapy for prostate cancer.

  17. Five-year follow-up using a prostate stent as fiducial in image-guided radiotherapy of prostate cancer.

    Science.gov (United States)

    Carl, Jesper; Sander, Lotte

    2015-06-01

    To report results from the five-year follow-up on a previously reported study using image-guided radiotherapy (IGRT) of localized or locally advanced prostate cancer (PC) and a removable prostate stent as fiducial. Patients with local or locally advanced PC were treated using five-field 3D conformal radiotherapy (3DRT). The clinical target volumes (CTV) were treated to 78 Gy in 39 fractions using daily on-line image guidance (IG). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were scored using the radiotherapy oncology group (RTOG) score and the common toxicity score of adverse events (CTC) score. Urinary symptoms were also scored using the international prostate symptom score (IPSS). Median observation time was 5.4 year. Sixty-two of the 90 patients from the original study cohort were eligible for toxicity assessment. Overall survival, cancer-specific survival and biochemical freedom from failure were 85%, 96% and 80%, respectively at five years after radiotherapy. Late toxicity GU and GI RTOG scores≥2 were 5% and 0%. Comparing pre- and post-radiotherapy IPSS scores indicate that development in urinary symptoms after radiotherapy may be complex. Prostate image-guided radiotherapy using a prostate stent demonstrated survival data comparable with recently published data. GU and GI toxicities at five-year follow-up were low and comparable to the lowest toxicity rates reported. These findings support that the precision of the prostate stent technique is at least as good as other techniques. IPSS revealed a complex development in urinary symptoms after radiotherapy.

  18. Toxicity Profile With a Large Prostate Volume After External Beam Radiotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Fischedick, Karin; Asadpour, Branka; Gagel, Bernd; Piroth, Marc D.; Nussen, Sandra; Eble, Michael J.

    2008-01-01

    Purpose: To assess the impact of prostate volume on health-related quality of life (HRQOL) before and at different intervals after radiotherapy for prostate cancer. Methods and Materials: A group of 204 patients was surveyed prospectively before (Time A), at the last day (Time B), 2 months after (Time C), and 16 months (median) after (Time D) radiotherapy, with a validated questionnaire (Expanded Prostate Cancer Index Composite). The group was divided into subgroups with a small (11-43 cm 3 ) and a large (44-151 cm 3 ) prostate volume. Results: Patients with large prostates presented with lower urinary bother scores (median 79 vs. 89; p = 0.01) before treatment. Urinary function/bother scores for patients with large prostates decreased significantly compared to patients with small prostates due to irritative/obstructive symptoms only at Time B (pain with urination more than once daily in 48% vs. 18%; p 3 vs. 47 cm 3 ; p < 0.01). Conclusions: Patients with a large prostate volume have a great risk of irritative/obstructive symptoms (particularly dysuria) in the acute radiotherapy phase. These symptoms recover rapidly and do not influence long-term HRQOL

  19. Guidelines for primary radiotherapy of patients with prostate cancer

    International Nuclear Information System (INIS)

    Boehmer, Dirk; Maingon, Philippe; Poortmans, Philip; Baron, Marie-Helene; Miralbell, Raymond; Remouchamps, Vincent; Scrase, Christopher; Bossi, Alberto; Bolla, Michel

    2006-01-01

    Background and purposes: The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. Patients and methods: Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. Results: Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. Conclusions: On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer

  20. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    Energy Technology Data Exchange (ETDEWEB)

    Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology; Linz Univ. (Austria). Medical Faculty; Roach, Mack III [California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology; Van As, Nicholas (ed.) [The Institute of Cancer Research, Sutton Surrey (United Kingdom)

    2015-04-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  1. Radiotherapy of prostate cancer with or without intensity modulated beams: a planning comparison

    International Nuclear Information System (INIS)

    Meerleer, Gert O. de; Vakaet, Luc A.M.L.; Gersem, Werner R.T. de; Wagter, Carlos de; Naeyer, Bart de; Neve, Wilfried de

    2000-01-01

    Purpose: To evaluate whether intensity modulated radiotherapy (IMRT) by static segmented beams allows the dose to the main portion of the prostate target to escalate while keeping the maximal dose at the anterior rectal wall at 72 Gy. The value of such IMRT plans was analyzed by comparison with non-IMRT plans using the same beam incidences. Methods and Materials: We performed a planning study on the CT data of 32 consecutive patients with localized adenocarcinoma of the prostate. Three fields in the transverse plane with gantry angles of 0 deg. , 116 deg. , and 244 deg. were isocentered at the center of gravity of the target volume (prostate and seminal vesicles). The geometry of the beams was determined by beam's eye view autocontouring of the target volume with a margin of 1.5 cm. In study 1, the beam weights were determined by a human planner (3D-man) or by computer optimization using a biological objective function with (3D-optim-lim) or without (3D-optim-unlim) a physical term to limit target dose inhomogeneity. In study 2, the 3 beam incidences mentioned above were used and in-field uniform segments were added to allow IMRT. Plans with (IMRT-lim) or without (IMRT-unlim) constraints on target dose inhomogeneity were compared. In the IMRT-lim plan, target dose inhomogeneity was constrained between 15% and 20%. After optimization, plans in both studies were normalized to a maximal rectal dose of 72 Gy. Biological (tumor control probability [TCP], normal tissue complication probability [NTCP]) and physical indices for tumor control and normal tissue complication probabilities were computed, as well as the probability of the uncomplicated local control (P+). Results: The IMRT-lim plan was superior to all other plans concerning TCP (p =no. 89%). For bladder, maximal bladder dose was significantly higher in the IMRT-unlim plan compared to all other plans (p no. <=no. 0.0001). P+ was significantly higher in both IMRT-plans than in all other plans. The 3D

  2. Robotic radiotherapy for prostate cancer with CyberKnife

    International Nuclear Information System (INIS)

    Hannoun-Levi, J.M.; Benezery, K.; Bondiau, P.Y.; Marcie, S.; Gerard, J.P.; Chamorey, E.

    2007-01-01

    After 3D conformal radiation therapy without and with modulated intensity, image-guided radiation therapy represents a new technological step. Should prostate cancer treatment using radiotherapy with the CyberKnife robotic system be considered as a new treatment and then investigated through classical clinical research procedure rather than a technical improvement of an already validated treatment? After a general presentation of the CyberKnife, the authors focused on prostate cancer treatment assuming that, according to dosimetric and biological considerations, the treatment by robotic system appears comparable to high dose rate brachytherapy. For prostate cancer treatment are discussed: biological rational for hypo fractionated treatment, high dose rate brachytherapy boost and interest of dose escalation. A comparison is presented between CyberKnife and other validated treatment for prostate cancer (radical prostatectomy, 3D conformal radiation therapy and low and high dose rate brachytherapy). In summary, CyberKnife treatment could be considered as a technical improvement of an already validated treatment in order to deliver a prostate boost after pelvic or peri-prostatic area irradiation. However, the clinical, biological and economical results must be precisely analyzed and could be assessed in the frame of a National Observatory based on shared therapeutic program. (authors)

  3. Clinical and technical guide on prostate cancer proposal treated with radiotherapy

    International Nuclear Information System (INIS)

    Loria Ruiz, Rolando Alberto

    2013-01-01

    New treatment schemes with radiotherapy in prostate cancer are reviewed. The different modalities for the treatment of prostate cancer are described, such as surgery, chemotherapy and radiotherapy. Hypofractionated treatments and intensity-modulated radiotherapy are studied. The benefit of implementing these schemes in the Caja Costarricense del Seguro Social is analyzed [es

  4. Dosimetric Evaluation of Intensity Modulated Radiotherapy and 4-Field 3-D Conformal Radiotherapy in Prostate Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Bora Uysal

    2013-03-01

    Full Text Available Objective: The purpose of this dosimetric study is the targeted dose homogeneity and critical organ dose comparison of 7-field Intensity Modulated Radiotherapy (IMRT and 3-D 4-field conformal radiotherapy. Study Design: Cross sectional study. Material and Methods: Twenty patients with low and moderate risk prostate cancer treated at Gülhane Military Medical School Radiation Oncology Department between January 2009 and December 2009 are included in this study. Two seperate dosimetric plans both for 7-field IMRT and 3D-CRT have been generated for each patient to comparatively evaluate the dosimetric status of both techniques and all the patients received 7-field IMRT. Results: Dose-comparative evaluation of two techniques revealed the superiority of IMRT technique with statistically significantly lower femoral head doses along with reduced critical organ dose-volume parameters of bladder V60 (the volume receiving 60 Gy and rectal V40 (the volume receiving 40 Gy and V60. Conclusion: It can be concluded that IMRT is an effective definitive management tool for prostate cancer with improved critical organ sparing and excellent dose homogenization in target organs of prostate and seminal vesicles.

  5. Quality of Life After Whole Pelvic Versus Prostate-Only External Beam Radiotherapy for Prostate Cancer: A Matched-Pair Comparison

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Piroth, Marc D.; Holy, Richard; Fischedick, Karin; Klotz, Jens; Szekely-Orban, Dalma; Eble, Michael J.

    2011-01-01

    Purpose: Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer. Methods and Materials: A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age ± 5years, planning target volume ± 10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT ± 10, and use of antiandrogens. Results: With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p once a day in 15% vs. 3%; p = 0.03), bloody stools (≥half the time in 7% vs. 0%; p = 0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p < 0.01) more often than did patients after PORT. Conclusion: In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.

  6. Prostate cancer radiotherapy in elderly person; Radiotherapie du cancer de la prostate chez la personne agee

    Energy Technology Data Exchange (ETDEWEB)

    Serre, A. [Centre Alexis-Vautrin, Nancy (France)

    2011-10-15

    The author discusses the issue of prostate cancer radiotherapy in the case of elderly persons. The choice of the therapeutic strategy (local, hormonotherapy, simple monitoring) is complex. Different aspects must be considered: the carcinologic situation assessment, the patient health condition, the patient life expectancy, and the possible side effects of treatment. Radiotherapy appears to be a major therapeutic asset, but dose levels, toxicity effects must then be considered. Short communication

  7. Sexual dysfunction after curietherapy and external radiotherapy of the prostate for localized prostate cancer

    International Nuclear Information System (INIS)

    Huyghe, E.; Bachaud, J.-M.; Achard, J.-L.; Bossi, A.; Droupy, S.

    2009-01-01

    Knowing the importance of sexuality items in the choice by the patient of the modality of treatment of localized prostate cancer, we aimed at reviewing and updating the effects of prostate radiotherapy and brachytherapy on sexual functions. A PubMed search was done using the keywords: prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, ejaculation and orgasm. After both radiotherapy and brachytherapy, sexual troubles occur progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. Even though the pathophysiological pathways by which radiotherapy and brachytherapy result in erectile dysfunction have not yet been fully clarified, arterial damage and exposure of neurovascular bundle to high levels of radiation seem to be two main causes of erectile dysfunction after radiotherapy and brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of erectile dysfunction. Another important factor following radiotherapy is the treatment modality. Not many data about ejaculation and orgasm after radiation treatments have been published yet. Recent data show that most of the population treated by brachytherapy conserves ejaculation and orgasm after treatment, even if a majority describe reduction of volume and deterioration of orgasm. Patients need to be correctly informed on the possible sequela of radiotherapy and brachytherapy on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for erectile dysfunction. (authors)

  8. Quality of radiotherapy reporting in randomized controlled trials of prostate cancer.

    Science.gov (United States)

    Soon, Yu Yang; Chen, Desiree; Tan, Teng Hwee; Tey, Jeremy

    2018-06-07

    Good radiotherapy reporting in clinical trials of prostate radiotherapy is important because it will allow accurate reproducibility of radiotherapy treatment and minimize treatment variations that can affect patient outcomes. The aim of our study is to assess the quality of prostate radiotherapy (RT) treatment reporting in randomized controlled trials in prostate cancer. We searched MEDLINE for randomized trials of prostate cancer, published from 1996 to 2016 and included prostate RT as one of the intervention arms. We assessed if the investigators reported the ten criteria adequately in the trial reports: RT dose prescription method; RT dose-planning procedures; organs at risk (OAR) dose constraints; target volume definition, simulation procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance (QA) as well as presence or absence of deviations in RT treatment planning and delivery. We performed multivariate logistic regression to determine the factors that may influence the quality of reporting. We found 59 eligible trials. There was significant variability in the quality of reporting. Target volume definition, total RT dose and fractionation schedule were reported adequately in 97% of included trials. OAR constraints, simulation procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in 30% of included trials. Twenty-four trials (40%) reported seven criteria or more adequately. Multivariable logistic analysis showed that trials that published their quality assurance results and cooperative group trials were more likely to have adequate quality in reporting in at least seven criteria. There is significant variability in the quality of reporting on prostate radiotherapy treatment in randomized trials of prostate cancer. We need to have consensus guidelines to standardize the reporting of radiotherapy treatment in randomized trials.

  9. Conformal radiotherapy for prostate cancer: contribution of pelvic immobilization and new fiducial markers

    International Nuclear Information System (INIS)

    Garcia, R.; Oozeer, R.; Le Thanh, H.; Chauvet, B.; Toy, B.J.; Reboul, F.

    1997-01-01

    To reduce errors in the positioning of patients treated with external conformal radiotherapy for prostate cancer, we evaluated both the use of an immobilization device and new fiducial markers. The immobilization device consisted of an individual mold made of polyurethane foam. Two sets of skin markers located on the anterior tibial surfaces were used to identify the pelvic isocenter. The patient's position was evaluated by orthogonal port film which were then compared with the original simulation film. Results are presented with respect to orthogonal axes. Comparison with classic procedures without immobilization showed that use of the mold and new fiducial markers led to a decrease in set-up errors which were less than 5 mm. With the use of an immobilization device and optimized techniques for patients' positioning, conformal radiotherapy of prostate cancer is more accurate. (authors)

  10. Peripheral lymphocyte subset variation predicts prostate cancer carbon ion radiotherapy outcomes

    Science.gov (United States)

    Shi, Ze-Liang; Li, Bing-Xin; Wu, Xian-Wei; Li, Ping; Zhang, Qing; Wei, Xun-Bin; Fu, Shen

    2016-01-01

    The immune system plays a complementary role in the cytotoxic activity of radiotherapy. Here, we examined changes in immune cell subsets after heavy ion therapy for prostate cancer. The lymphocyte counts were compared with acute radiotherapy-related toxicity, defined according to the Common Terminology Criteria for Adverse Events, and short-term local efficacy, defined based on prostate-specific antigen concentrations. Confirmed prostate cancer patients who had not received previous radiotherapy were administered carbon ion radiotherapy (CIR) in daily fractions of 2.74 GyE with a total dose of 63-66 GyE. Lymphocyte subset counts were investigated before, during and after radiotherapy, and at a 1 month follow-up. Most notable among our findings, the CD4/CD8 ratio and CD19+ cell counts were consistently higher in patients with a complete response (CR) or partial response (PR) to CIR than in those classified in the stable disease (SD) group (P<0.05 for both). But CD3+ and CD8+ cell counts were lower in the CR and PR groups than in the SD group. These results indicate that variations in peripheral lymphocyte subpopulations are predictive of outcome after CIR for prostate cancer. PMID:27029063

  11. Rotational radiotherapy for prostate cancer in clinical practice

    DEFF Research Database (Denmark)

    Aznar, Marianne C; Petersen, Peter Meidahl; Logadottir, Ashildur

    2010-01-01

    Radiotherapy is the standard treatment in locally advanced prostate cancer. The latest technological improvement is modulated rotational radiotherapy, where one single rotation of the treatment machine is used to conform the dose delivery to the target and spare organs at risk, requiring less than...

  12. Radiotherapy for prostatic cancer in patients aged 75 or older

    International Nuclear Information System (INIS)

    Hisada, Tomohiro; Kataoka, Masaaki; Mogami, Hiroshi; Inoue, Takeshi; Uemura, Masahiko; Sumiyoshi, Yoshiteru; Nagao, Shuji

    2000-01-01

    Thirty-eight patients with prostatic cancer treated with radiotherapy giving a mean dose of 60.7 Gy between 1992 and 1997 at Shikoku Cancer Center Hospital were reviewed and the treatment outcomes were investigated retrospectively. About two-third of the patients were treated with radiation by linear accelerator with 40 to 46 Gy to the whole pelvis and with 20 to 26 Gy boost to the prostate area and the other one-third were treated only to the prostate area. For almost patients, external beam radiotherapy in combination with endocrine therapy was used. The median duration of follow-up was 36 months. Overall 5-year survival and 5-year relapse-free survival rate were 65.8%, and 88.9%, respectively. Severe rectal late morbidity (over grade 3) according to RTOG grading system were seen in one (2.6%). Although the number of cases was rather small and the follow-up duration was rather short, conventional external beam radiotherapy in combination with endocrine therapy may contribute to the survival benefit of patients with prostatic cancer in aged 75 or older. Radiotherapy for elderly prostatic cancer patients should be treated with an effort to decrease the late morbidity and not to deteriorate the QOL of the patients, because many patients were died of other causes than cancer. (author)

  13. Chromosomal aberration in peripheral lymphocytes and doses to the active bone marrow in radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Gershkevitsh, E.; Trott, K.R.

    2002-01-01

    Purpose: Radiotherapy plays an important role in the management of prostate cancer. Epidemiological data indicate a small but significant risk of radiation-induced leukemia after radiotherapy which might be related to the high mean bone marrow dose associated with radiotherapy of prostate cancer. The purpose of the study was to investigate the relation between the mean bone marrow dose and unstable chromosome aberrations in peripheral blood lymphocytes in patients undergoing conformal radiotherapy for prostate cancer as a possible indicator of risk. Endometrial cancer patients were also included for comparison. Patients and Methods: Nine patients, six with prostate cancer (60-73 years old) and three with endometrial cancer (61-81 years old) treated with radiotherapy were included in the study. The non-bony spaces inside the pelvic bones were outlined on every CT slice using the treatment planning system and mean doses to the bone marrow calculated. Blood samples of the patients were obtained at different times before, during and at the end of treatment. Lymphocytes were cultured in the usual way and metaphases scored for dicentric aberrations. Results: 46 samples from nine patients were obtained. The mean number of metaphases analyzed per sample was 180 with a range from 52 to 435. The mean bone marrow doses for prostate cancer patients ranged from 2.8 to 4.2 Gy and for endometrial cancer patients from 12.8 to 14.8 Gy. The aberration yield increased with the planning target volume and the mean bone marrow dose. Conclusion: The yield of dicentric aberrations for prostate cancer patients correlated closely with the mean bone marrow dose albeit the induction of dicentrics occurred in mature T lymphocytes most of which were probably in transit through the irradiated volumes. Therefore, the observed relationship between dicentrics and mean bone marrow doses are indirect. (orig.) [de

  14. Testicular Doses in Image-Guided Radiotherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    Deng Jun; Chen Zhe; Yu, James B.; Roberts, Kenneth B.; Peschel, Richard E.; Nath, Ravinder

    2012-01-01

    Purpose: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. Results: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGy to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior–inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. Conclusions: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT–contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.

  15. Testicular Doses in Image-Guided Radiotherapy of Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Deng Jun, E-mail: jun.deng@yale.edu [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States); Chen Zhe; Yu, James B.; Roberts, Kenneth B.; Peschel, Richard E.; Nath, Ravinder [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States)

    2012-01-01

    Purpose: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. Results: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGy to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior-inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. Conclusions: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT-contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.

  16. Evaluation of inter-fraction error during prostate radiotherapy

    International Nuclear Information System (INIS)

    Komiyama, Takafumi; Nakamura, Koji; Motoyama, Tsuyoshi; Onishi, Hiroshi; Sano, Naoki

    2008-01-01

    The purpose of this study was to evaluate inter-fraction error (inter-fraction set-up error+inter-fraction internal organ motion) between treatment planning and delivery during radiotherapy for localized prostate cancer. Twenty three prostate cancer patients underwent image-guided radical irradiation with the CT-linac system. All patients were treated in the supine position. After set-up with external skin markers, using CT-linac system, pretherapy CT images were obtained and isocenter displacement was measured. The mean displacement of the isocenter was 1.8 mm, 3.3 mm, and 1.7 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The maximum displacement of the isocenter was 7 mm, 12 mm, and 9 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The mean interquartile range of displacement of the isocenter was 1.8 mm, 3.7 mm, and 2.0 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. In radiotherapy for localized prostate cancer, inter-fraction error was largest in the ventral-dorsal directions. Errors in the ventral-dorsal directions influence both local control and late adverse effects. Our study suggested the set-up with external skin markers was not enough for radical radiotherapy for localized prostate cancer, thereby those such as a CT-linac system for correction of inter-fraction error being required. (author)

  17. Health-related quality of life after adjuvant and salvage postoperative radiotherapy for prostate cancer - A prospective analysis

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Fischedick, Karin; Asadpour, Branka; Gagel, Bernd; Piroth, Marc D.; Holy, Richard; Krenkel, Barbara; Eble, Michael J.

    2008-01-01

    Background and purpose: The aim of the study was to analyze health-related quality of life changes after postoperative radiotherapy (RT) for prostate cancer. Materials and methods: A group of 101 patients has been surveyed prospectively before (time A), at the last day (B), two months after (C) and >1 year after (D) RT using a validated questionnaire (Expanded Prostate Cancer Index Composite) with urinary, bowel, sexual and hormonal domains. The prostatic fossa was treated with a four-field box technique up to a total dose of 66.6 Gy. Results: While median urinary scores reached baseline levels already two months after radiotherapy (function/bother scores at time A-B-C-D: 94/89-89/75-94/89-94/89; A vs. B: p 1 year, only minor HRQOL changes occurred in comparison to baseline scores

  18. DOSE-ESCALATED EXTERNAL BEAM RADIOTHERAPY DURING HORMONO-RADIOTHERAPY FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    Yu. V. Gumenetskaya

    2016-01-01

    Full Text Available Introduction. The introduction of modern technologies of conformal external beam radiotherapy (EBRT into clinical practice for the treatment of prostate cancer requires proper quality assurance measures as well as a careful analysis of both the efficacy and toxicity data of treatments. The purpose of this study was to inves- tigate tolerance and the immediate efficacy of conformal dose-escalated EBRT during hormono-radiotherapy for prostate cancer. material and methods. The study involved 156 prostate cancer patients treated with EBRT. Among them, 30 patients received a total dose of 70 Gy, and in 126 patients the total dose was esca- lated to 72-76 Gy (median total dose - 74.0 Gy. Fifty-nine patients received intensity modulated radiation therapy. Results. The prescribed course of treatment was completed in all the patients with prostate cancer. Acute radiation-induced bladder reactions (RTOG were observed in 50 (32.1 % patients, of whom 48 (30.8 % experienced grade I reactions, and 2 (1.3 % experienced grade II reactions. Eighteen (11.5 % patients had radiation-induced rectum reactions, not above grade I. The development of grade II dysuric phenomena necessitated treatment interruption only in two patients. Of 9 (5.8 % patients who had late bladder complica- tions (RTOG/EORTC, 8 (5.1 % patients developed grade I complications, and one (0.6 % patient developed grade II complications. Of 11 (7.1 % patients who had rectum complications, 8 (5.1 % patients developed grade I complications, and 3 (1.9 % patients developed grade II complications. No patients experienced the increase in toxicity of treatment during dose escalation up to a total dose exceeding 70 Gy. During the follow-up period, only one patient developed recurrent disease. Conclusion. The results of our study suggest acceptable levels of toxicity following a continuous course of dose-escalated EBRT given in conjunction with hormono-radiotherapy to prostate cancer patients. Further

  19. Prospective survey of erectile dysfunction after external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Kikuchi, Eiji; Ando, Toshiyuki; Nagata, Hirohiko; Miyajima, Akira; Nakagawa, Ken; Oya, Mototsugu; Nakashima, Jun; Marumo, Ken

    2011-01-01

    We prospectively evaluated the effect of external beam radiotherapy on erectile function in patients with localized or locally advanced prostate cancer using the Japanese version of the International Index of Erectile Function (IIEF) survey. From 2000 to 2007, we identified 55 patients who underwent external beam radiotherapy at our institution for localized or locally advanced prostate cancer and could respond to the IIEF survey. The patients did not receive neo- and/or adjuvant hormone therapy and they were followed-up for at least 12 months after radiotherapy. Mean patient age was 69 years and the mean prostate specific antigen (PSA) level before radiotherapy was 24.9 ng/ml. First we evaluated the change of the erectile function domain score over time before and after radiotherapy. The population of severe erectile dysfunction (ED) increased while those with no or mild ED decreased after radiotherapy. The erectile function and intercourse satisfaction domain score of the IIEF declined significantly after radiotherapy, however, the orgasmic function, sexual desire, and overall satisfaction domain scores did not change after external beam radiation. Of the 34 patients who had erectile function at baseline, 10 patients could maintain erectile function 12 months after radiotherapy. Though there were no significant differences in clinical features between patients who could maintain erectile function and those who had worsening erectile function 12 months after radiotherapy, the sexual desire domain score before radiotherapy was significantly higher in patients who could maintain erectile function than their counterparts. Using the IIEF survey, external beam radiation was found to affect erectile function in patients with localized or locally advanced prostate cancer. (author)

  20. Ultrasonographic changes in the normal and malignant prostate after definitive radiotherapy

    International Nuclear Information System (INIS)

    Egawa, S.; Carter, S.S.; Wheeler, T.M.; Scardino, P.T.

    1989-01-01

    As treatments for early localized prostate cancer come under closer scrutiny, the fundamental problem of documenting the success of radiotherapy becomes more obvious. Currently, no satisfactory method exists to determine tumor viability after radiotherapy. Transrectal ultrasonography is particularly valuable for monitoring the response of prostate cancer to radiotherapy. Persistent cancer retains its hypoechoic appearance after definitive radiotherapy. Hypoechoic lesions greater than 5 mm in diameter found more than 12 months after radiotherapy should be suspected of representing persistent local disease. In our study, albeit in a selected group of patients undergoing salvage radical prostatectomy, 92 per cent of such findings were associated with what we interpreted as viable tumor by light microscopy. Ultrasound-guided biopsy should be considered in such circumstances. The persistence of hypoechoic lesions in more than 65 per cent of patients 12 to 36 months after radiotherapy also suggests that local treatment failure may be underestimated by digital rectal examination and random digitally guided biopsy. Serial measurement of the diameter of hypoechoic lesions may provide a valuable indicator of progress in an individual patient. Patients with enlarging foci of tumor within the prostate after radiotherapy might be selected for biopsy and further treatment. If such a policy is employed, it is likely that a higher incidence of persistent cancer will be found after radiotherapy than has previously been discovered by random digitally guided biopsy

  1. Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pollack, Alan; Zagars, Gunar K; Kopplin, Susan

    1995-04-30

    Purpose: The response of patients with clinical stages T1-4 prostate cancer to radiotherapy is variable. A particularly poor prognostic group has been found to be comprised of those with pretreatment prostate specific antigen (PSA) levels above 30 ng/ml with any tumor grade, or PSA levels > 10 and {<=} 30 with tumors grade 3 or 4. These patients have over an 80% actuarial risk of biochemical failure 3 years after definitive external beam radiotherapy. Thus, patients with these high-risk features require more aggressive therapy. During the last 3-4 years, the policy to treat such patients with radiotherapy and androgen ablation (XRT/HORM) was instituted. A retrospective comparison was made between high-risk patients treated with radiotherapy alone (XRT) vs. XRT/HORM. Methods and Materials: Between 1987 and 1991, there were 81 high-risk patients treated with XRT. There were 38 high-risk patients treated with XRT/HORM between 1990 and 1992. The median follow-up was 37 months for the XRT group and 22 months for the XRT/HORM group. No patient had clinical, radiographic, or pathologic evidence of lymph node involvement. The median dose to the prostate was 66 Gy for the XRT group and 68 Gy for the XRT/HORM group. Results: The distributions of several potential prognostic factors were analyzed. Significant differences between the groups were observed for tumor grade, pretreatment prostatic acid phosphatase, and age. The XRT/HORM group was composed of patients with worse features, including a greater proportion of patients with grade 4 tumors, more with abnormal acid phosphatase levels, and more under 60 years of age. The actuarial incidence of a rising PSA at 3 years for the XRT group was 81% vs. 15% for the XRT/HORM group (p < 0.0001). In addition, local relapse at 3 years was 34% for the XRT group and 15% for the XRT/HORM group (p < 0.02). There was no difference between the groups in terms of survival. Cox proportional hazards analyses were performed using several

  2. Application of a hydrogel spacer for postoperative salvage radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Schubert, Carolin; Escobar-Corral, Nuria; Holy, Richard; Eble, Michael J.

    2015-01-01

    In contrast to primary radiotherapy, no reports are available for a hydrogel spacer application in postoperative salvage radiotherapy for prostate cancer. A 77-year-old patient presented 20 years after radical prostatectomy with a digitally palpable local recurrence at the urethrovesical anastomosis (PSA 5.5 ng/ml). The hydrogel spacer (10 ml, SpaceOAR trademark) was injected between the local recurrence and rectal wall under transrectal ultrasound guidance. Treatment planning was performed with an intensity-modulated technique up to a total dose of 76 Gy in 2-Gy fractions. The same planning was performed based on computed tomography before spacer injection for comparison. The local recurrence, initially directly on the rectal wall, could be displaced more than 1 cm from the rectal wall after hydrogel injection. With a mean total dose of 76 Gy to the planning target volume, rectal wall volumes included in the 70 Gy, 60 Gy, 50 Gy isodoses were 0 cm 3 , 0 cm 3 , and 0.4 cm 3 with a spacer and 2.9 cm 3 , 4.5 cm 3 , and 6.2 cm 3 without a spacer, respectively. The patient reported rectal urgency during radiotherapy, completely resolving after the end of treatment. The PSA level was 5.4 ng/ml a week before the end of radiotherapy and dropped to 0.9 ng/ml 5 months after radiotherapy. A hydrogel spacer was successfully applied for dose-escalated radiotherapy in a patient with macroscopic local prostate cancer recurrence at the urethrovesical anastomosis to decrease the dose at the rectal wall. This option can be considered in specifically selected patients. (orig.) [de

  3. Efficient CT simulation of the four-field technique for conformal radiotherapy of prostate carcinoma

    International Nuclear Information System (INIS)

    Valicenti, Richard K.; Waterman, Frank M.; Croce, Raymond J.; Corn, Benjamin; Suntharalingam, Nagalingam; Curran, Walter J.

    1997-01-01

    Purpose: Conformal radiotherapy of prostate carcinoma relies on contouring of individual CT slices for target and normal tissue localization. This process can be very time consuming. In the present report, we describe a method to more efficiently localize pelvic anatomy directly from digital reconstructed radiographs (DRRs). Materials and Methods: Ten patients with prostate carcinoma underwent CT simulation (the spiral mode at 3 mm separation) for conformal four-field 'box' radiotherapy. The bulbous urethra and bladder were opacified with iodinated contrast media. On lateral and anteroposterior DRRs, the volume of interest (VOI) was restricted to 1.0-1.5 cm tissue thickness to optimize digital radiograph reconstruction of the prostate and seminal vesicles. By removing unessential voxel elements, this method provided direct visualization of those structures. For comparison, the targets of each patient were also obtained by contouring CT axial slices. Results: The method was successfully performed if the target structures were readily visualized and geometrically corresponded to those generated by contouring axial images. The targets in 9 of 10 patients were reliable representations of the CT-contoured volumes. One patient had 18 mm variation due to the lack of bladder opacification. Using VOIs to generate thin tissue DRRs, the time required for target and normal tissue localization was on the average less than 5 min. Conclusion: In CT simulation of the four-field irradiation technique for prostate carcinoma, thin-tissue DRRs allowed for efficient and accurate target localization without requiring individual axial image contouring. This method may facilitate positioning of the beam isocenter and provide reliable conformal radiotherapy

  4. Clinical utility of the percentage of positive prostate biopsies in predicting prostate cancer-specific and overall survival after radiotherapy for patients with localized prostate cancer

    International Nuclear Information System (INIS)

    D'Amico, Anthony V.; Keshaviah, Aparna; Manola, Judith; Cote, Kerri; Loffredo, Marian; Iskrzytzky, Olga; Renshaw, Andrew A.

    2002-01-01

    Purpose: To determine whether the percentage of positive prostate biopsies provides clinically relevant information to a previously established risk stratification system with respect to the end points of prostate cancer-specific survival (PCSS) and overall survival after radiotherapy for patients with clinically localized prostate cancer. Methods and Materials: A Cox regression multivariable analysis was used to evaluate the ability of the percentage of positive prostate biopsies to predict PCSS and overall survival for 381 men who underwent radiotherapy for localized prostate cancer during the prostate-specific antigen era. Results: At a median follow-up of 4.3 years (range 0.8-13.3), the presence of ≤50% positive biopsies vs. >50% positive biopsies provided a clinically relevant stratification of the 7-year estimates of PCSS (100% vs. 57%, p=0.004) in intermediate-risk patients. Moreover, all patients could be stratified into a minimal or high-risk cohort on the basis of the 10-year estimates of PCSS (100% vs. 55%, p 50%] intermediate-risk + high-risk) cohort for prostate cancer-specific death after conventional dose radiotherapy. Additional follow-up and independent validation are needed to confirm these findings

  5. Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Carl, Jesper; Nielsen, Jane (Dept. of Medical Physics, Dept. of Oncology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)), e-mail: jhc@rn.dk; Holmberg, Mats (Dept. of Oncology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)); Larsen, Erik Hoejkjaer; Fabrin, Knud (Dept. of Urology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark)); Fisker, Rune V. (Dept. of Radiology, Aalborg Hospital, Aarhus Univ. Hospital, Aalborg (Denmark))

    2011-05-15

    Purpose. A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). Material and methods. The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. Results. One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. Conclusions. This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed

  6. Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Larsen, Erik Hoejkjaer; Fabrin, Knud; Fisker, Rune V.

    2011-01-01

    Purpose. A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). Material and methods. The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. Results. One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. Conclusions. This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed

  7. Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer.

    Science.gov (United States)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Larsen, Erik Hoejkjaer; Fabrin, Knud; Fisker, Rune V

    2011-05-01

    A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed.

  8. Optimal contouring of seminal vesicle for definitive radiotherapy of localized prostate cancer: comparison between EORTC prostate cancer radiotherapy guideline, RTOG0815 protocol and actual anatomy

    International Nuclear Information System (INIS)

    Qi, Xin; Gao, Xian-Shu; Asaumi, Junichi; Zhang, Min; Li, Hong-Zhen; Ma, Ming-Wei; Zhao, Bo; Li, Fei-Yu; Wang, Dian

    2014-01-01

    Intermediate- to-high-risk prostate cancer can locally invade seminal vesicle (SV). It is recommended that anatomic proximal 1-cm to 2-cm SV be included in the clinical target volume (CTV) for definitive radiotherapy based on pathology studies. However, it remains unclear whether the pathology indicated SV extent is included into the CTV defined by current guidelines. The purpose of this study is to compare the volume of proximal SV included in CTV defined by EORTC prostate cancer radiotherapy guideline and RTOG0815 protocol with the actual anatomic volume. Radiotherapy planning CT images from 114 patients with intermediate- (36.8%) or high-risk (63.2%) prostate cancer were reconstructed with 1-mm-thick sections. The starting and ending points of SV and the cross sections of SV at 1-cm and 2-cm from the starting point were determined using 3D-view. Maximum (D 1H , D 2H ) and minimum (D 1L , D 2L ) vertical distance from these cross sections to the starting point were measured. Then, CTV of proximal SV defined by actual anatomy, EORTC guideline and RTOG0815 protocol were contoured and compared (paired t test). Median length of D 1H , D 1L , D 2H and D 2L was 10.8 mm, 2.1 mm, 17.6 mm and 8.8 mm (95th percentile: 13.5mm, 5.0mm, 21.5mm and 13.5mm, respectively). For intermediate-risk patients, the proximal 1-cm SV CTV defined by EORTC guideline and RTOG0815 protocol inadequately included the anatomic proximal 1-cm SV in 62.3% (71/114) and 71.0% (81/114) cases, respectively. While for high-risk patients, the proximal 2-cm SV CTV defined by EORTC guideline inadequately included the anatomic proximal 2-cm SV in 17.5% (20/114) cases. SV involvement indicated by pathology studies was not completely included in the CTV defined by current guidelines. Delineation of proximal 1.4 cm and 2.2 cm SV in axial plane may be adequate to include the anatomic proximal 1-cm and 2-cm SV. However, part of SV may be over-contoured

  9. Treatment results of adjuvant radiotherapy and salvage radiotherapy after radical prostatectomy for prostate cancer

    International Nuclear Information System (INIS)

    Wadasaki, Koichi; Kaneyasu, Yuko; Kenjo, Masahiro; Matsuura, Kanji; Murakami, Yuji; Hashimoto, Yasutoshi; Ito, Katsuhide; Kiriu, Hiroshi; Ito, Atsushi

    2007-01-01

    The indications for and the efficacy of radiation therapy after radical operation for patients with prostate cancer are not clear. We analyzed the treatment results of adjuvant radiotherapy and salvage radiotherapy after radical prostatectomy. Between September 1997 and November 2004, 57 patients received adjuvant radiotherapy or salvage radiotherapy after radical prostatectomy. Fifteen patients received radiation therapy because of positive margins and/or extracapsular invasion in surgical specimens (adjuvant group). Forty-two patients received radiation therapy because of rising prostate-specific antigen (PSA) during follow-up (salvage group). Radiation therapy was delivered to the fossa of the prostate±seminal vesicles by a three-dimensional (3-D) conformal technique to a total dose of 60-66 Gy (median, 60 Gy). Biochemical control was defined as the maintenance of a PSA level of less than 0.2 ng/ml. The median follow-up period after radiation therapy was 33 months (range, 12-98 months). Three-year biochemical control rates were 87% for the adjuvant group and 61% for the salvage group. For patients in the salvage group treated without hormone therapy, the preradiation PSA value was the most significant factor for the biochemical control rate. The 3-year biochemical control rate was 93% in patients whose preradiation PSA was 0.5 ng/ml or less and 29% in patients whose preradiation PSA was more than 0.5 ng/ml. No severe adverse effects (equal to or more than grade 3) were seen in treated patients. Radiation therapy after radical prostatectomy seemed to be effective for adjuvant therapy and for salvage therapy in patients with a preradiation PSA of 0.5 ng/ml or less. Also, radiation to the fossa of the prostate±seminal vesicles, to a total dose of 60-66 Gy, using a three-dimensional (3-D) conformal technique, seemed to be safe. (author)

  10. Prostatic cancer: intolerance and morbidity of external radiotherapy

    International Nuclear Information System (INIS)

    Douchez, J.; Fregevu, Y.; Allain, Y.M.; Cellier, P.; Fenton, J.; Hay, M.; Le Bourgeois, J.P.; Vincent, F.

    1985-01-01

    The pertherapeutic intolerance and morbidity are analyzed in a groupe of 597 patients with localized prostatic carcinoma treated by definitive radiotherapy between 1975 and 1982. Minimum follow-up is 2 years, median is 46 months. The results are compared to following parameters: associated diseases, associated surgical treatments, doses and irradiated target volumes. Pertherapeutic intolerance manifestations were found in 73% of patients and lead to complications. Urinary incontinence and chronic cystitis were more frequent after transurethral resection or prostatic target volume and by split course irradiation. Chronic diarrhea was more frequent when using large target volume. Leg edema was closely associated with pelvic lymphadenectomy. The control of pertherapeutic manifestations and the prevention of complications should improve survival in patients treated by external radiotherapy [fr

  11. Effect of magnesium oxide on interfraction prostate motion and rectal filling in prostate cancer radiotherapy. Analysis of a randomized clinical trial

    International Nuclear Information System (INIS)

    Harder, Annemarie M. den; Kotte, Alexis N.T.J.; Vulpen, Marco van; Lips, Irene M.; Gils, Carla H. van

    2014-01-01

    To investigate whether magnesium oxide reduces the interfraction motion of the prostate and the amount of rectal filling and rectal gas, which influences prostate position during radiotherapy for prostate cancer. From December 2008 to February 2010, 92 prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. In a previous study, we investigated the effect on intrafraction motion and did not find a difference between the treatment arms. Here, we compared the interfraction prostate motion between the two treatment arms as well as the amount of rectal filling and rectal air pockets using pretreatment planning computed tomography and magnetic resonance imaging scans. There was no statistically significant difference between the treatment arms in translation and rotation of the prostate between treatment fractions, except for the rotation around the cranial caudal axis. However, the difference was less than 1 and therefore considered not clinically relevant. There was no significant difference in the amount of rectal filling and rectal air pockets between the treatment arms. Magnesium oxide is not effective in reducing the interfraction prostate motion or the amount of rectal filling and rectal gas during external-beam radiotherapy. Therefore, magnesium oxide is not recommended in clinical practice for these purposes. (orig.) [de

  12. Adjuvant radiotherapy for pathologically advanced prostate cancer a randomized clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Ian, M.; Thompson, J.R.; Catherine, M.; Tangen, P.H.; Paradelo, J.; Scott Lucia, M.; Miller, G.; Troyer, D.; Messing, E.; Forman, J.; Chin, J.; Swanson, G.; Canby-Hagino, E.; Crawford, E.D

    2008-01-15

    Context - Despite a stage-shift to earlier cancer stages and lower tumor volumes for prostate cancer, pathologically advanced disease is detected at radical prostatectomy in 38% to 52% of patients. However, the optimal management of these patients after radical prostatectomy is unknown. Objective - To determine whether adjuvant radiotherapy improves metastasis-free survival in patients with stage pT3 NO MO prostate cancer. Design, Setting, and Patients - Randomized, prospective, multi-institutional, US clinical trial with enrollment between August 15, 1988, and January 1, 1997 (with database frozen for statistical analysis on September 21, 2005). Patients were 425 men with pathologically advanced prostate cancer who had undergone radical prostatectomy. Intervention - Men were randomly assigned to receive 60 to 64 Gy of external beam radiotherapy delivered to the prostatic fossa (n = 214) or usual care plus observation (n = 211). Main Outcome Measures - Primary outcome was metastasis-free survival, defined as time to first occurrence of metastatic disease or death due to any cause. Secondary outcomes included prostate-specific antigen (PSA) relapse, recurrence-free survival, overall survival, freedom from hormonal therapy, and postoperative complications. Results - Among the 425 men, median follow-up was 10.6 years (inter-quartile range, 9.2-12.7 years). For metastasis-free survival,76 (35.5%) of 214 men in the adjuvant radiotherapy group were diagnosed with metastatic disease or died (median metastasis-free estimate, 14.7 years), compared with 91 (43.1%) of 211 (median metastasis-free estimate, 13.2 years) of those in the observation group (hazard ratio [HR], 0.75; 95% CI, 0.55-1.02; P = .06). There were no significant between-group differences for overall survival (71 deaths, median survival of 14.7 years for radiotherapy vs 83 deaths, median survival of 13.8 years for observation; HR, 0.80; 95% Cl, 0.58-1.09; P =.16). PSA relapse (median PSA relapse-free survival

  13. Adjuvant radiotherapy for pathologically advanced prostate cancer a randomized clinical trial

    International Nuclear Information System (INIS)

    Ian, M.; Thompson, J.R.; Catherine, M.; Tangen, P.H.; Paradelo, J.; Scott Lucia, M.; Miller, G.; Troyer, D.; Messing, E.; Forman, J.; Chin, J.; Swanson, G.; Canby-Hagino, E.; Crawford, E.D.

    2008-01-01

    Context - Despite a stage-shift to earlier cancer stages and lower tumor volumes for prostate cancer, pathologically advanced disease is detected at radical prostatectomy in 38% to 52% of patients. However, the optimal management of these patients after radical prostatectomy is unknown. Objective - To determine whether adjuvant radiotherapy improves metastasis-free survival in patients with stage pT3 NO MO prostate cancer. Design, Setting, and Patients - Randomized, prospective, multi-institutional, US clinical trial with enrollment between August 15, 1988, and January 1, 1997 (with database frozen for statistical analysis on September 21, 2005). Patients were 425 men with pathologically advanced prostate cancer who had undergone radical prostatectomy. Intervention - Men were randomly assigned to receive 60 to 64 Gy of external beam radiotherapy delivered to the prostatic fossa (n = 214) or usual care plus observation (n = 211). Main Outcome Measures - Primary outcome was metastasis-free survival, defined as time to first occurrence of metastatic disease or death due to any cause. Secondary outcomes included prostate-specific antigen (PSA) relapse, recurrence-free survival, overall survival, freedom from hormonal therapy, and postoperative complications. Results - Among the 425 men, median follow-up was 10.6 years (inter-quartile range, 9.2-12.7 years). For metastasis-free survival,76 (35.5%) of 214 men in the adjuvant radiotherapy group were diagnosed with metastatic disease or died (median metastasis-free estimate, 14.7 years), compared with 91 (43.1%) of 211 (median metastasis-free estimate, 13.2 years) of those in the observation group (hazard ratio [HR], 0.75; 95% CI, 0.55-1.02; P = .06). There were no significant between-group differences for overall survival (71 deaths, median survival of 14.7 years for radiotherapy vs 83 deaths, median survival of 13.8 years for observation; HR, 0.80; 95% Cl, 0.58-1.09; P =.16). PSA relapse (median PSA relapse-free survival

  14. Radiotherapy for local progression in patients with hormone-refractory prostate cancer

    International Nuclear Information System (INIS)

    Furuya, Yuzo; Akakura, Koichiro; Akimoto, Susumu; Ichikawa, Tomohiko; Ito, Haruo

    1999-01-01

    The aim of the present study was to investigate the effect of radiotherapy on the local progression of hormone-refractory prostate cancer. From 1986 to 1995, 38 patients were diagnosed with local progression without distant progression after hormonal therapy at Chiba University Hospital. Eleven cases were treated with irradiation for local progression. External beam irradiation was delivered to the prostate at a dose of 50-66.6 Gy. In patients treated with radiotherapy, the duration from initial treatment to local recurrence was 6-80 months (mean±SD: 33.9±22.9 months). The follow-up period after irradiation was 7-64 months (mean±SD: 25.4±18.8 months). Three and 5 year cause-specific survival rates from radiotherapy were 46.2 and 23.1%, respectively. Radiotherapy had a marked effect on symptoms associated with local progression and no patients suffered from the symptoms after the radiotherapy. Complications of radiotherapy were limited. In patients with hormone refractory local progression without distant progression, low morbidity, low mortality radiotherapy offers a variable therapy to other palliative treatments because radiotherapy is able to control local symptoms for a long period of time. (author)

  15. A Double-Blind Placebo-Controlled Randomized Clinical Trial With Magnesium Oxide to Reduce Intrafraction Prostate Motion for Prostate Cancer Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lips, Irene M., E-mail: i.m.lips@umcutrecht.nl [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Gils, Carla H. van [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Kotte, Alexis N.T.J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Leerdam, Monique E. van [Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (Netherlands); Franken, Stefan P.G.; Heide, Uulke A. van der; Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

    2012-06-01

    Purpose: To investigate whether magnesium oxide during external-beam radiotherapy for prostate cancer reduces intrafraction prostate motion in a double-blind, placebo-controlled randomized trial. Methods and Materials: At the Department of Radiotherapy, prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. The primary outcome was the proportion of patients with clinically relevant intrafraction prostate motion, defined as the proportion of patients who demonstrated in {>=}50% of the fractions an intrafraction motion outside a range of 2 mm. Secondary outcome measures included quality of life and acute toxicity. Results: In total, 46 patients per treatment arm were enrolled. The primary endpoint did not show a statistically significant difference between the treatment arms with a percentage of patients with clinically relevant intrafraction motion of 83% in the magnesium oxide arm as compared with 80% in the placebo arm (p = 1.00). Concerning the secondary endpoints, exploratory analyses demonstrated a trend towards worsened quality of life and slightly more toxicity in the magnesium oxide arm than in the placebo arm; however, these differences were not statistically significant. Conclusions: Magnesium oxide is not effective in reducing the intrafraction prostate motion during external-beam radiotherapy, and therefore there is no indication to use it in clinical practice for this purpose.

  16. Local high voltage radiotherapy with curative intent for prostatic carcinoma

    International Nuclear Information System (INIS)

    Jacobi, G.H.; Kurth, K.H.; Hohenfellner, R.

    1979-01-01

    In a 10-year interval 179 patients with prostatic carcinoma were treated by cobalt-60 teletherapy (7600 R). A selected group of 47 patients with localized disease and irradiated with curative intent had serial prostatic biopsies and were analized after a minimum follow-up of 1 year. Biopsies of half of the patients rendered definitively negative, on an average 14 months after radiotherapy. 8 patients with initial negative biopsy changed to positive secondarily. In one third of the patients histological conversion was missed, considered as radiation persister. Persistent carcinoma were of predominant low grade. 5 patients developed distant metastases 30 months after irradiation on an average. These patients had persistent positive tissue studies. Over all cumulative 5-years survival was 89%. In patients with prostatic carcinoma and local high voltage radiotherapy with curative intent (stage A through C) serial prostatic biopsies to document therapy effect seen mandatory. (orig.) 891 AJ/orig. 892 BRE [de

  17. Dosimetric predictors of diarrhea during radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Sanguineti, Giuseppe; Endres, Eugene J.; Parker, Brent C.; Sormani, Maria Pia

    2009-01-01

    Purpose: to investigate dosimetric predictors of diarrhea during radiotherapy (RT) for prostate cancer. Patients and methods: all patients who underwent external-beam radiotherapy as part of treatment for localized prostate cancer at the University of Texas Medical Branch, Galveston, TX, USA, from May 2002 to November 2006 were extracted from the own database. From the cumulative dose-volume histogram (DVH), the absolute volumes (V-value) of intestinal cavity (IC) receiving 15, 30, and 45 Gy were extracted for each patient. Acute gastrointestinal toxicity was prospectively scored at each weekly treatment visit according to CTC (common toxicity criteria) v2.0. The endpoint was the development of peak grade ≥ 2 diarrhea during RT. Various patient, tumor, and treatment characteristics were evaluated using logistic regression. Results: 149 patients were included in the analysis, 112 (75.2%) treated with whole-pelvis intensity-modulated radiotherapy (WP-IMRT) and 37 (24.8%) with prostate-only RT, including or not including, the seminal vesicles (PORT ± SV). 45 patients (30.2%) developed peak grade ≥ 2 diarrhea during treatment. At univariate analysis, IC-V 15 and IC-V 30 , but not IC-V 45 , were correlated to the endpoint; at multivariate analysis, only IC-V 15 (p = 0.047) along with peak acute proctitis (p = 0.041) was independently correlated with the endpoint. Conclusion: these data provide a novel and prostate treatment-specific ''upper limit'' DVH for IC. (orig.)

  18. Biochemical failure after radical external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Nomoto, Satoshi; Imada, Hajime; Kato, Fumio; Yahara, Katsuya; Morioka, Tomoaki; Ohguri, Takayuki; Nakano, Keita; Korogi, Yukunori

    2005-01-01

    The purpose of this study was to evaluate biochemical failures after radical external beam radiotherapy for prostate cancer. A total of 143 patients with prostate cancer (5 cases in stage A2, 95 in stage B and 43 in stage C; 18 in low risk group, 37 in intermediate risk group, 67 in high risk group and 21 in unknown group) were included in this study. Patients of stage A2 and B underwent external irradiation of 46 Gy to the prostate gland and seminal vesicle and additional 20 Gy to the prostate gland, while patients of stage C underwent external irradiation of 66 Gy to the prostate gland and seminal vesicle including 46 Gy to the pelvis. Neoadjuvant hormonal therapy was done in 66 cases, and long-term hormonal therapy in 75 cases; two cases were treated with radiation therapy alone. The 3-year relapse free survival rates by stage A2, B and C were 100%, 96.7% and 88.1%, respectively. The 3-year relapse free survival rates by low, intermediate and high risk groups were 100%, 92.3% and 89.7%, respectively. Biochemical failure was noted in nine cases during the average observation term of 32.2 months; in this group the median of prostate specific antigen (PSA) value was 2.6 ng/ml, the doubling time was 8.6 months, and the term of biochemical failure was 33.2 months. Six of eight cases with biochemical failure were the neoadjuvant hormonal therapy group, but biochemical no evidence of disease (bNED) curve showed no significant difference between neoadjuvant and long-term hormonal groups. It is supposed that unnecessary hormonal therapies were performed based on the nonspecific diagnosis of biochemical failure after radical radiotherapy in our group of patients. A precise criterion of biochemical failure after radical radiotherapy for prostate cancer is necessary. (author)

  19. Prostate specific cancer volume: a significant prognostic factor in prostate cancer patients at intermediate risk of failing radiotherapy

    International Nuclear Information System (INIS)

    Lankford, S.P.; Pollack, A.; Zagars, G.K.

    1996-01-01

    Purpose: Although the pretreatment serum prostate specific antigen level (PSAL) is the single most significant predictor of local and biochemical control in prostate cancer patients treated with radiotherapy, it is relatively insensitive for patients with a PSAL in the intermediate range (4-20 ng/ml). PSA density (PSAD) has been shown to be slightly more predictive of outcome than PSAL for this intermediate risk group; however, this improvement is small and of little use clinically. PSA cancer volume (PSACV) is an estimate of cancer volume based on PSA that was recently described by D'Amico and Propert (IJROBP 32:232, 1995) as providing significant and independent prognostic information in addition to PSAL. We report here a detailed comparison between this new prognostic factor, PSAL, and PSAD. Methods and Materials: The records of 356 patients treated with definitive external beam radiotherapy for regionally localized (T1-4, Nx, M0) adenocarcinoma of the prostate were reviewed. Each patient had a PSAL, biopsy Gleason score, and pretreatment prostate volume by transrectal ultrasonography. The median PSAL was 9.3 ng/ml and 66% had Gleason scores in the 2-6 range. The median radiation dose was 66.0 Gy and the median follow-up for those living was 27 months. PSACV is a calculated parameter that takes into account PSAL (total PSA), ultrasonographic prostate volume (estimate of PSA from benign epithelium), and Gleason grade (estimate of PSA per tumor volume). The median PSACV was 1.43 cc. Biochemical failure was defined as increases in two consecutive follow-up PSA levels, one increase by a factor > 1.5, or an absolute increase of > 1 ng/ml. Local failure was defined as a cancer-positive prostate biopsy, usually undertaken because of evidence of biochemical failure. Results: The distributions of PSACV and PSAL were similar and, when normalized by log-transformation, were highly correlated (p 4 cc, as compared to those with a PSACV ≤ 0.5 cc, was over 30%. Conclusion

  20. Radiotherapy and local hyperthermia plus androgen suppression in locally advanced prostate cancer

    International Nuclear Information System (INIS)

    Maluta, S.; Marciai, N.; Gabbani, M.; Palazzi, M.; Dall'Oglio, S.; Grandinetti, A.

    2005-01-01

    Full text: In advanced prostatic cancer, hyperthermia may be useful in order to enhance irradiation efficacy so to avoid delivering of too high dose of radiotherapy which increases acute and late sequelae. A multi-centric phase II study is warranted to give hyperthermia a level 3 evidence in prostate cancer treatment. A randomized phase III study to demonstrate efficacy of hyperthermia is not available because of the optimal results obtained by using radiotherapy combined with androgen suppression. To evaluate hyperthermia gain, LHT should be combined with radiotherapy alone in patients refusing androgen suppression or affected by hormone refractory prostate carcinoma (HRPC). Patients with HRPC have multiple possibilities of treatment improving performance status and median survival, as chemotherapy regimens, and new agents. All these treatments modalities need to be confirmed by phase III trials. Also hyperthermia may be considered among these promising approaches. (author)

  1. Real-Time Motion Management of Prostate Cancer Radiotherapy

    DEFF Research Database (Denmark)

    Pommer, Tobias

    , and for prostate cancer treatments, the proximity of the bladder and rectum makes radiotherapy treatment of this site a challenging task. Furthermore, the prostate may move during the radiation delivery and treatment margins are necessary to ensure that it is still receiving the intended dose. The main aim...... of the MLC on the performance of DMLC tracking were investigated. We found that for prostate motion, the main tracking error arose from the finite leaf width affecting the MLCs ability to construct the desired shape. Furthermore, we also attempted to model prostate motion using a random walk model. We found...... that for the slow and drifting motion, the model could satisfactory replicate the motion of the prostate, while the rapid and transient prostate motion observed in some cases was challenging for the model. We therefore added simulated transient motion to the random walk model, which slightly improved the results...

  2. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: Observational study of mortality outcomes

    NARCIS (Netherlands)

    P. Sooriakumaran (Prasanna); T. Nyberg (Tommy); O. Akre (Olof); L. Haendler (Leif); I. Heus (Inge); M. Olsson (Marita); S. Carlsson (Sigrid); M.J. Roobol-Bouts (Monique); G. Steineck (Gunnar); P. Wiklund (Peter)

    2014-01-01

    textabstractObjective: To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design: Observational study. Setting: Sweden, 1996-2010. Participants: 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982).

  3. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer

    International Nuclear Information System (INIS)

    Quilty, P.M.; Kirk, D.; Bolger, J.J.; Dearnaley, D.P.; Mason, M.D.; Lewington, V.J.; Reed, N.S.E.; Russell, J.M.; Yardley, J.

    1994-01-01

    From 1988 to 1991, 284 patients with prostatic cancer and painful bone metastases were treated with either radiotherapy or strontium-89 (200 MBq). Patients were first stratified according to suitability for local or hemibody radiotherapy, then randomly allocated that form of treatment or strontium-89 (i.v. injection). After 4,8 and 12 weeks pain sites were mapped, toxicity monitored, and all additional palliative treatments recorded. There was no significant difference in median survival (after >80% had died); 33 weeks following strontium 8 9 and 28 weeks following radiotherapy (p=0.1). All treatments provided effective pain relief; improvement was sustained to 3 months in 63.6% after hemibody radiotherapy compared with 66.1% after strontium-89, and in 61% after local radiotherapy compared with 65.9% in the comparable strontium 8 9 group. Fewer patients reported new pain sites after strontium-89 than after local or hemibody radiotherapy (p < 0.05). Radiotherapy to a new site was required by 12 patients in the local radiotherapy group compared with 2 after strontium-89 (p < 0.01), although there was no significant difference between hemibody radiotherapy (6 patients) and strontium-89 (9 patients) in this respect. Platelets and leukocytes fell by an average 30-40% after strontium-89 but sequelae were uncommon, and other symptoms rare

  4. SU-G-TeP1-05: Development and Clinical Introduction of Automated Radiotherapy Treatment Planning for Prostate Cancer

    International Nuclear Information System (INIS)

    Winkel, D; Bol, GH; Asselen, B van; Hes, J; Scholten, V; Kerkmeijer, LGW; Raaymakers, BW

    2016-01-01

    Purpose: To develop an automated radiotherapy treatment planning and optimization workflow for prostate cancer in order to generate clinical treatment plans. Methods: A fully automated radiotherapy treatment planning and optimization workflow was developed based on the treatment planning system Monaco (Elekta AB, Stockholm, Sweden). To evaluate our method, a retrospective planning study (n=100) was performed on patients treated for prostate cancer with 5 field intensity modulated radiotherapy, receiving a dose of 35×2Gy to the prostate and vesicles and a simultaneous integrated boost of 35×0.2Gy to the prostate only. A comparison was made between the dosimetric values of the automatically and manually generated plans. Operator time to generate a plan and plan efficiency was measured. Results: A comparison of the dosimetric values show that automatically generated plans yield more beneficial dosimetric values. In automatic plans reductions of 43% in the V72Gy of the rectum and 13% in the V72Gy of the bladder are observed when compared to the manually generated plans. Smaller variance in dosimetric values is seen, i.e. the intra- and interplanner variability is decreased. For 97% of the automatically generated plans and 86% of the clinical plans all criteria for target coverage and organs at risk constraints are met. The amount of plan segments and monitor units is reduced by 13% and 9% respectively. Automated planning requires less than one minute of operator time compared to over an hour for manual planning. Conclusion: The automatically generated plans are highly suitable for clinical use. The plans have less variance and a large gain in time efficiency has been achieved. Currently, a pilot study is performed, comparing the preference of the clinician and clinical physicist for the automatic versus manual plan. Future work will include expanding our automated treatment planning method to other tumor sites and develop other automated radiotherapy workflows.

  5. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    International Nuclear Information System (INIS)

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-01-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  6. Spacer stability and prostate position variability during radiotherapy for prostate cancer applying a hydrogel to protect the rectal wall

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Piroth, Marc D.; Holy, Richard; Escobar-Corral, Nuria; Caffaro, Mariana; Djukic, Victoria; Klotz, Jens; Eble, Michael J.

    2013-01-01

    Background and purpose: The aim was to evaluate the spacer dimensions and prostate position variability during the course of radiotherapy for prostate cancer. Materials and methods: CT scans were performed in a group of 15 patients (G1) after the 10 ml injection of a hydrogel spacer (SpaceOAR™) and 30 patients without a spacer (G2) before the beginning of treatment (CT1) and in the last treatment week, 10–12 weeks following spacer implantation (CT2). Spacer dimensions and displacements were determined and prostate displacements compared. Results: Mean volume of the hydrogel increased slightly (17%; p 2 cm 3 . The average displacement of the hydrogel center of mass was 0.6 mm (87% ⩽ 2.2 mm), −0.6 mm (100% ⩽ 2.2 mm) and 1.4 mm (87% ⩽ 4.3 mm) in the x-, y- and z-axes (not significant). The average distance between prostate and anterior rectal wall before/at the end of radiotherapy was 1.6 cm/1.5 cm, 1.2 cm/1.3 cm and 1.0 cm/1.1 cm at the level of the base, middle and apex (G1). Prostate position variations were similar comparing G1 and G2, but significant systematic posterior displacements were only found in G2. Conclusions: A stable distance between the prostate and anterior rectal wall results during the radiotherapy course after injection of the spacer before treatment planning. Larger posterior prostate displacements could be reduced

  7. Big Data Analytics for Prostate Radiotherapy.

    Science.gov (United States)

    Coates, James; Souhami, Luis; El Naqa, Issam

    2016-01-01

    Radiation therapy is a first-line treatment option for localized prostate cancer and radiation-induced normal tissue damage are often the main limiting factor for modern radiotherapy regimens. Conversely, under-dosing of target volumes in an attempt to spare adjacent healthy tissues limits the likelihood of achieving local, long-term control. Thus, the ability to generate personalized data-driven risk profiles for radiotherapy outcomes would provide valuable prognostic information to help guide both clinicians and patients alike. Big data applied to radiation oncology promises to deliver better understanding of outcomes by harvesting and integrating heterogeneous data types, including patient-specific clinical parameters, treatment-related dose-volume metrics, and biological risk factors. When taken together, such variables make up the basis for a multi-dimensional space (the "RadoncSpace") in which the presented modeling techniques search in order to identify significant predictors. Herein, we review outcome modeling and big data-mining techniques for both tumor control and radiotherapy-induced normal tissue effects. We apply many of the presented modeling approaches onto a cohort of hypofractionated prostate cancer patients taking into account different data types and a large heterogeneous mix of physical and biological parameters. Cross-validation techniques are also reviewed for the refinement of the proposed framework architecture and checking individual model performance. We conclude by considering advanced modeling techniques that borrow concepts from big data analytics, such as machine learning and artificial intelligence, before discussing the potential future impact of systems radiobiology approaches.

  8. Sexual Function After Stereotactic Body Radiotherapy for Prostate Cancer: Results of a Prospective Clinical Trial

    International Nuclear Information System (INIS)

    Wiegner, Ellen A.; King, Christopher R.

    2010-01-01

    Purpose: To study the sexual quality of life for prostate cancer patients after stereotactic body radiotherapy (SBRT). Methods and Materials: Using the Expanded Prostate Cancer Index Composite (EPIC)-validated quality-of-life questionnaire, the sexual function of 32 consecutive patients who received prostate SBRT in a prospective Phase II clinical trial were analyzed at baseline, and at median times of 4, 12, 20, and 50 months after treatment. SBRT consisted of 36.25 Gy in five fractions of 7.25 Gy using the Cyberknife. No androgen deprivation therapy was given. The use of erectile dysfunction (ED) medications was monitored. A comprehensive literature review for radiotherapy-alone modalities based on patient self-reported questionnaires served as historical comparison. Results: Median age at treatment was 67.5 years, and median follow-up was 35.5 months (minimum 12 months). The mean EPIC sexual domain summary score, sexual function score, and sexual bother score decreased by 45%, 49%, and 25% respectively at 50 months follow-up. These differences reached clinical relevance by 20 months after treatment. Baseline ED rate was 38% and increased to 71% after treatment (p = 0.024). Use of ED medications was 3% at baseline and progressed to 25%. For patients aged <70 years at follow-up, 60% maintained satisfactory erectile function after treatment compared with only 12% aged ≥70 years (p = 0.008). Penile bulb dose was not associated with ED. Conclusions: The rates of ED after treatment appear comparable to those reported for other modalities of radiotherapy. Given the modest size of this study and the uncertainties in the physiology of radiotherapy-related ED, these results merit further investigations.

  9. Intrafractional prostate motion during online image guided intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Budiharto, Tom; Slagmolen, Pieter; Haustermans, Karin; Maes, Frederik; Junius, Sara; Verstraete, Jan; Oyen, Raymond; Hermans, Jeroen; Van den Heuvel, Frank

    2011-01-01

    Introduction: Intrafractional motion consists of two components: (1) the movement between the on-line repositioning procedure and the treatment start and (2) the movement during the treatment delivery. The goal of this study is to estimate this intrafractional movement of the prostate during prostate cancer radiotherapy. Material and methods: Twenty-seven patients with prostate cancer and implanted fiducials underwent a marker match procedure before a five-field IMRT treatment. For all fields, in-treatment images were obtained and then processed to enable automatic marker detection. Combining the subsequent projection images, five positions of each marker were determined using the shortest path approach. The residual set-up error (RSE) after kV-MV based prostate localization, the prostate position as a function of time during a radiotherapy session and the required margins to account for intrafractional motion were determined. Results: The mean RSE and standard deviation in the antero-posterior, cranio-caudal and left-right direction were 2.3 ± 1.5 mm, 0.2 ± 1.1 mm and -0.1 ± 1.1 mm, respectively. Almost all motions occurred in the posterior direction before the first treatment beam as the percentage of excursions >5 mm was reduced significantly when the RSE was not accounted for. The required margins for intrafractional motion increased with prolongation of the treatment. Application of a repositioning protocol after every beam could decrease the 1 cm margin from CTV to PTV by 2 mm. Conclusions: The RSE is the main contributor to intrafractional motion. This RSE after on-line prostate localization and patient repositioning in the posterior direction emphasizes the need to speed up the marker match procedure. Also, a prostate IMRT treatment should be administered as fast as possible, to ensure that the pre-treatment repositioning efforts are not erased by intrafractional prostate motion. This warrants an optimized workflow with the use of faster treatment

  10. Hypofractionated Intensity-Modulated Radiotherapy for Carcinoma of the Prostate: Analysis of Toxicity

    International Nuclear Information System (INIS)

    Coote, Joanna H.; Wylie, James P.; Cowan, Richard A.; Logue, John P.; Swindell, Ric; Livsey, Jacqueline E.

    2009-01-01

    Purpose: Dose escalation for prostate cancer improves biological control but with a significant increase in late toxicity. Recent estimates of low α/β ratio for prostate cancer suggest that hypofractionation may result in biological advantage. Intensity-modulated radiotherapy (IMRT) should enable dose escalation to the prostate while reducing toxicity to local organs. We report late toxicity data of a hypofractionated IMRT regime. Methods and Materials: Eligible men had T2-3N0M0 adenocarcinoma prostate, and either Gleason score ≥ 7 or prostate-specific antigen 20-50 ng/L. Patients received 57-60 Gy to prostate in 19-20 fractions using five-field IMRT. All received hormonal therapy for 3 months before radiotherapy to a maximum of 6 months. Toxicity was assessed 2 years postradiotherapy using the RTOG criteria, LENT/SOMA, and UCLA prostate index assessment tools. Results: Acute toxicity was favorable with no RTOG Grade 3 or 4 toxicity. At 2 years, there was 4% Grade 2 bowel and 4.25% Grade 2 bladder toxicity. There was no Grade 3 or 4 bowel toxicity; one patient developed Grade 3 bladder toxicity. UCLA data showed a slight improvement in urinary function at 2 years compared with pretreatment. LENT/SOMA assessments demonstrated general worsening of bowel function at 2 years. Patients receiving 60 Gy were more likely to develop problems with bowel function than those receiving 57 Gy. Conclusions: These data demonstrate that hypofractionated radiotherapy using IMRT for prostate cancer is well tolerated with minimal late toxicity at 2 years posttreatment. Ongoing studies are looking at the efficacy of hypofractionated regimes with respect to biological control.

  11. Prostate-specific antigen cancer volume: a significant prognostic factor in prostate cancer patients at intermediate risk of failing radiotherapy

    International Nuclear Information System (INIS)

    Lankford, Scott P.; Pollack, Alan; Zagars, Gunar K.

    1997-01-01

    Purpose: Although the pretreatment serum prostate-specific antigen level (PSAL) is the single-most significant predictor of local and biochemical control in prostate cancer patients treated with radiotherapy, it is relatively insensitive for patients with a PSAL in the intermediate range (4-20 ng/ml). PSA density (PSAD) has been shown to be slightly more predictive of outcome than PSAL for this intermediate risk group; however, this improvement is small and of little use clinically. PSA cancer volume (PSACV), an estimate of cancer volume based on PSA, has recently been described and has been purported to be more significant t than PSAL in predicting early biochemical failure after radiotherapy. We report a detailed comparison between this new prognostic factor, PSAL, and PSAD. Methods and Materials: The records of 356 patients treated with definitive external beam radiotherapy for regionally localized (T1-4,Nx,M0) adenocarcinoma of the prostate were reviewed. Each patient had a PSAL, biopsy Gleason score, and pretreatment prostate volume by transrectal ultrasonography. The median PSAL was 9.3 ng/ml and 66% had Gleason scores in the 2-6 range. The median radiation dose was 66.0 Gy and the median follow-up for those living was 27 months. PSACV was calculated using a formula which takes into account PSAL, pretreatment prostate ultrasound volume, and Gleason score. The median PSACV was 1.43 cc. Biochemical failure was defined as increases in two consecutive follow-up PSA levels, one increase by a factor > 1.5, or an absolute increase of > 1 ng/ml. Local failure was defined as a cancer-positive prostate biopsy, obtained for evidence of tumor progression. Results: The distributions of PSACV and PSAL were similar and, when normalized by log transformation, were highly correlated (p < 0.0001, linear regression). There was a statistically significant relationship between PSACV and several potential prognostic factors including PSAL, PSAD, stage, Gleason score, and

  12. Comparison of serum YKL-40 bio marker levels in primary prostate cancer and recurrent cases after radiotherapy

    International Nuclear Information System (INIS)

    Ziada, M.M.S.

    2012-01-01

    YKL-40, also called human cartilage glycoprotein-39 is homologs of family 18 glycosyl hydrolases secreted by human macrophages.Although high levels of YKL-40 is associated with several diseases. YKL-40, a growth factor for connective tissue cells, a migration factor for endothelial and vascular smooth muscle cells, is expressed by several types of solid human carcinoma, including prostate carcinoma. The aim of this study was to evaluate diagnostic role of serum YKL-40 levels in primary prostate cancer and detection of recurrences after radiotherapy. Methods: YKL-40 determined in serum samples from 50 patients with primary prostate cancer and 25 patients with benign prostatic hyperplasia as control. Serum YKL-40 levels were measured by ELISA. PSA levels were also measured by using IMMULIT system. Results: Serum YKL-40 levels were significantly higher (P= 0.000) in patients with prostate cancer compared with control group whereas no significant elevation in BPH. Conclusion: High serum YKL-40 levels in patients with primary prostate cancer indicate that YKL-40 may have a function in the Progression of malignant diseases, whereas no significant elevation was observed in benign prostatic hyperplasia. Further studies are needed to elucidate the biologic role of YKL-40 in cancer aggressiveness and in progression of malignant diseases.

  13. External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months

    International Nuclear Information System (INIS)

    Ogawa, Kazuhiko; Nakamura, Katsumasa; Sasaki, Tomonari; Onishi, Hiroshi; Koizumi, Masahiko; Shioyama, Yoshiyuki; Araya, Masayuki; Mukumoto, Nobutaka M.S.; Mitsumori, Michihide; Teshima, Teruki

    2009-01-01

    Purpose: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy. Methods and Materials: Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months). Results: The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (≥0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy. Conclusions: External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.

  14. Observations of pretreatment prostate-specific antigen doubling time in 107 patients referred for definitive radiotherapy

    International Nuclear Information System (INIS)

    Lee, W. Robert; Hanks, Gerald E.; Corn, Benjamin W.; Schultheiss, Timothy E.

    1995-01-01

    Purpose: To determine pretreatment prostate-specific antigen doubling times (PSADT) in patients referred for definitive radiotherapy. Methods and Materials: One hundred and seven patients with histologically proven nonmetastatic prostate cancer and an elevated prostate-specific antigen (PSA) who were referred for radiation therapy had three serum PSA values obtained prior to the start of definitive therapy. Prostate-specific antigen doubling times were calculated by linear regression. Results: Prostate-specific antigen values increased during the period of observation in 78 patients (73%). Forty-three patients (40%) had calculated PSADT of less than 2 years and of those patients with pretreatment serum PSA values of greater than 10 ng/mL more than 50% has calculated PSADT of less than 2 years. Conclusions: A significant minority of patients referred for radiotherapy have calculated PSADT of less than 2 years. The significance of this relatively fast growth rate is as yet undetermined, but suggests that patients referred for radiotherapy may have aggressive disease prior to treatment

  15. The pitfalls of treating anorectal conditions after radiotherapy for prostate cancer.

    LENUS (Irish Health Repository)

    Thornhill, J A

    2012-03-01

    We present a salutary lesson learned from three cases with significant complications that followed anorectal intervention in the presence of radiation proctitis due to prior radiotherapy for adenocarcinoma of the prostate. After apparent routine rubber band ligation for painful haemorrhoids, one patient developed a colo-cutaneous fistula. Following laser coagulation for radiation proctitis, one patient required a pelvic exenteration for a fistula, while another developed a rectal stenosis. Those diagnosing and treating colonic conditions should be mindful of the increased prevalence of patients who have had radiotherapy for prostate cancer and the potential for complications in treating these patients.

  16. Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    Science.gov (United States)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J; Hoffmann, Matthew; McKay, Michael J; Shakespeare, Thomas P

    2014-02-01

    Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Patient repositioning in prostate conformal radiotherapy by image fusion

    International Nuclear Information System (INIS)

    Betrouni, Nacim

    2004-01-01

    This research thesis first proposes an overview of imaging modalities which are generally used in radiotherapy, and briefly presents operation principles for ultrasound scans, scanners and MRI. The issue of patient repositioning in radiotherapy is then introduced, and already proposed solutions are presented. In the next part, the author addresses space location and ultrasound-based location, with a brief overview of methods used to track the displacements of a mobile object, in this case an ultrasound probe, and calibration. Then, after a presentation of the adopted method, and a discussion of published works related to contour extraction and to filtering and noise reduction methods in ultrasound imagery, the author addresses the issue of prostate segmentation based on ultrasound images. The next part deals with image registration with an overview of available methods and tools. A method of registration of pre-operation images obtained by MRI or scanner, and of intra-operation ultrasound images is proposed for a real-time registration. This method is aimed at supporting patient repositioning during prostate conformal radiotherapy

  18. Pattern of decrease of prostate specific antigen after radical radiotherapy for the prostate cancer

    International Nuclear Information System (INIS)

    Kim, Bo Kyoung; Park, Suk Won; Ha, Sung Whan

    1999-01-01

    Prostate specific antigen (PSA) is a useful tumor marker, which is widely used as a diagnostic index and predictor of both treatment and follow-up result in prostate cancer. A prospective analysis was carried out to obtain the period of PSA normalization and the half life of PSA and to analyze the factors influencing the period of PSA normalization. The PSA level was checked before and serially after radical radiotherapy. Twenty patients with clinically localized prostate cancer who underwent radical external beam radiotherapy were enrolled in this study. Accrual period was from April 1993 to May 1998. Median follow-up period was 26 months. Radiotherapy was given to whole pelvis followed by a boost to prostate. Dose range for the whole pelvis was from 45 Gy to 50 Gy and boost dose to prostate, from 14 Gy to 20 Gy. The post-irradiation PSA normal value was under 3.0 ng/ml. The physical examination and serum PSA level evaluation were performed at 3 month interval in the first on year, and then at every 4 to 6 months. PSA value was normalized in nineteen patients (95%) within 12 months. The mean period of PSA normalization was 5.3 (±2.7) months. The half life of PSA ofd the nonfailing patients was 2.1 (±0.9) month. The nadir PSA level of the nonfailing patients was 0.8 (±0.5) ng/ml. The period of PSA normalization had the positive correlation with pretreatment PSA level (R 2 =0.468). The nadir PSA level had no definite positive correlation with the pretreatment PSA level (R 2 =0.175). The half life of serum PSA level also had no definite correlation with pretreatment PSA level (R 2 =0.029). The PSA level was mostly normalized within 8 months (85%). If it has not normalized within 12 months, we should consider the residual disease in prostate or distant metastasis. In 2 patients, the PSA level increased 6 months or 20 months before clinical disease was detected. So the serum PSA level can be used as early diagnostic indicator of treatment failure

  19. Clinical Usefulness of Implanted Fiducial Markers for Hypofractionated Radiotherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    Choi, Young Min; Ahn, Sung Hwan; Lee, Hyung Hwan; Lee, Hyung Sik; Hur, Woo Joo; Yoon, Jin Han; Kim, Tae Hyo; Kim, Soo Dong; Yun, Seong Guk

    2011-01-01

    To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1 mm, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was 0.94±0.62 mm (range, 0.09 to 3.01 mm; median, 0.81 mm), and the means of the lateral, craniocaudal, and anteroposterior errors were 0.39±0.34 mm, 0.46±0.34 mm, and 0.57±0.59 mm, respectively. The setup error of the pelvic bony matching was 3.15±2.03 mm (range, 0.25 to 8.23 mm; median, 2.95 mm), and the error of craniocaudal direction (2.29±1.95 mm) was significantly larger than those of anteroposterior (1.73±1.31 mm) and lateral directions (0.45±0.37 mm), respectively (p< 0.05). Incidences of over 3 mm and 5 mm in setup difference among the

  20. Intensity Modulated Neutron Radiotherapy for the Treatment of Adenocarcinoma of the Prostate

    International Nuclear Information System (INIS)

    Santanam, Lakshmi; He, Tony; Yudelev, Mark; Forman, Jeffrey D.; Orton, Colin G.; Heuvel, Frank van den; Maughan, Richard L.; Burmeister, Jay

    2007-01-01

    Purpose: This study investigates the enhanced conformality of neutron dose distributions obtainable through the application of intensity modulated neutron radiotherapy (IMNRT) to the treatment of prostate adenocarcinoma. Methods and Materials: An in-house algorithm was used to optimize individual segments for IMNRT generated using an organ-at-risk (OAR) avoidance approach. A number of beam orientation schemes were investigated in an attempt to approach an optimum solution. The IMNRT plans were created retrospectively for 5 patients previously treated for prostate adenocarcinoma using fast neutron therapy (FNT), and a comparison of these plans is presented. Dose distributions and dose-volume histograms (DVHs) were analyzed and plans were evaluated based on percentage volumes of rectum and bladder receiving 95%, 80%, and 50% (V 95 , V 80 , V 50 ) of the prescription dose, and on V 60 for both the femoral heads and GM muscle group. Results: Plans were normalized such that the IMNRT DVHs for prostate and seminal vesicles were nearly identical to those for conventional FNT plans. Use of IMNRT provided reductions in rectum V 95 and V 80 of 10% (2-27%) and 13% (5-28%), respectively, and reductions in bladder V 95 and V 80 of 12% (3-26%) and 4% (7-10%), respectively. The average decrease in V 60 for the femoral heads was 4.5% (1-18%), with no significant change in V 60 for the GM muscle group. Conclusions: This study provides the first analysis of the application of intensity modulation to neutron radiotherapy. The IMNRT technique provides a substantial reduction in normal tissue dose in the treatment of prostate cancer. This reduction should result in a significant clinical advantage for this and other treatment sites

  1. Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Poli, Ana Paula Diniz Fortuna, E-mail: anapaulafortuna@yahoo.com.br [Universidade Estadual de Campinas (CAISM/UNICAMP), Campinas, SP (Brazil). Centro de Atencao Integrada a Saude da Mulher. Divisao de Radioterapia; Dias, Rodrigo Souza; Giordani, Adelmo Jose; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Divisao de Radioterapia

    2016-01-15

    Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation (p = 0.037). A baseline rectal volume superior to 70 cm{sup 3} had a significant influence on the prostate motion in the anteroposterior direction (p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm{sup 3}. Therefore, the treatment of patients with a rectal volume > 70 cm{sup 3} should be re-planned with appropriate rectal preparation. Keywords: Rectal volume; Prostate cancer; Three-dimensional conformal radiotherapy. (author)

  2. Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial

    International Nuclear Information System (INIS)

    Yahya, Noorazrul; Ebert, Martin A.; Bulsara, Max; Haworth, Annette; Kennedy, Angel; Joseph, David J.; Denham, Jim W.

    2015-01-01

    Purpose/objective: To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. Material and methods: Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72 months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. Results: Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. Conclusions: The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact

  3. Changes in sexual function after radiotherapy treatment of prostate cancer

    International Nuclear Information System (INIS)

    Beckendorf, V.; Hay, M.; Rozan, R.; Lagrange, J.L.; N'Guyen, T.; Giraud, B.

    1996-01-01

    The objective was to assess sexual function before and after definitive irradiation for the treatment of cancer of the prostate. The study comprised 67 patients (mean age 68 years) treated in five radiotherapy departments and assessed with repeated questionnaires about their libido, arousal, frequency and quality of intercourse, and sexual satisfaction. Interviews were obtained before radiotherapy and at the end of the first year after treatment. Sixty-three patients were married and 50 had a sexually effective partner. Forty-six patients presented with another pathology or medical treatment capable of inducing sexual dysfunction. Before radiotherapy, 40 patients were sexually active, with good to acceptable intercourse. Between 10 and 24 months after the end of radiotherapy, no disease progression was observed and prostate-specific antigen levels remained high in only two patients. Sexual function was preserved in 67% of patients but only 50% observed no change. The functional prognosis seemed to be related to the initial frequency and quality of intercourse; more than three times per month, the prognosis remained good, under three per month, it was poor. The patient's age was a predictive factor for the frequency of intercourse. (author)

  4. Quality of life after radiotherapy for prostate cancer; Qualite de vie apres radiotherapie pour un cancer localise de la prostate

    Energy Technology Data Exchange (ETDEWEB)

    Joly, F. [Service d' oncologie medicale, CLCC Francois-Baclesse, 14 - Caen (France); CHU Cote-de-Nacre, 14 - Caen (France); Degrendel, A.C. [Service de radiotherapie, CLCC Francois-Baclesse, 14 - Caen (France); Guizard, A.V. [Registre general des tumeurs du Calvados, CLCC Francois-Baclesse, 14 - Caen (France)

    2010-10-15

    The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormono-therapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormono-therapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormono-therapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormono-therapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. (authors)

  5. Evaluation of inflammatory cytokines and oxidative stress markers in prostate cancer patients undergoing curative radiotherapy

    Directory of Open Access Journals (Sweden)

    Phebe L. Abdel-Messeih

    2017-05-01

    Full Text Available Prostate cancer is the second leading cause of cancer-related death in men. The present study was carried out to investigate the radiation response of serum cytokines and oxidative markers to find out if these novel biomarkers have significant applications regarding radiation outcome in prostate cancer patients. Significant elevations of prostatic specific antigen (PSA, asymmetric dimethyl arginine (ADMA and nitric oxide (NO were recorded in cancer prostate patients at the time of diagnosis compared to controls. Patients were subjected to radiotherapy post prostatectomy with a total dose of 66 Gy in 33 fractions (5 sessions/week for 7 weeks. At the end of the seventh week post radiotherapy, ADMA levels were accentuated while the levels of PSA and NO were lower than before therapy. The level of inflammatory cytokines (interleukins IL-4, IL-5 and interferon-gamma in post radiation therapy patients were significantly elevated compared to both controls and prostate cancer patients. A significant inverse correlation was observed in prostate cancer patients between ADMA and NO. Moreover, a significant inverse correlation in post radiation therapy patients was observed between IL-5 and PSA. These results are highly suggestive that there is a specific cytokine response in patients undergoing curative radiotherapy for prostate cancer.

  6. The importance of prostate bed tilt during postprostatectomy intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Bell, Linda J.; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2014-01-01

    Variations in rectal and bladder filling can create a tilt of the prostate bed, which generates the potential for a geographic miss during postprostatectomy radiotherapy. The aim of this study is to assess the effect that bladder and rectum filling has on planning target volume angle, to determine a method to assess prostate bed tilt leading to potential geographic miss, and to discuss possible implementation issues. The cone-beam computed tomography images (n = 377) of 40 patients who received postprostatectomy radiotherapy with intensity-modulated radiotherapy were reviewed. The amount of tilt in the prostate bed was defined as the angle change between 2 surgical clips, one in the upper prostate bed and another in the lower. A potential geographic miss was defined as movement of any clip of more than 1 cm in any direction or 0.5 cm posteriorly when aligned to bone anatomy. Variations in bladder and rectum size were correlated with the degree of prostate bed tilt, and the rate of potential geographic miss was determined. A possible clinical use of prostate bed tilt was then assessed for different imaging techniques. A tilt of more than 10° was seen in 20.2% of images, which resulted in a 57.9% geographic miss rate of the superior clip. When tilt remained within 10°, there was only a 9% rate of geographic miss. Potential geographic miss of the inferior surgical clip was rare, occurring in only 1.9% of all images reviewed. The most common occurrence when the prostate bed tilt increased by more than 10° was a smaller bladder and larger rectum (6.4% of all images). The most common occurrence when the prostate bed tilt decreased by more than 10° was a larger bladder and smaller rectum (1.3% of all images). Significant prostate bed tilt (>± 10°) occurred in more than 20% of images, creating a 58% rate of geographic miss. Greatest prostate bed tilt occurred when the bladder size increased or reduced by more than 2 cm or the superior rectum size increased by more

  7. The importance of prostate bed tilt during postprostatectomy intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bell, Linda J., E-mail: Linda.Bell1@health.nsw.gov.au [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Cox, Jennifer [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Eade, Thomas; Rinks, Marianne; Kneebone, Andrew [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia)

    2014-10-01

    Variations in rectal and bladder filling can create a tilt of the prostate bed, which generates the potential for a geographic miss during postprostatectomy radiotherapy. The aim of this study is to assess the effect that bladder and rectum filling has on planning target volume angle, to determine a method to assess prostate bed tilt leading to potential geographic miss, and to discuss possible implementation issues. The cone-beam computed tomography images (n = 377) of 40 patients who received postprostatectomy radiotherapy with intensity-modulated radiotherapy were reviewed. The amount of tilt in the prostate bed was defined as the angle change between 2 surgical clips, one in the upper prostate bed and another in the lower. A potential geographic miss was defined as movement of any clip of more than 1 cm in any direction or 0.5 cm posteriorly when aligned to bone anatomy. Variations in bladder and rectum size were correlated with the degree of prostate bed tilt, and the rate of potential geographic miss was determined. A possible clinical use of prostate bed tilt was then assessed for different imaging techniques. A tilt of more than 10° was seen in 20.2% of images, which resulted in a 57.9% geographic miss rate of the superior clip. When tilt remained within 10°, there was only a 9% rate of geographic miss. Potential geographic miss of the inferior surgical clip was rare, occurring in only 1.9% of all images reviewed. The most common occurrence when the prostate bed tilt increased by more than 10° was a smaller bladder and larger rectum (6.4% of all images). The most common occurrence when the prostate bed tilt decreased by more than 10° was a larger bladder and smaller rectum (1.3% of all images). Significant prostate bed tilt (>± 10°) occurred in more than 20% of images, creating a 58% rate of geographic miss. Greatest prostate bed tilt occurred when the bladder size increased or reduced by more than 2 cm or the superior rectum size increased by more

  8. Is “pelvic radiation disease” always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    International Nuclear Information System (INIS)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J.; Hoffmann, Matthew; McKay, Michael J.; Shakespeare, Thomas P.

    2014-01-01

    Background: Pelvic radiation disease (PRD) also widely known as “radiation proctopathy” is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. Methods and materials: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Results: Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Conclusions: Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines

  9. Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.

    NARCIS (Netherlands)

    Smeenk, R.J.; Lin, E.N.J.T. van; Kollenburg, P. van; Kunze-Busch, M.C.; Kaanders, J.H.A.M.

    2009-01-01

    BACKGROUND AND PURPOSE: To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. MATERIALS AND METHODS: In 24 patients with localized prostate carcinoma, two planning

  10. Quality of life after radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Joly, F.; Degrendel, A.C.; Guizard, A.V.

    2010-01-01

    The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormono-therapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormono-therapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormono-therapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormono-therapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. (authors)

  11. Intraoperative radiotherapy (IORT) for prostatic cancer

    International Nuclear Information System (INIS)

    Kojima, Shinichi; Satake, Ichiro; Tujii, Toshihiko; Tari, Kiyonobu; Sakura, Mizuyoshi

    1988-01-01

    Between February 1982 and February 1986, 30 patients with prostatic cancer received intaoperative radiotherapy (IORT). First 10 cases were treated by the transperineal approach, and after April 1983, 20 cases were done by the retropubic approach. We chose the retropubic approach, because it has advantages over the transperineal approach, which has a risk of rectal damage, lymph-adenectomy can not be performed and the patient can not sit down for a long time after the operation. In the IORT procedure for prostatic cancer by the retropubic approach, a longitudinal lower abdominal incision is made, and pushing down the bladder, the treatment cone is inserted to the prostate. We performed lymph-adenectomy at the same operation, if hard and large lymph-nodes were touched. Of 30 patients, 2 had stage B disease, 10 had stage C and 18 had stage D disease. The overall 5-year survival rate (Kaplan-Meier method) after IORT was 42.6 % where as that the 31 cases seen (stage C : 6 cases, stage D : 25 cases) since the Center was founded (October 1975) until the introduction of IORT was 3.2 %. Although no definite conclusion can be drawn because all cases received multidisciplinary therapy, IORT appears useful for the treatment of carcinoma of the prostate. (author)

  12. Dosimetric and Radiobiologic Comparison of 3D Conformal Versus Intensity Modulated Planning Techniques for Prostate Bed Radiotherapy

    International Nuclear Information System (INIS)

    Koontz, Bridget F.; Das, Shiva; Temple, Kathy; Bynum, Sigrun; Catalano, Suzanne; Koontz, Jason I.; Montana, Gustavo S.; Oleson, James R.

    2009-01-01

    Adjuvant radiotherapy for locally advanced prostate cancer improves biochemical and clinical disease-free survival. While comparisons in intact prostate cancer show a benefit for intensity modulated radiation therapy (IMRT) over 3D conformal planning, this has not been studied for post-prostatectomy radiotherapy (RT). This study compares normal tissue and target dosimetry and radiobiological modeling of IMRT vs. 3D conformal planning in the postoperative setting. 3D conformal plans were designed for 15 patients who had been treated with IMRT planning for salvage post-prostatectomy RT. The same computed tomography (CT) and target/normal structure contours, as well as prescription dose, was used for both IMRT and 3D plans. Normal tissue complication probabilities (NTCPs) were calculated based on the dose given to the bladder and rectum by both plans. Dose-volume histogram and NTCP data were compared by paired t-test. Bladder and rectal sparing were improved with IMRT planning compared to 3D conformal planning. The volume of the bladder receiving at least 75% (V75) and 50% (V50) of the dose was significantly reduced by 28% and 17%, respectively (p = 0.002 and 0.037). Rectal dose was similarly reduced, V75 by 33% and V50 by 17% (p = 0.001 and 0.004). While there was no difference in the volume of rectum receiving at least 65 Gy (V65), IMRT planning significant reduced the volume receiving 40 Gy or more (V40, p = 0.009). Bladder V40 and V65 were not significantly different between planning modalities. Despite these dosimetric differences, there was no significant difference in the NTCP for either bladder or rectal injury. IMRT planning reduces the volume of bladder and rectum receiving high doses during post-prostatectomy RT. Because of relatively low doses given to the bladder and rectum, there was no statistically significant improvement in NTCP between the 3D conformal and IMRT plans.

  13. Dosimetric and radiobiologic comparison of 3D conformal versus intensity modulated planning techniques for prostate bed radiotherapy.

    Science.gov (United States)

    Koontz, Bridget F; Das, Shiva; Temple, Kathy; Bynum, Sigrun; Catalano, Suzanne; Koontz, Jason I; Montana, Gustavo S; Oleson, James R

    2009-01-01

    Adjuvant radiotherapy for locally advanced prostate cancer improves biochemical and clinical disease-free survival. While comparisons in intact prostate cancer show a benefit for intensity modulated radiation therapy (IMRT) over 3D conformal planning, this has not been studied for post-prostatectomy radiotherapy (RT). This study compares normal tissue and target dosimetry and radiobiological modeling of IMRT vs. 3D conformal planning in the postoperative setting. 3D conformal plans were designed for 15 patients who had been treated with IMRT planning for salvage post-prostatectomy RT. The same computed tomography (CT) and target/normal structure contours, as well as prescription dose, was used for both IMRT and 3D plans. Normal tissue complication probabilities (NTCPs) were calculated based on the dose given to the bladder and rectum by both plans. Dose-volume histogram and NTCP data were compared by paired t-test. Bladder and rectal sparing were improved with IMRT planning compared to 3D conformal planning. The volume of the bladder receiving at least 75% (V75) and 50% (V50) of the dose was significantly reduced by 28% and 17%, respectively (p = 0.002 and 0.037). Rectal dose was similarly reduced, V75 by 33% and V50 by 17% (p = 0.001 and 0.004). While there was no difference in the volume of rectum receiving at least 65 Gy (V65), IMRT planning significant reduced the volume receiving 40 Gy or more (V40, p = 0.009). Bladder V40 and V65 were not significantly different between planning modalities. Despite these dosimetric differences, there was no significant difference in the NTCP for either bladder or rectal injury. IMRT planning reduces the volume of bladder and rectum receiving high doses during post-prostatectomy RT. Because of relatively low doses given to the bladder and rectum, there was no statistically significant improvement in NTCP between the 3D conformal and IMRT plans.

  14. Outcome of patients with localized prostate cancer treated by radiotherapy after confirming the absence of lymph node invasion

    International Nuclear Information System (INIS)

    Suzuki, Noriyuki; Shimbo, Masaki; Amiya, Yoshiyasu; Tomioka, Susumu; Shima, Takayuki; Murakami, Shino; Nakatsu, Hiroomi; Oota, Sayako; Shimazaki, Jun

    2010-01-01

    Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy. After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean). Biochemical failure occurred in 47 patients. Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk. Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure. Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate- and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective. Prostate-specific antigen parameters were predictive factors for further outcome. (author)

  15. Neurovascular bundle–sparing radiotherapy for prostate cancer using MRI-CT registration: A dosimetric feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Cassidy, R.J., E-mail: richardjcassidy@emory.edu [Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA (United States); Yang, X.; Liu, T.; Thomas, M. [Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA (United States); Nour, S.G. [Department of Radiology, Emory University, Atlanta, GA (United States); Jani, A.B. [Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA (United States)

    2016-01-01

    Purpose: Sexual dysfunction after radiotherapy for prostate cancer remains an important late adverse toxicity. The neurovascular bundles (NVB) that lie posterolaterally to the prostate are typically spared during prostatectomy, but in traditional radiotherapy planning they are not contoured as an organ-at-risk with dose constraints. Our goal was to determine the dosimetric feasibility of “NVB-sparing” prostate radiotherapy while still delivering adequate dose to the prostate. Methods: Twenty-five consecutive patients with prostate cancer (with no extraprostatic disease on pelvic magnetic resonance imaging [MRI]) who that were treated with external beam radiotherapy, with the same primary planning target volume margins, to a dose of 79.2 Gy were evaluated. Pelvic MRI and simulation computed tomography scans were registered using dedicated software to allow for bilateral NVB target delineation on T2-weighted MRI. A volumetric modulated arc therapy plan was generated using the NVB bilaterally with 2 mm margin as an organ to spare and compared to the patient’s previously delivered plan. Dose-volume histogram endpoints for NVB, rectum, bladder, and planning target volume 79.2 were compared between the 2 plans using a 2-tailed paired t-test. Results: The V70 for the NVB was significantly lower on the NVB-sparing plan (p <0.01), while rectum and bladder endpoints were similar. Target V100% was similar but V{sub 105%} was higher for the NVB-sparing plans (p <0.01). Conclusions: “NVB-sparing” radiotherapy is dosimetrically feasible using CT-MRI registration, and for volumetric modulated arc therapy technology — target coverage is acceptable without increased dose to other normal structures, but with higher target dose inhomogeneity. The clinical impact of “NVB-sparing” radiotherapy is currently under study at our institution.

  16. Method comparison of ultrasound and kilovoltage x-ray fiducial marker imaging for prostate radiotherapy targeting

    Science.gov (United States)

    Fuller, Clifton David; Thomas, Charles R., Jr.; Schwartz, Scott; Golden, Nanalei; Ting, Joe; Wong, Adrian; Erdogmus, Deniz; Scarbrough, Todd J.

    2006-10-01

    Several measurement techniques have been developed to address the capability for target volume reduction via target localization in image-guided radiotherapy; among these have been ultrasound (US) and fiducial marker (FM) software-assisted localization. In order to assess interchangeability between methods, US and FM localization were compared using established techniques for determination of agreement between measurement methods when a 'gold-standard' comparator does not exist, after performing both techniques daily on a sequential series of patients. At least 3 days prior to CT simulation, four gold seeds were placed within the prostate. FM software-assisted localization utilized the ExacTrac X-Ray 6D (BrainLab AG, Germany) kVp x-ray image acquisition system to determine prostate position; US prostate targeting was performed on each patient using the SonArray (Varian, Palo Alto, CA). Patients were aligned daily using laser alignment of skin marks. Directional shifts were then calculated by each respective system in the X, Y and Z dimensions before each daily treatment fraction, previous to any treatment or couch adjustment, as well as a composite vector of displacement. Directional shift agreement in each axis was compared using Altman-Bland limits of agreement, Lin's concordance coefficient with Partik's grading schema, and Deming orthogonal bias-weighted correlation methodology. 1019 software-assisted shifts were suggested by US and FM in 39 patients. The 95% limits of agreement in X, Y and Z axes were ±9.4 mm, ±11.3 mm and ±13.4, respectively. Three-dimensionally, measurements agreed within 13.4 mm in 95% of all paired measures. In all axes, concordance was graded as 'poor' or 'unacceptable'. Deming regression detected proportional bias in both directional axes and three-dimensional vectors. Our data suggest substantial differences between US and FM image-guided measures and subsequent suggested directional shifts. Analysis reveals that the vast majority of

  17. Salvage cryotherapy for local recurrence after radiotherapy for prostate cancer.

    Science.gov (United States)

    Kvorning Ternov, Klara; Krag Jakobsen, Ane; Bratt, Ola; Ahlgren, Göran

    2015-04-01

    The aim of this study was to present the outcome of patients treated with salvage cryotherapy after radiotherapy for prostate cancer at one institution. Consecutive patients treated between 2007 and 2013 with transperineal cryotherapy for biopsy-verified local recurrence after radiotherapy were investigated. An external reviewer retrieved outcome data retrospectively from medical records. Complications were graded according to the Clavien classification. One patient with less than 1 year of follow-up was excluded from the analysis of side-effects. Thirty patients were included, 29 of whom had a follow-up of at least 1 year. The median follow-up was 2.7 years (range 1-6.5 years). Eleven of the 23 patients without hormonal treatment at the time of cryotherapy reached a prostate-specific antigen (PSA) nadir of less than 0.5 ng/ml. At the end of follow-up five of these 23 patients still had a PSA below 0.5 ng/ml and 10 were free from recurrence according to the Phoenix definition. Clinical recurrence (verified with imaging or biopsies) was detected in 13 patients, six of which were local. One patient died from prostate cancer. Eleven patients had urinary incontinence grade 1-2 and three had grade 3-4, seven had pelvic pain, three had severe but transitory tissue sloughing, three developed a urethral stricture or had prolonged urinary retention, and one developed a urinary fistula 4.5 years after cryotherapy. Salvage cryotherapy should be considered as an alternative to hormonal treatment and surgery for local recurrence after radiotherapy for prostate cancer. The results compare well to those reported from centres with longer experience.

  18. Analysis of the testicular dose in patients undergoing radiotherapy for carcinoma of the prostate

    International Nuclear Information System (INIS)

    Bejar Navarro, M. J.; Ordonez Marquez, J.; Hervas Moron, A.; Alvarez Rodriguez, S.; Garcia-Galloway, E.; Sanchez Casanueva, R.; Polo Rubio, A.; Rodriguez-Patron, R.; Yanowsky, K.; Gomez Dos Santos, V.

    2013-01-01

    The objectives of this work are: -Studying comparatively the doses received in testes in patients undergoing radiotherapy of prostate carcinoma with external beam radiation and brachytherapy of low rate using I-125 seeds. -Compare doses due to images of verification using Cone Beam CT (CBCT), with doses of radiotherapy treatment itself. -Determine the seminal alterations and cytogenetic after treatment with ionizing radiation (RTE or BQT) in patients diagnosed with prostate cancer and its relation with testicular dose. (Author)

  19. The Role of Seminal Vesicle Motion in Target Margin Assessment for Online Image-Guided Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Liang Jian; Wu Qiuwen; Yan Di

    2009-01-01

    Purpose: For patients with intermediate- and high-risk prostate cancer, the seminal vesicles (SVs) are included in the clinical target volume (CTV). The purposes of this study are to investigate interfraction motion characteristics of the SVs and determine proper margins for online computed tomography image guidance. Methods and Materials: Twenty-four patients, each with 16 daily helical computed tomography scans, were included in this study. A binary image mask was used for image registration to determine daily organ motion. Two online image-guided radiotherapy strategies (prostate only and prostate + SVs) were simulated in a hypofractionated scheme. Three margin designs were studied for both three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT). In prostate-only guidance, Margin A was uniformly applied to the whole CTV, and Margin B was applied to the SVs with a fixed 3-mm prostate margin. In prostate plus SV guidance, Margin C was uniformly applied to the CTV. The minimum margins were sought to satisfy the criterion that minimum cumulative CTV dose be more than those of the planning target volume in the plan for greater than 95% of patients. Results: The prostate and SVs move significantly more in the anterior-posterior and superior-inferior than right-left directions. The anterior-posterior motion of the prostate and SVs correlated (R 2 = 0.7). The SVs move significantly more than the prostate. The minimum margins found were 2.5 mm for three-dimensional conformal radiotherapy and 4.5, 4.5, and 3.0 mm for Margins A, B, and C for IMRT, respectively. Margins for IMRT were larger, but the irradiated volume and doses to critical structures were smaller. Minimum margins of 4.5 mm to the SVs and 3 mm to the prostate are recommended for IMRT with prostate-only guidance. Conclusions: The SVs move independently from the prostate gland, and additional margins are necessary for image-guided radiotherapy

  20. The role and principles of radiotherapy in prostate cancer in the elderly subject

    International Nuclear Information System (INIS)

    Richaud, P.; Salomon, L.; Mongiat-Artus, P.; Gaschignard, N.; Beuzeboc, P.; Peyromaure, M.; Bastide, C.; Cornud, F.; Molinie, V.; Rozet, F.; Staerman, F.; Soulie, M.

    2009-01-01

    The aging of the population has resulted in an increase in the number of elderly patients with prostate cancer. Among the curative treatment options in the elderly subject, external radiotherapy is the most frequently chosen option. Combined treatment including radiotherapy and hormone therapy should be preferred to hormonal therapy alone, including in elderly patients, whenever life expectancy surpasses 4-5 years. The indications for this radiotherapy should be defined in an attempt to prevent excessive or insufficient treatment, to adapt the treatment modalities to the patient's age by assessing its potential toxicity, and to discuss the possible alternatives. In cases of localized prostate cancer in men who are aging well, a standard treatment should be proposed, preferring radiotherapy possibly associated with hormone therapy in cases with negative prognostic factors. Patients with a reversible health problems can also receive standard treatment, notably in cases with aggressive prognostic factors. (authors)

  1. Daily Prostate Volume and Position Monitoring Using Implanted Gold Markers and On-Board Imaging during Radiotherapy

    Directory of Open Access Journals (Sweden)

    Linda Kašaová

    2011-01-01

    Full Text Available Purpose: This study aimed to evaluate prostate volume changes and prostate motions during radiotherapy. Methods: In 2010, twenty-five patients were treated for prostate cancer by external beam radiotherapy with implanted fiducial markers. Coordinates of three gold markers on kilovoltage images were calculated daily. Volume changes in target structure were observed through changes in intermarker distances. Differences in patient position between laser-tattoo alignment and gold marker localization were evaluated. Intrafraction motion was assessed by measuring marker displacement on kilovoltage images acquired before and after fraction delivery. Results: Prostate shrinkage was observed in 60% of patients. The average shrinkage was 7% of the prostate’s initial volume. Corrections after laser-tattoo alignment remained mostly below 1 cm. The difference between marker centroid position on the actual images and the planning images was 2 ± 1 mm on average. The extension of intrafraction movements was 7.6 ± 0.2 mm on average. Conclusions: In our retrospective study, the possibility for prostate volume changes during radiotherapy was revealed. Intrafraction movements turned out to be the limiting factor in safety margin reduction.

  2. Predictive value of bcl-2 immunoreactivity in prostate cancer patients treated with radiotherapy

    International Nuclear Information System (INIS)

    Bylund, A.; Widmark, A.; Stattin, P.; Bergh, A.

    1998-01-01

    Background and purpose: Recent experimental evidence suggests that overexpression of bcl-2, a protein functioning by blocking apoptosis, may influence the treatment outcome in human tumours, including prostate cancer. To test the clinical implications of this hypothesis, tumours from patients with prostate cancer treated with external beam radiotherapy were investigated for bcl-2 immunoreactivity (IR) and correlated with prognosis and treatment outcome. Materials and methods: Bcl-2 IR was evaluated in archival tumour specimens obtained through transurethral resection from 42 patients with localized prostate cancer (T0-T4, N0 and M0). Bcl-2 IR expression was related to stage, grade and cancer-specific survival. Specimens were obtained prior to administrating routine radiotherapy for all patients. Results: Bcl-2 IR was present in 19/42 (45%) tumours. The bcl-2-positive patients had a significantly longer cancer-specific survival than the bcl-2-negative patients (10.3 versus 3.4 years, P<0.04). At follow-up (7-19 years), nine patients were still alive, 26 patients had died of prostate cancer and seven patients had died of other causes. Conclusions: This study indicates that pre-treatment bcl-2 overexpression is related to a favourable outcome in prostate cancer treated with radiotherapy. Low bcl-2 along with a high stage may be a predictor of poor prognosis and these patients might benefit from additional treatment. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  3. Sexual function disorders after local radiotherapy for carcinoma of the prostate

    International Nuclear Information System (INIS)

    Van Heeringen, C.; Verbeek, E.; De Schryver, A.

    1988-01-01

    In order to contribute some insight into the extent to which local radiotherapy for carcinoma of the prostate is followed by disorders in sexual functioning, 18 patients whose age ranged from 60 to 82, were interviewed 4 to 45 months after their Radiotherapy (RT). Our results confirmed the fact that RT was followed by impotence as such in only a minority of cases (3 out of 12 or 0.25). However, when other aspects of sexuality were taken into account, a higher proportion appeared to have problems. In a substantial number of patients, psychogenic factors seemed to be (at least partly) responsible. More attention to these facts and, when necessary, psychiatric assistance, may help reduce the incidence of sexual disorders following RT to the prostate

  4. Hyperfractionated conformal radiotherapy in locally advanced prostate cancer: results of a dose escalation study

    International Nuclear Information System (INIS)

    Forman, Jeffrey D.; Duclos, Marie; Shamsa, Falah; Porter, Arthur T.; Orton, Colin

    1996-01-01

    Purpose: This study was initiated to assess the incidence of chronic complications and histologic and biochemical control following hyperfractionated conformal radiotherapy in patients with locally advanced prostate cancer. Methods and Materials: Between October 1991 and October 1994, 49 patients with locally advanced prostate cancer were entered on the first two dose levels of a prospective dose-escalation study using hyperfractionated three dimensional conformal radiotherapy. The first 25 patients received a minimum tumor dose of 78 Gy to the prostate and seminal vesicles in 6 weeks at 1.3 Gy, b.i.d. No increase in chronic toxicity compared with conventional radiotherapy was noted; therefore, an additional 24 patients were treated to a minimum tumor dose of 82.8 Gy to the prostate and seminal vesicles in 7 weeks at 1.15 Gy, b.i.d. Toxicity was scored according to the Radiation Therapy Oncology Group morbidity grading scale. Efficacy was assessed through scheduled postradiation prostate specific antigen values and ultrasound-guided biopsies. The median follow-up for the entire group was 20 months. Results: The hyperfractionated external radiation was well tolerated with minimal acute morbidity. At 30 months, the actuarial probability of Grade 2 gastrointestinal toxicity was 17%. At 30 months, the actuarial probability of Grade 2 genitourinary toxicity was 16%. There was no statistically significant difference between the two dose levels. No Grade 3 or 4 gastrointestinal or genitourinary toxicity was noted. At 12 months, 84% of patients had a prostate specific antigen ≤ 4; and 53%; ≤ 1 ng/ml. At 12 months, 71% of patients had post radiation biopsies that were either negative (55%) or showed a marked therapeutic effect (16%). Conclusion: The use of hyperfractionated conformal radiotherapy facilitated dose escalation with no increase in chronic toxicity compared to standard doses. The initial tumor response based on prostate specific antigen measurements and

  5. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy.

    NARCIS (Netherlands)

    Smeenk, R.J.; Hoffmann, A.L.; Hopman, W.P.M.; Lin, E.N.J.T. van; Kaanders, J.H.A.M.

    2012-01-01

    PURPOSE: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). METHODS AND MATERIALS: In 48 patients treated for localized prostate

  6. Impact of different setup approaches in image-guided radiotherapy as primary treatment for prostate cancer. A study of 2940 setup deviations in 980 MVCTs

    International Nuclear Information System (INIS)

    Schiller, Kilian; Specht, Hanno; Kampfer, Severin; Duma, Marciana Nona; Petrucci, Alessia; Geinitz, Hans; Schuster, Tibor

    2014-01-01

    The goal of this study was to assess the impact of different setup approaches in image-guided radiotherapy (IMRT) of the prostatic gland. In all, 28 patients with prostate cancer were enrolled in this study. After the placement of an endorectal balloon, the planning target volume (PTV) was treated to a dose of 70 Gy in 35 fractions. A simultaneously integrated boost (SIB) of 76 Gy (2.17 Gy per fraction and per day) was delivered to a smaller target volume. All patients underwent daily prostate-aligned IGRT by megavoltage CT (MVCT). Retrospectively, three different setup approaches were evaluated by comparison to the prostate alignment: setup by skin alignment, endorectal balloon alignment, and automatic registration by bones. A total of 2,940 setup deviations were analyzed in 980 fractions. Compared to prostate alignment, skin mark alignment was associated with substantial displacements, which were ≥ 8 mm in 13 %, 5 %, and 44 % of all fractions in the lateral, longitudinal, and vertical directions, respectively. Endorectal balloon alignment yielded displacements ≥ 8 mm in 3 %, 19 %, and 1 % of all setups; and ≥ 3 mm in 27 %, 58 %, and 18 % of all fractions, respectively. For bone matching, the values were 1 %, 1 %, and 2 % and 3 %, 11 %, and 34 %, respectively. For prostate radiotherapy, setup by skin marks alone is inappropriate for patient positioning due to the fact that, during almost half of the fractions, parts of the prostate would not be targeted successfully with an 8-mm safety margin. Bone matching performs better but not sufficiently for safety margins ≤ 3 mm. Endorectal balloon matching can be combined with bone alignment to increase accuracy in the vertical direction when prostate-based setup is not available. Daily prostate alignment remains the gold standard for high-precision radiotherapy with small safety margins. (orig.) [de

  7. Clinical Outcomes for Patients with Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiotherapy or Radical Prostatectomy: A Multi-institutional Comparative Analysis.

    Science.gov (United States)

    Kishan, Amar U; Shaikh, Talha; Wang, Pin-Chieh; Reiter, Robert E; Said, Jonathan; Raghavan, Govind; Nickols, Nicholas G; Aronson, William J; Sadeghi, Ahmad; Kamrava, Mitchell; Demanes, David Jeffrey; Steinberg, Michael L; Horwitz, Eric M; Kupelian, Patrick A; King, Christopher R

    2017-05-01

    The long natural history of prostate cancer (CaP) limits comparisons of efficacy between radical prostatectomy (RP) and external beam radiotherapy (EBRT), since patients treated years ago received treatments considered suboptimal by modern standards (particularly with regards to androgen deprivation therapy [ADT] and radiotherapy dose-escalation]. Gleason score (GS) 9-10 CaP is particularly aggressive, and clinically-relevant endpoints occur early, facilitating meaningful comparisons. To compare outcomes of patients with GS 9-10 CaP following EBRT, extremely-dose escalated radiotherapy (as exemplified by EBRT+brachytherapy [EBRT+BT]), and RP. Retrospective analysis of 487 patients with biopsy GS 9-10 CaP treated between 2000 and 2013 (230 with EBRT, 87 with EBRT+BT, and 170 with RP). Most radiotherapy patients received ADT and dose-escalated radiotherapy. Kaplan-Meier analysis and multivariate Cox regression estimated and compared 5-yr and 10-yr rates of distant metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS). The median follow-up was 4.6 yr. Local salvage and systemic salvage were performed more frequently in RP patients (49.0% and 30.1%) when compared with either EBRT patients (0.9% and 19.7%) or EBRT+BT patients (1.2% and 16.1%, pRadiotherapy and RP provide equivalent CSS and OS. Extremely dose-escalated radiotherapy with ADT in particular offers improved systemic control when compared with either EBRT or RP. These data suggest that extremely dose-escalated radiotherapy with ADT might be the optimal upfront treatment for patients with biopsy GS 9-10 CaP. While some prostate cancers are slow-growing requiring many years, sometimes decades, of follow-up in order to compare between radiation and surgery, high-risk and very aggressive cancers follow a much shorter time course allowing such comparisons to be made and updated as treatments, especially radiation, rapidly evolve. We showed that radiation-based treatments and surgery

  8. Cross-Linked Hyaluronan Gel Reduces the Acute Rectal Toxicity of Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Wilder, Richard B.; Barme, Greg A.; Gilbert, Ronald F.; Holevas, Richard E.; Kobashi, Luis I.; Reed, Richard R.; Solomon, Ronald S.; Walter, Nancy L.; Chittenden, Lucy; Mesa, Albert V.; Agustin, Jeffrey; Lizarde, Jessica; Macedo, Jorge; Ravera, John; Tokita, Kenneth M.

    2010-01-01

    Purpose: To prospectively analyze whether cross-linked hyaluronan gel reduces the mean rectal dose and acute rectal toxicity of radiotherapy for prostate cancer. Methods and Materials: Between September 2008 and March 2009, we transperitoneally injected 9mL of cross-linked hyaluronan gel (Hylaform; Genzyme Corporation, Cambridge, MA) into the anterior perirectal fat of 10 early-stage prostate cancer patients to increase the separation between the prostate and rectum by 8 to 18mm at the start of radiotherapy. Patients then underwent high-dose rate brachytherapy to 2,200cGy followed by intensity-modulated radiation therapy to 5,040cGy. We assessed acute rectal toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 grading scheme. Results: Median follow-up was 3 months. The anteroposterior dimensions of Hylaform at the start and end of radiotherapy were 13 ± 3mm (mean ± SD) and 10 ± 4mm, respectively. At the start of intensity-modulated radiation therapy, daily mean rectal doses were 73 ± 13cGy with Hylaform vs. 106 ± 20cGy without Hylaform (p = 0.005). There was a 0% incidence of National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 Grade 1, 2, or 3 acute diarrhea in 10 patients who received Hylaform vs. a 29.7% incidence (n = 71) in 239 historical controls who did not receive Hylaform (p = 0.04). Conclusions: By increasing the separation between the prostate and rectum, Hylaform decreased the mean rectal dose. This led to a significant reduction in the acute rectal toxicity of radiotherapy for prostate cancer.

  9. The development of intensity modulated radiotherapy (IMRT) for prostate cancer at Austin and Repatriation Medical Centre (ARMC)

    International Nuclear Information System (INIS)

    Joon, D.L.; Mantle, C.; Viotto, A.; Rolfo, A.; Rykers, K.; Fernando, W.; Grace, M.; Liu, G.; Quong, G.; Feigen, M.; Wada, M.; Joon, M.L.; Fogarty, G.; Chao, M.W.; Khoo, V.

    2003-01-01

    To describe the protocol development of the IMRT program for prostate cancer at the ARMC. A series of protocols were defined and developed to facilitate the delivery of intensity modulated radiotherapy for prostate cancer. These included the following: 1. Physical Simulation including bowel and bladder preparation and immobilization 2. Image Acquisition including CT and MRI simulation scans with image co-registration 3. Contouring Definitions including target and organ at risk volumes as well as IMRT optimization and evaluation volumes 4. Radiotherapy Planning including constraint definition, inverse planning and CMS Focus specific parameters 5. DICOM RT interface including data transfer between CMS Focus and the Elekta Linac Desktop record and verify system 6. Verification including action limits and pre-treatment online EPID verification 7. Radiotherapy Delivery being that of step and shoot 8. Quality Assurance including physics testing and documentation The protocol development and testing has lead to the precise clinical delivery of IMRT for prostate cancer at ARMC that exceeds most of the parameters that were previously measured with our conventional and 3D conformal radiotherapy. Further development is now underway to allow it to be implemented as the routine treatment of prostate cancer at ARMC. The clinical implementation of IMRT for prostate cancer involves a collaborative team approach including radiation oncologists, radiation therapists, and radiation physics. This is necessary to develop the appropriate protocols and quality assurance for precision radiotherapy that is required for IMRT

  10. Side effects of curative radiotherapy of the prostatic cancer

    International Nuclear Information System (INIS)

    Ziegler, F.; Metzger, H.; Huebener, K.H.; Kurtz, B.

    1984-01-01

    The side effects of primary percutaneous radiotherapy in 100 patients with prostatic cancer were evaluated and classified into different degrees of gravity. It was shown that especially chronic side effects are benign in most of all cases. Severe - but not vitally dangerous - complications in bladder and intestine are rare (3%); their percentage corresponds roughly to the average mortality rate of surgical intervention (radical prostatectomy). Contrary to operation, troubles of the sexual function appear only in one third of the patients. Taking into consideration the similar therapeutic results of intervention and radiotherapy, radiotherapy is more favorable with respect to side effects. This essential aspects should be considered when making a decision whether to apply a surgical or radiotherapeutic treatment. (orig.) [de

  11. Method comparison of ultrasound and kilovoltage x-ray fiducial marker imaging for prostate radiotherapy targeting

    International Nuclear Information System (INIS)

    Fuller, Clifton David; Jr, Charles R Thomas; Schwartz, Scott; Golden, Nanalei; Ting, Joe; Wong, Adrian; Erdogmus, Deniz; Scarbrough, Todd J

    2006-01-01

    Several measurement techniques have been developed to address the capability for target volume reduction via target localization in image-guided radiotherapy; among these have been ultrasound (US) and fiducial marker (FM) software-assisted localization. In order to assess interchangeability between methods, US and FM localization were compared using established techniques for determination of agreement between measurement methods when a 'gold-standard' comparator does not exist, after performing both techniques daily on a sequential series of patients. At least 3 days prior to CT simulation, four gold seeds were placed within the prostate. FM software-assisted localization utilized the ExacTrac X-Ray 6D (BrainLab AG, Germany) kVp x-ray image acquisition system to determine prostate position; US prostate targeting was performed on each patient using the SonArray (Varian, Palo Alto, CA). Patients were aligned daily using laser alignment of skin marks. Directional shifts were then calculated by each respective system in the X, Y and Z dimensions before each daily treatment fraction, previous to any treatment or couch adjustment, as well as a composite vector of displacement. Directional shift agreement in each axis was compared using Altman-Bland limits of agreement, Lin's concordance coefficient with Partik's grading schema, and Deming orthogonal bias-weighted correlation methodology. 1019 software-assisted shifts were suggested by US and FM in 39 patients. The 95% limits of agreement in X, Y and Z axes were ±9.4 mm, ±11.3 mm and ±13.4, respectively. Three-dimensionally, measurements agreed within 13.4 mm in 95% of all paired measures. In all axes, concordance was graded as 'poor' or 'unacceptable'. Deming regression detected proportional bias in both directional axes and three-dimensional vectors. Our data suggest substantial differences between US and FM image-guided measures and subsequent suggested directional shifts. Analysis reveals that the vast majority of

  12. Prostate specific antigen levels during and after external beam radiotherapy for localized carcinoma of the prostate: Predictor of therapeutic efficancy

    International Nuclear Information System (INIS)

    Rodrigus, P.; Landeghem, A.A.J. van

    1992-01-01

    For 105 patients with locoregional carcinoma of the prostate, prostate specific antigen (PSA) levels were evaluated before, during and after external beam radiotherapy. The median follow-up is 17 months. In 51 patients (48.5%) initial PSA levels exceeded the maximum normal value of 20 ng/ml. Nine patients kept non-declining high levels just after radiotherapy. Only one of these is free of disease. Assuming PSA levels decrease exponentially during radiotherapy, a mean half-life of 62 days (median 54, SD 26 days) was calculated. Three out of five patients with a PSA half-life of more than 88 days relapsed as compared to a 8% (3/37) relapse rate in patients with a 'normal' half-life. Prolonged PSA half-life suggests residual disease. PSA levels are expected to further decrease after radiation. Six months after irradiation persistent high PSA levels were found in 14/51 (27.5%) patients. Only four of them had no evidence of manifest disease. Important negative prognostic factors for disease control in our series were non-declining high levels of PSA, a PSA serum half-life exceeding 88 days and persistence of elevated PSA values longer than six months after treatment. In our opinion, PSA is a valuable marker in the follow-up of prostate cancer patients during and after radiotherapy. (orig.) [de

  13. Localized field conformation radiotherapy combined with endocrine therapy for the treatment of prostate cancer

    International Nuclear Information System (INIS)

    Karasawa, Katsuyuki; Kaizu, Toshihide; Kurosaki, Hiromasa; Tanaka, Yoshiaki

    1999-01-01

    To improve the quality of life (QOL) of the patients with prostate cancer, we limit the radiotherapy target volume to the prostate and seminal vesicles while using endocrine therapy towards the disease outside the target volume. Radiotherapy technique was rotation conformation technique with computer-controlled multileaf collimators to the total doses of up to 66-70 Gy. Among 145 evaluable cases with the median age of 74, overall and cause-specific 5-year survival rates were 59.3% and 84.1%, respectively, and the relative survival rate of the Stage A-C cases was 100%. The two thirds (33/50) of the deaths were not of prostate cancer. The rate of severe complication was 1.4%. As for QOL, the rate of impotence was 90%, however, the patients' overall satisfaction towards the treatment was 90%. From this analysis, this combined treatment seems beneficial in the treatment of prostate cancer. (author)

  14. Dosimetric comparison of standard three-dimensional conformal radiotherapy followed by intensity-modulated radiotherapy boost schedule (sequential IMRT plan) with simultaneous integrated boost-IMRT (SIB IMRT) treatment plan in patients with localized carcinoma prostate.

    Science.gov (United States)

    Bansal, A; Kapoor, R; Singh, S K; Kumar, N; Oinam, A S; Sharma, S C

    2012-07-01

    DOSIMETERIC AND RADIOBIOLOGICAL COMPARISON OF TWO RADIATION SCHEDULES IN LOCALIZED CARCINOMA PROSTATE: Standard Three-Dimensional Conformal Radiotherapy (3DCRT) followed by Intensity Modulated Radiotherapy (IMRT) boost (sequential-IMRT) with Simultaneous Integrated Boost IMRT (SIB-IMRT). Thirty patients were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum and small bowel. All patients were treated with sequential-IMRT plan, but for dosimetric comparison, SIB-IMRT plan was also created. The prescription dose to PTV P + SV was 74 Gy in both strategies but with different dose per fraction, however, the dose to PTV LN was 50 Gy delivered in 25 fractions over 5 weeks for sequential-IMRT and 54 Gy delivered in 27 fractions over 5.5 weeks for SIB-IMRT. The treatment plans were compared in terms of dose-volume histograms. Also, Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) obtained with the two plans were compared. The volume of rectum receiving 70 Gy or more (V > 70 Gy) was reduced to 18.23% with SIB-IMRT from 22.81% with sequential-IMRT. SIB-IMRT reduced the mean doses to both bladder and rectum by 13% and 17%, respectively, as compared to sequential-IMRT. NTCP of 0.86 ± 0.75% and 0.01 ± 0.02% for the bladder, 5.87 ± 2.58% and 4.31 ± 2.61% for the rectum and 8.83 ± 7.08% and 8.25 ± 7.98% for the bowel was seen with sequential-IMRT and SIB-IMRT plans respectively. For equal PTV coverage, SIB-IMRT markedly reduced doses to critical structures, therefore should be considered as the strategy for dose escalation. SIB-IMRT achieves lesser NTCP than sequential-IMRT.

  15. Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Flentje, Michael; Guckenberger, Matthias; Ok, Sami; Polat, Buelent; Sweeney, Reinhart A.

    2010-01-01

    Purpose: To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery. Patients and Methods: 100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0). Results: Treatment was completed as planned by all patients. Acute GI and GU toxicity grade ≥ 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade ≥ 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade ≥ 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006). Conclusion: High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising. (orig.)

  16. Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Flentje, Michael [Dept. of Radiotherapy, Univ. Hospital Wuerzburg (Germany); Guckenberger, Matthias; Ok, Sami; Polat, Buelent; Sweeney, Reinhart A.

    2010-10-15

    Purpose: To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery. Patients and Methods: 100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0). Results: Treatment was completed as planned by all patients. Acute GI and GU toxicity grade {>=} 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade {>=} 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade {>=} 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006). Conclusion: High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising. (orig.)

  17. Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Hidayet Sarı

    2016-12-01

    Full Text Available Prostate cancer is one of the most common malignancies in men. Pelvic radiotherapy is commonly used in both radical and palliative treatment for prostate cancer. Radiation-induced adverse effects might be seen on adjacent healthy tissues (such as vessels, bones and soft tissues with the exception of targeted area. Particularly several years after radiotherapy, low back and hip pain may occur due to bone edema, necrosis or fractures. In these cases, whether complaints due to the degenerative, metastatic or radiotherapy complications must be examined and appropriate treatment should be arranged. For this purpose, we present our elderly patient who received radiotherapy for prostate cancer, and thereafter, developed bilateral avascular hip necrosis and pelvic insufficiency fractures.

  18. Treatment outcome of localized prostate cancer by 70 Gy hypofractionated intensity-modulated radiotherapy with a customized rectal balloon

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jung; Kim, Jun Won; Hong, Sung Joon; Rha, Koon Ho; Lee, Chang Geol; Yang, Seung Choul; Choi, Young Deuk; Suh, Chang Ok; Cho, Jae Ho [Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity > or =grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

  19. A nonaxial boost may reduce late complications of radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ben-Josef, E; Mesina, C F; Choi, J; Forman, J D

    1995-07-01

    Purpose: The nonaxial external beam (NAEBT) prostate boost technique was designed to reduce late complications of radiotherapy for prostate cancer. It has been previously shown that with this beam arrangement, the volumes of bladder and rectum receiving high doses could be substantially reduced. This study was undertaken to find if these advantages in dose distribution would translate into clinically significant benefits. Materials and Methods: Follow-up was obtained on 106 prostate cancer patients who had been treated with 3D conformal radiotherapy. Late complications were scored using the RTOG scale. A standard four-field axial (STD) technique had been used to deliver 45 Gy to the prostate, seminal vesicles and periprostatic lymph-nodes. A subsequent 24 Gy boost had been delivered using a STD technique (58 patients) or a NAEBT technique (48 patients). In the latter, the opposing anterior and posterior pair of beams had been substituted for a right and left anterior infero-superior pair. Actuarial probabilities of developing late complications were calculated by the life-table method. The Mantel-Haenszel test was used to compare these probabilities between the two groups. Results: The groups were comparable in regard to age, race, pretreatment serum PSA, stage distribution and dose to prostate. With a median follow-up of 21 months, 18 patients have developed grade 1-2 gastrointestinal or genitourinary complications (14 in the STD group, 4 in the NAEBT group). There were no grade 3-4 complications. The actuarial 3-year complication probability was 58% and 11% in the STD and NAEBT groups, respectively. However, this difference was not statistically significant. Gastrointestinal and genitourinary complications were reduced from 12.1% to 6.2% and from 15.5% to 4.2%, respectively. Conclusion: The use of a nonaxial boost technique has resulted in fewer complications in patients treated with 3D conformal radiotherapy for localized prostate cancer. The greater reduction

  20. Online Adaptive Replanning Method for Prostate Radiotherapy

    International Nuclear Information System (INIS)

    Ahunbay, Ergun E.; Peng Cheng; Holmes, Shannon; Godley, Andrew; Lawton, Colleen; Li, X. Allen

    2010-01-01

    Purpose: To report the application of an adaptive replanning technique for prostate cancer radiotherapy (RT), consisting of two steps: (1) segment aperture morphing (SAM), and (2) segment weight optimization (SWO), to account for interfraction variations. Methods and Materials: The new 'SAM+SWO' scheme was retroactively applied to the daily CT images acquired for 10 prostate cancer patients on a linear accelerator and CT-on-Rails combination during the course of RT. Doses generated by the SAM+SWO scheme based on the daily CT images were compared with doses generated after patient repositioning using the current planning target volume (PTV) margin (5 mm, 3 mm toward rectum) and a reduced margin (2 mm), along with full reoptimization scans based on the daily CT images to evaluate dosimetry benefits. Results: For all cases studied, the online replanning method provided significantly better target coverage when compared with repositioning with reduced PTV (13% increase in minimum prostate dose) and improved organ sparing when compared with repositioning with regular PTV (13% decrease in the generalized equivalent uniform dose of rectum). The time required to complete the online replanning process was 6 ± 2 minutes. Conclusion: The proposed online replanning method can be used to account for interfraction variations for prostate RT with a practically acceptable time frame (5-10 min) and with significant dosimetric benefits. On the basis of this study, the developed online replanning scheme is being implemented in the clinic for prostate RT.

  1. Initial Australian experience with daily ultrasound localisation for prostate radiotherapy

    International Nuclear Information System (INIS)

    Kneebone, A.; Fuller, M.W.; Williams, M.J.

    2003-01-01

    Variability in prostate position is a major problem in the delivery of external beam radiotherapy (EBRT). Daily ultrasound localisation prior to radiotherapy has become popular in the United States but to date has not been used clinically in Australia or New Zealand. Daily transabdominal ultrasound images through the prostate were acquired using the BAT ultrasound system. Contour data from the planning system is reconstructed at the same locations/angles as the BAT images. By overlaying the planned contours with the newly acquired images, the isocentre is adjusted to ensure that the prostate will be within the irradiated volume. After commissioning by Medical Physics, an initial pre-clinical trial period was adopted. This involved performing BAT alignments daily but treating to the planned isocentre in 30 patients. Eighty three percent of patients (25/30) had images judged to be of good or excellent quality by the reviewing radiation oncologist. It was noted that for each operator there was a period needed to build confidence/competence in both imaging and interpreting the images for the moves. The median scan time in addition to the normal patient set-up was 3.2 minutes (range=1.5-12.0 mins) with the second 15 patients scanned quicker than the first 15 (2.9 minutes versus 3.8 minutes). A summary of the movements recommended by the BAT system is contained in the table. We feel that daily prostate ultrasound localization offers a significant advance in delivering EBRT for prostate cancer. The incorporation of the system into clinical use, however, was not without difficulty and requires significant time and effort from therapists, physicists and medical staff. Further clinical evaluation of the unit is ongoing

  2. Outcome analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy

    International Nuclear Information System (INIS)

    Higgins, Geoffrey S.; McLaren, Duncan B.; Kerr, Gillian R.; Elliott, Tony; Howard, Grahame

    2006-01-01

    Purpose: Neoadjuvant androgen deprivation and radical radiotherapy is an established treatment for localized prostate carcinoma. This study sought to analyze the outcomes of patients treated with relatively low-dose hypofractionated radiotherapy. Methods and Materials: Three hundred patients with T1-T3 prostate cancer were treated between 1996 and 2001. Patients were prescribed 3 months of neoadjuvant androgen deprivation before receiving 5250 cGy in 20 fractions. Patients' case notes and the oncology database were used to retrospectively assess outcomes. Median follow-up was 58 months. Results: Patients presented with prostate cancer with poorer prognostic indicators than that reported in other series. At 5 years, the actuarial cause-specific survival rate was 83.2% and the prostate-specific antigen (PSA) relapse rate was 57.3%. Metastatic disease had developed in 23.4% of patients. PSA relapse continued to occur 5 years from treatment in all prognostic groups. Independent prognostic factors for relapse included treatment near the start of the study period, neoadjuvant oral anti-androgen monotherapy rather than neoadjuvant luteinizing hormone releasing hormone therapy, and diagnosis through transurethral resection of the prostate rather than transrectal ultrasound. Conclusion: This is the largest reported series of patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy in the United Kingdom. Neoadjuvant hormonal therapy did not appear to adequately compensate for the relatively low effective radiation dose used

  3. Feasibility study using a Ni-Ti stent and electronic portal imaging to localize the prostate during radiotherapy.

    Science.gov (United States)

    Carl, Jesper; Lund, Bente; Larsen, Erik Hoejkjaer; Nielsen, Jane

    2006-02-01

    A new method for localization of the prostate during external beam radiotherapy is presented. The method is based on insertion of a thermo-expandable Ni-Ti stent. The stent is originally developed for treatment of bladder outlet obstruction caused by benign hyperplasia. The radiological properties of the stent are used for precise prostate localization during treatment using electronic portal images. Patients referred for intended curative radiotherapy and having a length of their prostatic urethra in the range from 25 to 65 mm were included. Pairs of isocentric orthogonal portal images were used to determine the 3D position at eight different treatment sessions for each patient. Fourteen patients were enrolled in the study. The data obtained demonstrated that the stent position was representative of the prostate location. The stent may also improve delineation of the prostate GTV, and prevent obstruction of bladder outlet during treatment. Precision in localization of the stent was less than 1 mm. Random errors in stent position were left-right 1.6 mm, cranial-caudal 2.2 mm and anterior-posterior 3.2 mm. In four of 14 patients a dislocation of the stent to the bladder occurred. Dislocation only occurred in patients with length of prostatic urethra less than 40 mm. A new method for radiological high precision localization of the prostate during radiotherapy is presented. The method is based on insertion of a standard Ni-Ti thermo-expandable stent, designed for treatment of benign prostate hyperplasia.

  4. Prostate motion during standard radiotherapy as assessed by fiducial markers

    International Nuclear Information System (INIS)

    Raymond, Y.; Crook, J.M.; Salhani, D.; Yang, H.; Esche, B.

    1995-01-01

    From November 1993 to August 1994, 55 patients with localized prostate carcinoma had three gold seeds placed in the prostate under transrectal ultrasound guidance prior to the start of radiotherapy in order to track prostate motion. Patients had a planning CT scan before initial simulation and again at about 40 Gy, just prior to simulation of a field reduction. Seed position relative to fixed bony landmarks (pubic symphysis and both ischial tuberosities) was digitized from each pair of orthogonal films from the initial and boost simulation using the Nucletron brachytherapy planning system. Vector analysis was performed to rule out the possibility of independent seed migration within the prostate between the time of initial and boost simulation. Prostate motion was seen in the posterior (mean: 0.56 cm; SD: 0.41 cm) and inferior directions (mean: 0.59 cm; SD: 0.45 cm). The base of the prostate was displaced more than 1 cm posteriorly in 30% of patients and in 11% in the inferior direction. Prostate position is related to rectal and bladder filling. Distension of these organs displaces the prostate in an anterosuperior direction, with lesser degrees of filling allowing the prostate to move posteriorly and inferiorly. Conformal therapy planning must take this motion into consideration. Changes in prostate position of this magnitude preclude the use of standard margins

  5. Sexual (dys)function after radiotherapy for prostate cancer: a review

    International Nuclear Information System (INIS)

    Incrocci, Luca; Slob, A. Koos; Levendag, Peter C.

    2002-01-01

    Purpose: Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important. Methods and materials: We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly. Results: Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood. Conclusions: Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices

  6. Sexual (dys)function after radiotherapy for prostate cancer: a review.

    Science.gov (United States)

    Incrocci, Luca; Slob, A Koos; Levendag, Peter C

    2002-03-01

    Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important. We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly. Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood. Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices.

  7. Faecal incontinence following radiotherapy for prostate cancer: A systematic review

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Høyer, Morten; Lundby, Lilli

    2011-01-01

    BACKGROUND: Faecal incontinence (FI) after radiotherapy is a known phenomenon, but has received little attention to date. This article aimed to review current knowledge on faecal incontinence related to radiotherapy for prostate cancer. METHODS: PubMed was searched for English-language articles......-volume parameters and incidence is equivocal, although some studies suggest parameters confined to the lower rectum and/or anal canal may be of value to predict the extent of the injury and could be used as constraints in the dose planning process. CONCLUSIONS: Interpretation of data is limited due to lack of large...

  8. Prostate cancer: Doses and volumes of radiotherapy

    International Nuclear Information System (INIS)

    Hennequin, C.; Rivera, S.; Quero, L.; Latorzeff, I.

    2010-01-01

    Radiotherapy is nowadays a major therapeutic option in prostate cancer. Technological improvements allowed dose escalation without increasing late toxicity. Some randomized trials have shown that dose escalation decreases the biochemical failure rate, without any benefit in survival with the present follow-up. However, some studies indicate that the distant metastases rate is also decreased. Most of these studies have been done without hormonal treatment, and the role of dose escalation in case of long-term androgen deprivation is unknown. The target volume encompassed the whole gland: however, complete or partial focal treatment of the prostate can be done with sophisticated IMRT technique and must be evaluated. Proximal part of the seminal vesicles must be included in the target volumes. The role of nodal irradiation is another debate, but it could be logically proposed for the unfavourable group. (authors)

  9. Preclinical evaluation of intraoperative low-energy photon radiotherapy using sphericalapplicators in locally advanced prostate cancer

    Directory of Open Access Journals (Sweden)

    François eBuge

    2015-09-01

    Full Text Available Background: Surgery plus adjuvant radiotherapy is standard care for locally advanced prostatecancer (stage pT3R1. Intraoperative low-energy photon radiotherapy offers several advantages overexternal beam radiotherapy, and several systems are now available for its delivery, using sphericalapplicators which require only limited shielding. The aim of this study was to evaluate the feasibilityof this technique for the prostate bed.Materials & Methods: Applicators were assessed using MRI image data and cadavericdissection. In cadavers, targeted tissues, defined as a urethral section, both neurovascular bundlesections, the bladder neck and the beds of the seminal vesicles, were marked with metallic surgicalclips. Distances between clips and applicator were measured using CT. A dosimetric study of theapplication of 12 Gy at 5mm depth was performed using CT images of prostatectomized cadavers.Results: Using MRI images from 34 prostate cancer patients, we showed that the ideal applicatordiameter ranges from 45 to 70 mm. Using applicators of different sizes to encompass the prostate bedin nine cadavers, we showed that the distance between target tissues and applicator was less than 2mm for all target tissues except the upper extremity of the seminal vesicles (19 mm. Dosimetric studyshowed a good dose distribution in all target tissues in contact with the applicator, with a lowprobability of rectum and bladder complication.Conclusions: Intraoperative radiotherapy of the prostate bed is feasible, with good coverage oftargeted tissues. Clinical study of safety and efficacy is now required.

  10. Comparison of Automated Atlas Based Segmentation Software for postoperative prostate cancer radiotherapy

    Directory of Open Access Journals (Sweden)

    Grégory Delpon

    2016-08-01

    Full Text Available Automated atlas-based segmentation algorithms present the potential to reduce the variability in volume delineation. Several vendors offer software that are mainly used for cranial, head and neck and prostate cases. The present study will compare the contours produced by a radiation oncologist to the contours computed by different automated atlas-based segmentation algorithms for prostate bed cases, including femoral heads, bladder and rectum. Contour comparison was evaluated by different metrics such as volume ratio, Dice coefficient and Hausdorff distance. Results depended on the volume of interest and showed some discrepancies between the different software. Automatic contours could be a good starting point for the delineation of organs since efficient editing tools are provided by different vendors. It should become an important help in the next few years for organ at risk delineation.

  11. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hermesse, Johanne; Biver, Sylvie; Jansen, Nicolas; Coucke, Philippe [Dept. of Radiation Oncology, Liege Univ. Hospital (Belgium); Lenaerts, Eric [Dept. of Medical Physics, Liege Univ. Hospital (Belgium); De Patoul, Nathalie; Vynckier, Stefaan [Dept. of Medical Physics, St Luc Univ. Hospital, Brussels (Belgium); Scalliet, Pierre [Dept. of Radiation Oncology, St Luc Univ. Hospital, Brussels (Belgium); Nickers, Philippe [Dept. of Radiation Oncology, Oscar Lambret Center, Lille (France)

    2009-11-15

    Background and purpose: dose escalation in order to improve the biochemical control in prostate cancer requires the application of irradiation techniques with high conformality. The dosimetric selectivity of three radiation modalities is compared: high-dose-rate brachytherapy (HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and helical tomotherapy (HT). Patients and methods: ten patients with prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after external-beam radiotherapy were investigated. For each patient, HDR-BT, IMRT and HT theoretical treatment plans were realized using common contour sets. A 10-Gy dose was prescribed to the planning target volume (PTV). The PTVs and critical organs' dose-volume histograms obtained were compared using Student's t-test. Results: HDR-BT delivers spontaneously higher mean doses to the PTV with smaller cold spots compared to IMRT and HT. 33% of the rectal volume received a mean HDR-BT dose of 3.86 {+-} 0.3 Gy in comparison with a mean IMRT dose of 6.57 {+-} 0.68 Gy and a mean HT dose of 5.58 {+-} 0.71 Gy (p < 0.0001). HDR-BT also enables to better spare the bladder. The hot spots inside the urethra are greater with HDR-BT. The volume of healthy tissue receiving 10% of the prescribed dose is reduced at least by a factor of 8 with HDR-BT (p < 0.0001). Conclusion: HDR-BT offers better conformality in comparison with HT and IMRT and reduces the volume of healthy tissue receiving a low dose. (orig.)

  12. Influence of Antiflatulent Dietary Advice on Intrafraction Motion for Prostate Cancer Radiotherapy

    International Nuclear Information System (INIS)

    Lips, Irene M.; Kotte, Alexis N.T.J.; Gils, Carla H. van; Leerdam, Monique E. van; Heide, Uulke A. van der; Vulpen, Marco van

    2011-01-01

    Purpose: To evaluate the effect of an antiflatulent dietary advice on the intrafraction prostate motion in patients treated with intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Between February 2002 and December 2009, 977 patients received five-beam IMRT for prostate cancer to a dose of 76 Gy in 35 fractions combined with fiducial markers for position verification. In July 2008, the diet, consisting of dietary guidelines to obtain regular bowel movements and to reduce intestinal gas by avoiding certain foods and air swallowing, was introduced to reduce the prostate motion. The intrafraction prostate movement was determined from the portal images of the first segment of all five beams. Clinically relevant intrafraction motion was defined as ≥50% of the fractions with an intrafraction motion outside a range of 3 mm. Results: A total of 739 patients were treated without the diet and 105 patients were treated with radiotherapy after introduction of the diet. The median and interquartile range of the average intrafraction motion per patient was 2.53 mm (interquartile range, 2.2–3.0) without the diet and 3.00 mm (interquartile range, 2.4–3.5) with the diet (p < .0001). The percentage of patients with clinically relevant intrafraction motion increased statistically significant from 19.1% without diet to 42.9% with a diet (odds ratio, 3.18; 95% confidence interval, 2.07–4.88; p < .0001). Conclusions: The results of the present study suggest that antiflatulent dietary advice for patients undergoing IMRT for prostate cancer does not reduce the intrafraction movement of the prostate. Therefore, antiflatulent dietary advice is not recommended in clinical practice for this purpose.

  13. Combined curative radiotherapy including HDR brachytherapy and androgen deprivation in localized prostate cancer: A prospective assessment of acute and late treatment toxicity

    International Nuclear Information System (INIS)

    Wahlgren, Thomas; Nilsson, Sten; Ryberg, Marianne; Brandberg, Yvonne; Lennernaes, Bo

    2005-01-01

    Self-reported symptoms including urinary, bowel and sexual side effects were investigated prospectively at multiple assessment points before and after combined radiotherapy of prostate cancer including HDR brachytherapy and neoadjuvant androgen deprivation therapy. Between April 2000 and June 2003, patients with predominantly advanced localized prostate tumours subjected to this treatment were asked before treatment and on follow-up visits to complete a questionnaire covering urinary, bowel and sexual problems. The mainly descriptive analyses included 525 patients, responding to at least one questionnaire before or during the period 2-34 months after radiotherapy. Adding androgen deprivation before radiotherapy significantly worsened sexual function. During radiotherapy, urinary, bowel and sexual problems increased and were reported at higher levels up to 34 months, although there seemed to be a general tendency to less pronounced irritative bowel and urinary tract symptoms over time. No side effects requiring surgery were reported. Classic late irradiation effects such as mucosal bleeding were demonstrated mainly during the second year after therapy, but appear less pronounced in comparison with dose escalated EBRT series. In conclusion, despite the high radiation dose given, the toxicity seemed comparable with that of other series but long term (5-10 years) symptom outcome has to be determined

  14. Salvage HIFU after radiotherapy and salvage radiotherapy after HIFU in locally recurrent prostate cancer: Retrospective analysis of morbidity

    International Nuclear Information System (INIS)

    Lee, J.-W.; Hannoun-Leviac, J.-M.; Chevallier, D.; Rouscoff, Y.; Durand, M.; Amiel, J.; Gal, J.; Natale, R.; Chand, M.-E.; Raffaelli, C.; Ambrosetti, D.

    2012-01-01

    To evaluate the toxicity of therapeutic sequences High Intensity Focused Ultrasound (HIFU)-salvage radiotherapy (HIFU-RT) or radiotherapy-salvage HIFU (RT-HIFU) in case of locally recurrent prostate cancer. Nineteen patients had a local recurrence of prostate cancer. Among them, 10 patients were treated by HIFU-RT and 9 patients by RT- HIFU (4 by external beam radiotherapy [EBR] and 5 by brachytherapy [BRACHY]). Urinary side effects were assessed using CTCAE v4. At the time of the initial management, the median age was 66.5 years (53 72), the median PSA was 10.8 ng/mL (3.4 50) and the median initial Gleason score was 6.3 (5 8). Median follow-up after salvage treatment was 46.3 months (2 108). Thirty percent of the patients in the HIFU-RT group and 33.3 % of the patients in the RT-HIFU group, all belonging to the sub-group BRACHY-HIFU, had urinary complication greater than or equal to grade 2. Among all the patients, only 1 had grade 1 gastrointestinal toxicity. BRACHY-HIFU sequence seems to be purveyor of many significant urinary side effects. A larger database is needed to confirm this conclusion. (authors)

  15. Feasibility study using a Ni-Ti stent and electronic portal imaging to localize the prostate during radiotherapy

    International Nuclear Information System (INIS)

    Carl, Jesper; Lund, Bente; Larsen, Erik Hoejkjaer; Nielsen, Jane

    2006-01-01

    Background and purpose: A new method for localization of the prostate during external beam radiotherapy is presented. The method is based on insertion of a thermo-expandable Ni-Ti stent. The stent is originally developed for treatment of bladder outlet obstruction caused by benign hyperplasia. The radiological properties of the stent are used for precise prostate localization during treatment using electronic portal images. Patients and methods: Patients referred for intended curative radiotherapy and having a length of their prostatic urethra in the range from 25 to 65 mm were included. Pairs of isocentric orthogonal portal images were used to determine the 3D position at eight different treatment sessions for each patient. Results: Fourteen patients were enrolled in the study. The data obtained demonstrated that the stent position was representative of the prostate location. The stent may also improve delineation of the prostate GTV, and prevent obstruction of bladder outlet during treatment. Precision in localization of the stent was less than 1 mm. Random errors in stent position were left-right 1.6 mm, cranial-caudal 2.2 mm and anterior-posterior 3.2 mm. In four of 14 patients a dislocation of the stent to the bladder occurred. Dislocation only occurred in patients with length of prostatic urethra less than 40 mm. Conclusions: A new method for radiological high precision localization of the prostate during radiotherapy is presented. The method is based on insertion of a standard Ni-Ti thermo-expandable stent, designed for treatment of benign prostate hyperplasia

  16. Genetic Modeling of Radiation Injury in Prostate Cancer Patients Treated with Radiotherapy

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-15-1-0681 TITLE: Genetic Modeling of Radiation Injury in Prostate Cancer Patients Treated with Radiotherapy PRINCIPAL...TITLE AND SUBTITLE 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-1-0681Genetic Modeling of Radiation Injury in Prostate Cancer Patients Treated...effects, urinary morbidity, rectal injury, sexual dysfunction 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF

  17. MR-CT registration using a Ni-Ti prostate stent in image-guided radiotherapy of prostate cancer.

    Science.gov (United States)

    Korsager, Anne Sofie; Carl, Jesper; Østergaard, Lasse Riis

    2013-06-01

    In image-guided radiotherapy of prostate cancer defining the clinical target volume often relies on magnetic resonance (MR). The task of transferring the clinical target volume from MR to standard planning computed tomography (CT) is not trivial due to prostate mobility. In this paper, an automatic local registration approach is proposed based on a newly developed removable Ni-Ti prostate stent. The registration uses the voxel similarity measure mutual information in a two-step approach where the pelvic bones are used to establish an initial registration for the local registration. In a phantom study, the accuracy was measured to 0.97 mm and visual inspection showed accurate registration of all 30 data sets. The consistency of the registration was examined where translation and rotation displacements yield a rotation error of 0.41° ± 0.45° and a translation error of 1.67 ± 2.24 mm. This study demonstrated the feasibility for an automatic local MR-CT registration using the prostate stent.

  18. Dosimetric Study of Pelvic Proton Radiotherapy for High-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Chera, Bhishamjit S.; Vargas, Carlos; Morris, Christopher G.; Louis, Debbie; Flampouri, Stella; Yeung, Daniel; Duvvuri, Srividya; Li Zuofeng; Mendenhall, Nancy Price

    2009-01-01

    Purpose: To compare dose distributions in targeted tissues (prostate, seminal vesicles, pelvic regional nodes) and nontargeted tissues in the pelvis with intensity-modulated radiotherapy (IMRT) and forward-planned, double-scattered, three-dimensional proton radiotherapy (3D-PRT). Methods and Materials: IMRT, IMRT followed by a prostate 3D-PRT boost (IMRT/3D-PRT), and 3D-PRT plans were created for 5 high-risk prostate cancer patients (n = 15 plans). A 78-CGE/Gy dose was prescribed to the prostate and proximal seminal vesicles and a 46-CGE/Gy was prescribed to the pelvic nodes. Various dosimetric endpoints were compared. Results: Target coverage of the prostate and nodal planning target volumes was adequate for all three plans. Compared with the IMRT and IMRT/3D-PRT plans, the 3D-PRT plans reduced the mean dose to the rectum, rectal wall, bladder, bladder wall, small bowel, and pelvis. The relative benefit of 3D-PRT (vs IMRT) at reducing the rectum and rectal wall V5-V40 was 53% to 71% (p < 0.05). For the bladder and bladder wall, the relative benefit for V5 to V40 CGE/Gy was 40% to 63% (p < 0.05). The relative benefit for reducing the volume of small bowel irradiated from 5 to 30 CGE/Gy in the 3D-PRT ranged from 62% to 69% (p < 0.05). Use of 3D-PRT did not produce the typical low-dose 'bath' of radiation to the pelvis seen with IMRT. Femoral head doses were higher for the 3D-PRT. Conclusions: Use of 3D-PRT significantly reduced the dose to normal tissues in the pelvis while maintaining adequate target coverage compared with IMRT or IMRT/3D-PRT. When treating the prostate, seminal vesicles, and pelvic lymph nodes in prostate cancer, proton therapy may improve the therapeutic ratio beyond what is possible with IMRT.

  19. Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer. Changing focus from rectal bleeding to detailed quality of life analysis

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Nakamura, Satoaki; Nishimura, Takuya; Yoshida, Ken; Yoshioka, Yasuo; Koizumi, Masahiko; Ogawa, Kazuhiko

    2014-01-01

    With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (1) because of the increasing number of patients aged >80 years, and (2) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment. (author)

  20. Benchmarking Dosimetric Quality Assessment of Prostate Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Senthi, Sashendra; Gill, Suki S.; Haworth, Annette; Kron, Tomas; Cramb, Jim; Rolfo, Aldo; Thomas, Jessica; Duchesne, Gillian M.; Hamilton, Christopher H.; Joon, Daryl Lim; Bowden, Patrick; Foroudi, Farshad

    2012-01-01

    Purpose: To benchmark the dosimetric quality assessment of prostate intensity-modulated radiotherapy and determine whether the quality is influenced by disease or treatment factors. Patients and Methods: We retrospectively analyzed the data from 155 consecutive men treated radically for prostate cancer using intensity-modulated radiotherapy to 78 Gy between January 2007 and March 2009 across six radiotherapy treatment centers. The plan quality was determined by the measures of coverage, homogeneity, and conformity. Tumor coverage was measured using the planning target volume (PTV) receiving 95% and 100% of the prescribed dose (V 95% and V 100% , respectively) and the clinical target volume (CTV) receiving 95% and 100% of the prescribed dose. Homogeneity was measured using the sigma index of the PTV and CTV. Conformity was measured using the lesion coverage factor, healthy tissue conformity index, and the conformity number. Multivariate regression models were created to determine the relationship between these and T stage, risk status, androgen deprivation therapy use, treatment center, planning system, and treatment date. Results: The largest discriminatory measurements of coverage, homogeneity, and conformity were the PTV V 95% , PTV sigma index, and conformity number. The mean PTV V 95% was 92.5% (95% confidence interval, 91.3–93.7%). The mean PTV sigma index was 2.10 Gy (95% confidence interval, 1.90–2.20). The mean conformity number was 0.78 (95% confidence interval, 0.76–0.79). The treatment center independently influenced the coverage, homogeneity, and conformity (all p 95% only, with it being better at the start (p = .013). Risk status, T stage, and the use of androgen deprivation therapy did not influence any aspect of plan quality. Conclusion: Our study has benchmarked measures of coverage, homogeneity, and conformity for the treatment of prostate cancer using IMRT. The differences seen between centers and planning systems and the coverage

  1. 3-D conformal radiotherapy of localized prostate cancer: A subgroup analysis of rectoscopic findings prior to radiotherapy and acute/late rectal side effects

    International Nuclear Information System (INIS)

    Goldner, Gregor; Zimmermann, Frank; Feldmann, Horst; Glocker, Stefan; Wachter-Gerstner, Natascha; Geinitz, Hans; Becker, Gerd; Poetzi, Regina; Wambersie, Andre; Bamberg, Michael; Molls, Michael; Wachter, Stefan; Poetter, Richard

    2006-01-01

    Background and purpose: To identify endoscopic pathological findings prior to radiotherapy and a possible correlation with acute or chronic rectal side effects after three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Patients and methods: Between 03/99 and 07/02, a total of 298 patients, who consented in a voluntary rectoscopy prior to radiotherapy were included into the analysis. Patients were treated with a total dose of either 70 or 74 Gy. Pathological rectoscopic findings like hemorrhoids, polyps or diverticula were documented. Acute and late rectal side effects were scored using the EORTC/RTOG score. Results: The most frequent pathological endosopic findings were hemorrhoids (35%), polyps (24%) and diverticula (13%). Rectal toxicity was mostly low to moderate. Grade 0/1 cumulative acute and late rectal side effects were 82 and 84%, grade 2 were 18 and 17%, respectively. We could not identify any correlation between preexisting pathological findings and rectal side effects by statistical analysis. Conclusions: There is no evidence that prostate cancer patients presenting with endoscopic verified pathological findings in the rectal mucosa at diagnosis are at an increased risk to develop rectal side effects when treated with 3D-CRT of the prostatic region

  2. External Beam Radiotherapy for Prostate Cancer Patients on Anticoagulation Therapy: How Significant is the Bleeding Toxicity?

    International Nuclear Information System (INIS)

    Choe, Kevin S.; Jani, Ashesh B.; Liauw, Stanley L.

    2010-01-01

    Purpose: To characterize the bleeding toxicity associated with external beam radiotherapy for prostate cancer patients receiving anticoagulation (AC) therapy. Methods and Materials: The study cohort consisted of 568 patients with adenocarcinoma of the prostate who were treated with definitive external beam radiotherapy. Of these men, 79 were receiving AC therapy with either warfarin or clopidogrel. All patients were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Bleeding complications were recorded during treatment and subsequent follow-up visits. Results: With a median follow-up of 48 months, the 4-year actuarial risk of Grade 3 or worse bleeding toxicity was 15.5% for those receiving AC therapy compared with 3.6% among those not receiving AC (p < .0001). On multivariate analysis, AC therapy was the only significant factor associated with Grade 3 or worse bleeding (p < .0001). For patients taking AC therapy, the crude rate of bleeding was 39.2%. Multivariate analysis within the AC group demonstrated that a higher radiotherapy dose (p = .0408), intensity-modulated radiotherapy (p = 0.0136), and previous transurethral resection of the prostate (p = .0001) were associated with Grade 2 or worse bleeding toxicity. Androgen deprivation therapy was protective against bleeding, with borderline significance (p = 0.0599). Dose-volume histogram analysis revealed that Grade 3 or worse bleeding was minimized if the percentage of the rectum receiving ≥70 Gy was <10% or the rectum receiving ≥50 Gy was <50%. Conclusion: Patients taking AC therapy have a substantial risk of bleeding toxicity from external beam radiotherapy. In this setting, dose escalation or intensity-modulated radiotherapy should be used judiciously. With adherence to strict dose-volume histogram criteria and minimizing hotspots, the risk of severe bleeding might be reduced.

  3. Testicular dose in prostate cancer radiotherapy. Impact on impairment of fertility and hormonal function

    Energy Technology Data Exchange (ETDEWEB)

    Boehmer, D.; Badakhshi, H.; Budach, V. [Dept. of Radiation Oncology, Charite - Univ. Clinic - Campus Mitte, Berlin (Germany); Kuschke, W.; Bohsung, J. [Dept. of Medical Physics, Charite - Univ. Clinic - Campus Mitte, Berlin (Germany)

    2005-03-01

    Purpose: to determine the dose received by the unshielded testicles during a course of 20-MV conventional external-beam radiotherapy for patients with localized prostate cancer. Critical evaluation of the potential impact on fertility and hormonal impairment in these patients according to the literature. Patients and methods: the absolute dose received by the testicles of 20 randomly selected patients undergoing radiotherapy of prostate cancer was measured by on-line thermoluminescence dosimetry. Patients were treated in supine position with an immobilization cushion under their knees. A flexible tube, containing three calibrated thermoluminescence dosimeters (TLDs) was placed on top or underneath the testicle closest to the perineal region with a day-to-day alternation. The single dose to the planning target volume was 1.8 Gy. Ten subsequent testicle measurements were performed on each patient. The individual TLDs were then read out and the total absorbed dose was calculated. Results: the mean total dose ({+-} standard deviation) measured in a series of 10 subsequent treatment days in all patients was 49 cGy ({+-} 36 cGy). The calculated projected doses made on a standard series of 40 fractions of external-beam radiotherapy were 196 cGy ({+-} 145 cGy). The results of this study are appraised with the available data in the literature. Conclusion: the dose received by the unshielded testes can be assessed as a risk for permanent infertility and impairment of hormonal function in prostate cancer patients treated with external-beam radiotherapy. (orig.)

  4. Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review

    International Nuclear Information System (INIS)

    Sasse, André D; Sasse, Elisa; Carvalho, Albertina M; Macedo, Ligia T

    2012-01-01

    Locally advanced prostate cancer is often associated with elevated recurrence rates. Despite the modest response observed, external-beam radiotherapy has been the preferred treatment for this condition. More recent evidence from randomised trials has demonstrated clinical benefit with the combined use of androgen suppression in such cases. The aim of this meta-analysis is to compare the combination of distinct hormone therapy modalities versus radiotherapy alone for overall survival, disease-free survival and toxicity. Databases (MEDLINE, EMBASE, LILACS, Cochrane databases and ClinicalTrials.gov) were scanned for randomised clinical trials involving radiotherapy with or without androgen suppression in local prostate cancer. The search strategy included articles published until October 2011. The studies were examined and the data of interest were plotted for meta-analysis. Survival outcomes were reported as a hazard ratio with corresponding 95% confidence intervals. Data from ten trials published from 1988 to 2011 were included, comprising 6555 patients. There was a statistically significant advantage to the use of androgen suppression, in terms of both overall survival and disease free survival, when compared to radiotherapy alone. The use of long-term goserelin (up to three years) was the strategy providing the higher magnitude of clinical benefit. In contrast to goserelin, there were no trials evaluating the use of other luteinizing hormone-releasing hormone (LHRH) analogues as monotherapy. Complete hormonal blockade was not shown to be superior to goserelin monotherapy. Based on the findings of this systematic review, the evidence supports the use of androgen suppression with goserelin monotherapy as the standard treatment for patients with prostate cancer treated with radiotherapy, which are at high risk of recurrence or metastases

  5. Postoperative radiotherapy for prostate cancer. Morbidity of local-only or local-plus-pelvic radiotherapy

    International Nuclear Information System (INIS)

    Waldstein, Cora; Poetter, Richard; Widder, Joachim; Goldner, Gregor; Doerr, Wolfgang

    2018-01-01

    The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer. Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups. For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5-year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5-year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%. Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4-field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects. (orig.) [de

  6. Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer

    International Nuclear Information System (INIS)

    Schmitz, Matthew D; Padula, Gilbert DA; Chun, Patrick Y; Davis, Alan T

    2010-01-01

    The purpose of this study was to determine the expected time to prostate specific antigen (PSA) normalization with or without neoadjuvant androgen deprivation (NAAD) therapy after treatment with intensity modulated radiotherapy (IMRT) for patients with clinically localized prostate cancer. A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging) treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p < 0.05. Fifty-six of the 133 patients received NAAD (42.1%). Thirty-one patients (23.8%) received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%). The times to serum PSA normalization < 2 ng/mL when treated with or without NAAD were 298 ± 24 and 302 ± 33 days (mean ± SEM), respectively (p > 0.05), and 303 ± 24 and 405 ± 46 days, respectively, for PSA < 1 ng/mL (p < 0.05). Stage T1 and T2 tumors had significantly increased time to PSA normalization < 1 ng/mL in comparison to Stage T3 tumors. Also, higher Gleason scores were significantly correlated with a faster time to PSA normalization < 1 ng/mL. Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA < 1 ng/mL in patients with clinically localized prostate cancer

  7. Late urinary morbidity and quality of life after radical prostatectomy and salvage radiotherapy for prostate cancer

    DEFF Research Database (Denmark)

    Ervandian, Maria; Hoyer, Morten; Petersen, Stine Elleberg

    2017-01-01

    OBJECTIVE: There is a paucity of knowledge of long-term urinary morbidity in patients treated for prostate cancer (PCa) with radical prostatectomy (RP) and salvage radiotherapy (SRT). Improved long-term survival calls for heightened awareness of late effects from radiotherapy after RP. The purpos...

  8. Effect of magnesium oxide on interfraction prostate motion and rectal filling in prostate cancer radiotherapy. Analysis of a randomized clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Harder, Annemarie M. den; Kotte, Alexis N.T.J.; Vulpen, Marco van; Lips, Irene M. [University Medical Center Utrecht, Department of Radiation Oncology, Utrecht (Netherlands); Gils, Carla H. van [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands)

    2014-08-15

    To investigate whether magnesium oxide reduces the interfraction motion of the prostate and the amount of rectal filling and rectal gas, which influences prostate position during radiotherapy for prostate cancer. From December 2008 to February 2010, 92 prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. In a previous study, we investigated the effect on intrafraction motion and did not find a difference between the treatment arms. Here, we compared the interfraction prostate motion between the two treatment arms as well as the amount of rectal filling and rectal air pockets using pretreatment planning computed tomography and magnetic resonance imaging scans. There was no statistically significant difference between the treatment arms in translation and rotation of the prostate between treatment fractions, except for the rotation around the cranial caudal axis. However, the difference was less than 1 and therefore considered not clinically relevant. There was no significant difference in the amount of rectal filling and rectal air pockets between the treatment arms. Magnesium oxide is not effective in reducing the interfraction prostate motion or the amount of rectal filling and rectal gas during external-beam radiotherapy. Therefore, magnesium oxide is not recommended in clinical practice for these purposes. (orig.) [German] Ziel der Studie war es, zu untersuchen, ob Magnesiumoxid die interfraktionaere Bewegung und die rektale Fuellung sowie rektales Gas reduziert, was die Position der Prostata waehrend der Strahlentherapie bei Prostatakrebs beeinflusst. Von Dezember 2008 bis Februar 2010 haben 92 Prostatakrebspatienten die intensitaetsmodulierte Strahlentherapie (IMRT) mit bezugsmarkenbasierter Positionsverifikation erhalten (77 Gy in 35 Fraktionen). Sie wurden waehrend

  9. Three dimensional conformal radiation therapy (3d-crt) in prostate carcinoma: for whom and how?; La radiotherapie conformationnelle dans le cancer de la prostate: pour qui et comment?

    Energy Technology Data Exchange (ETDEWEB)

    Bey, P.; Beckendorf, V.; Aletti, P.; Marchesi, V. [Centre Alexis-Vautrin, Dept. de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France)

    2002-05-01

    External radiotherapy is one of the modalities use o cure localized prostate carcinoma. Most of localized prostate carcinomas, specially those of the intermediate prognostic group, may benefit from escalated dose above 70 Gy at least as regard biochemical and clinical relapse free survival. 3D-CRT allows a reduction of the dose received by organs at risk and an increase of prostate dose over 70 Gy. It is on the way to become a standard. Intensity modulated radiation therapy increases dose homogeneity and reduces rectal dose. These methods necessitate rigorous procedures in reproducibility, delineation of volumes, dosimetry, daily treatment. They need also technological and human means. It is clear that localized prostate cancer is a good example for evaluation of these new radiotherapy modalities. (author)

  10. Residual Prostate Cancer in Patients Treated With Endocrine Therapy With or Without Radical Radiotherapy: A Side Study of the SPCG-7 Randomized Trial

    International Nuclear Information System (INIS)

    Solberg, Arne; Haugen, Olav A.; Viset, Trond; Bergh, Anders; Tasdemir, Ilker; Ahlgren, Goeran; Widmark, Anders; Angelsen, Anders

    2011-01-01

    Purpose: The Scandinavian Prostate Cancer Group-7 randomized trial demonstrated a survival benefit of combined endocrine therapy and external-beam radiotherapy over endocrine therapy alone in patients with high-risk prostate cancer. In a subset of the study population, the incidence and clinical implications of residual prostate cancer in posttreatment prostate biopsy specimens was evaluated. Methods and Materials: Biopsy specimens were obtained from 120 of 875 men in the Scandinavian Prostate Cancer Group-7 study. Results: Biopsies were performed at median of 45 months follow-up. In 63 patients receiving endocrine treatment only and 57 patients receiving combined treatment, residual cancer was found in 66% (n = 41) and 22% (n = 12), respectively (p < 0.0001). The vast majority of residual tumors were poorly differentiated (Gleason score ≥8). Endocrine therapy alone was predictive of residual prostate cancer: odds ratio 7.49 (3.18-17.7), p < 0.0001. In patients with positive vs. negative biopsy the incidences of clinical events were as follows: biochemical recurrence 74% vs. 27% (p < 0.0001), local progression 26% vs. 4.7% (p = 0.002), distant recurrence 17% vs. 9.4% (p = 0.27), clinical recurrence 36% vs. 13% (p = 0.006), cancer-specific death 19% vs. 9.7% (p = 0.025). In multivariable analysis, biochemical recurrence was significantly associated with residual cancer: hazard ratio 2.69 (1.45-4.99), p = 0.002, and endocrine therapy alone hazard ratio 3.45 (1.80-6.62), p < 0.0001. Conclusions: Radiotherapy combined with hormones improved local tumor control in comparison with endocrine therapy alone. Residual prostate cancer was significantly associated with serum prostate-specific antigen recurrence, local tumor progression, clinical recurrence, and cancer-specific death in univariable analysis. Residual cancer was predictive of prostate-specific antigen recurrence in multivariable analysis.

  11. A national survey of current practices of preparation and management of radical prostate radiotherapy patients during treatment

    International Nuclear Information System (INIS)

    Nightingale, H.; Conroy, R.; Elliott, T.; Coyle, C.; Wylie, J.P.; Choudhury, A.

    2017-01-01

    Aims: Radiotherapy is an important radical treatment for prostate cancer patients with services continually evolving. This survey aims to gain an insight in to the variation of radiotherapy practices in the UK, focussing on pre-treatment preparations, on-treatment review and management of radical prostate cancer patients undergoing radiotherapy. To our knowledge this is the first survey reported focussing on prostate radiotherapy practices with responses from a mix of health professionals. Materials and methods: A national survey was designed based on current known practices in supportive care and management of prostate cancer patients. The survey was distributed to lead radiotherapy personnel in radiotherapy services across the UK with a 77% response rate (n = 54). Results: Pre-treatment protocols were mandated in the majority of departments. Use of bladder filling (98%) and bowel emptying (66%) were frequently deployed. Bowel preparation varied between use of laxatives (13%) or enemas (41%) to achieve consistency. On-treatment reviews were carried out by a mix of health professionals; most commonly shared between oncologists and radiographers (20%). Radiographers reviewing patients were independent prescribers in 22% of departments. Toxicity grading tools were not used by almost half of departments (47%) either at baseline and/or on-treatment reviews. Written information about follow-up was given to patients towards the end of their radiotherapy; however, fewer departments included the length of hormone duration (13%). Conclusion: This survey has demonstrated variations in practice exist across the UK. These variations suggest that important questions about the best methods for treatment accuracy and patient management need to be established through further research. - Highlights: • Results of a national survey demonstrate wide variations in UK practice. • Lack of a clear evidence base could be a contributing factor to such variation. • Practices are

  12. Hypofractionated Accelerated Radiotherapy Using Concomitant Intensity-Modulated Radiotherapy Boost Technique for Localized High-Risk Prostate Cancer: Acute Toxicity Results

    International Nuclear Information System (INIS)

    Lim, Tee S.; Cheung, Patrick; Loblaw, D. Andrew; Morton, Gerard; Sixel, Katharina E.; Pang, Geordi; Basran, Parminder; Zhang Liying; Tirona, Romeo; Szumacher, Ewa; Danjoux, Cyril; Choo, Richard; Thomas, Gillian

    2008-01-01

    Purpose: To evaluate the acute toxicities of hypofractionated accelerated radiotherapy (RT) using a concomitant intensity-modulated RT boost in conjunction with elective pelvic nodal irradiation for high-risk prostate cancer. Methods and Materials: This report focused on 66 patients entered into this prospective Phase I study. The eligible patients had clinically localized prostate cancer with at least one of the following high-risk features (Stage T3, Gleason score ≥8, or prostate-specific antigen level >20 ng/mL). Patients were treated with 45 Gy in 25 fractions to the pelvic lymph nodes using a conventional four-field technique. A concomitant intensity-modulated radiotherapy boost of 22.5 Gy in 25 fractions was delivered to the prostate. Thus, the prostate received 67.5 Gy in 25 fractions within 5 weeks. Next, the patients underwent 3 years of adjuvant androgen ablative therapy. Acute toxicities were assessed using the Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment and at 3 months after RT. Results: The median patient age was 71 years. The median pretreatment prostate-specific antigen level and Gleason score was 18.7 ng/L and 8, respectively. Grade 1-2 genitourinary and gastrointestinal toxicities were common during RT but most had settled at 3 months after treatment. Only 5 patients had acute Grade 3 genitourinary toxicity, in the form of urinary incontinence (n = 1), urinary frequency/urgency (n = 3), and urinary retention (n = 1). None of the patients developed Grade 3 or greater gastrointestinal or Grade 4 or greater genitourinary toxicity. Conclusion: The results of the present study have indicated that hypofractionated accelerated RT with a concomitant intensity-modulated RT boost and pelvic nodal irradiation is feasible with acceptable acute toxicity

  13. A semi-automated 2D/3D marker-based registration algorithm modelling prostate shrinkage during radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Budiharto, Tom; Slagmolen, Pieter; Hermans, Jeroen; Maes, Frederik; Verstraete, Jan; Heuvel, Frank Van den; Depuydt, Tom; Oyen, Raymond; Haustermans, Karin

    2009-01-01

    Background and purpose: Currently, most available patient alignment tools based on implanted markers use manual marker matching and rigid registration transformations to measure the needed translational shifts. To quantify the particular effect of prostate gland shrinkage, implanted gold markers were tracked during a course of radiotherapy including an isotropic scaling factor to model prostate shrinkage. Materials and methods: Eight patients with prostate cancer had gold markers implanted transrectally and seven were treated with (neo) adjuvant androgen deprivation therapy. After patient alignment to skin tattoos, orthogonal electronic portal images (EPIs) were taken. A semi-automated 2D/3D marker-based registration was performed to calculate the necessary couch shifts. The registration consists of a rigid transformation combined with an isotropic scaling to model prostate shrinkage. Results: The inclusion of an isotropic shrinkage model in the registration algorithm cancelled the corresponding increase in registration error. The mean scaling factor was 0.89 ± 0.09. For all but two patients, a decrease of the isotropic scaling factor during treatment was observed. However, there was almost no difference in the translation offset between the manual matching of the EPIs to the digitally reconstructed radiographs and the semi-automated 2D/3D registration. A decrease in the intermarker distance was found correlating with prostate shrinkage rather than with random marker migration. Conclusions: Inclusion of shrinkage in the registration process reduces registration errors during a course of radiotherapy. Nevertheless, this did not lead to a clinically significant change in the proposed table translations when compared to translations obtained with manual marker matching without a scaling correction

  14. Radiation therapy of newly diagnosed, advanced prostatic cancer and hormonally relapsed prostatic cancer

    International Nuclear Information System (INIS)

    Suzuki, Minoru; Fujiwara, Kazuhisa; Hayakawa, Katsumi; Hida, Shuichi

    1994-01-01

    Ten patients with newly diagnosed, advanced prostatic cancer were treated with radiotherapy and hormone therapy to improve tumor control and survival. Eight patients with hormonally relapsed prostatic cancer were treated with radiotherapy to improve their quality of life. Local control of the tumor was achieved in 9 of 10 patients with newly diagnosed, advanced prostatic cancer. Five of eight patients with hormonally relapsed prostatic cancer obtained improved quality of life. Combined radiotherapy and hormone therapy were effective in the treatment of newly diagnosed, advanced prostatic cancer, and radiotherapy was useful for improving the quality of life of patients with hormonally relapsed prostatic cancer. (author)

  15. Dosimetric comparison between VMAT and RC3D techniques: case of prostate treatment

    Science.gov (United States)

    Chemingui, Fatima Zohra; Benrachi, Fatima; Bali, Mohamed Saleh; Ladjal, Hamid

    2017-09-01

    Considered as the second men cancer in Algeria, prostate cancer is treated in 70% by radiation. That's why radiation therapy is therapeutic weapon for prostate cancer. Conformational Radiotherapy in 3D is the most common technique [1-5]. The use of conventionally optimized treatment plans was compared at case scenario of optimized treatment plans VMAT for prostate cancer. The evaluation of the two optimizations strategies focused on the resulting plans ability to retain dose objectives under the influence of patient set up. Dose Volume Histogram in the Planning Target Volume and dose in the Organs At Risks were used to calculate the conformity index, and evaluation ratio of irradiated volume which represent the main tool of comparison [6,7]. The situation was analysed systematically. The 14% dose increase in the target leads to a decrease in the dose in adjacent organs with 39% in the bladder. Therefore, the criterion for better efficacy and less toxicity reveal that VMAT is the best choice.

  16. Dosimetric comparison between VMAT and RC3D techniques: case of prostate treatment

    Directory of Open Access Journals (Sweden)

    Chemingui Fatima Zohra

    2017-01-01

    Full Text Available Considered as the second men cancer in Algeria, prostate cancer is treated in 70% by radiation. That's why radiation therapy is therapeutic weapon for prostate cancer. Conformational Radiotherapy in 3D is the most common technique [1−5]. The use of conventionally optimized treatment plans was compared at case scenario of optimized treatment plans VMAT for prostate cancer. The evaluation of the two optimizations strategies focused on the resulting plans ability to retain dose objectives under the influence of patient set up. Dose Volume Histogram in the Planning Target Volume and dose in the Organs At Risks were used to calculate the conformity index, and evaluation ratio of irradiated volume which represent the main tool of comparison [6,7]. The situation was analysed systematically. The 14% dose increase in the target leads to a decrease in the dose in adjacent organs with 39% in the bladder. Therefore, the criterion for better efficacy and less toxicity reveal that VMAT is the best choice.

  17. Bicalutamide ('Casodex') 150 mg as adjuvant to radiotherapy in patients with localised or locally advanced prostate cancer: Results from the randomised Early Prostate Cancer Programme

    Energy Technology Data Exchange (ETDEWEB)

    Tyrrell, Chris J [Derriford Hospital, Plymouth (United Kingdom); Payne, Heather [Middlesex Hospital, London (United Kingdom); See, William A [Medical College of Wisconsin, Milwaukee, WI (United States); McLeod, David G [Walter Reed Army Medical Center, Washington, DC (United States); Wirth, Manfred P [Department of Urology, Technical University of Dresden (Germany); Iversen, Peter [Department of Urology, Rigshospitalet, Copenhagen (Denmark); Armstrong, Jon [AstraZeneca, Macclesfield (United Kingdom); Morris, Clive [AstraZeneca, Macclesfield (United Kingdom)

    2005-07-01

    Background and purpose: The ongoing Early Prostate Cancer (EPC) programme is assessing bicalutamide ('Casodex') 150 mg, either alone or as adjuvant to treatment of curative intent, in patients with localised or locally advanced prostate cancer (n=8113). This paper presents an exploratory analysis of the subgroup of the EPC programme who received radiotherapy with curative intent (n=1370) in order to determine the efficacy (in terms of progression-free survival [PFS]) and tolerability of bicalutamide 150 mg in this setting. Patients and methods: 1370 patients with T1-4, M0, any N prostate cancer received bicalutamide 150 mg or placebo adjuvant to radiotherapy of curative intent. This analysis was undertaken at median 5.3 years' follow-up. Results: In patients with locally advanced disease (n=305), bicalutamide adjuvant to radiotherapy significantly increased PFS by 53% (event-time ratio 1.53; 95% confidence intervals [CI] 1.16, 2.02) compared with placebo and reduced the risk of disease progression by 42% (hazard ratio [HR] 0.58; 95% CI 0.41, 0.84; P=0.00348). In these patients, objective progression was experienced by 33.5% of those randomised to bicalutamide versus 48.6% for those randomised to placebo. The between-group difference in patients with localised disease (n=1065) failed to reach statistical significance (HR 0.80; 95% CI 0.62, 1.03; P=0.088). The most common adverse events were breast pain (74.8%) and gynaecomastia (66.6%), which were mild to moderate in >90% of cases. Conclusions: Bicalutamide 150 mg/day given as adjuvant to radiotherapy significantly improved PFS in patients with locally advanced prostate cancer. For patients with localised disease, the results at this stage from the radiotherapy subgroup and the overall EPC programme suggest that adjuvant hormonal therapy is currently not appropriate. There were no unexpected tolerability findings.

  18. Technique of Injection of Hyaluronic Acid as a Prostatic Spacer and Fiducials Before Hypofractionated External Beam Radiotherapy for Prostate Cancer.

    Science.gov (United States)

    Boissier, Romain; Udrescu, Corina; Rebillard, Xavier; Terrier, Jean-Etienne; Faix, Antoine; Chapet, Olivier; Azria, David; Devonec, Marian; Paparel, Philippe; Ruffion, Alain

    2017-01-01

    To describe a technique combining the implantation of fiducials and a prostatic spacer (hyaluronic acid [HA]) to decrease the rectal toxicity after an image-guided external beam radiotherapy (EBRT) with hypofractionation for prostate cancer and to assess the tolerance and the learning curve of the procedure. Thirty patients with prostate cancer at low or intermediate risk were included in a phase II trial: image-guided EBRT of 62 Gy in 20 fractions of 3.1 Gy with intensity-modulated radiotherapy. A transrectal implantation of 3 fiducials and transperineal injection of 10 cc of HA (NASHA gel spacer, Q-Med AB, Uppsala, Sweden) between the rectum and the prostate was performed by 1 operator. The thickness of HA was measured at 10 points on magnetic resonance imaging to establish a quality score of the injection (maximum score = 10) and determine the learning curve of the procedure. The quality score increased from patients 1-10, 11-20, to 21-30 with respective median scores: 7 [2-10], 5 [4-7], and 8 [3-10]. The average thicknesses of HA between the base, middle part, and apex of the prostate and the rectum were the following: 15.1 mm [6.4-29], 9.8 mm [5-21.2], and 9.9 mm [3.2-21.5]. The injection of the HA induced a median pain score of 4 [1-8] and no residual pain at mid-long term. Creating an interface between the rectum and the prostate and the implantation of fiducials were feasible under local anesthesia with a short learning curve and could become a standard procedure before a hypofractionated EBRT for prostate cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Systematisation of spatial uncertainties for comparison between a MR and a CT-based radiotherapy workflow for prostate treatments

    International Nuclear Information System (INIS)

    Nyholm, Tufve; Nyberg, Morgan; Karlsson, Magnus G; Karlsson, Mikael

    2009-01-01

    In the present work we compared the spatial uncertainties associated with a MR-based workflow for external radiotherapy of prostate cancer to a standard CT-based workflow. The MR-based workflow relies on target definition and patient positioning based on MR imaging. A solution for patient transport between the MR scanner and the treatment units has been developed. For the CT-based workflow, the target is defined on a MR series but then transferred to a CT study through image registration before treatment planning, and a patient positioning using portal imaging and fiducial markers. An 'open bore' 1.5T MRI scanner, Siemens Espree, has been installed in the radiotherapy department in near proximity to a treatment unit to enable patient transport between the two installations, and hence use the MRI for patient positioning. The spatial uncertainty caused by the transport was added to the uncertainty originating from the target definition process, estimated through a review of the scientific literature. The uncertainty in the CT-based workflow was estimated through a literature review. The systematic uncertainties, affecting all treatment fractions, are reduced from 3-4 mm (1Sd) with a CT based workflow to 2-3 mm with a MR based workflow. The main contributing factor to this improvement is the exclusion of registration between MR and CT in the planning phase of the treatment. Treatment planning directly on MR images reduce the spatial uncertainty for prostate treatments

  20. An Adaptive Off-Line Procedure for Radiotherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    Nuver, Tonnis T.; Hoogeman, Mischa S.; Remeijer, Peter; Herk, Marcel van; Lebesque, Joos V.

    2007-01-01

    Purpose: To determine the planning target volume (PTV) margin for an adaptive radiotherapy procedure that uses five computed tomography (CT) scans to calculate an average prostate position and rectum shape. To evaluate alternative methods to determine an average rectum based on a single delineation. Methods and Materials: Repeat CT scans (8-13) of 19 patients were used. The contoured prostates of the first four scans were matched on the planning CT (pCT) prostate contours. With the resulting translations and rotations the average prostate position was determined. An average rectum was obtained by either averaging the coordinates of corresponding points on the rectal walls or by selecting the 'best' rectum or transforming the pCT rectum. Dose distributions were calculated for various expanded average prostates. The remaining CT scans were used to determine the dose received by prostate and rectum during treatment. Results: For the prostate of the pCT scan and a 10-mm margin, all patients received more than 95% of the prescribed dose to 95% of the prostate. For the average prostate, a margin of 7 mm was needed to obtain a similar result (average PTV reduction 30%). The average rectum overestimated the mean dose to the rectum by 0.4 ± 1.6 Gy, which was better than the pCT rectum (2.1 ± 3.0 Gy) and the alternative average rectums (1.0 ± 2.6 Gy and 1.4 ± 3.2 Gy). Conclusions: Our adaptive procedure allows for reduction of the PTV margin to 7 mm without decreasing prostate coverage during treatment. For accurate estimation of the rectum dose, rectums need to be delineated and averaged over multiple scans

  1. MR-CT registration using a Ni-Ti prostate stent in image-guided radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Korsager, Anne Sofie; Østergaard, Lasse Riis; Carl, Jesper

    2013-01-01

    Purpose: In image-guided radiotherapy of prostate cancer defining the clinical target volume often relies on magnetic resonance (MR). The task of transferring the clinical target volume from MR to standard planning computed tomography (CT) is not trivial due to prostate mobility. In this paper, an automatic local registration approach is proposed based on a newly developed removable Ni-Ti prostate stent.Methods: The registration uses the voxel similarity measure mutual information in a two-step approach where the pelvic bones are used to establish an initial registration for the local registration.Results: In a phantom study, the accuracy was measured to 0.97 mm and visual inspection showed accurate registration of all 30 data sets. The consistency of the registration was examined where translation and rotation displacements yield a rotation error of 0.41° ± 0.45° and a translation error of 1.67 ± 2.24 mm.Conclusions: This study demonstrated the feasibility for an automatic local MR-CT registration using the prostate stent.

  2. MR-CT registration using a Ni-Ti prostate stent in image-guided radiotherapy of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Korsager, Anne Sofie; Ostergaard, Lasse Riis [Department of Health Science and Technology, Aalborg University, Aalborg 9220 (Denmark); Carl, Jesper [Department of Medical Physics, Oncology, Aalborg Hospital, Aalborg 9100 (Denmark)

    2013-06-15

    Purpose: In image-guided radiotherapy of prostate cancer defining the clinical target volume often relies on magnetic resonance (MR). The task of transferring the clinical target volume from MR to standard planning computed tomography (CT) is not trivial due to prostate mobility. In this paper, an automatic local registration approach is proposed based on a newly developed removable Ni-Ti prostate stent.Methods: The registration uses the voxel similarity measure mutual information in a two-step approach where the pelvic bones are used to establish an initial registration for the local registration.Results: In a phantom study, the accuracy was measured to 0.97 mm and visual inspection showed accurate registration of all 30 data sets. The consistency of the registration was examined where translation and rotation displacements yield a rotation error of 0.41 Degree-Sign {+-} 0.45 Degree-Sign and a translation error of 1.67 {+-} 2.24 mm.Conclusions: This study demonstrated the feasibility for an automatic local MR-CT registration using the prostate stent.

  3. Cystectomy and Urinary Diversion for the Management of a Devastated Lower Urinary Tract Following Prostatic Cryotherapy and/or Radiotherapy.

    Science.gov (United States)

    Sack, Bryan S; Langenstroer, Peter; Guralnick, Michael L; Jacobsohn, Kenneth M; O'Connor, R Corey

    2016-04-01

    We investigated the outcomes and quality of life measures in men who underwent cystectomy and urinary diversion for devastating lower urinary tract toxicity after prostatic radiotherapy and/or cryotherapy for the treatment of prostate cancer. Records of patients who underwent cystectomy and urinary diversion for the management of a devastated lower urinary tract following prostatic radiotherapy or cryotherapy were reviewed retrospectively. A postoperative, retrospective quality of life (QOL) survey was designed specific to this patient subset and obtained by telephone interview. Extirpative surgery with urinary diversion for management of a devastated lower urinary tract was performed on 15 patients with a mean age of 72 years (range 63-82). Toxicities leading to bladder removal included bladder neck contractures, prostatic necrosis, incontinence, osteomyelitis, bladder calculi, fistulae, urethral strictures, abscesses, necrotizing fasciitis, and radiation/hemorrhagic cystitis. The mean number of failed conservative, minimally invasive interventions per patients prior to cystectomy was 3.7 (range 1-12). The average time period from major complication following radiotherapy/cryotherapy to cystectomy was 29.1 months (range 5-65). The QOL survey showed all of the patients who completed the survey (n = 13) would undergo the procedure again and 11 (85%) would have undergone the procedure an average of 13.2 months sooner (range 5-36). Toxicities secondary to prostatic radiotherapy or cryotherapy may be debilitating. Our results demonstrate that cystectomy with urinary diversion can improve QOL in patients with a devastated lower urinary tract.

  4. Health-related quality of life after carbon-ion radiotherapy for prostate cancer. A 3-year prospective study

    International Nuclear Information System (INIS)

    Katoh, Hiroyuki; Tsuji, Hiroshi; Ishikawa, Hitoshi

    2014-01-01

    To assess 3-year health-related quality of life of patients treated with carbon ion radiotherapy for prostate cancer. A total of 213 patients received carbon-ion radiotherapy at a total dose of 66 Gy equivalent in 20 fractions over 5 weeks, and neoadjuvant and adjuvant androgen deprivation therapy were administered for high-risk patients for at least 12 months. A health-related quality of life assessment was carried out at four time-points (immediately before the initiation of carbon-ion radiotherapy, immediately after, 12 and 36 months after completion of carbon-ion radiotherapy) using Functional Assessment of Cancer Therapy General and for Prostate Cancer Patients. The evaluable response rates among all responses were more than 94%. Overall, a significant decrease in the scores of the health-related quality of life 12 months after carbon-ion radiotherapy returned to their baseline levels at 36 months. Additionally, no significant decrease was observed in the scores at any of the assessment time-points compared with their baseline scores in the group of carbon-ion radiotherapy without androgen deprivation therapy; however, the presence of morbidity and biochemical failure significantly worsened the scores, and the decreases in the scores did not improve even at 36 months after carbon-ion radiotherapy. An assessment based on a subjective scoring system shows a significant decrease in health-related quality of life at 12 months after carbon-ion radiation therapy, which tends to return to baseline levels at 36 months. The presence of morbidity and bio-chemical failure significantly worsen health-related quality of life scores. Further controlled studies focusing on health-related quality of life assessment in patients with prostate cancer are warranted. (author)

  5. Quality of Life After Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Quon, Harvey; Cheung, Patrick C.F.; Loblaw, D. Andrew; Morton, Gerard; Pang, Geordi; Szumacher, Ewa; Danjoux, Cyril; Choo, Richard; Kiss, Alex; Mamedov, Alexandre; Deabreu, Andrea

    2012-01-01

    Purpose: To evaluate the change in health-related quality of life (QOL) of patients with high-risk prostate cancer treated using hypofractionated radiotherapy combined with long-term androgen deprivation therapy. Methods and Materials: A prospective Phase I–II study enrolled patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level ≥20 ng/mL, or Gleason score 8–10. Radiotherapy consisted of 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes with a concomitant 22.5 Gy intensity-modulated radiotherapy boost to the prostate, for a total of 67.5 Gy (2.7 Gy per fraction) in 25 fractions over 5 weeks. Daily image guidance was performed using three gold seed fiducials. Quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), a validated tool that assesses four primary domains (urinary, bowel, sexual, and hormonal). Results: From 2004 to 2007, 97 patients were treated. Median follow-up was 39 months. Compared with baseline, at 24 months there was no statistically significant change in the mean urinary domain score (p = 0.99), whereas there were decreases in the bowel (p < 0.01), sexual (p < 0.01), and hormonal (p < 0.01) domains. The proportion of patients reporting a clinically significant difference in EPIC urinary, bowel, sexual, and hormonal scores at 24 months was 27%, 31%, 55%, and 60%, respectively. However, moderate and severe distress related to these symptoms was minimal, with increases of only 3% and 5% in the urinary and bowel domains, respectively. Conclusions: Hypofractionated radiotherapy combined with long-term androgen deprivation therapy was well tolerated. Although there were modest rates of clinically significant patient-reported urinary and bowel toxicity, most of this caused only mild distress, and moderate and severe effects on QOL were limited. Additional follow-up is ongoing to characterize long-term QOL.

  6. Defining a dose-response relationship for prostate external beam radiotherapy

    International Nuclear Information System (INIS)

    Trada, Yuvnik; Plank, Ash; Martin, Jarad

    2013-01-01

    We aimed to quantify a relationship between radiotherapy dose and freedom from biochemical failure (FFBF) in low- and intermediate-risk prostate cancer. To reduce confounding we used data with a standardised end–point, mature follow-up, low competing risk of metastatic failure, conventional fractionation and separate reporting for outcomes with hormonal therapy (HT). A systematic review of the literature was carried out. Studies that reported the use of radiotherapy alone in 1.8–2Gy fractions in low- and intermediate-risk prostate cancer were included. The primary end–point was Phoenix definition 5-year FFBF. A logistic regression was used to quantify the dose–response relationship. Data from eight studies with 3037 patients met the inclusion criteria. The data from 810 low-risk patients and 2245 intermediate-risk patients were analysed. A strong association between radiotherapy dose and FFBF was found in low- and intermediate-risk patients managed with radiotherapy alone. In low-risk patients not treated with HT the dose required to achieve 50% biochemical tumour control (TCD 50 ) is 52.0 Gy and the slope of the dose–response curve at TCD 50 (γ 50 ) is 2.1%/Gy. At 78Gy this represented a FFBF of 90.3%. In intermediate-risk patients not treated with HT the TCD 50 is 64.7Gy and γ 50 is 3.2%/Gy. At 78 Gy this translated into a FFBF of 84.3%. HT had a small effect for low-risk patients and an inconsistent effect for intermediate-risk men. A strong association was found between radiation dose and biochemical outcome in both low- and intermediate-risk patients. Standardised reporting of results from future studies will make future analyses more robust.

  7. Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.

    Science.gov (United States)

    Smeenk, Robert Jan; van Lin, Emile N J Th; van Kollenburg, Peter; Kunze-Busch, Martina; Kaanders, Johannes H A M

    2009-10-01

    To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. In 24 patients with localized prostate carcinoma, two planning CT-scans were performed: with and without ERB. A prostate planning target volume (PTV) was defined, and the Awall was delineated, using two different methods. Three-field and 4-field 3D-CRT plans, and IMRT plans were generated with a prescription dose of 78Gy. In 144 treatment plans, the minimum dose (D(min)), maximum dose (D(max)), and mean dose (D(mean)) to the Awall were calculated, as well as the Awall volumes exposed to doses ranging from >or=20Gy to >or=70Gy (V(20)-V(70), respectively). In the 3D-CRT plans, an ERB significantly reduced D(mean), D(max), and V(30)-V(70). For IMRT all investigated dose parameters were significantly reduced by the ERB. The absolute reduction of D(mean) was 12Gy in 3D-CRT and was 7.5Gy in IMRT for both methods of Awall delineation. Application of an ERB showed a significant Awall sparing effect in both 3D-CRT and IMRT. This may lead to reduced late anal toxicity in prostate radiotherapy.

  8. Cone beam computed tomography: An accurate imaging technique in comparison with orthogonal portal imaging in intensity-modulated radiotherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Om Prakash Gurjar

    2016-03-01

    Full Text Available Purpose: Various factors cause geometric uncertainties during prostate radiotherapy, including interfractional and intrafractional patient motions, organ motion, and daily setup errors. This may lead to increased normal tissue complications when a high dose to the prostate is administered. More-accurate treatment delivery is possible with daily imaging and localization of the prostate. This study aims to measure the shift of the prostate by using kilovoltage (kV cone beam computed tomography (CBCT after position verification by kV orthogonal portal imaging (OPI.Methods: Position verification in 10 patients with prostate cancer was performed by using OPI followed by CBCT before treatment delivery in 25 sessions per patient. In each session, OPI was performed by using an on-board imaging (OBI system and pelvic bone-to-pelvic bone matching was performed. After applying the noted shift by using OPI, CBCT was performed by using the OBI system and prostate-to-prostate matching was performed. The isocenter shifts along all three translational directions in both techniques were combined into a three-dimensional (3-D iso-displacement vector (IDV.Results: The mean (SD IDV (in centimeters calculated during the 250 imaging sessions was 0.931 (0.598, median 0.825 for OPI and 0.515 (336, median 0.43 for CBCT, p-value was less than 0.0001 which shows extremely statistical significant difference.Conclusion: Even after bone-to-bone matching by using OPI, a significant shift in prostate was observed on CBCT. This study concludes that imaging with CBCT provides a more accurate prostate localization than the OPI technique. Hence, CBCT should be chosen as the preferred imaging technique.

  9. Prostate Bed Motion During Intensity-Modulated Radiotherapy Treatment

    International Nuclear Information System (INIS)

    Klayton, Tracy; Price, Robert; Buyyounouski, Mark K.; Sobczak, Mark; Greenberg, Richard; Li, Jinsheng; Keller, Lanea; Sopka, Dennis; Kutikov, Alexander; Horwitz, Eric M.

    2012-01-01

    Purpose: Conformal radiation therapy in the postprostatectomy setting requires accurate setup and localization of the prostatic fossa. In this series, we report prostate bed localization and motion characteristics, using data collected from implanted radiofrequency transponders. Methods and Materials: The Calypso four-dimensional localization system uses three implanted radiofrequency transponders for daily target localization and real-time tracking throughout a course of radiation therapy. We reviewed the localization and tracking reports for 20 patients who received ultrasonography-guided placement of Calypso transponders within the prostate bed prior to a course of intensity-modulated radiation therapy at Fox Chase Cancer Center. Results: At localization, prostate bed displacement relative to bony anatomy exceeded 5 mm in 9% of fractions in the anterior-posterior (A-P) direction and 21% of fractions in the superior-inferior (S-I) direction. The three-dimensional vector length from skin marks to Calypso alignment exceeded 1 cm in 24% of all 652 fractions with available setup data. During treatment, the target exceeded the 5-mm tracking limit for at least 30 sec in 11% of all fractions, generally in the A-P or S-I direction. In the A-P direction, target motion was twice as likely to move posteriorly, toward the rectum, than anteriorly. Fifteen percent of all treatments were interrupted for repositioning, and 70% of patients were repositioned at least once during their treatment course. Conclusion: Set-up errors and motion of the prostatic fossa during radiotherapy are nontrivial, leading to potential undertreatment of target and excess normal tissue toxicity if not taken into account during treatment planning. Localization and real-time tracking of the prostate bed via implanted Calypso transponders can be used to improve the accuracy of plan delivery.

  10. The comparison of 5-field conformal radiotherapy techniques for the treatment of prostate cancer: The best for femoral head sparing

    International Nuclear Information System (INIS)

    Zare, Mahkameh; Lashkari, Marzieh; Ghalehtaki, Reza; Ghasemi, Arash; Dehghan Manshadi, Hamidreza; Mir, Ali; Noorollahi, Somayeh; Alamolhoda, Mahboobeh

    2016-01-01

    External radiotherapy is a standard treatment procedure for localized prostate cancer. Given the relatively high long term survival treatment complications have been brought in center of attention. In this planning study, between 2012 and 2014, CT simulation data of 90 consecutive high-risk prostate cancer patients were collected. In the first phase, all were planned for whole pelvis irradiation up to 46Gy in 23 daily fractions. In the second phase, only the prostate gland was the target of radiation. Next, the subjects were divided randomly into three groups and each received a unique 5field conformal radiation plan including Plan A (Gantry angle: 0, 60, 120, 240, and 300), Plan B (Gantry angles: 0, 90, 120, 240, and 270) and Plan C (Gantry angles: 0, 60, 90, 270, and 300). The total dose was 70Gy. For each patient, the rectum, bladder, and both femoral heads were contoured as the at risk organs (OAR). From dose volume histograms, the proportional dose of PTV V100, the bladder and rectum V80 and V90 and femoral head V50 and V100 were calculated in all subjects and compared across plans. A statistically significant difference in the femoral head V50 and V100 was found between our studied 5field plans so that in Plan A (beam angles: 0, 60, 120, 240 and 300) less dose was received by both heads of femur. This study suggests that 5 field treatment planning including an anterior, two anterior oblique and two posterior oblique portals to be more proper for 3D conformal radiotherapy in order to spare femoral head with acceptable PTV coverage, and bladder and rectal doses.

  11. Benchmarking Dosimetric Quality Assessment of Prostate Intensity-Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Senthi, Sashendra, E-mail: sasha.senthi@petermac.org [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Gill, Suki S. [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Haworth, Annette; Kron, Tomas; Cramb, Jim [Department of Physical Sciences, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Rolfo, Aldo [Radiation Therapy Services, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Thomas, Jessica [Biostatistics and Clinical Trials, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Duchesne, Gillian M. [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Hamilton, Christopher H.; Joon, Daryl Lim [Radiation Oncology Department, Austin Repatriation Hospital, Heidelberg, VIC (Australia); Bowden, Patrick [Radiation Oncology Department, Tattersall' s Cancer Center, East Melbourne, VIC (Australia); Foroudi, Farshad [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia)

    2012-02-01

    Purpose: To benchmark the dosimetric quality assessment of prostate intensity-modulated radiotherapy and determine whether the quality is influenced by disease or treatment factors. Patients and Methods: We retrospectively analyzed the data from 155 consecutive men treated radically for prostate cancer using intensity-modulated radiotherapy to 78 Gy between January 2007 and March 2009 across six radiotherapy treatment centers. The plan quality was determined by the measures of coverage, homogeneity, and conformity. Tumor coverage was measured using the planning target volume (PTV) receiving 95% and 100% of the prescribed dose (V{sub 95%} and V{sub 100%}, respectively) and the clinical target volume (CTV) receiving 95% and 100% of the prescribed dose. Homogeneity was measured using the sigma index of the PTV and CTV. Conformity was measured using the lesion coverage factor, healthy tissue conformity index, and the conformity number. Multivariate regression models were created to determine the relationship between these and T stage, risk status, androgen deprivation therapy use, treatment center, planning system, and treatment date. Results: The largest discriminatory measurements of coverage, homogeneity, and conformity were the PTV V{sub 95%}, PTV sigma index, and conformity number. The mean PTV V{sub 95%} was 92.5% (95% confidence interval, 91.3-93.7%). The mean PTV sigma index was 2.10 Gy (95% confidence interval, 1.90-2.20). The mean conformity number was 0.78 (95% confidence interval, 0.76-0.79). The treatment center independently influenced the coverage, homogeneity, and conformity (all p < .0001). The planning system independently influenced homogeneity (p = .038) and conformity (p = .021). The treatment date independently influenced the PTV V{sub 95%} only, with it being better at the start (p = .013). Risk status, T stage, and the use of androgen deprivation therapy did not influence any aspect of plan quality. Conclusion: Our study has benchmarked measures

  12. External beam radiotherapy of localized prostatic adenocarcinoma. Evaluation of conformal therapy, field number and target margins

    International Nuclear Information System (INIS)

    Lennernaes, B.; Rikner, G.; Letocha, H.; Nilsson, S.

    1995-01-01

    The purpose of the present study was to identify factors of importance in the planning of external beam radiotherapy of prostatic adenocarcinoma. Seven patients with urogenital cancers were planned for external radiotherapy of the prostate. Four different techniques were used, viz. a 4-field box technique and four-, five- or six-field conformal therapy set-ups combined with three different margins (1-3 cm). The evaluations were based on the doses delivered to the rectum and the urinary bladder. A normal tissue complication probability (NTCP) was calculated for each plan using Lyman's dose volume reduction method. The most important factors that resulted in a decrease of the dose delivered to the rectum and the bladder were the use of conformal therapy and smaller margins. Conformal therapy seemed more important for the dose distribution in the urinary bladder. Five- and six-field set-ups were not significantly better than those with four fields. NTCP calculations were in accordance with the evaluation of the dose volume histograms. To conclude, four-field conformal therapy utilizing reduced margins improves the dose distribution to the rectum and the urinary bladder in the radiotherapy of prostatic adenocarcinoma. (orig.)

  13. How to identify rectal sub-regions likely involved in rectal bleeding in prostate cancer radiotherapy

    Science.gov (United States)

    Dréan, G.; Acosta, O.; Ospina, J. D.; Voisin, C.; Rigaud, B.; Simon, A.; Haigron, P.; de Crevoisier, R.

    2013-11-01

    Nowadays, the de nition of patient-speci c constraints in prostate cancer radiotherapy planning are solely based on dose-volume histogram (DVH) parameters. Nevertheless those DVH models lack of spatial accuracy since they do not use the complete 3D information of the dose distribution. The goal of the study was to propose an automatic work ow to de ne patient-speci c rectal sub-regions (RSR) involved in rectal bleeding (RB) in case of prostate cancer radiotherapy. A multi-atlas database spanning the large rectal shape variability was built from a population of 116 individuals. Non-rigid registration followed by voxel-wise statistical analysis on those templates allowed nding RSR likely correlated with RB (from a learning cohort of 63 patients). To de ne patient-speci c RSR, weighted atlas-based segmentation with a vote was then applied to 30 test patients. Results show the potentiality of the method to be used for patient-speci c planning of intensity modulated radiotherapy (IMRT).

  14. Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Ana Paula Diniz Fortuna Poli

    2016-02-01

    Full Text Available Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037. A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045. Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

  15. Stereotactic body radiotherapy for primary prostate cancer: a systematic review

    International Nuclear Information System (INIS)

    Tan, Tze-Jian; Foroudi, Farsgad; Gill, Suki; Siva, Shankar

    2014-01-01

    Stereotactic body radiotherapy (SBRT) for prostate cancer allows overall treatment times to be reduced to as little as 1 week while maintaining a non-invasive approach. This study provides a comprehensive summary of the literature relating to SBRT in prostate cancer. A systematic review of the relevant literature was performed using structured search terms. Fourteen phase I–II trials and retrospective studies using SBRT for the treatment of prostate cancer were used. Three studies were identified which addressed cost. Dose fractionation, radiotherapy procedures, biochemical progression-free survival, toxicity, cost and quality of life were critically appraised. A total of 1472 patients were examined across studies. Median follow-up ranged from 11 to 60 months. The most common dose fractionation was 35–36.25Gy in five fractions, used in nine out of 14 studies. Ten of 14 studies used CyberKnife. The overall biochemical progression-free survival ranged 81–100%. Acute grade 2 urinary and rectal toxicities were reported in 5–42% and 0–27% of patients, respectively. Acute grade 3 or more urinary and rectal toxicity were 0.5% and 0%, respectively. Late grade 2 urinary toxicity was reported in 0–29% of patients, while 1.3% had a late grade 3 urinary toxicity. There were no late grade 4 urinary toxicities seen. Late grade 2 rectal toxicity was reported in 0–11%, while 0.5% had a late grade 3 rectal toxicity. Late grade 4 rectal toxicity was reported in 0.2% of patients.

  16. A comparison of ventilatory prostate movement in four treatment positions

    International Nuclear Information System (INIS)

    Dawson, Laura A.; Litzenberg, Dale W.; Brock, Kristy K.; Sanda, Martin; Sullivan, Molly; Sandler, Howard M.; Balter, James M.

    2000-01-01

    Purpose: To ensure target coverage during radiotherapy, all sources of geometric uncertainty in target position must be considered. Movement of the prostate due to breathing has not traditionally been considered in prostate radiotherapy. The purpose of this study is to report the influence of patient orientation and immobilization on prostate movement due to breathing. Methods and Materials: Four patients had radiopaque markers implanted in the prostate. Fluoroscopy was performed in four different positions: prone in alpha cradle, prone with an aquaplast mold, supine on a flat table, and supine with a false table under the buttocks. Fluoroscopic movies were videotaped and digitized. Frames were analyzed using 2D-alignment software to determine the extent of movement of the prostate markers and the skeleton for each position during normal and deep breathing. Results: During normal breathing, maximal movement of the prostate markers was seen in the prone position (cranial-caudal [CC] range: 0.9-5.1 mm; anterior-posterior [AP] range: up to 3.5 mm). In the supine position, prostate movement during normal breathing was less than 1 mm in all directions. Deep breathing resulted in CC movements of 3.8-10.5 mm in the prone position (with and without an aquaplast mold). This range was reduced to 2.0-7.3 mm in the supine position and 0.5-2.1 mm with the use of the false table top. Deep breathing resulted in AP skeletal movements of 2.7-13.1 mm in the prone position, whereas AP skeletal movements in the supine position were negligible. Conclusion: Ventilatory movement of the prostate is substantial in the prone position and is reduced in the supine position. The potential for breathing to influence prostate movement, and thus the dose delivered to the prostate and normal tissues, should be considered when positioning and planning patients for conformal irradiation

  17. Converting from CT- to MRI-only-based target definition in radiotherapy of localized prostate cancer: A comparison between two modalities.

    Science.gov (United States)

    Seppälä, Tiina; Visapää, Harri; Collan, Juhani; Kapanen, Mika; Beule, Annette; Kouri, Mauri; Tenhunen, Mikko; Saarilahti, Kauko

    2015-11-01

    To investigate the conversion of prostate cancer radiotherapy (RT) target definition from CT-based planning into an MRI-only-based planning procedure. Using the CT- and MRI-only-based RT planning protocols, 30 prostate cancer patients were imaged in the RT fixation position. Two physicians delineated the prostate in both CT and T2-weighted MRI images. The CT and MRI images were coregistered based on gold seeds and anatomic borders of the prostate. The uncertainty of the coregistration, as well as differences in target volumes and uncertainty of contour delineation were investigated. Conversion of margins and dose constraints from CT- to MRI-only-based treatment planning was assessed. On average, the uncertainty of image coregistration was 0.4 ± 0.5 mm (one standard deviation, SD), 0.9 ± 0.8 mm and 0.9 ± 0.9 mm in the lateral, anterior-posterior and base-apex direction, respectively. The average ratio of the prostate volume between CT and MRI was 1.20 ± 0.15 (one SD). Compared to the CT-based contours, the MRI-based contours were on average 2-7 mm smaller in the apex, 0-1 mm smaller in the rectal direction and 1-4 mm smaller elsewhere. When converting from a CT-based planning procedure to an MRI-based one, the overall planning target volumes (PTV) are prominently reduced only in the apex. The prostate margins and dose constraints can be retained by this conversion.

  18. Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy

    Directory of Open Access Journals (Sweden)

    Williams Scott

    2011-10-01

    Full Text Available Abstract Background Image-guided radiotherapy (IGRT increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically. Methods Between 2006 and 2009, acute toxicity data for ten symptoms were collected prospectively onto standardized assessment forms. Toxicity was scored during radiotherapy, according to the Common Terminology Criteria Adverse Events V3.0, for 275 prostate cancer patients before and after the implementation of a fiducial marker IGRT program and dose escalation from 74Gy in 37 fractions, to 78Gy in 39 fractions. Margins and planning constraints were maintained the same during the study period. The symptoms scored were urinary frequency, cystitis, bladder spasm, urinary incontinence, urinary retention, diarrhoea, haemorrhoids, proctitis, anal skin discomfort and fatigue. Analysis was conducted for the maximum grade of toxicity and the median number of days from the onset of that toxicity to the end of treatment. Results In the IGRT group, 14228 toxicity scores were analysed from 249 patients. In the non-IGRT group, 1893 toxicity scores were analysed from 26 patients. Urinary frequency ≥G3 affected 23% and 7% in the non-IGRT and IGRT group respectively (p = 0.0188. Diarrhoea ≥G2 affected 15% and 3% of patients in the non-IGRT and IGRT groups (p = 0.0174. Fatigue ≥G2 affected 23% and 8% of patients in the non-IGRT and IGRT groups (p = 0.0271. The median number of days with a toxicity was higher for ≥G2 (p = 0.0179 and ≥G3 frequency (p = 0.0027, ≥G2 diarrhoea (p = 0.0033 and ≥G2 fatigue (p = 0.0088 in the non-IGRT group compared to the IGRT group. Other toxicities were not of significant statistical difference. Conclusions In this study, prostate cancer patients treated radically with IGRT had less severe urinary frequency, diarrhoea and fatigue during treatment

  19. Conformal fields in prostate radiotherapy: A comparison between measurement, calculation and simulation

    Directory of Open Access Journals (Sweden)

    Seied R Mahdavi

    2012-01-01

    Full Text Available Aims: The objective of this study is to evaluate the accuracy of a treatment planning system (TPS for calculating the dose distribution parameters in conformal fields (CF. Dosimetric parameters of CF′s were compared between measurement, Monte Carlo simulation (MCNP4C and TPS calculation. Materials and Methods: Field analyzer water phantom was used for obtaining percentage depth dose (PDD curves and beam profiles (BP of different conformal fields. MCNP4C was used to model conformal fields dose specification factors and head of linear accelerator varian model 2100C/D. Results: Results showed that the distance to agreement (DTA and dose difference (DD of our findings were well within the acceptance criteria of 3 mm and 3%, respectively. Conclusions: According to this study it can be revealed that TPS using equivalent tissue air ratio calculation method is still convenient for dose prediction in non small conformal fields normally used in prostate radiotherapy. It was also showed that, since there is a close correlation with Monte Carlo simulation, measurements and TPS, Monte Carlo can be further confirmed for implementation and calculation dose distribution in non standard and complex conformal irradiation field for treatment planning systems.

  20. Influence of radiotherapy on node-positive prostate cancer treated with androgen ablation

    Energy Technology Data Exchange (ETDEWEB)

    Sands, M Elizabeth; Pollack, Alan; Zagars, Gunar K

    1995-01-01

    Purpose: Patients with node-positive prostate cancer that is regionally localized (T1-4, N1-3, M0) have a relatively poor prognosis when a single-treatment modality such as radical surgery, definitive radiotherapy, or androgen ablation is used. While promising results using radical surgery and androgen ablation have been reported, there are no data to support an analogous approach using local radiotherapy and androgen ablation. In this retrospective review, the outcome after local radiotherapy and early androgen ablation (XRT/HORM) was compared to early androgen ablation alone (HORM). Methods and Materials: Between 1984 and 1992 there were 181 patients treated with HORM and 27 patients treated with XRT/HORM at the University of Texas M. D. Anderson Cancer Center. The nodal status of all patients was established pathologically by lymph node dissection, which was terminated after frozen section confirmation of involvement. In the majority of cases androgen ablation was by orchiectomy. The median dose to the prostate in XRT/HORM group was 66 Gy. The median follow-up was 45 months; 49 months for the HORM group and 25 months for the XRT/HORM group. Results: The distribution of prognostic factors between the HORM and XRT/HORM groups was similar, with the exception of tumor grade. There was a significantly larger proportion of high grade tumors in the HORM group. In terms of actuarial disease outcome, at 4 years the results of patients in the HORM group were significantly worse, including a rising prostate specific antigen (PSA) of 53%, any disease progression of 32%, a rising PSA or disease progression of 55%, and local progression of 22%. None of the patients in the XRT/HORM group failed biochemically or clinically. To determine the impact of grade on these findings, the analyses were repeated, using only those with grade 2 tumors. A similar pattern was evidenced with significantly worse actuarial outcome at 4 years for the HORM group using the endpoints of a rising PSA

  1. Management of Men with Prostate-specific Antigen Failure After Prostate Radiotherapy: The Case Against Early Androgen Deprivation.

    Science.gov (United States)

    Brand, Douglas; Parker, Chris

    2018-04-01

    In men with prostate-specific antigen failure after radical radiotherapy, androgen deprivation therapy should be delayed until the site of recurrence is known to allow consideration of curative treatment options, to delay androgen deprivation therapy-related morbidity, and to enable earlier access to abiraterone and docetaxel. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  2. Patient costs associated with external beam radiotherapy treatment for localized prostate cancer: the benefits of hypofractionated over conventionally fractionated radiotherapy.

    Science.gov (United States)

    Sethukavalan, Perakaa; Cheung, Patrick; Tang, Colin I; Quon, Harvey; Morton, Gerard; Nam, Robert; Loblaw, Andrew

    2012-04-01

    To estimate the out-of-pocket costs for patients undergoing external beam radiotherapy (EBRT) for prostate cancer and calculate the patient-related savings of being treated with a 5-fraction versus a standard 39-fraction approach. Seventy patients accrued to the pHART3 (n = 84) study were analyzed for out-of-pocket patient costs as a result of undergoing treatment. All costs are in Canadian dollars. Using the postal code of the patient's residence, the distance between the hospital and patient home was found using Google Maps. The Canada Revenue Agency automobile allowance rate was then applied to determine the cost per kilometer driven. The average cost of travel from the hospital and pHART3 patient's residence was $246 per person after five trips. In a standard fractionation regimen, pHART3 patients would have incurred an average cost of $1921 after 39 visits. The patients receiving hypofractionated radiotherapy would have paid an average of $38 in parking while those receiving conventional treatment would have paid $293. The difference in out-of-pocket costs for the patients receiving a standard versus hypofractionated treatment was $1930. Medium term prospective data shows that hypofractionated radiotherapy is an effective treatment method for localized prostate cancer. Compared to standard EBRT, hypofractionated radiotherapy requires significantly fewer visits. Due to the long distance patients may have to travel to the cancer center and the expense of parking, the short course treatment saves each patient an average of $1900. A randomized study of standard versus hypofractionated accelerated radiotherapy should be conducted to confirm a favorable efficacy and tolerability profile of the shorter fractionation scheme.

  3. Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy

    International Nuclear Information System (INIS)

    Smeenk, Robert Jan; Lin, Emile N.J.Th. van; Kollenburg, Peter van; Kunze-Busch, Martina; Kaanders, Johannes H.A.M.

    2009-01-01

    Background and purpose: To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer. Materials and methods: In 24 patients with localized prostate carcinoma, two planning CT-scans were performed: with and without ERB. A prostate planning target volume (PTV) was defined, and the Awall was delineated, using two different methods. Three-field and 4-field 3D-CRT plans, and IMRT plans were generated with a prescription dose of 78 Gy. In 144 treatment plans, the minimum dose (D min ), maximum dose (D max ), and mean dose (D mean ) to the Awall were calculated, as well as the Awall volumes exposed to doses ranging from ≥20 Gy to ≥70 Gy (V 20 - V 70 , respectively). Results: In the 3D-CRT plans, an ERB significantly reduced D mean , D max , and V 30 - V 70 . For IMRT all investigated dose parameters were significantly reduced by the ERB. The absolute reduction of D mean was 12 Gy in 3D-CRT and was 7.5 Gy in IMRT for both methods of Awall delineation. Conclusions: Application of an ERB showed a significant Awall sparing effect in both 3D-CRT and IMRT. This may lead to reduced late anal toxicity in prostate radiotherapy.

  4. Dosimetric and geometric evaluation of a hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Liu Han; Wu Qiuwen

    2011-01-01

    For prostate cancer patients, online image-guided (IG) radiotherapy has been widely used in clinic to correct the translational inter-fractional motion at each treatment fraction. For uncertainties that cannot be corrected online, such as rotation and deformation of the target volume, margins are still required to be added to the clinical target volume (CTV) for the treatment planning. Offline adaptive radiotherapy has been implemented to optimize the treatment for each individual patient based on the measurements at early stages of treatment process. It has been shown that offline adaptive radiotherapy can effectively reduce the required margin. Recently a hybrid strategy of offline adaptive replanning and online IG was proposed and the geometric evaluation was performed. It was found that the planning margins can further be reduced by 1-2 mm compared to online IG only strategy. The purpose of this study was to investigate the dosimetric benefits of such a hybrid strategy on the target and organs at risk. A total of 420 repeated helical computed tomography scans from 28 patients were included in the study. Both low-risk patients (LRP, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles, SV) were included in the simulation. Two registration methods, based on center-of-mass shift of prostate only and prostate plus SV, were performed for IRP. The intensity-modulated radiotherapy was used in the simulation. Criteria on both cumulative and fractional doses were evaluated. Furthermore, the geometric evaluation was extended to investigate the optimal number of fractions necessary to construct the internal target volume (ITV) for the hybrid strategy. The dosimetric margin improvement was smaller than its geometric counterpart and was in the range of 0-1 mm. The optimal number of fractions necessary for the ITV construction is 2 for LRPs and 3-4 for IRPs in a hypofractionation protocol. A new cumulative index of target volume was proposed

  5. The Early Result of Whole Pelvic Radiotherapy and Stereotactic Body Radiotherapy Boost for High Risk Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Yu-Wei eLin

    2014-10-01

    Full Text Available PurposeThe rationale for hypofractionated radiotherapy in the treatment of prostate cancer is based on the modern understanding of radiobiology and advances in stereotactic body radiotherapy (SBRT techniques. Whole-pelvis irradiation combined with SBRT boost for high-risk prostate cancer might escalate biologically effective dose without increasing toxicity. Here, we report our 4-year results of SBRT boost for high-risk localized prostate cancer.Methods and MaterialsFrom October 2009 to August 2012, 41 patients of newly diagnosed, high-risk or very high-risk (NCCN definition localized prostate cancer patients were treated with whole-pelvis irradiation and SBRT boost. The whole pelvis dose was 45Gy (25 fractions of 1.8Gy. The SBRT boost dose was 21 Gy (three fractions of 7 Gy. Ninety percent of these patients received hormone therapy. The toxicities of gastrointestinal (GI and genitourinary (GU tracts were scored by Common Toxicity Criteria Adverse Effect (CTCAE v3.0. Biochemical failure was defined by Phoenix definition.ResultsMedian follow-up was 42 months. Mean PSA before treatment was 44.18 ng/ml. Mean PSA level at 3, 6, 12, 18, and 24 months was 0.94, 0.44, 0.13, 0.12, and 0.05 ng/ml, respectively. The estimated 4-year biochemical failure-free survival was 91.9%. Three biochemical failures were observed. GI and GU tract toxicities were minimal. No grade 3 acute GU or GI toxicity was noted. During radiation therapy, 27% of the patient had grade 2 acute GU toxicity and 12% had grade 2 acute GI toxicity. At 3 months, most toxicity scores had returned to baseline. At the last follow up, there was no grade 3 late GU or GI toxicity.ConclusionsWhole-pelvis irradiation combined with SBRT boost for high-risk localized prostate cancer is feasible with minimal toxicity and encouraging biochemical failure-free survival. Continued accrual and follow-up would be necessary to confirm the biochemical control rate and the toxicity profiles.

  6. External beam radiotherapy for carcinoma of the prostate: a retrospective study

    International Nuclear Information System (INIS)

    Mithal, N.P.; Hoskin, P.J.

    1993-01-01

    Two hundred and thirty-seven consecutive patients receiving radiotherapy for primary prostatic carcinoma have been reviewed. The presenting symptoms included acute retention, chronic outflow obstruction and haematuria. The diagnosis was confirmed at trans-urethral resection of the prostate (TURP) in 95%; all but seven patients had adenocarcinoma. The clinical stage at presentation was T 0 (3%), T 1 (9%), T 2 (49%), T 3 (21%) and T 4 (17%). Two hundred and six patients received primary radiotherapy, 38 had concurrent endocrine therapy. Local relapse alone occurred in 38 patients (16%), distant relapse alone occurred in 30 (13%), and both local and distant relapse occurred in 30 (13%). Median time to local relapse alone was 25 months, distant relapse alone 14 months, and local and distant relapse 22 months. Overall survival was related to stage and grade at presentation. No influence of endocrine therapy, dose or planning technique was seen, but a significant advantage for those patients treated using a planned volume compared with parallel opposed fields was observed. Acute radiation toxicity affecting the bladder occurred in 42% and the bowel in 45%. Late toxicity affecting the bladder occurred in 7% and the bowel in 2%. (author)

  7. Radiotherapy does not cause increase psychological fatigue in prostate cancer patients: a prospective study

    International Nuclear Information System (INIS)

    Monga, Uma; Kerrigan, Anthony J.; Monga, Trilok N.

    1997-01-01

    Objectives: The origin of fatigue, a common symptom in cancer patients undergoing radiotherapy(RT), remains unresolved. The objectives of this study were to evaluate subjective fatigue in patients with localized prostate cancer utilizing validated instruments and to examine the relationship of fatigue with radiotherapy. Methods: Instruments used included: Piper Fatigue Scale (PFS), Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS) and Functional Assessment of Cancer Therapy - Prostate (FACT-P). Patients are evaluated before radiation therapy (PRT), at 4 weeks' (RT4), at completion of RT (7-8 weeks, RTC) of radiotherapy, and at 4 weeks follow-up (RTF). Seventeen prostate cancer subjects with a mean age of 64.6 years (range 55-73) were assessed. Results: PRT median scores on BDI, PFS, ESS, FACT(G), and FACT (P) were 4.00, 2.41, 6.0, 94, and 130 respectively. No significant changes in these scores were noted at RT4, RTC and RTF. Significant negative relationship was noted between PFS and physical well being sub-scale of FACT (G) at PRT(r=-0.76), RTC(r=-0.58), and RTF(r=-0.86). On BDI, four subjects reported depressive symptoms PRT. Two of these four subjects also scored higher on PFS. However, no significant changes were noted on their BDI and PFS scores during the study. No other patients reported depressive symptoms during treatment. Conclusions: These findings indicate: (1) No significant change in the baseline scores of fatigue and psychological measures during radiotherapy. (2) Self reported fatigue is not common in our patient population. (3) A significant relationship exists between scores on PFS and Physical well being sub-scale of FACT (G). Relationship between PFS, FACT-P and psychological functioning, severity of disease and PSA levels will also be presented

  8. Prostate cancer: variables to keep in mind at the moment to decide the external radiotherapy dose

    International Nuclear Information System (INIS)

    Donato, H.; Barros, J.M.; Fernandez Bibiloni, C.; Barrios, E.; Martinez, A.; Broda, E.; Cardiello, C.; Alva, R.; Chiozza, J.; Filomia, M.L.; Rafailovici, L.; Dosoretz, B.

    2007-01-01

    The objective of this work is to evaluate forecast factors and other variables in the decision of the final dose for prostate cancer treatment with 3D conformal radiotherapy techniques of modulated intensity. To determine the optimal dose, direct and indirect variables related to the disease should be considered. Also the equipment and the radiotherapy technique will impact on this decision [es

  9. An interactive tool for CT volume rendering and sagittal plane-picking of the prostate for radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Jani, Ashesh B.; Pelizzari, Charles A.; Chen, George T.Y.; Grzezcszuk, Robert P.; Vijayakumar, Srinivasan

    1997-01-01

    Objective: Accurate and precise target volume and critical structure definition is a basic necessity in radiotherapy. The prostate, particularly the apex (an important potential site of recurrence in prostate cancer patients), is a challenging structure to define using any modality, including conventional axial CT. Invasive or expensive techniques, such as retrograde urethrography or MRI, could be avoided if localization of the prostate were possible using information already available on the planning CT. Our primary objective was to build a software tool to determine whether volume rendering and sagittal plane-picking, which are CT-based, noninvasive visualization techniques, were of utility in radiotherapy treatment planning for the prostate. Methods: Using AVS (Application Visualization System) on a Silicon Graphics Indigo 2 High Impact workstation, we have developed a tool that enables the clinician to efficiently navigate a CT volume and to use volume rendering and sagittal plane-picking to better define structures at any anatomic site. We applied the tool to the specific example of the prostate to compare the two visualization techniques with the current standard of axial CT. The prostate was defined on 80-slice CT scans (scanning thickness 4mm, pixel size 2mm x 2mm) of prostate cancer patients using axial CT images, volume-rendered CT images, and sagittal plane-picked images. Results: The navigation of the prostate using the different visualization techniques qualitatively demonstrated that the sagittal plane-picked images, and even more so the volume-rendered images, revealed the prostate (particularly the lower border) better in relationship to the surrounding regional anatomy (bladder, rectum, pelvis, and penile structures) than did the axial images. A quantitative comparison of the target volumes obtained by navigating using the different visualization techniques demonstrated that, when compared to the prostate volume defined on axial CT, a larger volume

  10. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. III. Radiation treated patients

    International Nuclear Information System (INIS)

    Stamey, T.A.; Kabalin, J.N.; Ferrari, M.

    1989-01-01

    Serum prostate specific antigen was determined (Yang polyclonal radioimmunoassay) in 183 men after radiation therapy for adenocarcinoma of the prostate. A total of 163 men had received 7,000 rad external beam radiotherapy and 20 had been implanted with iodine-125 seeds. Only 11 per cent of these 183 patients had undetectable prostate specific antigen levels at a mean interval of 5 years since completion of radiotherapy. Prostate specific antigen levels after radiotherapy were directly related to initial clinical stage and Gleason score before treatment. Multiple prostate specific antigen determinations were performed with time in 124 of 183 patients. During year 1 after radiotherapy prostate specific antigen levels were decreasing in 82 per cent of the patients but only 8 per cent continued to decrease beyond year 1. Of 80 patients observed greater than 1 year after completion of radiotherapy 51 per cent had increasing values and 41 per cent had stable values. Increasing prostate specific antigen values after radiotherapy were correlated with progression to metastastic disease and residual cancer on prostate biopsy. Total serum acid phosphatase levels were poorly related to prostate specific antigen levels, were less effective in discriminating patients with metastatic disease and provided no additional information beyond that provided by prostate specific antigen

  11. Segmenting CT prostate images using population and patient-specific statistics for radiotherapy

    International Nuclear Information System (INIS)

    Feng, Qianjin; Foskey, Mark; Chen Wufan; Shen Dinggang

    2010-01-01

    learning mechanism, the authors carried out a comparison between partial online update strategy and full online update strategy. Using the full online update strategy, the mean DSC was improved from 86.6% to 89.3% with 2.8% gain. On the basis of full online update strategy, the manual modification before online update strategy was introduced and tested, the best performance was obtained; here, the mean DSC and the mean ASD achieved 92.4% and 1.47 mm, respectively. Conclusions: The proposed prostate segmentation method provided accurate and robust segmentation results for CT images even under the situation where the samples of patient under radiotherapy were limited. A conclusion that the proposed method is suitable for clinical application can be drawn.

  12. Segmenting CT prostate images using population and patient-specific statistics for radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Qianjin; Foskey, Mark; Chen Wufan; Shen Dinggang [Biomedical Engineering College, South Medical University, Guangzhou (China) and Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27510 (United States); Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina 27599 (United States); Biomedical Engineering College, South Medical University, Guangzhou 510510 (China); Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27510 (United States)

    2010-08-15

    learning mechanism, the authors carried out a comparison between partial online update strategy and full online update strategy. Using the full online update strategy, the mean DSC was improved from 86.6% to 89.3% with 2.8% gain. On the basis of full online update strategy, the manual modification before online update strategy was introduced and tested, the best performance was obtained; here, the mean DSC and the mean ASD achieved 92.4% and 1.47 mm, respectively. Conclusions: The proposed prostate segmentation method provided accurate and robust segmentation results for CT images even under the situation where the samples of patient under radiotherapy were limited. A conclusion that the proposed method is suitable for clinical application can be drawn.

  13. Assessment of prostate motion during radiotherapy using fiducial markers and CT reconstruction

    International Nuclear Information System (INIS)

    Crook, J.; Salhani, D.; Yang, H.; Deshaies, Y.; Raymond, Y.; Malone, S.; Esche, B.

    1996-01-01

    Purpose: To assess changes in prostate position during a course of pelvic radiotherapy for prostate cancer using fiducial markers and sequential planning CT scans. Methods and Materials: Three gold seeds are implanted in the apex, base and posterior aspect of the prostate under trans-rectal ultrasound guidance prior to initial simulation. In addition, treatment planning CT scans with 5 mm slices through the prostate are obtained at 0 and 40 Gy. Patients are scanned, simulated and treated with full bladder and are positioned using a standard foam leg support from the knees to the ankles. Prostate movement is assessed by two independent methods: [1] Localization of the fiducial markers using orthogonal simulator films taken just prior to the initial and boost stages of treatment and [2] a three-dimensional reconstruction methodology using CT datasets again obtained prior to the initial and boost stages. In both cases, rigid-body transformations of selected bony landmarks were used to eliminate patient movement between simulations and CT scans. For CT reconstruction, high order polynomial extrapolation and Chebychev multi-domain interpolation methods are employed to determine the coordinates of the fiducial markers. Prostatic movement, between initial and boost imaging, is estimated from the variance of the position of the corresponding seeds. Results: At present, seed data is available for sixty (60) patients. An additional nineteen (19) patients were excluded because of suspected seed migration > 3.0 mm or a localization uncertainty > 1.5 mm. The range of movement seen in the lateral direction is -0.25 to 0.48 cm (mean: 0.11, SD: 0.15), in the cranio-caudal direction -1.57 to 0.64 cm (mean: 0.59 SD: 0.48), and in the antero-posterior direction -1.91 to .47 cm (mean: 0.53, SD: 0.39). Results disclosed 53% of the patients with a caudal shift of the prostate > 0.5 cm and 10% > 1.0 cm. Further, 60% of the patients showed a posterior shift > 0.5 cm and 27% > 1.0 cm. CT

  14. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    King, Christopher R.; Brooks, James D.; Gill, Harcharan; Presti, Joseph C.

    2012-01-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 ± 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%–102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  15. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    King, Christopher R., E-mail: crking@mednet.ucla.edu [Departments of Radiation Oncology and Urology, University of California Los Angeles School of Medicine, Los Angeles, CA (United States); Brooks, James D.; Gill, Harcharan; Presti, Joseph C. [Department of Urology, Stanford University School of Medicine, Stanford, CA (United States)

    2012-02-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 {+-} 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%-102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  16. High biologically effective dose radiation therapy using brachytherapy in combination with external beam radiotherapy for high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Keisei Okamoto

    2017-02-01

    Full Text Available Purpose : To evaluate the outcomes of high-risk prostate cancer patients treated with biologically effective dose (BED ≥ 220 Gy of high-dose radiotherapy, using low-dose-rate (LDR brachytherapy in combination with external beam radiotherapy (EBRT and short-term androgen deprivation therapy (ADT. Material and methods : From 2005 to 2013, a total of 143 patients with high-risk prostate cancer were treated by radiotherapy of BED ≥ 220 Gy with a combination of LDR brachytherapy, EBRT, and androgen deprivation therapy (ADT. The high-risk patients in the present study included both high-risk and very high-risk prostate cancer. The number of high-risk features were: 60 patients with 1 high-risk factor (42%, 61 patients with 2 high-risk factors (43%, and 22 patients with 3 high-risk factors (15% including five N1 disease. External beam radiotherapy fields included prostate and seminal vesicles only or whole pelvis depending on the extension of the disease. Biochemical failure was defined by the Phoenix definition. Results : Six patients developed biochemical failure, thus providing a 5-year actual biochemical failure-free survival (BFFS rate of 95.2%. Biochemical failure was observed exclusively in cases with distant metastasis in the present study. All six patients with biochemical relapse had clinical failure due to bone metastasis, thus yielding a 5-year freedom from clinical failure (FFCF rate of 93.0%. None of the cases with N1 disease experienced biochemical failure. We observed four deaths, including one death from prostate cancer, therefore yielding a cause-specific survival (CSS rate of 97.2%, and an overall survival (OS rate of 95.5%. Conclusions : High-dose (BED ≥ 220 Gy radiotherapy by LDR in combination with EBRT has shown an excellent outcome on BFFS in high-risk and very high-risk cancer, although causal relationship between BED and BFFS remain to be explained further.

  17. Prostate image-guided radiotherapy by megavolt cone-beam CT

    International Nuclear Information System (INIS)

    Zucca, Sergio; Carau, Barbara; Solla, Ignazio; Garibaldi, Elisabetta; Farace, Paolo; Lay, Giancarlo; Meleddu, Gianfranco; Gabriele, Pietro

    2011-01-01

    To test megavolt cone-beam CT (MV-CBCT) in order to evaluate setup errors in prostate radiotherapy. The setup of 9 patients was verified weekly by electronic portal imaging (EPI) and MV-CBCT, both performed in the same treatment session. EPI were compared with digitally reconstructed radiographies (DRRs). MV-CBCTs were matched to simulation CTs by manual registration based on bone markers (BMR), by manual registration based on soft tissues (STR) - rectum, bladder, and seminal vesicles - and by automatic registration (AR) performed by a mutual information algorithm. Shifts were evaluated along the three main axes: anteroposterior (AP), craniocaudal (CC), and laterolateral (LL). Finally, in 4 additional patients showing intraprostatic calcifications, the calcification mismatch error was used to evaluate the three MV-CBCT matching methods. A total of 50 pairs of orthogonal EPIs and 50 MV-CBCTs were analyzed. Assuming an overall tolerance of 2 mm, no significant differences were observed comparing EPI vs BMR in any axis. A significant difference (p < 0.001) was observed along the AP axis comparing EPI vs AR and EPI vs STR. On the calcification data set (22 measures), the calcification mismatch along the AP direction was significantly lower (p < 0.05) after STR than after BMR or AR. Bone markers were not an effective surrogate of the target position and significant differences were observed comparing EPI or BMR vs STR, supporting the assessment of soft tissue position by MVCBs to verify and correct patient setup in prostate radiotherapy. (orig.)

  18. Prostate image-guided radiotherapy by megavolt cone-beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Zucca, Sergio; Carau, Barbara; Solla, Ignazio; Garibaldi, Elisabetta; Farace, Paolo; Lay, Giancarlo; Meleddu, Gianfranco; Gabriele, Pietro [Regional Oncological Hospital, Cagliari (Italy). Dept. of Radiooncology

    2011-08-15

    To test megavolt cone-beam CT (MV-CBCT) in order to evaluate setup errors in prostate radiotherapy. The setup of 9 patients was verified weekly by electronic portal imaging (EPI) and MV-CBCT, both performed in the same treatment session. EPI were compared with digitally reconstructed radiographies (DRRs). MV-CBCTs were matched to simulation CTs by manual registration based on bone markers (BMR), by manual registration based on soft tissues (STR) - rectum, bladder, and seminal vesicles - and by automatic registration (AR) performed by a mutual information algorithm. Shifts were evaluated along the three main axes: anteroposterior (AP), craniocaudal (CC), and laterolateral (LL). Finally, in 4 additional patients showing intraprostatic calcifications, the calcification mismatch error was used to evaluate the three MV-CBCT matching methods. A total of 50 pairs of orthogonal EPIs and 50 MV-CBCTs were analyzed. Assuming an overall tolerance of 2 mm, no significant differences were observed comparing EPI vs BMR in any axis. A significant difference (p < 0.001) was observed along the AP axis comparing EPI vs AR and EPI vs STR. On the calcification data set (22 measures), the calcification mismatch along the AP direction was significantly lower (p < 0.05) after STR than after BMR or AR. Bone markers were not an effective surrogate of the target position and significant differences were observed comparing EPI or BMR vs STR, supporting the assessment of soft tissue position by MVCBs to verify and correct patient setup in prostate radiotherapy. (orig.)

  19. Postoperative Radiotherapy in Prostate Cancer: The Case of the Missing Target

    International Nuclear Information System (INIS)

    Croke, Jennifer; Malone, Shawn; Roustan Delatour, Nicolas; Belanger, Eric; Avruch, Leonard; Morash, Christopher; Kayser, Cathleen; Underhill, Kathryn; Spaans, Johanna

    2012-01-01

    Purpose: Postoperative radiotherapy (XRT) increases survival in high-risk prostate cancer patients. Approximately 50% of patients on long-term follow-up relapse despite adjuvant XRT and the predominant site of failure remains local. Four consensus guidelines define postoperative clinical target volume (CTV) in prostate cancer. We explore the possibility that inadequate CTV coverage is an important cause of local failure. This study evaluates the utility of preoperative magnetic resonance imaging (MRI) in defining prostate bed CTV. Methods and Materials: Twenty prostate cancer patients treated with postoperative XRT who also had preoperative staging MRI were included. The four guidelines were applied and the CTVs were expanded to create planning target volumes (PTVs). Preoperative MRIs were fused with postoperative planning CT scans. MRI-based prostate and gross visible tumors were contoured. Three-dimensional (3D) conformal four- and six-field XRT plans were developed and dose–volume histograms analyzed. Subtraction analysis was conducted to assess the adequacy of prostate/gross tumor coverage. Results: Gross tumor was visible in 18 cases. In all 20 cases, the consensus CTVs did not fully cover the MRI-defined prostate. On average, 35% of the prostate volume and 32% of the gross tumor volume were missed using six-field 3D treatment plans. The entire MRI-defined gross tumor volume was completely covered in only two cases (six-field plans). The expanded PTVs did not cover the entire prostate bed in 50% of cases. Prostate base and mid-zones were the predominant site of inadequate coverage. Conclusions: Current postoperative CTV guidelines do not adequately cover the prostate bed and/or gross tumor based on preoperative MRI imaging. Additionally, expanded PTVs do not fully cover the prostate bed in 50% of cases. Inadequate CTV definition is likely a major contributing factor for the high risk of relapse despite adjuvant XRT. Preoperative imaging may lead to more

  20. Health-Related Quality of Life in Patients With Locally Advanced Prostate Cancer After 76 Gy Intensity-Modulated Radiotherapy vs. 70 Gy Conformal Radiotherapy in a Prospective and Longitudinal Study

    International Nuclear Information System (INIS)

    Lips, Irene; Dehnad, Human; Kruger, Arto Boeken; Moorselaar, Jeroen van; Heide, Uulke van; Battermann, Jan; Vulpen, Marco van

    2007-01-01

    Purpose: To compare quality of life (QoL) after 70 Gy conformal radiotherapy with QoL after 76 Gy intensity-modulated radiotherapy (IMRT) in patients with locally advanced prostate carcinoma. Methods and Materials: Seventy-eight patients with locally advanced prostate cancer were treated with 70 Gy three-field conformal radiotherapy, and 92 patients received 76 Gy IMRT with fiducial markers for position verification. Quality of life was measured by RAND-36, the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30(+3)), and the prostate-specific EORTC QLQ-PR25, before radiotherapy (baseline) and 1 month and 6 months after treatment. Quality of life changes in time (baseline vs. 1 month and baseline vs. 6 months) of ≥10 points were considered clinically relevant. Results: Differences between the treatment groups for QoL changes over time occurred in several QoL domains. The 76-Gy group revealed no significant deterioration in QoL compared with the 70-Gy group. The IMRT 76-Gy group even demonstrated a significantly better change in QoL from baseline to 1 month in several domains. The conformal 70-Gy group revealed temporary deterioration in pain, role functioning, and urinary symptoms; for the IMRT 76-Gy group a better QoL in terms of change in health existed after 1 month, which persisted after 6 months. For both treatment groups temporary deterioration in physical role restriction occurred after 1 month, and an improvement in emotional role restriction occurred after 6 months. Sexual activity was reduced after treatment for both groups and remained decreased after 6 months. Conclusions: Intensity-modulated radiotherapy and accurate position verification seem to provide a possibility to increase the radiation dose for prostate cancer without deterioration in QoL

  1. Haralick textural features on T2 -weighted MRI are associated with biochemical recurrence following radiotherapy for peripheral zone prostate cancer.

    Science.gov (United States)

    Gnep, Khémara; Fargeas, Auréline; Gutiérrez-Carvajal, Ricardo E; Commandeur, Frédéric; Mathieu, Romain; Ospina, Juan D; Rolland, Yan; Rohou, Tanguy; Vincendeau, Sébastien; Hatt, Mathieu; Acosta, Oscar; de Crevoisier, Renaud

    2017-01-01

    To explore the association between magnetic resonance imaging (MRI), including Haralick textural features, and biochemical recurrence following prostate cancer radiotherapy. In all, 74 patients with peripheral zone localized prostate adenocarcinoma underwent pretreatment 3.0T MRI before external beam radiotherapy. Median follow-up of 47 months revealed 11 patients with biochemical recurrence. Prostate tumors were segmented on T 2 -weighted sequences (T 2 -w) and contours were propagated onto the coregistered apparent diffusion coefficient (ADC) images. We extracted 140 image features from normalized T 2 -w and ADC images corresponding to first-order (n = 6), gradient-based (n = 4), and second-order Haralick textural features (n = 130). Four geometrical features (tumor diameter, perimeter, area, and volume) were also computed. Correlations between Gleason score and MRI features were assessed. Cox regression analysis and random survival forests (RSF) were performed to assess the association between MRI features and biochemical recurrence. Three T 2 -w and one ADC Haralick textural features were significantly correlated with Gleason score (P recurrence (P recurrence following prostate cancer radiotherapy. 3 J. Magn. Reson. Imaging 2017;45:103-117. © 2016 International Society for Magnetic Resonance in Medicine.

  2. Automatic prostate localization on cone-beam CT scans for high precision image-guided radiotherapy

    NARCIS (Netherlands)

    Smitsmans, Monique H. P.; de Bois, Josien; Sonke, Jan-Jakob; Betgen, Anja; Zijp, Lambert J.; Jaffray, David A.; Lebesque, Joos V.; van Herk, Marcel

    2005-01-01

    PURPOSE: Previously, we developed an automatic three-dimensional gray-value registration (GR) method for fast prostate localization that could be used during online or offline image-guided radiotherapy. The method was tested on conventional computed tomography (CT) scans. In this study, the

  3. Early hematologic changes during prostate cancer radiotherapy predictive for late urinary and bowel toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, Michael; Djukic, Victoria; Klotz, Jens; Holy, Richard; Eble, Michael J. [RWTH Aachen University, Department of Radiation Oncology, Aachen (Germany); Ribbing, Carolina [RWTH Aachen University, Department of Diagnostic and Interventional Radiology, Aachen (Germany)

    2015-10-15

    The primary objective of the study was to identify early hematologic changes predictive for radiotherapy (RT)-associated genitourinary and gastrointestinal toxicity. In a group of 91 prostate cancer patients presenting for primary (n = 51) or postoperative (n = 40) curative RT, blood samples (blood count, acute phase proteins, and cytokines) were analyzed before (T1), three times during (T2-T4), and 6-8 weeks after (T5) radiotherapy. Before RT (baseline), on the last day (acute toxicity), a median of 2 months and 16 months (late toxicity) after RT, patients responded to a validated questionnaire (Expanded Prostate Cancer Index Composite). Acute score changes > 20 points and late changes > 10 points were considered clinically relevant. Radiotherapy resulted in significant changes of hematologic parameters, with the largest effect on lymphocytes (mean decrease of 31-45 %) and significant dependence on target volume. C-reactive protein (CRP) elevation > 5 mg/l and hemoglobin level decrease ≥ 5 G/1 at T2 were found to be independently predictive for acute urinary toxicity (p < 0.01, respectively). CRP elevation was predominantly detected in primary prostate RT (p = 0.02). Early lymphocyte level elevation ≥ 0.3G/l at T2 was protective against late urinary and bowel toxicity (p = 0.02, respectively). Other significant predictive factors for late bowel toxicity were decreasing hemoglobin levels (cut-off ≥ 5 G/l) at T2 (p = 0.04); changes of TNF-α (tumor necrosis factor; p = 0.03) and ferritin levels (p = 0.02) at T5. All patients with late bowel toxicity had interleukin (IL)-6 levels < 1.5 ng/l at T2 (63 % without; p = 0.01). Early hematologic changes during prostate cancer radiotherapy are predictive for late urinary and bowel toxicity. (orig.) [German] Das primaere Ziel der Studie war die Identifikation von fruehen haematologischen Veraenderungen mit praediktiver Bedeutung fuer radiotherapieassoziierte genitourinale und gastrointestinale Toxizitaet. In einer

  4. A comparison of different three-dimensional treatment planning techniques for localized radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Koswig, S.; Dinges, S.; Buchali, A.; Boehmer, D.; Salk, J.; Rosenthal, P.; Harder, C.; Schlenger, L.; Budach, V.

    1999-01-01

    Purpose: Four different three-dimensional planning techniques for localized radiotherapy of prostate cancer were compared with regard to dose homogeneity within the target volume and dose to organs at risk, dependent upon tumor stage. Patients and Methods: Six patients with stage T1, 7 patients with stage T2 and 4 patients with stage T3 were included in this study. Four different 3D treatment plans (rotation, 4-field, 5-field and 6-field technique) were calculated for each patient. Dose was calculated with the reference point at the isocenter (100%). The planning target volume was encompassed within the 95% isodose surface. All the techniques used different shaped portal for each beam. Dose volume histograms were created and compared for the planning target volume and the organs at risk (33%, 50%, 66% volume level) in all techniques. Results: The 4 different three-dimensional planning techniques revealed no differences concerning dose homogeneity within the planning target volume. The dose volume distribution at organs at risk show differences between the calculated techniques. In our study the best protection for bladder and rectum in stage T1 and T2 was achieved by the 6-field technique. A significant difference was achieved between 6-field and 4-field technique only in the 50% volume of the bladder (p=0.034), between the 6-field and rotation technique (all volume levels) and between 5-field and rotation technique (all volume levels). In stage T1, T2 6-field and 4-field technique in 50% (p-0.033) and 66% (p=0.011) of the rectum volume. In stage T3 a significant difference was not observed between the 4 techniques. The best protection of head of the femur was achieved by the rotation technique. Conclusion: In the localized radiotherapy of prostate cancer in stage T1 or T2 the best protection for bladder and rectum was achieved by a 3D-planned conformal 6-field technique. If the seminal vesicles have been included in the target volume and in the case of large

  5. Four and five dimensional radiotherapy with reference to prostate cancer - definitions, state of the art and further directions - an overview

    Energy Technology Data Exchange (ETDEWEB)

    Lennernaes, Bo (Dept. of Oncology, Sahlgrenska Hospital and Academy, Univ. of Gothenburg, Gothenburg (Sweden)), e-mail: bo.lennernas@telia.com; Castellanos, Enrique; Nilsson, Sten; Levitt, Seymour (Dept. of Oncology/Pathology, Karolinska Univ. Hospital and Institutet, Stockholm (Sweden))

    2011-06-15

    Radiotherapy (RT) always requires a compromise between tumor control and normal tissue side-effects. Technical innovation in radiation therapy (RT), such as three dimensional RT, is now established. Concerning prostate cancer (PC), it is reasonable to assume that RT of PC will increase in the future. The combination of small margins, a movable target (prostate), few fractions and high doses will probably demand dynamically positioning systems and in real time. This is called four dimensional radiotherapy (4DRT). Moreover, biological factors must be included in new treatments such as hypofractionation schedules. This new era is called five dimensional radiotherapy, 5DRT. In this paper we discuss new concepts in RT in respect to PC

  6. The role of diffusion-weighted MRI: In assessment of response to radiotherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Manal H. Wahba

    2015-03-01

    Conclusion: With the use of a 1.5-T MR scanner, our preliminary results suggest that ADC values may be useful as a non-invasive imaging biomarker for monitoring therapeutic response of prostate cancer to radiotherapy.

  7. Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group

    International Nuclear Information System (INIS)

    Poortmans, Philip; Bossi, Alberto; Vandeputte, Katia; Bosset, Mathieu; Miralbell, Raymond; Maingon, Philippe; Boehmer, Dirk; Budiharto, Tom; Symon, Zvi; Bergh, Alfons C.M. van den; Scrase, Christopher; Poppel, Hendrik van; Bolla, Michel

    2007-01-01

    The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing post-operative radiotherapy for prostate cancer requires a standardisation of the target volume definition and delineation as well as standardisation of the clinical quality assurance procedures. Recommendations for this are presented on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group and in addition to the already published guidelines for radiotherapy as the primary treatment

  8. Sexual function in prostatic cancer patients treated with radiotherapy, orchiectomy or oestrogens

    International Nuclear Information System (INIS)

    Bergman, B.; Damber, J.-E.; Littbrand, B.; Sjoegren, K.; Tomic, R.

    1984-01-01

    Sexual function in prostatic carcinoma patients was studied in 12 patients from each of three treatment groups: radiotherapy, orchiectomy and oestrogen treatment. Significant deterioration occurred in all groups. Although erectile potency was preserved in 9 of 12 patients treated with radiotherapy, 7 of these had a marked reduction in the frequency of sexual activity. Men subjected to orchiectomy or oestrogen treatment were seldom capable of having intercourse or of experiencing orgasm. However, oestrogen-treated men continued sexual activity with their partner more often than orchiectomised subjects. Patients receiving oestrogen treatment scored significantly higher for mental depression than those in the other two treatment groups. (author)

  9. Sexual function in prostatic cancer patients treated with radiotherapy, orchiectomy or oestrogens

    Energy Technology Data Exchange (ETDEWEB)

    Bergman, B.; Damber, J.E.; Littbrand, B.; Sjoegren, K.; Tomic, R. (Umeaa Univ. (Sweden))

    1984-02-01

    Sexual function in prostatic carcinoma patients was studied in 12 patients from each of three treatment groups: radiotherapy, orchiectomy and oestrogen treatment. Significant deterioration occurred in all groups. Although erectile potency was preserved in 9 of 12 patients treated with radiotherapy, 7 of these had a marked reduction in the frequency of sexual activity. Men subjected to orchiectomy or oestrogen treatment were seldom capable of having intercourse or of experiencing orgasm. However, oestrogen-treated men continued sexual activity with their partner more often than orchiectomised subjects. Patients receiving oestrogen treatment scored significantly higher for mental depression than those in the other two treatment groups.

  10. Adjuvant radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate: Ten-year update

    International Nuclear Information System (INIS)

    Anscher, Mitchell S.; Robertson, Cary N.; Prosnitz, Leonard R.

    1995-01-01

    Purpose: To determine the role of adjuvant postoperative radiotherapy (RT) following radical prostatectomy (RP) in a group of patients with pathologic Stage T3/4 adenocarcinoma of the prostate followed for a median of 10 years after treatment. Methods and Materials: Between 1970 and 1983, 159 patients underwent RP for newly diagnosed adenocarcinoma of the prostate and were found to have pathologic Stage T3/4 tumors. Forty-six received adjuvant RT and 113 did not. Radiotherapy usually consisted of 45-50 Gy to the whole pelvis followed by a boost to the prostate bed of 10-15 Gy, to a total dose of 55-65 Gy. Patients were analyzed with respect to survival, disease-free survival, local control, and freedom from distant metastases. A rising prostate-specific antigen in the absence of other evidence of relapse was scored as a separate category of recurrence. Results: Both groups of patients have been followed for a median of 10 years. The actuarial survival at 10 and 15 years was 62% and 62% for the RT group compared to 52% and 37%, respectively, for the RP group (p = 0.18). The disease-free survival for the RT group was 55% and 48% at 10 and 15 years, respectively, compared to 37% and 33% for the RP group (p = 0.16). Similarly, there was no difference in the rate of distant metastases between the two groups. In contrast, the local relapse rate was significantly reduced by the addition of postoperative radiotherapy. The actuarial local control rate at 10 and 15 years was 92% and 82%, respectively, for the RT group vs. 60% and 53% for the RP group (p 0.002). Conclusions: While postoperative pelvic RT significantly improves local control compared to RP alone for pathologic Stage T3/4 prostate cancer, it has no impact on distant metastases and consequently does not improve survival. These data are consistent with the conclusion that many patients with pathologic Stage T3/4 prostate cancer have occult metastases at presentation and will not be cured by local therapies alone

  11. Evaluating efficiency of split VMAT plan for prostate cancer radiotherapy involving pelvic lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Jun Ki; Son, Sang Jun; Kim, Dae Ho; Seo, Seok Jin [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2015-12-15

    The purpose of this study is to evaluate the efficiency of Split VMAT planning(Contouring rectum divided into an upper and a lower for reduce rectum dose) compare to Conventional VMAT planning(Contouring whole rectum) for prostate cancer radiotherapy involving pelvic lymph nodes. A total of 9 cases were enrolled. Each case received radiotherapy with Split VMAT planning to the prostate involving pelvic lymph nodes. Treatment was delivered using TrueBeam STX(Varian Medical Systems, USA) and planned on Eclipse(Ver. 10.0.42, Varian, USA), PRO3(Progressive Resolution Optimizer 10.0.28), AAA(Anisotropic Analytic Algorithm Ver. 10.0.28). Lower rectum contour was defined as starting 1 cm superior and ending 1 cm inferior to the prostate PTV, upper rectum is a part, except lower rectum from the whole rectum. Split VMAT plan parameters consisted of 10 MV coplanar 360° arcs. Each arc had 30° and 30° collimator angle, respectively. An SIB(Simultaneous Integrated Boost) treatment prescription was employed delivering 50.4 Gy to pelvic lymph nodes and 63- 70 Gy to the prostate in 28 fractions. D{sub mean} of whole rectum on Split VMAT plan was applied for DVC(Dose Volume Constraint) of the whole rectum for Conventional VMAT plan. In addition, all parameters were set to be the same of existing treatment plans. To minimize the dose difference that shows up randomly on optimizing, all plans were optimized and calculated twice respectively using a 0.2 cm grid. All plans were normalized to the prostate PTV{sub 100%} = 90% or 95%. A comparison of D{sub mean} of whole rectum, upperr ectum, lower rectum, and bladder, V{sub 50%} of upper rectum, total MU and H.I.(Homogeneity Index) and C.I.(Conformity Index) of the PTV was used for technique evaluation. All Split VMAT plans were verified by gamma test with portal dosimetry using EPID. Using DVH analysis, a difference between the Conventional and the Split VMAT plans was demonstrated. The Split VMAT plan demonstrated better in the D

  12. Class solution to decrease rectal dose in prostate radiotherapy treatments 3D-CRT

    International Nuclear Information System (INIS)

    Andres Rodriguez, C.; Tortosa Oliver, R.; Alonso Hernandez, D.; Mari Palacios, A.; Castillo Belmonte, A. del

    2011-01-01

    This paper contains a method developed in our center with conventional 3D radiotherapy techniques to increase the dose conformation around the target volume in prostate cancer treatments significantly reduced the doses to the rectum. To evaluate the goodness of the method, the results are compared with two classical techniques of treatment.

  13. Prostate position variability and dose-volume histograms in radiotherapy for prostate cancer with full and empty bladder

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Asadpour, Branka; Gagel, Bernd; Piroth, Marc D.; Holy, Richard; Eble, Michael J.

    2006-01-01

    Purpose: To evaluate prostate position variability and dose-volume histograms in prostate radiotherapy with full bladder (FB) and empty bladder (EB). Methods and Materials: Thirty patients underwent planning computed tomography scans in a supine position with FB and EB before and after 4 and 8 weeks of radiation therapy. The scans were matched by alignment of pelvic bones. Displacements of the prostate/seminal vesicle organ borders and center of mass were determined. Treatment plans (FB vs. EB) were compared. Results: Compared with the primary scan, FB volume varied more than EB volume (standard deviation, 106 cm 3 vs. 47 cm 3 ), but the prostate/seminal vesicle center of mass position variability was the same (>3 mm deviation in right-left, anterior-posterior, and superior-inferior directions in 0, 41%, and 33%, respectively, with FB vs. 0, 44%, and 33% with EB). The bladder volume treated with 90% of the prescription dose was significantly larger with EB (39% ± 14% vs. 22% ± 10%; p < 0.01). Bowel loops received ≥90% of prescription dose in 37% (3% with FB; p < 0.01). Conclusion: Despite the larger variability of bladder filling, prostate position stability was the same with FB compared with EB. An increased amount of bladder volume in the high-dose region and a higher dose to bowel loops result from treatment plans with EB

  14. Intra-fractional uncertainties in image-guided intensity-modulated radiotherapy (IMRT) of prostate cancer

    International Nuclear Information System (INIS)

    Polat, Buelent; Guenther, Iris; Wilbert, Juergen; Goebel, Joachim; Sweeney, Reinhart A.; Flentje, Michael; Guckenberger, Matthias

    2008-01-01

    To evaluate intra-fractional uncertainties during intensity-modulated radiotherapy (IMRT) of prostate cancer. During IMRT of 21 consecutive patients, kilovolt (kV) cone-beam computed tomography (CBCT) images were acquired prior to and immediately after treatment: a total of 252 treatment fractions with 504 CBCT studies were basis of this analysis. The prostate position in anterior-posterior (AP) direction was determined using contour matching; patient set-up based on the pelvic bony anatomy was evaluated using automatic image registration. Internal variability of the prostate position was the difference between absolute prostate and patient position errors. Intra-fractional changes of prostate position, patient position, rectal distension in AP direction and bladder volume were analyzed. With a median treatment time of 16 min, intra-fractional drifts of the prostate were > 5 mm in 12% of all fractions and a margin of 6 mm was calculated for compensation of this uncertainty. Mobility of the prostate was independent from the bony anatomy with poor correlation between absolute prostate motion and motion of the bony anatomy (R 2 = 0.24). A systematic increase of bladder filling by 41 ccm on average was observed; however, these changes did not influence the prostate position. Small variations of the prostate position occurred independently from intra-fractional changes of the rectal distension; a weak correlation between large internal prostate motion and changes of the rectal volume was observed (R 2 = 0.55). Clinically significant intra-fractional changes of the prostate position were observed and margins of 6 mm were calculated for this intra-fractional uncertainty. Repeated or continuous verification of the prostate position may allow further margin reduction. (orig.)

  15. Intra-fractional uncertainties in image-guided intensity-modulated radiotherapy (IMRT) of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Polat, Buelent; Guenther, Iris; Wilbert, Juergen; Goebel, Joachim; Sweeney, Reinhart A.; Flentje, Michael; Guckenberger, Matthias [Wuerzburg Univ. (Germany). Dept. of Radiation Oncology

    2008-12-15

    To evaluate intra-fractional uncertainties during intensity-modulated radiotherapy (IMRT) of prostate cancer. During IMRT of 21 consecutive patients, kilovolt (kV) cone-beam computed tomography (CBCT) images were acquired prior to and immediately after treatment: a total of 252 treatment fractions with 504 CBCT studies were basis of this analysis. The prostate position in anterior-posterior (AP) direction was determined using contour matching; patient set-up based on the pelvic bony anatomy was evaluated using automatic image registration. Internal variability of the prostate position was the difference between absolute prostate and patient position errors. Intra-fractional changes of prostate position, patient position, rectal distension in AP direction and bladder volume were analyzed. With a median treatment time of 16 min, intra-fractional drifts of the prostate were > 5 mm in 12% of all fractions and a margin of 6 mm was calculated for compensation of this uncertainty. Mobility of the prostate was independent from the bony anatomy with poor correlation between absolute prostate motion and motion of the bony anatomy (R{sup 2} = 0.24). A systematic increase of bladder filling by 41 ccm on average was observed; however, these changes did not influence the prostate position. Small variations of the prostate position occurred independently from intra-fractional changes of the rectal distension; a weak correlation between large internal prostate motion and changes of the rectal volume was observed (R{sup 2} = 0.55). Clinically significant intra-fractional changes of the prostate position were observed and margins of 6 mm were calculated for this intra-fractional uncertainty. Repeated or continuous verification of the prostate position may allow further margin reduction. (orig.)

  16. MR-CBCT image-guided system for radiotherapy of orthotopic rat prostate tumors.

    Directory of Open Access Journals (Sweden)

    Tsuicheng D Chiu

    Full Text Available Multi-modality image-guided radiotherapy is the standard of care in contemporary cancer management; however, it is not common in preclinical settings due to both hardware and software limitations. Soft tissue lesions, such as orthotopic prostate tumors, are difficult to identify using cone beam computed tomography (CBCT imaging alone. In this study, we characterized a research magnetic resonance (MR scanner for preclinical studies and created a protocol for combined MR-CBCT image-guided small animal radiotherapy. Two in-house dual-modality, MR and CBCT compatible, phantoms were designed and manufactured using 3D printing technology. The phantoms were used for quality assurance tests and to facilitate end-to-end testing for combined preclinical MR and CBCT based treatment planning. MR and CBCT images of the phantoms were acquired utilizing a Varian 4.7 T scanner and XRad-225Cx irradiator, respectively. The geometry distortion was assessed by comparing MR images to phantom blueprints and CBCT. The corrected MR scans were co-registered with CBCT and subsequently used for treatment planning. The fidelity of 3D printed phantoms compared to the blueprint design yielded favorable agreement as verified with the CBCT measurements. The geometric distortion, which varied between -5% and 11% throughout the scanning volume, was substantially reduced to within 0.4% after correction. The distortion free MR images were co-registered with the corresponding CBCT images and imported into a commercial treatment planning software SmART Plan. The planning target volume (PTV was on average 19% smaller when contoured on the corrected MR-CBCT images relative to raw images without distortion correction. An MR-CBCT based preclinical workflow was successfully designed and implemented for small animal radiotherapy. Combined MR-CBCT image-guided radiotherapy for preclinical research potentially delivers enhanced relevance to human radiotherapy for various disease sites. This

  17. MR-CBCT image-guided system for radiotherapy of orthotopic rat prostate tumors.

    Science.gov (United States)

    Chiu, Tsuicheng D; Arai, Tatsuya J; Campbell Iii, James; Jiang, Steve B; Mason, Ralph P; Stojadinovic, Strahinja

    2018-01-01

    Multi-modality image-guided radiotherapy is the standard of care in contemporary cancer management; however, it is not common in preclinical settings due to both hardware and software limitations. Soft tissue lesions, such as orthotopic prostate tumors, are difficult to identify using cone beam computed tomography (CBCT) imaging alone. In this study, we characterized a research magnetic resonance (MR) scanner for preclinical studies and created a protocol for combined MR-CBCT image-guided small animal radiotherapy. Two in-house dual-modality, MR and CBCT compatible, phantoms were designed and manufactured using 3D printing technology. The phantoms were used for quality assurance tests and to facilitate end-to-end testing for combined preclinical MR and CBCT based treatment planning. MR and CBCT images of the phantoms were acquired utilizing a Varian 4.7 T scanner and XRad-225Cx irradiator, respectively. The geometry distortion was assessed by comparing MR images to phantom blueprints and CBCT. The corrected MR scans were co-registered with CBCT and subsequently used for treatment planning. The fidelity of 3D printed phantoms compared to the blueprint design yielded favorable agreement as verified with the CBCT measurements. The geometric distortion, which varied between -5% and 11% throughout the scanning volume, was substantially reduced to within 0.4% after correction. The distortion free MR images were co-registered with the corresponding CBCT images and imported into a commercial treatment planning software SmART Plan. The planning target volume (PTV) was on average 19% smaller when contoured on the corrected MR-CBCT images relative to raw images without distortion correction. An MR-CBCT based preclinical workflow was successfully designed and implemented for small animal radiotherapy. Combined MR-CBCT image-guided radiotherapy for preclinical research potentially delivers enhanced relevance to human radiotherapy for various disease sites. This novel protocol

  18. Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Fiorino, C.; Cattaneo, G.M.; Calandrino, R.; Reni, M.; Bolognesi, A.; Bonini, A.

    1998-01-01

    Background: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. Purpose: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. Materials and methods: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. Results 5 mm equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy

  19. Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer.

    Science.gov (United States)

    Madalinska, J B; Essink-Bot, M L; de Koning, H J; Kirkels, W J; van der Maas, P J; Schröder, F H

    2001-03-15

    The current study was undertaken within the framework of a screening trial to compare the health-related quality-of-life (HRQOL) outcomes of two primary treatment modalities for localized prostate cancer: radical prostatectomy and external-beam radiotherapy. We conducted a prospective longitudinal cohort study among 278 patients with early screen-detected (59%) or clinically diagnosed (41%) prostate cancer using both generic and disease-specific HRQOL measures (SF-36, UCLA Prostate Cancer Index [urinary and bowel modules] and items relating to sexual functioning) at three points in time: t1 (baseline), t2 (6 months later), and t3 (12 months after t1). Questionnaires were completed by 88% to 93% of all initially enrolled patients. Patients referred for primary radiotherapy were significantly older than prostatectomy patients (63 v 68 years, P screen-detected and clinically diagnosed cancer reported similar posttreatment HRQOL. Prostatectomy and radiotherapy differed in the type of HRQOL impairment. Because the HRQOL effects may be valued differently at the individual level, patients should be made fully aware of the potential benefits and adverse consequences of therapies for early prostate cancer. Differences in posttreatment HRQOL were not related to the method of cancer detection.

  20. Salvage external beam radiotherapy for clinical failure after cryosurgery for prostate cancer

    International Nuclear Information System (INIS)

    McDonough, Michael J.; Feldmeier, John J.; Parsai, Ishmael; Dobelbower, Ralph R.; Selman, Steven H.

    2001-01-01

    Purpose: To investigate the role of external beam radiotherapy (EBRT) as salvage treatment of prostate cancer after cryosurgery failure. Methods and Materials: Between 1993 and 1998, 6 patients underwent EBRT with curative intent for local recurrence of prostate cancer after cryosurgery. All 6 patients had biopsy-proven recurrence and palpable disease on digital rectal examination at the time of EBRT. The median follow-up was 34 months (range 8-46). The median prostate-specific antigen level was 2.3 ng/mL (range 0.8-4.1). No patient had evidence of metastatic disease. Two patients received hormonal therapy before beginning EBRT. No patient received hormonal therapy after EBRT completion. The median elapsed time between cryosurgery and EBRT was 3 years (range 1.5-4). The median delivered dose was 66 Gy (range 62-70.2) using a 10-MeV photon beam. An in-house-developed three-dimensional treatment planning system was used to plan delivery of the prescribed dose with conformal radiotherapy techniques. Results: After EBRT, all patients had complete resolution of palpable disease. Four patients (66%) were disease free at the time of the last follow-up. Two patients developed biochemical failure as defined by the American Society for Therapeutic Radiology and Oncology consensus definition. One of these patients had a prostate-specific antigen level of 97 ng/mL before cryosurgery. No patient developed distant metastasis during follow-up. Two patients (33%) developed proctitis; 1 case resolved with Rowasa suppositories and 1 required blood transfusion. Conclusions: Our preliminary results suggest that EBRT can render a significant number of patients biochemically free of disease and can cause complete resolution of clinically palpable disease after initial cryosurgery. The results also showed that EBRT can be given without excessive morbidity. EBRT should be considered as a treatment option in these potentially curable cases

  1. Hydrogel injection reduces rectal toxicity after radiotherapy for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, Michael; Berneking, Vanessa; Koenig, Liane; Frank, Dilini; Bretgeld, Marilou; Eble, Michael J. [RWTH Aachen University, Department of Radiation Oncology, Aachen (Germany)

    2017-01-15

    Injection of a hydrogel spacer before prostate cancer radiotherapy (RT) is known to reduce the dose to the rectal wall. Clinical results from the patient's perspective are needed to better assess a possible benefit. A group of 167 consecutive patients who received prostate RT during the years 2010 to 2013 with 2-Gy fractions up to 76 Gy (without hydrogel, n = 66) or 76-80 Gy (with hydrogel, n = 101) were included. The numbers of interventions resulting from bowel problems during the first 2 years after RT were compared. Patients were surveyed prospectively before RT, at the last day of RT, and at a median of 2 and 17 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Baseline patient characteristics were well balanced. Treatment for bowel symptoms (0 vs. 11 %; p < 0.01) and endoscopic examinations (3 vs. 19 %; p < 0.01) were performed less frequently with a spacer. Mean bowel function scores did not change for patients with a spacer in contrast to patients without a spacer (mean decrease of 5 points) >1 year after RT in comparison to baseline, with 0 vs. 12 % reporting a new moderate/big problem with passing stools (p < 0.01). Statistically significant differences were found for the items ''loose stools'', ''bloody stools'', ''painful bowel movements'' and ''frequency of bowel movements''. Spacer injection is associated with a significant benefit for patients after prostate cancer RT. (orig.) [German] Bei der Radiotherapie (RT) des Prostatakarzinoms kann die Dosis an der Rektumwand durch die Injektion eines Hydrogelabstandhalters gesenkt werden. Klinische Ergebnisse aus der Sicht des Patienten sind zur Einschaetzung eines moeglichen Vorteils erforderlich. Eine Gruppe von 167 konsekutiven Patienten, die in den Jahren 2010-2013 eine Prostata-RT mit Einzeldosen von 2 bis 76 Gy (ohne Hydrogel, n = 66) bzw. 76-80 Gy (mit Hydrogel, n = 101

  2. Survival benefit associated with adjuvant androgen deprivation therapy combined with radiotherapy for high- and low-risk patients with nonmetastatic prostate cancer

    International Nuclear Information System (INIS)

    Zeliadt, Steven B.; Potosky, Arnold L.; Penson, David F.; Etzioni, Ruth

    2006-01-01

    Background: The use of adjuvant androgen deprivation therapy (ADT) combined with radiotherapy has become common in low-risk patients, although clinical trials have focused primarily on high-risk patients. This study examines the effectiveness of adjuvant ADT combined with radiotherapy for a wide range of patients treated in the 1990s. Methods and Materials: Prostate cancer survival was examined in a population based cohort of 31,643 patients aged 65 to 85 years who were diagnosed with nonmetastatic prostate cancer and treated with external beam radiotherapy and/or brachytherapy. Instrumental variable analysis methods were used to control for selection bias. Results: Patients with stage T3/T4 disease who received adjuvant ADT experienced improved 5-year and 8-year survival. No survival advantage was observed for men with T1/T2 disease during this interval. Conclusion: High-risk patients who receive primary radiotherapy have benefited from adjuvant ADT, whereas low-risk patients with disease confined to the prostate have not yet benefited from adjuvant therapy within the first 8 years after treatment. These findings are consistent with practice guidelines, which recommend adjuvant ADT for patients with high-risk disease

  3. Salvage High-intensity Focused Ultrasound for the Recurrent Prostate Cancer after Radiotherapy

    International Nuclear Information System (INIS)

    Shoji, S.; Nakano, M.; Omata, T.; Harano, Y.; Nagata, Y.; Uchida, T.; Usui, Y.; Terachi, T.

    2010-01-01

    To investigate the use of minimally invasive high-intensity focused ultrasound (HIFU) as a salvage therapy in men with localized prostate cancer recurrence following external beam radiotherapy (EBRT), brachytherapy or proton therapy. A review of 20 cases treated using the Sonablate registered 500 HIFU device, between August 28, 2002 and September 1, 2009, was carried out. All men had presumed organ-confined, histologically confirmed recurrent prostate adenocarcinoma following radiation therapy. All men with presumed, organ-confined, recurrent disease following EBRT in 8 patients, brachytherapy in 7 patients or proton therapy in 5 patients treated with salvage HIFU were included. The patients were followed for a mean (range) of 16.0 (3-80) months. Biochemical disease-free survival (bDFS) rates in patients with low-intermediate and high risk groups were 86% and 50%, respectively. Side-effects included urethral stricture in 2 of the 16 patients (13%), urinary tract infection or dysuria syndrome in eight (26%), and urinary incontinence in one (6%). Recto-urethral fistula occurred in one patient (6%). Transrectal HIFU is an effective treatment for recurrence after radiotherapy especially in patients with low- and intermediate risk groups.

  4. A phase I trial of pre-operative radiotherapy for prostate cancer: Clinical and translational studies

    International Nuclear Information System (INIS)

    Supiot, Stephane; Shubbar, Shubber; Fleshner, Neil; Warde, Padraig; Hersey, Karen; Wallace, Kris; Cole, Heather; Sweet, Joan; Tsihlias, John; Jewett, Michael A.S.; Klotz, Laurence; Bristow, Robert G.

    2008-01-01

    Background and purpose: Selected patients undergoing radical prostatectomy for localized prostate cancer can be at high-risk for pT3 disease and require subsequent radiotherapy. In a phase I trial, we investigated the feasibility of pre-operative radiotherapy for this patient subset. Materials and methods: Eligibility criteria were: T1/T2N0M0 tumors plus (i) Gleason ≥ 7, PSA > 10 ng/ml and 15 ng/ml and less WAF associated with reduced cell proliferation. Conclusion: Intra-operative morbidity is low following short-course, pre-operative radiotherapy. A phase II trial is planned to fully document biochemical response with this combined-modality approach

  5. Three-dimensional conformal radiotherapy in the treatment of prostate cancer in Australia and New Zealand: Report on a survey of radiotherapy centres and the proceedings of a consensus workshop

    International Nuclear Information System (INIS)

    Tai, K.-H.; Duchesne, G.; See, A.; Berry, M.

    2004-01-01

    There is an increasing use of 3-D conformal radiotherapy (3DCRT) in the radiotherapeutic management of prostate cancer. The Faculty of Radiation Oncology Genito-Urinary Group carried out a survey of Australian and New Zealand radiotherapy centres in the preparation of a consensus workshop. Of the 19 centres that were represented, there were 24 radiation oncologists, 16 radiation therapists and 12 medical physicists. The survey collected demographic information and data on the practices undertaken at those centres when delivering curative radiotherapy in the treatment of prostate cancer. There was much variation in the delivery of treatment in the areas of patient set-up, contouring of target volumes and organs of interest during computer planning, the techniques and the dose constraints used in these techniques, the use of adjuvant androgen deprivation therapy and the quality assurance processes used in monitoring effects of treatment. This variability reflects the range of data in the published literature. Emerging trends of practices were also identified. This is a first report on a multi-disciplinary approach to the development of guidelines in 3DCRT of prostate cancer. Copyright (2004) Blackwell Science Pty Ltd

  6. Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

    Directory of Open Access Journals (Sweden)

    Maurizio Valeriani

    2014-01-01

    Full Text Available Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT. Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60 Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI and genitourinary (GU toxicity rates were 11.9% and 40.7%, respectively. Grade 1 GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ≥2 late toxicities were recorded. Acute grade 2-3 GU toxicity resulted significantly lower (P=0.04 in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2 GU toxicity was significantly higher (P<0.001 for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT.

  7. Scanned ion beam therapy for prostate carcinoma. Comparison of single plan treatment and daily plan-adapted treatment

    International Nuclear Information System (INIS)

    Hild, Sebastian; Graeff, Christian; Rucinski, Antoni; Zink, Klemens; Habl, Gregor; Durante, Marco; Herfarth, Klaus; Bert, Christoph

    2016-01-01

    Intensity-modulated particle therapy (IMPT) for tumors showing interfraction motion is a topic of current research. The purpose of this work is to compare three treatment strategies for IMPT to determine potential advantages and disadvantages of ion prostate cancer therapy. Simulations for three treatment strategies, conventional one-plan radiotherapy (ConvRT), image-guided radiotherapy (IGRT), and online adaptive radiotherapy (ART) were performed employing a dataset of 10 prostate cancer patients with six CT scans taken at one week intervals. The simulation results, using a geometric margin concept (7-2 mm) as well as patient-specific internal target volume definitions for IMPT were analyzed by target coverage and exposure of critical structures on single fraction dose distributions. All strategies led to clinically acceptable target coverage in patients exhibiting small prostate motion (mean displacement < 4 mm), but IGRT and especially ART led to significant sparing of the rectum. In 20 % of the patients, prostate motion exceeded 4 mm causing insufficient target coverage for ConvRT (V95 mean = 0.86, range 0.63-0.99) and IGRT (V95 mean = 0.91, range 0.68-1.00), while ART maintained acceptable target coverage. IMPT of prostate cancer demands consideration of rectal sparing and adaptive treatment replanning for patients exhibiting large prostate motion. (orig.) [de

  8. Characterizing Interfraction Variations and Their Dosimetric Effects in Prostate Cancer Radiotherapy

    International Nuclear Information System (INIS)

    Peng Cheng; Ahunbay, Ergun; Chen Guangpei; Anderson, Savannah; Lawton, Colleen; Li, X. Allen

    2011-01-01

    Purpose: To quantitatively characterize the interfraction variations and their dosimetric effects in radiotherapy for prostate cancer. Methods and Materials: A total of 486 daily computed tomography (CT) sets acquired for 20 prostate cancer patients treated with daily CT-guided repositioning using a linear accelerator and CT-on-rail combination were analyzed. The prostate, rectum, and bladder, delineated on each daily CT data set, were compared with those from the planning CT scan. Several quantities, including Dice's coefficient and the maximal overlapping rate, were used to characterize the interfraction variations. The delivered dose was reconstructed by applying the original plan to the daily CT scan with consideration of proper repositioning. Results: The mean prostate Dice's coefficient and maximal overlapping rate after bony registration was 69.7% ± 13.8% (standard deviation) and 85.6% ± 7.8% (standard deviation), respectively. The daily delivered dose distributions were generally inferior to the planned dose distribution for target coverage and/or normal structure sparing. For example, for approximately 5% of the treatment fractions, the prostate volume receiving 100% of the prescription dose decreased dramatically (15-20%) compared with its planned value. The magnitudes of the interfraction variations and their dosimetric effects indicated that, statistically, current standard repositioning using prostate alignment might be adequate for two-thirds of the fractions, but for the rest of the fractions, better on-line correction strategies, such as on-line replanning, are needed. Conclusion: Different adaptive correction schemes for prostatic interfraction changes can be used according to the anatomic changes, as quantified by the organ displacement and deformation parameters. On-line replanning is needed for approximately one-third of the treatment fractions.

  9. TGFB1 Single Nucleotide Polymorphisms Are Associated With Adverse Quality of Life in Prostate Cancer Patients Treated With Radiotherapy

    International Nuclear Information System (INIS)

    Peters, Christopher A.; Stock, Richard G.; Cesaretti, Jamie A.; Atencio, David P.; Peters, Sheila B.A.; Burri, Ryan J.; Stone, Nelson N.; Ostrer, Harry; Rosenstein, Barry S.

    2008-01-01

    Purpose: To investigate whether the presence of single nucleotide polymorphisms (SNPs) located within TGFB1 might be predictive for the development of adverse quality-of-life outcomes in prostate cancer patients treated with radiotherapy. Methods and Materials: A total of 141 prostate cancer patients treated with radiotherapy were screened for SNPs in TGFB1 using DNA sequencing. Three quality-of-life outcomes were investigated: (1) prospective decline in erectile function, (2) urinary quality of life, and (3) rectal bleeding. Median follow-up was 51.3 months (range, 12-138 months; SD, 24.4 months). Results: Those patients who possessed either the T/T genotype at position -509, the C/C genotype at position 869 (pro/pro, codon 10) or the G/C genotype at position 915 (arg/pro, codon 25) were significantly associated with the development of a decline in erectile function compared with those who did not have these genotypes: 56% (9 of 16) vs. 24% (11 of 45) (p = 0.02). In addition, patients with the -509 T/T genotype had a significantly increased risk of developing late rectal bleeding compared with those who had either the C/T or C/C genotype at this position: 55% (6 of 11) vs. 26% (34 of 130) (p = 0.05). Conclusions: Possession of certain TGFB1 genotypes is associated with the development of both erectile dysfunction and late rectal bleeding in patients treated with radiotherapy for prostate cancer. Therefore, identification of patients harboring these genotypes may represent a means to predict which men are most likely to suffer from poor quality-of-life outcomes after radiotherapy for prostate cancer

  10. Development and evaluation of radiographer led telephone follow up following radical radiotherapy to the prostate. A report of a Macmillan Cancer Support Sponsored Pilot project at Mount Vernon Hospital

    International Nuclear Information System (INIS)

    Verma, R.; Treasure, P.; Hughes, R.

    2015-01-01

    Radiotherapy for localised prostate cancer is an effective and well tolerated treatment. Following radiotherapy, most men are followed up either in doctor or specialist nurse led hospital outpatient clinics. Attending clinics may be of little personal benefit as the majority of patients have few ongoing symptoms post radiotherapy and have very good cancer prognoses. Recognising the limitations outpatient clinic follow up, we developed a radiographer led model of remote telephone follow up of patients completing radiotherapy for low to intermediate risk prostate cancer. Standardised toxicity assessments were performed and patient satisfaction assessed. Radiographer led follow up detected similar levels of post radiotherapy GI, GU and sexual toxicity as outpatient clinic appointments, with a very high level of patient satisfaction compared to routine outpatient clinics. We believe that radiographer led telephone follow up provides an alternative model for long term follow up of men after prostate radiotherapy

  11. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes

    Directory of Open Access Journals (Sweden)

    King Christopher R

    2011-01-01

    Full Text Available Abstract Purpose Hypofractionated, stereotactic body radiotherapy (SBRT is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Method and Materials Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method and RTOG toxicity outcomes were assessed. Results At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%. Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusion Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

  12. Prostate bed motion may cause geographic miss in post-prostatectomy image-guided intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Bell, Linda J.; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2013-01-01

    There is little data to guide radiation oncologists on appropriate margin selection in the post-prostatectomy setting. The aim of this study was to quantify interfraction variation in motion of the prostate bed to determine these margins. The superior and inferior surgical clips in the prostate bed were tracked on pretreatment cone beam CT images (n=377) for 40 patients who had received post-prostatectomy radiotherapy. Prostate bed motion was calculated for the upper and lower segments by measuring the position of surgical clips located close to midline relative to bony anatomy in the axial (translational) and sagittal (tilt) planes. The frequency of potential geographic misses was calculated for either 1cm or 0.5cm posterior planning target volume margins. The mean magnitude of movement of the prostate bed in the anterior–posterior, superior–inferior and left–right planes, respectively, were as follows: upper portion, 0.50cm, 0.28cm, 0.10cm; lower portion, 0.18cm, 0.18cm, 0.08cm. The random and systematic errors, respectively, of the prostate bed motion in the anterior–posterior, superior–inferior and left–right planes, respectively, were as follows: upper portion, 0.47cm and 0.50cm, 0.28cm and 0.27cm, 0.11cm and 0.11cm; lower portion, 0.17cm and 18cm, 0.17cm and 0.19cm, 0.08cm and 0.10cm. Most geographic misses occurred in the upper prostate bed in the anterior–posterior plane. The median prostate bed tilt was 1.8° (range −23.4° to 42.3°). Variability was seen in all planes for the movement of both surgical clips. The greatest movement occurred in the anterior–posterior plane in the upper prostate bed, which could cause geographic miss of treatment delivery. The variability in the movement of the superior and inferior clips indicates a prostate bed tilt that would be difficult to correct with standard online matching techniques. This creates a strong argument for using anisotropic planning target volume margins in post

  13. Impact of Image Guidance on Outcomes After External Beam Radiotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Willoughby, Twyla R.; Reddy, Chandana A.; Klein, Eric A.; Mahadevan, Arul

    2008-01-01

    Purpose: To verify whether rectal distention at the time of planning impacts outcomes in patients with localized prostate cancer treated with daily image guidance. Methods and Materials: Between 1998 and 2002, a total of 488 prostate cancer patients were treated with intensity-modulated radiotherapy. The radiation dose was 70 Gy delivered at 2.5 Gy per fraction in all cases. All cases were treated with a 4-mm margin posteriorly. In all cases the total rectal volume documented on the CT scan was used for treatment planning. No special bowel preparation instructions were given, either for the simulation or the daily treatments. Before each daily treatment, alignment of the prostate was performed with the B-mode acquisition and targeting (BAT) transabdominal ultrasound system. The median follow-up for all 488 patients was 60 months (range, 24-96 months). Results: For all patients the biochemical relapse-free survival (bRFS) rate at 5 years was 86%. The 5-year bRFS rate for the rectal distention 3 , 50 to 3 , and ≥100 cm 3 groups was 90%, 83%, and 85%, respectively (p = 0.18). To adjust for other potential variables affecting bRFS rates, a multivariate time-to-failure analysis using the Cox proportional hazards model was performed. Rectal distention was not an independent predictor of biochemical failure on multivariate analysis (p = 0.80). Rectal distention was not a predictor of rectal or urinary toxicity. Conclusion: The use of daily image guidance eliminates errors such as rectal distention at the initial planning stage that can affect outcomes after radiotherapy for localized prostate cancer

  14. Development of Multiorgan Finite Element-Based Prostate Deformation Model Enabling Registration of Endorectal Coil Magnetic Resonance Imaging for Radiotherapy Planning

    International Nuclear Information System (INIS)

    Hensel, Jennifer M.; Menard, Cynthia; Chung, Peter W.M.; Milosevic, Michael F.; Kirilova, Anna; Moseley, Joanne L.; Haider, Masoom A.; Brock, Kristy K.

    2007-01-01

    Purpose: Endorectal coil (ERC) magnetic resonance imaging (MRI) provides superior visualization of the prostate compared with computed tomography at the expense of deformation. This study aimed to develop a multiorgan finite element deformable method, Morfeus, to accurately co-register these images for radiotherapy planning. Methods: Patients with prostate cancer underwent fiducial marker implantation and computed tomography simulation for radiotherapy planning. A series of axial MRI scans were acquired with and without an ERC. The prostate, bladder, rectum, and pubic bones were manually segmented and assigned linear elastic material properties. Morfeus mapped the surface of the bladder and rectum between two imaged states, calculating the deformation of the prostate through biomechanical properties. The accuracy of deformation was measured as fiducial marker error and residual surface deformation between the inferred and actual prostate. The deformation map was inverted to deform from 100 cm 3 to no coil. Results: The data from 19 patients were analyzed. Significant prostate deformation occurred with the ERC (mean intrapatient range, 0.88 ± 0.25 cm). The mean vector error in fiducial marker position (n = 57) was 0.22 ± 0.09 cm, and the mean vector residual surface deformation (n = 19) was 0.15 ± 0.06 cm for deformation from no coil to 100-cm 3 ERC, with an image vector resolution of 0.22 cm. Accurately deformed MRI scans improved soft-tissue resolution of the anatomy for radiotherapy planning. Conclusions: This method of multiorgan deformable registration enabled accurate co-registration of ERC-MRI scans with computed tomography treatment planning images. Superior structural detail was visible on ERC-MRI, which has potential for improving target delineation

  15. The hypo-fractionated radiotherapy in the treatment of the prostate cancer: Radiate less to treat more

    International Nuclear Information System (INIS)

    Boissier, R.; Gross, E.

    2012-01-01

    The principle of the hypo-fractionation in radiotherapy is to deliver a higher dose by session and to reduce the duration of treatment. In the particular case of the cancer of prostate, a hypo-fractionated protocol allows to deliver an equivalent radiobiological dose identical even higher than a standard plan of irradiation. The hypo-fractionation is presented as a solution to improve the access to the care (fewer processing times by patient, more patients treated by machine) while increasing the quality of the care: better carcinological control, less radiotoxicity. The objective of this article is to make a clarification on the hypo-fractionated radiotherapy in first intention in the treatment of the localized prostate cancer. We count three studies on large cohorts, comparing standard plans to 1.8 2 Gy/session and hypo-fractionated plans (2.5 3 Gy/session). The inferior carcinological results of the two first comparative studies with regard to the study of phase I/II of the Cleveland clinic were owed to a sub-dosage of hypo-fractionated plans. The administered equivalent biological doses were lower than the at present recommended total doses and lower than the theoretical doses, calculated on the bases of an erroneous evaluation of the radio-sensibility of the prostate cancer. In the comparative study of Arcangeli, the rate of survival without biological recurrence in 4 years (82%) was significantly to the advantage of the hypo-fractionated group, while reducing the duration of treatment of 3 weeks. Four comparative studies reported acute/late toxicity, gastrointestinal (GI)/genito-urinary acceptable (GU) even lower with a hypo-fractionated plan. The hypo-fractionation is potentially the future of the radiotherapy in the treatment of the localized prostate cancer thanks to the technological innovation, but for all that does not constitute at present a standard. (authors)

  16. Measurement of prostate movement over the course of routine radiotherapy using implanted markers

    International Nuclear Information System (INIS)

    Balter, James M.; Sandler, Howard M.; Lam, Kwok; Bree, Robert L.; Lichter, Allen S.; Haken, Randall K. ten

    1995-01-01

    Purpose: To measure the range and frequency of occurrence of intertreatment movement of the prostate gland over the course of radiotherapy, and to demonstrate that the prostate may move independently of the surrounding bones of the pelvis. Methods and Materials: Ten patients underwent implantation of radiopaque markers around the prostate. Orthogonal portal films were taken at multiple stages during the course of treatment and digitized. An image registration tool was used to solve for film detector placement and, subsequently, to determine positional changes between structures on a reference portal image pair and all subsequent pairs for each patient. Transformations describing prostate movement were measured independently of those describing setup variations of the pelvic girdle. Results: Translation and/or rotation of the prostate was detected in 70% of the treatments for which films were taken. The maximum measured displacement was 7.5 mm along a major axis. Typical translations of the prostate were between 0-4 mm. The translation and rotation had a predominant direction, suggesting a natural axis for prostate movement. Conclusion: Although significant prostate displacement can occur between treatments, the typical range of movement seen along a major axis was less than 5 mm. Proper treatment planning should consider the movement of the target independent of surrounding bony anatomy. Advances in online portal imaging, image registration, and dynamic field shaping may permit shaped fields that encompass the prostate gland in its position at the time of treatment, allowing for the use of smaller fields while ensuring proper target coverage

  17. Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate

    NARCIS (Netherlands)

    Steenbakkers, Roel J. H. M.; Deurloo, Kirsten E. I.; Nowak, Peter J. C. M.; Lebesque, Joos V.; van Herk, Marcel; Rasch, Coen R. N.

    2003-01-01

    PURPOSE: The prostate volume delineated on MRI is smaller than on CT. The purpose of this study was to determine the influence of MRI- vs. CT-based prostate delineation using multiple observers on the dose to the target and organs at risk during external beam radiotherapy. MATERIALS AND METHODS: CT

  18. Expression of Bcl-2, p53, and MDM2 in Localized Prostate Cancer With Respect to the Outcome of Radical Radiotherapy Dose Escalation

    International Nuclear Information System (INIS)

    Vergis, Roy; Corbishley, Catherine M.; Thomas, Karen

    2010-01-01

    Purpose: Established prognostic factors in localized prostate cancer explain only a moderate proportion of variation in outcome. We analyzed tumor expression of apoptotic markers with respect to outcome in men with localized prostate cancer in two randomized controlled trials of radiotherapy dose escalation. Methods and Materials: Between 1995 and 2001, 308 patients with localized prostate cancer received neoadjuvant androgen deprivation and radical radiotherapy at our institution in one of two dose-escalation trials. The biopsy specimens in 201 cases were used to make a biopsy tissue microarray. We evaluated tumor expression of Bcl-2, p53, and MDM2 by immunohistochemistry with respect to outcome. Results: Median follow-up was 7 years, and 5-year freedom from biochemical failure (FFBF) was 70.4% (95% CI, 63.5-76.3%). On univariate analysis, expression of Bcl-2 (p < 0.001) and p53 (p = 0.017), but not MDM2 (p = 0.224), was significantly associated with FFBF. Expression of Bcl-2 remained significantly associated with FFBF (p = 0.001) on multivariate analysis, independently of T stage, Gleason score, initial prostate-specific antigen level, and radiotherapy dose. Seven-year biochemical control was 61% vs. 41% (p = 0.0122) for 74 Gy vs. 64 Gy, respectively, among patients with Bcl-2-positive tumors and 87% vs. 81% (p = 0.423) for 74 Gy vs. 64 Gy, respectively, among patients with Bcl-2-negative tumors. There was no statistically significant interaction between dose and Bcl-2 expression. Conclusions: Bcl-2 expression was a significant, independent determinant of biochemical control after neoadjuvant androgen deprivation and radical radiotherapy for prostate cancer. These data generate the hypothesis that Bcl-2 expression could be used to inform the choice of radiotherapy dose in individual patients.

  19. Effect of rectal enema on intrafraction prostate movement during image-guided radiotherapy.

    Science.gov (United States)

    Choi, Youngmin; Kwak, Dong-Won; Lee, Hyung-Sik; Hur, Won-Joo; Cho, Won-Yeol; Sung, Gyung Tak; Kim, Tae-Hyo; Kim, Soo-Dong; Yun, Seong-Guk

    2015-04-01

    Rectal volume and movement are major factors that influence prostate location. The aim of this study was to assess the effect of a rectal enema on intrafraction prostate motion. The data from 12 patients with localised prostate cancer were analysed. Each patient underwent image-guided radiotherapy (RT), receiving a total dose of 70 Gy in 28 fractions. Rectal enemas were administered to all of the patients before each RT fraction. The location of the prostate was determined by implanting three fiducial markers under the guidance of transrectal ultrasound. Each patient underwent preparation for IGRT twice before an RT fraction and in the middle of the fraction. The intrafraction displacement of the prostate was calculated by comparing fiducial marker locations before and in the middle of an RT fraction. The rectal enemas were well tolerated by patients. The mean intrafraction prostate movement in 336 RT fractions was 1.11 ± 0.77 mm (range 0.08-7.20 mm). Intrafraction motions of 1, 2 and 3 mm were observed in 56.0%, 89.0% and 97.6% of all RT fractions, respectively. The intrafraction movements on supero-inferior and anteroposterior axes were larger than on the right-to-left axes (P movement, calculated using the van Herk formula (2.5Σ + 0.7σ), was 1.50 mm. A daily rectal enema before each RT fraction was tolerable and yielded little intrafraction prostate displacement. We think the use of rectal enemas is a feasible method to reduce prostate movement during RT. © 2014 The Royal Australian and New Zealand College of Radiologists.

  20. Effect of rectal enema on intrafraction prostate movement during image-guided radiotherapy

    International Nuclear Information System (INIS)

    Choi, Youngmin; Kwak, Dong-Won; Lee, Hyung-Sik; Hur, Won-Jooh; Cho, Won-Yeol; Sung, Gyung Tak; Kim, Tae-Hyo; Kim, Soo-Dong; Yun, Seong-Guk

    2015-01-01

    Rectal volume and movement are major factors that influence prostate location. The aim of this study was to assess the effect of a rectal enema on intrafraction prostate motion. The data from 12 patients with localised prostate cancer were analysed. Each patient underwent image-guided radiotherapy (RT), receiving a total dose of 70 Gy in 28 fractions. Rectal enemas were administered to all of the patients before each RT fraction. The location of the prostate was determined by implanting three fiducial markers under the guidance of transrectal ultrasound. Each patient underwent preparation for IGRT twice before an RT fraction and in the middle of the fraction. The intrafraction displacement of the prostate was calculated by comparing fiducial marker locations before and in the middle of an RT fraction. The rectal enemas were well tolerated by patients. The mean intrafraction prostate movement in 336 RT fractions was 1.11 ± 0.77 mm (range 0.08–7.20 mm). Intrafraction motions of 1, 2 and 3 mm were observed in 56.0%, 89.0% and 97.6% of all RT fractions, respectively. The intrafraction movements on supero-inferior and anteroposterior axes were larger than on the right-to-left axes (P < 0.05). The CTV-to-PTV margin necessary to allow for movement, calculated using the van Herk formula (2.5Σ + 0.7σ), was 1.50 mm. A daily rectal enema before each RT fraction was tolerable and yielded little intrafraction prostate displacement. We think the use of rectal enemas is a feasible method to reduce prostate movement during RT.

  1. Interobserver Delineation variation using CT versus combined CT + MRI in intensity- modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Villeirs, G.M.; Verstraete, K.L.; Vaerenbergh, K. van; Vakaet, L.; Bral, S.; Claus, F.; Neve, W.J. de; Meerleer, G.O. de

    2005-01-01

    Purpose: to quantify interobserver variation of prostate and seminal vesicle delineations using CT only versus CT + MRI in consensus reading with a radiologist. Material and methods: the prostate and seminal vesicles of 13 patients treated with intensity-modulated radiotherapy for prostatic adenocarcinoma were retrospectively delineated by three radiation oncologists on CT only and on CT + MRI in consensus reading with a radiologist. The volumes and margin positions were calculated and intermodality and interobserver variations were assessed for the clinical target volume (CTV), seminal vesicles, prostate and three prostatic subdivisions (apical, middle and basal third). Results: using CT + MRI as compared to CT alone, the mean CTV, prostate and seminal vesicle volumes significantly decreased by 6.54%, 5.21% and 10.47%, respectively. More importantly, their standard deviations significantly decreased by 63.06%, 62.65% and 44.83%, respectively. The highest level of variation was found at the prostatic apex, followed by the prostatic base and seminal vesicles. Conclusion: addition of MRI to CT in consensus reading with a radiologist results in a moderate decrease of the CTV, but an important decrease of the interobserver delineation variation, especially at the prostatic apex. (orig.)

  2. ATM Heterozygosity and the Development of Radiation-Induced Erectile Dysfunction and Urinary Morbidity Following Radiotherapy for Prostate Cancer

    National Research Council Canada - National Science Library

    Cesaretti, Jamie A

    2006-01-01

    The goal of this training grant project is to determine whether the prevalence of ATM carriers among prostate cancer patients treated with radiotherapy that develop erectile dysfunction and urinary...

  3. ATM Heterozygosity and the Development of Radiation-Induced Erectile Dysfunction and Urinary Morbidity Following Radiotherapy for Prostate Cancer

    National Research Council Canada - National Science Library

    Cesaretti, Jamie A

    2007-01-01

    The goal of this training grant project is to determine whether the prevalence of ATM carriers among prostate cancer patients treated with radiotherapy that develop erectile dysfunction and urinary...

  4. ATM Heterozygosity and the Development of Radiation-Induced Erectile Dysfunction and Urinary Morbidity Following Radiotherapy for Prostate Cancer

    National Research Council Canada - National Science Library

    Cesaretti, Jamie A

    2008-01-01

    The goal of this training grant project is to determine whether the prevalence of ATM carriers among prostate cancer patients treated with radiotherapy that develop erectile dysfunction and urinary...

  5. The design and evaluation of a phantom for the audit of the treatment chain for prostate radiotherapy

    International Nuclear Information System (INIS)

    Perrin, Bruce A.; Jordan, Thomas J.; Hounsell, Alan R.

    2001-01-01

    Background and Purpose: A phantom has been designed and built for a multi-institutional technique audit of the planning and delivery for radiotherapy to the prostate. The phantom was designed to test both the geometric and dosimetric accuracy of each aspect of the process. Materials and Methods: The phantom consists of two curved water filled perspex tanks either side of a central block of solid water equivalent material. There are two options for the central section; a target defining block and a dose measurement block. The target defining block uses air holes to define a 3-D target volume for imaging via a CT scanner or a simulator. These holes can subsequently be filled with steel pins to allow megavoltage imaging. The dose measurement block allows thimble chamber measurements to be made at pre-selected points in a 5x5mm array. Five dose measurement points, typical for a prostate planning target volume (PTV) were selected. Initial evaluation of the phantom was performed by auditing the prostate radiotherapy planning and treatment chain at one institution. Results: Agreement between the phantom and planned geometry confirmed that the stages of image acquisition, transfer and manipulation were accurately performed. Agreement within 0.5% was found between phantom and water tank measurements for dose calibration at a reference point. The measured dose delivered was within 2% of the dose calculated by the planning computer for all of the selected measurement points. The target volume marked by the steel pins was visible using electronic portal imaging. Conclusions: The phantom is a useful tool for the technique audit of prostate radiotherapy

  6. The relationship between the bladder volume and optimal treatment planning in definitive radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Naoki; Sekiguchi, Kenji; Akahane, Keiko; Shikama, Naoto; Takahashi, Osamu; Hama, Yukihiro; Nakagawa, Keiichi

    2012-01-01

    Background and purpose: There is no current consensus regarding the optimal bladder volumes in definitive radiotherapy for localized prostate cancer. The aim of this study was to clarify the relationship between the bladder volume and optimal treatment planning in radiotherapy for localized prostate cancer. Material and methods: Two hundred and forty-three patients underwent definitive radiotherapy with helical tomotherapy for intermediate- and high-risk localized prostate cancer. The prescribed dose defined as 95 % of the planning target volume (PTV) receiving 100 % of the prescription dose was 76 Gy in 38 fractions. The clinical target volume (CTV) was defined as the prostate with a 5-mm margin and 2 cm of the proximal seminal vesicle. The PTV was defined as the CTV with a 5-mm margin. Treatment plans were optimized to satisfy the dose constraints defined by in-house protocols for PTV and organs at risk (rectum wall, bladder wall, sigmoid colon and small intestine). If all dose constraints were satisfied, the plan was defined as an optimal plan (OP). Results: An OP was achieved with 203 patients (84%). Mean bladder volume (± 1 SD) was 266 ml (± 130 ml) among those with an OP and 214 ml (±130 ml) among those without an OP (p = 0.02). Logistic regression analysis also showed that bladder volumes below 150 ml decreased the possibility of achieving an OP. However, the percentage of patients with an OP showed a plateau effect at bladder volumes above 150 ml. Conclusions. Bladder volume is a significant factor affecting OP rates. However, our results suggest that bladder volumes exceeding 150 ml may not help meet planning dose constraints

  7. Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art

    Directory of Open Access Journals (Sweden)

    Piotr Milecki

    2010-10-01

    Full Text Available Piotr Milecki1,2, Piotr Martenka1, Andrzej Antczak3, Zbigniew Kwias31Department of Radiotherapy, Greater Poland Cancer Center, Poznan, Poland; 2Department of Electroradiology, Medical University, Poznan, Poland; 3Chair of Urology, Medical University, Poznan, PolandAbstract: Androgen-deprivation therapy (ADT is used routinely in combination with definitive external beam radiation therapy (EBRT in patients with high-risk clinically localized or locally advanced disease. The combined treatment (ADT–EBRT also seems to play a significant role in improving treatment results in the intermediate-risk group of prostate cancer patients. On the other hand, there is a growing body of evidence that treatment with ADT can be associated with serious and lifelong adverse events including osteoporosis, cardiovascular disease, diabetes, and many others. Almost all ADT adverse events are time dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, it is crucial to clearly state the optimal schedule for ADT in combination with EBRT, that maintaining the positive effect on treatment efficacy would keep the adverse events risk at reasonable level. To achieve this goal, treatment schedule may have to be highly individualized on the basis of the patient-specific potential vulnerability to adverse events. In this study, the concise and evidence-based review of current literature concerning the general rationales for combining radiotherapy and hormonal therapy, its mechanism, treatment results, and toxicity profile is presented.Keywords: prostate cancer, radiotherapy, androgen deprivation, combined treatment

  8. The impact of bladder preparation protocols on post treatment toxicity in radiotherapy for localised prostate cancer patients

    Directory of Open Access Journals (Sweden)

    Yat Man Tsang

    2017-09-01

    Conclusion: The empty bladder preparation approach has non-inferior acute and intermediate post RT GI and GU toxicities in patients treated for localised prostate cancer with advanced radiotherapy techniques compared to the full bladder preparation.

  9. Consequential late effects after radiotherapy for prostate cancer - a prospective longitudinal quality of life study

    Directory of Open Access Journals (Sweden)

    Schaar Sandra

    2010-04-01

    Full Text Available Abstract Background To answer the question if and to which extent acute symptoms at the end and/or several weeks after radiotherapy can predict adverse urinary and gastrointestinal long-term quality of life (QoL. Methods A group of 298 patients has been surveyed prospectively before (time A, at the last day (B, two months after (C and >one year after (D radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite. A subgroup of 10% with the greatest urinary/bowel bother score decrease at time D was defined as patients with adverse long-term QoL. Results Subgroup and correlation analyses could demonstrate a strong dependence of urinary/bowel QoL after radiotherapy on urinary/bowel QoL before radiotherapy. In contrast to absolute scores, QoL score changes (relative to baseline scores did not correlate with pretreatment scores. Long-term changes could be well predicted by acute changes. Patients reporting great/moderate bother with urinary/bowel problems at time C reported to have great/moderate bother at time D in ≥ 50%, respectively. In a multivariate analysis of factors for adverse long-term urinary and bowel QoL, score changes at time C were found to be independent predictors, respectively. Additionally, QoL changes at time B were independently predictive for adverse long-term bowel QoL. Conclusions Consequential late effects play a major role after radiotherapy for prostate cancer. Patients with greater and particularly longer non-healing acute toxicity are candidates for closer follow-up and possible prophylactic actions to reduce a high probability of long-term problems.

  10. Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Ferrer, Montserrat; Suarez, Jose Francisco; Guedea, Ferran; Fernandez, Pablo; Macias, Victor; Marino, Alfonso; Hervas, Asuncion; Herruzo, Ismael; Ortiz, Maria Jose; Villavicencio, Humberto; Craven-Bratle, Jordi; Garin, Olatz; Aguilo, Ferran

    2008-01-01

    Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

  11. Magnetic Resonance-Based Treatment Planning for Prostate Intensity-Modulated Radiotherapy: Creation of Digitally Reconstructed Radiographs

    International Nuclear Information System (INIS)

    Chen, Lili; Nguyen, Thai-Binh; Jones, Elan; Chen Zuoqun; Luo Wei; Wang Lu; Price, Robert A.; Pollack, Alan; Ma, C.-M. Charlie

    2007-01-01

    Purpose: To develop a technique to create magnetic resonance (MR)-based digitally reconstructed radiographs (DRR) for initial patient setup for routine clinical applications of MR-based treatment planning for prostate intensity-modulated radiotherapy. Methods and Materials: Twenty prostate cancer patients' computed tomography (CT) and MR images were used for the study. Computed tomography and MR images were fused. The pelvic bony structures, including femoral heads, pubic rami, ischium, and ischial tuberosity, that are relevant for routine clinical patient setup were manually contoured on axial MR images. The contoured bony structures were then assigned a bulk density of 2.0 g/cm 3 . The MR-based DRRs were generated. The accuracy of the MR-based DDRs was quantitatively evaluated by comparing MR-based DRRs with CT-based DRRs for these patients. For each patient, eight measuring points on both coronal and sagittal DRRs were used for quantitative evaluation. Results: The maximum difference in the mean values of these measurement points was 1.3 ± 1.6 mm, and the maximum difference in absolute positions was within 3 mm for the 20 patients investigated. Conclusions: Magnetic resonance-based DRRs are comparable to CT-based DRRs for prostate intensity-modulated radiotherapy and can be used for patient treatment setup when MR-based treatment planning is applied clinically

  12. Infections after fiducial marker implantation for prostate radiotherapy: are we underestimating the risks?

    International Nuclear Information System (INIS)

    Loh, Jasmin; Baker, Katie; Sridharan, Swetha; Greer, Peter; Wratten, Chris; Capp, Anne; Gallagher, Sarah; Martin, Jarad

    2015-01-01

    The use of gold fiducial markers (FM) for prostate image-guided radiotherapy (IGRT) is standard practice. Published literature suggests low rates of serious infection following this procedure of 0-1.3%, but this may be an underestimate. We aim to report on the infection incidence and severity associated with the use of transrectally implanted intraprostatic gold FM. Three hundred and fifty-nine patients who underwent transrectal FM insertion between January 2012 and December 2013 were assessed retrospectively via a self-reported questionnaire. All had standard oral fluoroquinolone antibiotic prophylaxis. The patients were asked about infective symptoms and the treatment received including antibiotics and/or related hospital admissions. Potential infective events were confirmed through medical records. 285 patients (79.4%) completed the questionnaire. 77 (27.0%) patients experienced increased urinary frequency and dysuria, and 33 patients (11.6%) reported episodes of chills and fevers after the procedure. 22 patients (7.7%) reported receiving antibiotics for urinary infection and eight patients (2.8%) reported hospital admission for urosepsis related to the procedure. The overall rate of symptomatic infection with FM implantation in this study is 7.7%, with one third requiring hospital admission. This exceeds the reported rates in other FM implantation series, but is in keeping with the larger prostate biopsy literature. Given the higher than expected complication rate, a risk-adaptive approach may be helpful. Where higher accuracy is important such as stereotactic prostate radiotherapy, the benefits of FM may still outweigh the risks. For others, a non-invasive approach for prostate IGRT such as cone-beam CT could be considered. The online version of this article (doi:10.1186/s13014-015-0347-2) contains supplementary material, which is available to authorized users

  13. Magnetic Resonance Imaging and conformal radiotherapy: Characterization of MRI alone simulation for conformal radiotherapy. Development and evaluation of an automatic volumes of interest segmentation tool for prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Pasquier, David

    2006-01-01

    Radiotherapy is a curative treatment of malignant tumours. Radiotherapy techniques considerably evolved last years with the increasing integration of medical images in conformal radiotherapy. This technique makes it possible to elaborate a complex ballistics conforming to target volume and sparing healthy tissues. The examination currently used to delineate volumes of interest is Computed Tomography (CT), on account of its geometrical precision and the information that it provides on electronic densities needed to dose calculation. Magnetic Resonance Imaging (MRI) ensures a more precise delineation of target volumes in many locations, such as pelvis and brain. For pelvic tumours, the use of MRI needs image registration, which complicates treatment planning and poses the problem of the lack of in vivo standard method of validation. The obstacles in the use of MRI alone in treatment planning were evaluated. Neither geometrical distortion linked with the system and the patient nor the lack of information on electronic densities represent stumbling obstacles. Distortion remained low even in edge of large field of view on modern machines. The assignment of electronic densities to bone structures and soft tissues in MR images permitted to obtain equivalent dosimetry to that carried out on the original CT, with a good reproducibility and homogeneous distribution within target volume. The assignment of electronic densities could not be carried out using 20 MV photons and suitable ballistics. The development of Image Guided Radiotherapy could facilitate the use of MRI alone in treatment planning. Target volumes and organ at risk delineation is a time consuming task in radiotherapy planning. We took part in the development and evaluated a method of automatic and semi automatic delineation of volumes of interest from MRI images for prostate cancer radiotherapy. For prostate and organ at risk automatic delineation an organ model-based method and a seeded region growing method

  14. Comparison between external beam radiotherapy (70 Gy/74 Gy) and permanent interstitial brachytherapy in 890 intermediate risk prostate cancer patients

    International Nuclear Information System (INIS)

    Goldner, Gregor; Pötter, Richard; Battermann, Jan J.; Kirisits, Christian; Schmid, Maximilian P.; Sljivic, Samir; Vulpen, Marco van

    2012-01-01

    Purpose: Aim of this analysis was to compare biochemical no evidence of disease (bNED) rates in intermediate-risk prostate-cancer patients treated at two centres of excellence using different approaches: permanent interstitial brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 890 intermediate-risk prostate-cancer patients, who were treated from 1998 to 2008, were identified in the two local databases. In Utrecht 601 patients received I-125 BT applying a dose of 144 Gy. In Vienna 289 patients were treated by EBRT, applying a local dose of 70 Gy in 105 patients and 74 Gy in 184 patients. bNED-rates (Phoenix-definition) were assessed. Results: Median follow-up was 48 months (1–150). 5-Year actuarial bNED-rates were 81% for BT-patients and 75% for EBRT-patients (67% for 70 Gy and 82% for 74 Gy), respectively. In univariate analysis no difference between BT and EBRT could be detected. In multivariate analysis including tumour-stage, GleasonScore, initial PSA, hormonal therapy and treatment-centre (BT vs. EBRT) only T-stage, GleasonScore and PSA were found to be significant. Additional analysis including radiation dose showed the same outcome. Conclusions: Intermediate-risk prostate cancer patients treated by permanent interstitial brachytherapy show biochemical tumour-control-rates which are comparable to EBRT of 74 Gy.

  15. Intra-fraction prostate displacement in radiotherapy estimated from pre- and post-treatment imaging of patients with implanted fiducial markers

    International Nuclear Information System (INIS)

    Kron, Tomas; Thomas, Jessica; Fox, Chris; Thompson, Ann; Owen, Rebecca; Herschtal, Alan; Haworth, Annette; Tai, Keen-Hun; Foroudi, Farshad

    2010-01-01

    Purpose: To determine intra-fraction displacement of the prostate gland from imaging pre- and post-radiotherapy delivery of prostate cancer patients with three implanted fiducial markers. Methods and materials: Data were collected from 184 patients who had two orthogonal X-rays pre- and post-delivery on at least 20 occasions using a Varian On Board kV Imaging system. A total of 5778 image pairs covering time intervals between 3 and 30 min between pre- and post-imaging were evaluated for intra-fraction prostate displacement. Results: The mean three dimensional vector shift between images was 1.7 mm ranging from 0 to 25 mm. No preferential direction of displacement was found; however, there was an increase of prostate displacement with time between images. There was a large variation in typical shifts between patients (range 1 ± 1 to 6 ± 2 mm) with no apparent trends throughout the treatment course. Images acquired in the first five fractions of treatment could be used to predict displacement patterns for individual patients. Conclusion: Intra-fraction motion of the prostate gland appears to be a limiting factor when considering margins for radiotherapy. Given the variation between patients, a uniform set of margins for all patients may not be satisfactory when high target doses are to be delivered.

  16. Accuracy of image-guided radiotherapy of prostate cancer based on the BeamCath urethral catheter technique

    DEFF Research Database (Denmark)

    Poulsen, Per Rugaard; Fokdal, Lars; Petersen, Jørgen B.B.

    2007-01-01

    BACKGROUND AND PURPOSE: To examine the accuracy of the BeamCath urethral catheter technique for prostate localization during radiotherapy. MATERIALS AND METHODS: Sixty-four patients were CT scanned twice with the BeamCath catheter, and once without the catheter. The catheter contains radiopaque...

  17. A case study of radiotherapy planning for a bilateral metal hip prosthesis prostate cancer patient

    International Nuclear Information System (INIS)

    Su, Andy; Reft, Chester; Rash, Carla; Price, Jennifer; Jani, Ashesh B.

    2005-01-01

    The purpose of this report is to communicate the observed advantage of intensity-modulated radiotherapy (IMRT) in a patient with bilateral metallic hip prostheses. In this patient with early-stage low-risk disease, a dose of 74 Gy was planned in two phases-an initial 50 Gy to the prostate and seminal vesicles and an additional 24 Gy to the prostate alone. Each coplanar beam avoided the prosthesis in the beam's eye view. Using the same target expansions for each phase, IMRT and 3D-conformal radiotherapy (CRT) plans were compared for target coverage and inhomogeneity as well as dose to the bladder and rectum. The results of the analysis demonstrated that IMRT provided superior target coverage with reduced dose to normal tissues for both individual phases of the treatment plan as well as for the composite treatment plan. The dose to the rectum was significantly reduced with the IMRT technique, with a composite V80 of 35% for the IMRT plan versus 70% for 3D-CRT plan. Similarly, the dose to the bladder was significantly reduced with a V80 of 9% versus 20%. Overall, various dosimetric parameters revealed the corresponding 3D-CRT plan would not have been acceptable. The results indicate significant success with IMRT in a clinical scenario where there were no curative alternatives for local treatment other than external beam radiotherapy. Therefore, definitive external beam radiation of prostate cancer patients with bilateral prosthesis is made feasible with IMRT. The work described herein may also have applicability to other groups of patients, such as those with gynecological or other pelvic malignancies

  18. Time management in radiation oncology: evaluation of time, attendance of medical staff, and resources during radiotherapy for prostate cancer: the DEGRO-QUIRO trial.

    Science.gov (United States)

    Keilholz, L; Willner, J; Thiel, H-J; Zamboglou, N; Sack, H; Popp, W

    2014-01-01

    In order to evaluate resource requirements, the German Society of Radiation Oncology (DEGRO) recorded the times needed for core procedures in the radio-oncological treatment of various cancer types within the scope of its QUIRO trial. The present study investigated the personnel and infrastructural resources required in radiotherapy of prostate cancer. The investigation was carried out in the setting of definitive radiotherapy of prostate cancer patients between July and October 2008 at two radiotherapy centers, both with well-trained staff and modern technical facilities at their disposal. Personnel attendance times and room occupancy times required for core procedures (modules) were each measured prospectively by two independently trained observers using time measurements differentiated on the basis of professional group (physician, physicist, and technician), 3D conformal (3D-cRT), and intensity-modulated radiotherapy (IMRT). Total time requirements of 983 min for 3D-cRT and 1485 min for step-and-shoot IMRT were measured for the technician (in terms of professional group) in all modules recorded and over the entire course of radiotherapy for prostate cancer (72-76 Gy). Times needed for the medical specialist/physician were 255 min (3D-cRT) and 271 min (IMRT), times of the physicist were 181 min (3D-cRT) and 213 min (IMRT). The difference in time was significant, although variations in time spans occurred primarily as a result of various problems during patient treatment. This investigation has permitted, for the first time, a realistic estimation of average personnel and infrastructural requirements for core procedures in quality-assured definitive radiotherapy of prostate cancer. The increased time needed for IMRT applies to the step-and-shoot procedure with verification measurements for each irradiation planning.

  19. Expression of Ku70 predicts results of radiotherapy in prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Tomokazu; Someya, Masanori; Hori, Masakazu; Nakata, Kensei; Kitagawa, Mio; Tsuchiya, Takaaki; Sakata, Koh-ichi [Sapporo Medical University School of medicine, Department of Radiology, Chuo-ku, Sapporo, Hokkaido (Japan); Matsumoto, Yoshihisa [Research Laboratory for Nuclear Reactors, Tokyo Institute of Technology, Meguro-ku, Tokyo (Japan); Nojima, Masanori [The University of Tokyo, The Institute of Medical Science Hospital, Minatoku, Tokyo (Japan); Masumori, Naoya [Sapporo Medical University School of medicine, Department of Urology, Chuo-ku, Sapporo, Hokkaido (Japan); Hasegawa, Tadashi [Sapporo Medical University School of medicine, Department of Surgical Pathology, Chuo-ku, Sapporo, Hokkaido (Japan)

    2017-01-15

    Therapeutic strategy for prostate cancer is decided according to T stage, Gleason score, and prostate-specific antigen (PSA) level. These clinical factors are not accurate enough to predict individual risk of local failure of prostate cancer after radiotherapy. Parameters involved with radiosensitivity are required to improve the predictive capability for local relapse. We analyzed 58 patients with localized adenocarcinoma of the prostate between August 2007 and October 2010 treated with 76 Gy of intensity-modulated radiotherapy (IMRT) as a discovery cohort and 42 patients between March 2001 and May 2007 treated with three-dimensional conformal radiotherapy (3D-CRT) as a validation cohort. Immunohistochemical examination for proteins involved in nonhomologous end-joining was performed using biopsy specimens. Ku70 expression was not correlated with various clinical parameters, such as the Gleason score and D'amico risk classification, indicating that Ku70 expression was an independent prognostic factor. The predictive value for PSA relapse was markedly improved after the combination of Gleason score and Ku70 expression, as compared with Gleason score alone. In patients treated with radiotherapy and androgen deprivation therapy (ADT), no relapses were observed in patients with Gleason score ≤7 or low Ku70 expression. In contrast, patients with Gleason score ≥8 and high Ku70 expression had high PSA relapse rates. In the validation cohort, similar results were obtained. Treatment with 76 Gy and ADT can be effective for patients with Gleason score ≤7 or low Ku70 expression, but is not enough for patients with Gleason score ≥8 and high Ku70 expression and, thus, require other treatment approaches. (orig.) [German] Die Behandlung beim Prostatakarzinom ist abhaengig von T-Stadium, Gleason-Score und prostataspezifischem Antigen (PSA). Diese klinischen Faktoren sind jedoch zu ungenau, um das individuelle Lokalrezidivrisiko beim Prostatakarzinom nach

  20. Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

    International Nuclear Information System (INIS)

    Mantini, Giovanna; Tagliaferri, Luca; Mattiucci, Gian Carlo; Balducci, Mario; Frascino, Vincenzo; Dinapoli, Nicola; Di Gesù, Cinzia; Ippolito, Edy; Morganti, Alessio G.; Cellini, Numa

    2011-01-01

    Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score ≥7 and/or prostate-specific antigen level ≥20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12–38). With a median follow-up of 52 months (range, 20–150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.

  1. Magnetic resonance assessment of prostate localization variability in intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Villeirs, Geert M.; Meerleer, Gert O. de; Verstraete, Koenraad L.; Neve, Wilfried J. de

    2004-01-01

    Purpose: To measure prostate motion with magnetic resonance imaging (MRI) during a course of intensity-modulated radiotherapy. Methods and materials: Seven patients with prostate carcinoma were scanned supine on a 1.5-Tesla MRI system with weekly pretreatment and on-treatment HASTE T2-weighted images in 3 orthogonal planes. The bladder and rectal volumes and position of the prostatic midpoint (PMP) and margins relative to the bony pelvis were measured. Results: All pretreatment positions were at the mean position as computed from the on-treatment scans in each patient. The PMP variability (given as 1 SD) in the anterior-posterior (AP), superior-inferior (SI), and right-left (RL) directions was 2.6, 2.4, and 1.0 mm, respectively. The largest variabilities occurred at the posterior (3.2 mm), superior (2.6 mm), and inferior (2.6 mm) margins. A strong correlation was found between large rectal volume (>95th percentile) and anterior PMP displacement. A weak correlation was found between bladder volume and superior PMP displacement. Conclusions: All pretreatment positions were representative of the subsequent on-treatment positions. A clinical target volume (CTV) expansion of 5.3 mm in any direction was sufficient to ascertain a 95% coverage of the CTV within the planning target volume (PTV), provided that a rectal suppository is administered to avoid rectal overdistension and that the patient has a comfortably filled bladder (<300 mL)

  2. No supra-additive effects of goserelin and radiotherapy on clonogenic survival of prostate carcinoma cells in vitro

    Directory of Open Access Journals (Sweden)

    Thelen Paul

    2007-08-01

    Full Text Available Abstract Background Oncological results of radiotherapy for locally advanced prostate cancer (PC are significantly improved by simultaneous application of LHRH analoga (e.g. goserelin. As 85% of PC express LHRH receptors, we investigated the interaction of goserelin incubation with radiotherapy under androgen-deprived conditions in vitro. Methods LNCaP and PC-3 cells were stained for LHRH receptors. Downstream the LHRH receptor, changes in protein expression of c-fos, phosphorylated p38 and phosphorylated ERK1/2 were analyzed by means of Western blotting after incubation with goserelin and irradiation with 4 Gy. Both cell lines were incubated with different concentrations of goserelin in hormone-free medium. 12 h later cells were irradiated (0 – 4 Gy and after 12 h goserelin was withdrawn. Endpoints were clonogenic survival and cell viability (12 h, 36 h and 60 h after irradiation. Results Both tested cell lines expressed LHRH-receptors. Changes in protein expression demonstrated the functional activity of goserelin in the tested cell lines. Neither in LNCaP nor in PC-3 any significant effects of additional goserelin incubation on clonogenic survival or cell viability for all tested concentrations in comparison to radiation alone were seen. Conclusion The clinically observed increase in tumor control after combination of goserelin with radiotherapy in PC cannot be attributed to an increase in radiosensitivity of PC cells by goserelin in vitro.

  3. Individualized planning target volumes for intrafraction motion during hypofractionated intensity-modulated radiotherapy boost for prostate cancer

    International Nuclear Information System (INIS)

    Cheung, Patrick; Sixel, Katharina; Morton, Gerard; Loblaw, D. Andrew; Tirona, Romeo; Pang, Geordi; Choo, Richard; Szumacher, Ewa; DeBoer, Gerrit; Pignol, Jean-Philippe

    2005-01-01

    Purpose: The objective of the study was to access toxicities of delivering a hypofractionated intensity-modulated radiotherapy (IMRT) boost with individualized intrafraction planning target volume (PTV) margins and daily online correction for prostate position. Methods and materials: Phase I involved delivering 42 Gy in 21 fractions using three-dimensional conformal radiotherapy, followed by a Phase II IMRT boost of 30 Gy in 10 fractions. Digital fluoroscopy was used to measure respiratory-induced motion of implanted fiducial markers within the prostate. Electronic portal images were taken of fiducial marker positions before and after each fraction of radiotherapy during the first 9 days of treatment to calculate intrafraction motion. A uniform 10-mm PTV margin was used for the first phase of treatment. PTV margins for Phase II were patient-specific and were calculated from the respiratory and intrafraction motion data obtained from Phase I. The IMRT boost was delivered with daily online correction of fiducial marker position. Acute toxicity was measured using National Cancer Institute Common Toxicity Criteria, version 2.0. Results: In 33 patients who had completed treatment, the average PTV margin used during the hypofractionated IMRT boost was 3 mm in the lateral direction, 3 mm in the superior-inferior direction, and 4 mm in the anteroposterior direction. No patients developed acute Grade 3 rectal toxicity. Three patients developed acute Grade 3 urinary frequency and urgency. Conclusions: PTV margins can be reduced significantly with daily online correction of prostate position. Delivering a hypofractionated boost with this high-precision IMRT technique resulted in acceptable acute toxicity

  4. Long-term outcomes from dose-escalated image-guided intensity-modulated radiotherapy with androgen deprivation: encouraging results for intermediate- and high-risk prostate cancer.

    Science.gov (United States)

    Wilcox, Shea W; Aherne, Noel J; Benjamin, Linus C; Wu, Bosco; de Campos Silva, Thomaz; McLachlan, Craig S; McKay, Michael J; Last, Andrew J; Shakespeare, Thomas P

    2014-01-01

    Dose-escalated (DE) radiotherapy in the setting of localized prostate cancer has been shown to improve biochemical disease-free survival (bDFS) in several studies. In the same group of patients, androgen deprivation therapy (ADT) has been shown to confer a survival benefit when combined with radiotherapy doses of up to 70 Gy; however, there is currently little long-term data on patients who have received high-dose intensity-modulated radiotherapy (IMRT) with ADT. We report the long-term outcomes in a large cohort of patients treated with the combination of DE image-guided IMRT (IG-IMRT) and ADT. Patients with localized prostate cancer were identified from a centralized database across an integrated cancer center. All patients received DE IG-IMRT, combined with ADT, and had a minimum follow up of 12 months post-radiotherapy. All relapse and toxicity data were collected prospectively. Actuarial bDFS, metastasis-free survival, prostate cancer-specific survival, and multivariate analyses were calculated using the SPSS v20.0 statistical package. Seven hundred and eighty-two eligible patients were identified with a median follow up of 46 months. Overall, 4.3% of patients relapsed, 2.0% developed distant metastases, and 0.6% died from metastatic prostate cancer. At 5-years, bDFS was 88%, metastasis-free survival was 95%, and prostate cancer-specific survival was 98%. Five-year grade 2 genitourinary and gastrointestinal toxicity was 2.1% and 3.4%, respectively. No grade 3 or 4 late toxicities were reported. Pretreatment prostate specific antigen (P=0.001) and Gleason score (P=0.03) were significant in predicting biochemical failure on multivariate analysis. There is a high probability of tumor control with DE IG-IMRT combined with androgen deprivation, and this is a technique with a low probability of significant late toxicity. Our long term results corroborate the safety and efficacy of treating with IG-IMRT to high doses and compares favorably with published series for

  5. Method for automatic re contouring straight adaptive radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Rodriguez Vila, B.; Garcia Vicente, F.; Aguilera, E. J.

    2011-01-01

    Outline of quickly and accurately the rectal wall is important in Image Guided Radiotherapy (IGRT in the acronym) as an organ of greatest influence in limiting the dose in the planning of radiation therapy in prostate cancer. Deformabies registration methods based on image intensity can not create a correct spatial transformation if there is no correspondence between the image and image planning session. The rectal content variation creates a non-correspondence in the image intensity becomes a major obstacle to the deformable registration based on image intensity.

  6. Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hun Jung; Phak, Jeong Hoon; Kim, Woo Chul [Dept. of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

    2016-12-15

    Stereotactic body radiotherapy (SBRT) takes advantage of low α/β ratio of prostate cancer to deliver a large dose in few fractions. We examined clinical outcomes of SBRT using CyberKnife for the treatment of low- and intermediate-risk prostate cancer. This study was based on a retrospective analysis of the 33 patients treated with SBRT using CyberKnife for localized prostate cancer (27.3% in low-risk and 72.7% in intermediate-risk). Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. The acute and late toxicities were recorded using the Radiation Therapy Oncology Group scale. Prostate-specific antigen (PSA) response was monitored. Thirty-three patients with a median 51 months (range, 6 to 71 months) follow-up were analyzed. There was no biochemical failure. Median PSA nadir was 0.27 ng/mL at median 33 months and PSA bounce occurred in 30.3% (n = 10) of patients at median at median 10.5 months after SBRT. No grade 3 acute toxicity was noted. The 18.2% of the patients had acute grade 2 genitourinary (GU) toxicities and 21.2% had acute grade 2 gastrointestinal (GI) toxicities. After follow-up of 2 months, most complications had returned to baseline. There was no grade 3 late GU and GI toxicity. Our experience with SBRT using CyberKnife in low- and intermediate-risk prostate cancer demonstrates favorable efficacy and toxicity. Further studies with more patients and longer follow-up duration are required.

  7. Real-Time Study of Prostate Intrafraction Motion During External Beam Radiotherapy With Daily Endorectal Balloon

    Energy Technology Data Exchange (ETDEWEB)

    Both, Stefan, E-mail: Stefan.Both@uphs.upenn.edu [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Wang, Ken Kang-Hsin; Plastaras, John P.; Deville, Curtiland; Bar Ad, Voika; Tochner, Zelig; Vapiwala, Neha [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)

    2011-12-01

    Purpose: To prospectively investigate intrafraction prostate motion during radiofrequency-guided prostate radiotherapy with implanted electromagnetic transponders when daily endorectal balloon (ERB) is used. Methods and Materials: Intrafraction prostate motion from 24 patients in 787 treatment sessions was evaluated based on three-dimensional (3D), lateral, cranial-caudal (CC), and anterior-posterior (AP) displacements. The mean percentage of time with 3D, lateral, CC, and AP prostate displacements >2, 3, 4, 5, 6, 7, 8, 9, and 10 mm in 1 minute intervals was calculated for up to 6 minutes of treatment time. Correlation between the mean percentage time with 3D prostate displacement >3 mm vs. treatment week was investigated. Results: The percentage of time with 3D prostate movement >2, 3, and 4 mm increased with elapsed treatment time (p < 0.05). Prostate movement >5 mm was independent of elapsed treatment time (p = 0.11). The overall mean time with prostate excursions >3 mm was 5%. Directional analysis showed negligible lateral prostate motion; AP and CC motion were comparable. The fraction of time with 3D prostate movement >3 mm did not depend on treatment week of (p > 0.05) over a 4-minute mean treatment time. Conclusions: Daily endorectal balloon consistently stabilizes the prostate, preventing clinically significant displacement (>5 mm). A 3-mm internal margin may sufficiently account for 95% of intrafraction prostate movement for up to 6 minutes of treatment time. Directional analysis suggests that the lateral internal margin could be further reduced to 2 mm.

  8. Development of indicators of the quality of radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Danielson, Brita; Brundage, Michael; Pearcey, Robert; Bass, Brenda; Pickles, Tom; Bahary, Jean-Paul; Foley, Kimberley; Mackillop, William

    2011-01-01

    Purpose: To develop a set of indicators of the quality of radiotherapy (RT) for localized prostate cancer. Methods and materials: Following a comprehensive review of the literature to identify candidate quality indicators, we utilized a modified Delphi technique to develop a set of indicators of the quality of RT for localized prostate cancer. The first Delphi round consisted of an online survey in which radiation oncologists were asked to rate the importance of the candidate quality indicators. The second round was a face-to-face meeting of a smaller group of radiation oncologists to discuss, rate, and rank a final set of quality indicators. Results: The literature review identified 57 candidate quality indicators. After the two rounds of the Delphi process, a final set of 25 indicators was agreed upon. The set includes quality indicators covering all aspects of prostate cancer radical RT management: pre-treatment assessment, external beam RT, brachytherapy, androgen deprivation therapy, and follow-up. Conclusions: This new set of quality indicators is more comprehensive than others described in the literature, and can be applied to patterns of care studies that assess the quality of RT for prostate cancer. The process used to develop this set of indicators can be readily adapted for use in other contexts.

  9. Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

    International Nuclear Information System (INIS)

    D'Ambrosio, David J.; Li Tianyu; Horwitz, Eric M.; Chen, David Y.T.; Pollack, Alan; Buyyounouski, Mark K.

    2008-01-01

    Purpose: The protraction of external beam radiotherapy (RT) time is detrimental in several disease sites. In prostate cancer, the overall treatment time can be considerable, as can the potential for treatment breaks. We evaluated the effect of elapsed treatment time on outcome after RT for prostate cancer. Methods and Materials: Between April 1989 and November 2004, 1,796 men with prostate cancer were treated with RT alone. The nontreatment day ratio (NTDR) was defined as the number of nontreatment days divided by the total elapsed days of RT. This ratio was used to account for the relationship between treatment duration and total RT dose. Men were stratified into low risk (n = 789), intermediate risk (n = 798), and high risk (n = 209) using a single-factor model. Results: The 10-year freedom from biochemical failure (FFBF) rate was 68% for a NTDR <33% vs. 58% for NTDR ≥33% (p = 0.02; BF was defined as a prostate-specific antigen nadir + 2 ng/mL). In the low-risk group, the 10-year FFBF rate was 82% for NTDR <33% vs. 57% for NTDR ≥33% (p = 0.0019). The NTDR was independently predictive for FFBF (p = 0.03), in addition to T stage (p = 0.005) and initial prostate-specific antigen level (p < 0.0001) on multivariate analysis, including Gleason score and radiation dose. The NTDR was not a significant predictor of FFBF when examined in the intermediate-risk group, high-risk group, or all risk groups combined. Conclusions: A proportionally longer treatment duration was identified as an adverse factor in low-risk patients. Treatment breaks resulting in a NTDR of ≥33% (e.g., four or more breaks during a 40-fraction treatment, 5 d/wk) should be avoided

  10. X-ray-assisted positioning of patients treated by conformal arc radiotherapy for prostate cancer: Comparison of setup accuracy using implanted markers versus bony structures

    International Nuclear Information System (INIS)

    Soete, Guy; Cock, Mieke de; Verellen, Dirk; Michielsen, Dirk; Keuppens, Frans; Storme, Guy

    2007-01-01

    Purpose: The aim of this study was to compare setup accuracy of NovalisBody stereoscopic X-ray positioning using implanted markers in the prostate vs. bony structures in patients treated with dynamic conformal arc radiotherapy for prostate cancer. Methods and Materials: Random and systematic setup errors (RE and SE) of the isocenter with regard to the center of gravity of three fiducial markers were measured by means of orthogonal verification films in 120 treatment sessions in 12 patients. Positioning was performed using NovalisBody semiautomated marker fusion. The results were compared with a control group of 261 measurements in 15 patients who were positioned with NovalisBody automated bone fusion. In addition, interfraction and intrafraction prostate motion was registered in the patients with implanted markers. Results: Marker-based X-ray positioning resulted in a reduction of RE as well as SE in the anteroposterior, craniocaudal, and left-right directions compared with those in the control group. The interfraction prostate displacements with regard to the bony pelvis that could be avoided by marker positioning ranged between 1.6 and 2.8 mm for RE and between 1.3 and 4.3 mm for SE. Intrafraction random and systematic prostate movements ranged between 1.4 and 2.4 mm and between 0.8 and 1.3 mm, respectively. Conclusion: The problem of interfraction prostate motion can be solved by using implanted markers. In addition, the NovalisBody X-ray system performs more accurately with markers compared with bone fusion. Intrafraction organ motion has become the limiting factor for margin reduction around the clinical target volume

  11. CONSERVATIVE TREATMENT IN LOCALLY AND LOCALLY-ADVANCED PROSTATE CANCER USING CONFORMAL RADIOTHERAPY

    Directory of Open Access Journals (Sweden)

    Tkachev Sergey Ivanovich

    2013-01-01

    Full Text Available The combination of androgen deprivation and radiotherapy increase the probability of diseases full regresses and survival rate. Modern technical and technological opportunities of 3D CRT allow to increase total dose to prostate up to 72-76Gy vs. radiotherapy of 66-70Gy. In this study we compare the rates of post radiation toxicity and the efficiency of treatment for the patients receiving conventional radiotherapy and 3D CRT. The use of 3D CRT has not only result to increase of 10-years recurrence free survival rate from 74% (I grope to 86,5% (II grope, р=0,01, but also to increase of 10-years overall survival, 70% versus 78,4% (р=0,04. The proposed version of conformal 3D CRT radiation therapy made ​​it possible compared to conventional 2D RT radiation therapy by increasing SOD radiation to the tumor, accuracy and compliance with the quality assurance of radiation therapy significantly reduce rates of recurrence and significantly increase the performance of 10-year overall and disease-free survival.

  12. Prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, G.P.; Kuss, R., Khoury, S.; Chatelain, C.; Denis, L.

    1987-01-01

    This book contains over 70 selections. Some of the titles are: Place of the Computed Tomography in the Staging of Prostatic Cancer; Magnetic Resonance Imaging (MRI) in Staging of the Prostatic Cancer; Magnetic Resonance Imaging of the Prostate; Long-Term Results in Radiotherapy of Prostatic Cancer; Interstitial Irradiation Using I-125 Seeds; and Treatment of Cancer of the Prostate by Use of Physiotherapy: Long-Term Results.

  13. Prostate cancer

    International Nuclear Information System (INIS)

    Murphy, G.P.; Kuss, R.; Khoury, S.; Chatelain, C.; Denis, L.

    1987-01-01

    This book contains over 70 selections. Some of the titles are: Place of the Computed Tomography in the Staging of Prostatic Cancer; Magnetic Resonance Imaging (MRI) in Staging of the Prostatic Cancer; Magnetic Resonance Imaging of the Prostate; Long-Term Results in Radiotherapy of Prostatic Cancer; Interstitial Irradiation Using I-125 Seeds; and Treatment of Cancer of the Prostate by Use of Physiotherapy: Long-Term Results

  14. Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Carlos R. Monti

    2006-08-01

    Full Text Available OBJECTIVE: Assess the results of salvage conformal radiotherapy in patients with biochemical failure after radical prostatectomy and identify prognostic factors for biochemical recurrence and toxicity of the treatment. MATERIALS AND METHODS: From June 1998 to November 2001, 35 patients were submitted to conformal radiotherapy for PSA > 0.2 ng/mL in progression after radical prostatectomy and were retrospectively analyzed. The mean dose of radiation in prostatic bed was of 77.4 Gy (68-81. Variables related to the treatment and to tumor were assessed to identify prognostic factors for biochemical recurrence after salvage radiotherapy. RESULTS: The median follow-up was of 55 months (17-83. The actuarial survival rates free of biochemical recurrence and free of metastasis at a distance of 5 years were 79.7% e 84.7%, respectively. The actuarial global survival rate in 5 years was 96.1%.The actuarial survival rate free of biochemical recurrence in 5 years was 83.3% with PSA pre-radiotherapy 1 and 2 (p = 0.023. Dose > 70 Gy in 30% of the bladder volume implied in more acute urinary toxicity (p = 0.035. The mean time for the development of late urinary toxicity was 21 months (12-51. Dose > 55 Gy in 50% bladder volume implied in more late urinary toxicity (p = 0.018. A patient presented late rectal toxicity of 2nd grade. CONCLUSIONS: Conformal radiotherapy showed to be effective for the control of biochemical recurrence after radical prostatectomy. Patients with pre-therapy PSA < 2 ng/mL have more biochemical control.

  15. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience

    Directory of Open Access Journals (Sweden)

    George Felix Acquah

    2014-02-01

    Full Text Available The success of radiotherapy cancer treatment delivery depends on the accuracy of patient setup for each fraction. A significant problem arises from reproducing the same patient position and prostate location during treatment planning for every fraction of the treatment process. To analyze the daily movements of the prostate, gold markers are implanted in the prostate and portal images taken and manually matched with reference images to locate the prostate. Geometrical and fiducial markers are annotated onto a highly quality generated digitally reconstructed radiographs, that are compared with portal images acquired right before treatment dose delivery. A 0 and 270 degree treatment fields are used to calculate prostate shifts for all prostate cancer patients undergoing treatment at the Sweden Ghana Medical Centre, using an iViewGT portal imaging device. After aligning of the marker positions onto the reference images, the set-up deviations corrections are displayed and an on-line correction procedure applied. The measured migrations of the prostate markers are below the threshold of 3 mm for the main plans and 2 mm for the boost plans. With daily electronic portal imaging combined with gold markers, provides an objective method for verifying and correcting the position of the prostate immediately prior to radiation delivery.--------------------------------------------Cite this article as: Acquah GF. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience. Int J Cancer Ther Oncol 2014; 2(1:020112.DOI: http://dx.doi.org/10.14319/ijcto.0201.12

  16. Prophylactic Breast Bud Radiotherapy for Patients Taking Bicalutamide: Should This Still Be Practised for Patients with Prostate Cancer?

    Directory of Open Access Journals (Sweden)

    R. Lewis

    2012-01-01

    Full Text Available Prophylactic breast bud radiotherapy is used to prevent gynaecomastia and mastalgia in patients with prostate cancer who are being treated with antiandrogen and oestrogen therapy. Here a case is presented of a patient who developed soft-tissue sarcoma of the breast subsequent to breast bud radiotherapy prior to bicalutamide hormone treatment. Bicalutamide is often prescribed for younger men in the adjuvant setting or as monotherapy for locally advanced disease. The data regarding the efficacy of prophylactic breast bud radiotherapy is reviewed, and it is proposed that alternative therapies should be considered such as tamoxifen.

  17. Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Goldner, G.; Poetter, R.; Schmid, M.P.; Kirisits, C. [University Hospital of Vienna (Austria). Dept. of Radiotherapy and Radiobiology; Battermann, J.J.; Sljivic, S.; Vulpen, M. van [University Medical Center Utrecht (Netherlands). Dept. of Radiation Oncology

    2012-04-15

    The aim of this analysis was to compare the biochemical no evidence of disease (bNED) rates in low-risk prostate cancer patients treated at two centers of excellence using different approaches: seed brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 919 low-risk prostate cancer patients, treated from 1998-2008, were identified in the two databases. In Utrecht, 667 patients received I-125 BT applying a dose of 144 Gy. In Vienna, 252 patients were treated with EBRT, applying a local dose of 70 Gy in 82 patients and 74 Gy in 170 patients. bNED rates (Phoenix definition) were assessed. Results: The median follow-up was 46 months (range 1-148 months). The 5-year actuarial bNED rates were 94% for BT patients and 88% for EBRT patients (p = 0.002) - 84% for patients receiving 70 Gy and 91% for patients receiving 74 Gy, respectively. In the univariate analysis, patients receiving 70 Gy showed significantly worse outcome compared to BT (p = 0.001) and a difference close to significance compared to 74 Gy (p = 0.06). In the multivariate analysis including tumor stage, Gleason score, initial PSA, hormonal therapy, and dose, patients receiving 70 Gy EBRT showed significantly worse bNED rates compared to BT patients. Conclusion: Low-risk prostate cancer patients receiving 74 Gy by EBRT show comparable biochemical control rates to patients receiving seed brachytherapy, whereas patients receiving 70 Gy show significantly worse outcome. (orig.)

  18. Radiotherapy-induced plasticity of prostate cancer mobilizes stem-like non-adherent, Erk signaling-dependent cells

    Czech Academy of Sciences Publication Activity Database

    Kyjacová, Lenka; Hubáčková, Soňa; Krejčíková, Kateřina; Strauss, R.; Hanzlíková, Hana; Dzijak, Rastislav; Imrichová, Terezie; Šímová, Jana; Reiniš, Milan; Bartek, Jiří; Hodný, Zdeněk

    2015-01-01

    Roč. 22, č. 6 (2015), s. 898-911 ISSN 1350-9047 R&D Projects: GA ČR GA13-17658S; GA MZd NT14461 EU Projects: European Commission 259893 Institutional support: RVO:68378050 Keywords : Radiotherapy-induced plasticity * prostate cancer * Erk signaling Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 8.218, year: 2015

  19. Preliminary results of the study about predictors of rectal side effects in radical radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Vera, L; Barrios, E; Kasdorf, P; Valdagni, R; Paolini, G

    2010-01-01

    Objective: To analyze quantitatively and qualitatively the rectal side effect of radical radiotherapy applied to prostate cancer in patients treated at the National Cancer Institute (INCA) with three-dimensional external radiotherapy which the purposes is to determine predictions of this. Materials and Methods: From July 2008 to July 2010 98 patients were recruited, 63 of whom were followed up for 6 months. The gastrointestinal secondary effects occurred in different times of monitoring patients with RTOG / EORTC classifications (Radiation Therapy Oncology Group / European Organization for Research and Treatment of Cancer) and SOMA / LENT, is also used a questionnaire specifically constructed and validated by the cooperative Italian group . The results were correlated with clinical parameters (PSA, Gleason score, clinical T, risk class, hypertension and diabetes) and dosimetry (treatment volume, rectal volume, Total Dose, Dose Maximum rectum, mean dose to the rectum) to assess the correlation between them and the appearance of gastrointestinal secondary effects. Results: 27% and 28% patients experienced grade 1 and 2 RTOG rectal secondary effect at 1 and 3 months and 6 months the SOMA / LENT classification determined by 25%. Qualitatively altered intestinal transit is the most affected in these patients, it is having also found some relationship between the probability of occurrence of abnormal intestinal transit, and the tracking time passed. Conclusions: The rectal secondary effects is one of the major side effects both acute an chronic of the prostate radiotherapy, identify the determinants effects of the INCA patient population implies a substantial improvement in the quality of prostate cancer patients. Patients treated with radical radiotherapy for prostate cancer often have long survivals and consequently may suffer chronic effects of radiation therapy. We have verified the existence of secondary effects in the intestine but the results are very preliminary

  20. Radiation-Induced Cancers From Modern Radiotherapy Techniques: Intensity-Modulated Radiotherapy Versus Proton Therapy

    International Nuclear Information System (INIS)

    Yoon, Myonggeun; Ahn, Sung Hwan; Kim, Jinsung; Shin, Dong Ho; Park, Sung Yong; Lee, Se Byeong; Shin, Kyung Hwan; Cho, Kwan Ho

    2010-01-01

    Purpose: To assess and compare secondary cancer risk resulting from intensity-modulated radiotherapy (IMRT) and proton therapy in patients with prostate and head-and-neck cancer. Methods and Materials: Intensity-modulated radiotherapy and proton therapy in the scattering mode were planned for 5 prostate caner patients and 5 head-and-neck cancer patients. The secondary doses during irradiation were measured using ion chamber and CR-39 detectors for IMRT and proton therapy, respectively. Organ-specific radiation-induced cancer risk was estimated by applying organ equivalent dose to dose distributions. Results: The average secondary doses of proton therapy for prostate cancer patients, measured 20-60cm from the isocenter, ranged from 0.4 mSv/Gy to 0.1 mSv/Gy. The average secondary doses of IMRT for prostate patients, however, ranged between 3 mSv/Gy and 1 mSv/Gy, approximately one order of magnitude higher than for proton therapy. Although the average secondary doses of IMRT were higher than those of proton therapy for head-and-neck cancers, these differences were not significant. Organ equivalent dose calculations showed that, for prostate cancer patients, the risk of secondary cancers in out-of-field organs, such as the stomach, lungs, and thyroid, was at least 5 times higher for IMRT than for proton therapy, whereas the difference was lower for head-and-neck cancer patients. Conclusions: Comparisons of organ-specific organ equivalent dose showed that the estimated secondary cancer risk using scattering mode in proton therapy is either significantly lower than the cases in IMRT treatment or, at least, does not exceed the risk induced by conventional IMRT treatment.

  1. Postoperative Intensity Modulated Radiation Therapy in High Risk Prostate Cancer: A Dosimetric Comparison

    International Nuclear Information System (INIS)

    Digesu, Cinzia; Cilla, Savino; De Gaetano, Andrea; Massaccesi, Mariangela; Macchia, Gabriella; Ippolito, Edy; Deodato, Francesco; Panunzi, Simona; Iapalucci, Chiara; Mattiucci, Gian Carlo; D'Angelo, Elisa; Padula, Gilbert D.A.; Valentini, Vincenzo; Cellini, Numa

    2011-01-01

    The aim of this study was to compare intensity-modulated radiation therapy (IMRT) with 3D conformal technique (3D-CRT), with respect to target coverage and irradiation of organs at risk for high dose postoperative radiotherapy (PORT) of the prostate fossa. 3D-CRT and IMRT treatment plans were compared with respect to dose to the rectum and bladder. The dosimetric comparison was carried out in 15 patients considering 2 different scenarios: (1) exclusive prostate fossa irradiation, and (2) pelvic node irradiation followed by a boost on the prostate fossa. In scenario (1), a 3D-CRT plan (box technique) and an IMRT plan were calculated and compared for each patient. In scenario (2), 3 treatment plans were calculated and compared for each patient: (a) 3D-CRT box technique for both pelvic (prophylactic nodal irradiation) and prostate fossa irradiation (3D-CRT only); (b) 3D-CRT box technique for pelvic irradiation followed by an IMRT boost to the prostatic fossa (hybrid 3D-CRT and IMRT); and (c) IMRT for both pelvic and prostate fossa irradiation (IMRT only). For exclusive prostate fossa irradiation, IMRT significantly reduced the dose to the rectum (lower Dmean, V50%, V75%, V90%, V100%, EUD, and NTCP) and the bladder (lower Dmean, V50%, V90%, EUD and NTCP). When prophylactic irradiation of the pelvis was also considered, plan C (IMRT only) performed better than plan B (hybrid 3D-CRT and IMRT) as respect to both rectum and bladder irradiation (reduction of Dmean, V50%, V75%, V90%, equivalent uniform dose [EUD], and normal tissue complication probability [NTCP]). Plan (b) (hybrid 3D-CRT and IMRT) performed better than plan (a) (3D-CRT only) with respect to dose to the rectum (lower Dmean, V75%, V90%, V100%, EUD, and NTCP) and the bladder (Dmean, EUD, and NTCP). Postoperative IMRT in prostate cancer significantly reduces rectum and bladder irradiation compared with 3D-CRT.

  2. Investigation of normal tissue complication probabilities in prostate and partial breast irradiation radiotherapy techniques

    International Nuclear Information System (INIS)

    Bezak, E.; Takam, R.; Bensaleh, S.; Yeoh, E.; Marcu, L.

    2011-01-01

    Full text: Normal- Tissue-Complication Probabilities of rectum, bladder and urethra following various radiation techniques for prostate cancer were evaluated using the relative-seriality and Lyman models. NTCPs of lungs, heart and skin, their dependence on sourceposition, balloon-deformation were also investigated for HDR mammosite brachytherapy. The prostate treatment techniques included external three dimentional conformal-radiotherapy, Low-Dose-Rate brachytherapy (1-125), High-Dose-Rate brachytherapy (Ir-I92). Dose- Volume-Histograms of critical structures for prostate and breast radiotherapy, retrieved from corresponding treatment planning systems, were converted to Biological Effective Dose (BEffD)-based and Equivalent Dose(Deq)-based DVHs to account for differences in radiation delivery and fractionation schedule. Literature-based model parameters were used to calculate NTCPs. Hypofractionated 3D-CRT (2.75 Gy/fraction, total dose 55 Gy) NTCPs of rectum, bladder and urethra were less than those for standard fractionated 4-field 3D-CRT (2-Gy/fraction, 64 Gy) and dose-escalated 4- and 5-field 3D-CRT (74 Gy). Rectal and bladder NTCPs (5.2% and 6.6%) following the dose-escalated 4-field 3D-CRT (74 Gy) were the highest among analyzed techniques. The average NTCP for rectum and urethra were 0.6% and 24.7% for LDRBT and 0.5% and 11.2% for HDR-BT. For Mammosite, NTCP was estimated to be 0.1 %, 0.1 %, 1.2% and 3.5% for skin desquamation, erythema, telangiectasia and fibrosis respectively (the source positioned at the balloon centre). A 4 mm Mammosite-balloon deformation leads to overdosing of PTV regions by ∼40%, resulting in excessive skin dose and increased NTCP. Conclusions Prostate brachytherapy resulted in NTCPs lower compared to external beam techniques. Mammosite-brachytherapy resulted in no heart/lung complications regardless of balloon deformation. However, 4 mm deformation caused 0.6% increase in tissue fibrosis NTCP.

  3. Five-year quality of life assessment after carbon ion radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Maruyama, Katsuya; Tsuji, Hiroshi; Nomiya, Takuma; Katoh, Hiroyuki; Ishikawa, Hitoshi; Kamada, Tadashi; Wakatsuki, Masaru; Akakura, Koichiro; Shimazaki, Jun; Aoyama, Hidefumi; Tsujii, Hirohiko

    2017-01-01

    The aim of this study was to prospectively assess 5-year health-related quality of life (HRQOL) of patients treated with carbon ion radiotherapy (C-ion RT) for clinically localized prostate cancer. A total of 417 patients received carbon ion radiotherapy at a total dose of 63–66 Gray-equivalents (GyE) in 20 fractions over 5 weeks, and neoadjuvant and adjuvant androgen deprivation therapy (ADT) were administered for intermediate and high-risk patients. A HRQOL assessment was performed at five time points (immediately before the initiation of C-ion RT, immediately after, and at 12, 36 and 60 months after completion of C-ion RT) using Functional Assessment of Cancer Therapy (FACT) questionnaires. FACT-G and FACT-P scores were significantly decreased; however, the absolute change after 60 months was minimal. The transient decreases in the Trial Outcome Index (TOI) score returned to their baseline levels. Use of ADT, presence of adverse events, and biochemical failure were related to lower scores. Scores of subdomains of FACT instruments indicated characteristic changes. The pattern of HRQOL change after C-ion RT was similar to that of other modalities. Further controlled studies focusing on a HRQOL in patients with prostate cancer are warranted.

  4. Improving Positioning in High-Dose Radiotherapy for Prostate Cancer: Safety and Visibility of Frequently Used Gold Fiducial Markers

    Energy Technology Data Exchange (ETDEWEB)

    Fonteyne, Valerie, E-mail: valerie.fonteyne@uzgent.be [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Ost, Piet [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Villeirs, Geert [Department of Radiology, Ghent University Hospital, Ghent (Belgium); Oosterlinck, Willem [Department of Urology, Ghent University Hospital, Ghent (Belgium); Impens, Aline; De Gersem, Werner; De Wagter, Carlos; De Meerleer, Gert [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)

    2012-05-01

    Purpose: The use of gold fiducial markers (GFMs) for prostate positioning in high-dose radiotherapy is gaining interest. The purpose of this study was to compare five GFMs regarding feasibility of ultrasound-based implantation in the prostate and intraprostatic lesion (IPL); toxicity; visibility on transabdominal ultrasound (TU) and cone-beam CT (CBCT); reliability of automatic, soft tissue, and GFM-based CBCT patient positioning by comparing manual and automatic fusion CBCT. Methods and Materials: Twenty-five patients were included. Pain and toxicity were scored after implantation and high-dose radiotherapy. Fisher exact test was used to evaluate the correlation of patients' characteristics and prostatitis. Positioning was evaluated on TU and kilovoltage CBCT images. CBCT fusion was performed automatically (Elekta XVI technology, release 3.5.1 b27, based on grey values) and manually on soft tissue and GFMs. Pearson correlation statistics and Bland-Altman evaluation were used. Five GFMs were compared. Results: Twenty percent of the patients developed prostatitis despite antibiotic prophylaxis. Cigarette smoking was significantly correlated with prostatitis. The visualization of all GFMs on TU was disappointing. Consequently we cannot recommend the use of these GFMs for TU-based prostate positioning. For all GFMs, there was only fair to poor linear correlation between automatic and manual CBCT images, indicating that even when GFMs are used, an operator evaluation is imperative. However, when GFMs were analyzed individually, a moderate to very strong correlation between automatic and manual positioning was found for larger GFMs in all directions. Conclusion: The incidence of prostatitis in our series was high. Further research is imperative to define the ideal preparation protocol preimplantation and to select patients. Automatic fusion is more reliable with larger GFMs at the cost of more scatter. The stability of all GFMs was proven.

  5. Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Schmitz Matthew D

    2010-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the expected time to prostate specific antigen (PSA normalization with or without neoadjuvant androgen deprivation (NAAD therapy after treatment with intensity modulated radiotherapy (IMRT for patients with clinically localized prostate cancer. Methods A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p Results Fifty-six of the 133 patients received NAAD (42.1%. Thirty-one patients (23.8% received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%. The times to serum PSA normalization 0.05, and 303 ± 24 and 405 ± 46 days, respectively, for PSA Conclusions Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA

  6. Second cancers in children treated with modern radiotherapy techniques

    International Nuclear Information System (INIS)

    Schneider, Uwe; Lomax, Antony; Timmermann, Beate

    2008-01-01

    Background and Purpose: The scattered radiation from the treatment volume might be more significant for children than for adults and, as a consequence, modern radiotherapy treatment techniques such as IMRT and passive proton therapy could potentially increase the number of secondary cancers. In this report, secondary cancer risk resulting from new treatment technologies was estimated for an adult prostate patient and a child. Material and methods: The organ equivalent dose (OED) concept with a linear-exponential, a plateau and a linear dose-response curve was applied to dose distributions of an adult prostate patient and a child with a rhabdomyosarcoma of the prostate. Conformal radiotherapy, IMRT with 6 MV photons and proton therapy were planned. OED (cancer risk) was estimated for the whole body, the rectum and the bladder. In addition, relative cumulative risk was calculated. Results: Secondary cancer risk in the adult is not more than 15% it increased when IMRT or passive proton therapy was compared to conventional treatment planning. In the child, risk remains practically constant or was even reduced for proton therapy. The cumulative risk in the child relative to that in the adult can be as large as 10-15. Conclusions: By a comparison between an adult patient and a child treated for a disease of the prostate, it was shown that modern radiotherapy techniques such as IMRT and proton therapy (active and passive) do not increase the risk for secondary cancers

  7. Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era

    International Nuclear Information System (INIS)

    D'Amico, Anthony V.; Chen, M.-H.; Oh-Ung, Jean; Renshaw, Andrew A.; Cote, Kerri; Loffredo, Marian; Richie, Jerome P.

    2002-01-01

    Purpose: To evaluate the change in prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) or external beam radiotherapy (EBRT), controlling for follow-up during the PSA era. Methods and Materials: The study cohort consisted of 1440 patients with clinically localized prostate cancer managed with RP (n=1059) or EBRT (n=381) between 1989 and 2000. A single genitourinary pathologist reviewed all pathology specimens. For patients with a 2-year minimal follow-up, the 2-year actual PSA outcome stratified by risk group (low vs. high) was calculated for three periods (January 1, 1989 to December 31, 1992; January 1, 1993 to December 31, 1996; and January 1, 1997 to December 31, 2000) and compared for each treatment modality. PSA failure was defined using the American Society for Therapeutic Radiology and Oncology consensus definition for all patients, and comparisons were made using a chi-square metric. Results: During the study period, the proportion of patients treated with RP and EBRT with low-risk disease increased significantly (p <0.0001) from 60% to 89% and from 26% to 76%, respectively. In addition, the 2-year actual PSA outcome also improved from 60% to 82% (RP: p<0.0001) and from 67% to 91% (RT: p=0.0008). The 2-year actual PSA outcome was not significantly different in the low-risk patients but improved during the three periods in the high-risk patients treated with RP (from 20% to 39% to 75%, p=0.0004) or EBRT (from 50% to 59% to 83%, p=0.01). This improvement in PSA outcome could be explained by a shift toward a more favorable PSA level (RP: p=0.0002; RT: p=0.006) and clinical T stage (RP: p=0.0008, RT: p<0.0001) distribution for patients with biopsy Gleason score ≥7 disease. Conclusion: Improved PSA outcome during the PSA era after RP or EBRT has resulted from a shift in presentation toward low-risk disease and earlier detection of high-grade disease

  8. PSA Density as a prognostic factor in prostate cancer patients treated with radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lankford, Scott; Pollack, Alan; Zagars, Gunar K

    1995-07-01

    Purpose/Objective: The pretreatment serum prostate specific antigen level (PSAL) is the most significant predictor of biochemical failure in patients treated with definitive radiotherapy. While one report indicates that PSA density (PSAD) is an important prognostic factor for patients treated with radiotherapy, another claims that it adds nothing to that seen with PSAL. We describe here a comparative analysis of the prognostic value of PSAL and PSAD using the endpoints of local control (LC), freedom from distant metastasis (FFDM), freedom from biochemical failure (FFBF), and freedom from any failure (FFAF, biochemical and/or clinical failure). Materials and Methods: There were 353 patients who between 1987-1993 were treated for regionally localized adenocarcinoma of the prostate and in whom PSAL and pretreatment prostate volume by ultrasound were available. External beam radiotherapy was administered to 334 patients using a four field box with high energy photons to {<=}70 Gy in 35 fractions. The remainder received between 76-78 Gy using conformal radiotherapy. The mean and median doses were 66.8 Gy and 66.0 Gy. Median follow-up for those living was 27 mo. The mean PSAL was 12.0 ng/ml with a median of 9.3 ng/ml. The PSAL was divided into 4 groups that we have described previously as correlating strongly with LC, FFBF, and FFAF; there were 64 patients with a PSA of {<=}4, 133 with >4 and {<=}10, 107 with >10 and {<=}20, and 49 with >20 ng/ml. PSAD was calculated by dividing the PSAL by the pretreatment prostate volume (in cc). The PSAD was divided into 4 groups based on the frequency distribution, which was not normally distributed. The subdivisions were 110 patients with a PSAD of {<=}0.2, 113 with {<=}0.2 and {<=}0.4, 87 with >0.4 and {<=}0.8, and 43 with >0.8. Patient breakdown by Stage was 106 with T1, 130 with T2, and 117 with T3/T4 disease. Patient breakdown by Gleason score was 76 patients with tumor scores of 2-4, 151 with scores of 5 or 6, 83 with a score

  9. Robotic Image-Guided Stereotactic Radiotherapy, for Isolated Recurrent Primary, Lymph Node or Metastatic Prostate Cancer

    International Nuclear Information System (INIS)

    Jereczek-Fossa, Barbara Alicja; Beltramo, Giancarlo; Fariselli, Laura; Fodor, Cristiana; Santoro, Luigi; Vavassori, Andrea; Zerini, Dario; Gherardi, Federica; Ascione, Carmen; Bossi-Zanetti, Isa; Mauro, Roberta; Bregantin, Achille; Bianchi, Livia Corinna; De Cobelli, Ottavio; Orecchia, Roberto

    2012-01-01

    Purpose: To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)–based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer. Methods and Materials: Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [ 11 C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months). Results: The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease. Conclusions: CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor

  10. ANALYSIS OF COMPLICATIONS DUE TO INTRATISSUE RADIOTHERAPY USING CONSTANT SOURCES IN PATIENTS WITH PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    A. V. Petrovsky

    2011-01-01

    Full Text Available Brachytherapy is a standard treatment for localized advanced prostate cancer (PC. Complications due to interstitial radiotherapy using permanent sources were analyzed in 149 patients. The incidence of early grade 3 radiation urethritis was 7.4 % and that of rectitis was 3.4%. Late radiation urethritis and rectitis were recorded in 3.4 and 0.7 %, respectively. Sexual function 12 months later was preserved in 86.6 % of the patients. Studies established no statistically significant factors that influenced the frequency of complications. The patients with a prostate volume of > 50 cm3, a preoperative international prostate symptom score of > 15, a urine flow rate of < 15 ml/min, and urethral andrectal radiation doses of > 210 and > 180 Gy, respectively, tended to have more common radiation reactions. Thus, brachytherapy is a reasonably safe treatment for PC.

  11. ANALYSIS OF COMPLICATIONS DUE TO INTRATISSUE RADIOTHERAPY USING CONSTANT SOURCES IN PATIENTS WITH PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    A. V. Petrovsky

    2014-07-01

    Full Text Available Brachytherapy is a standard treatment for localized advanced prostate cancer (PC. Complications due to interstitial radiotherapy using permanent sources were analyzed in 149 patients. The incidence of early grade 3 radiation urethritis was 7.4 % and that of rectitis was 3.4%. Late radiation urethritis and rectitis were recorded in 3.4 and 0.7 %, respectively. Sexual function 12 months later was preserved in 86.6 % of the patients. Studies established no statistically significant factors that influenced the frequency of complications. The patients with a prostate volume of > 50 cm3, a preoperative international prostate symptom score of > 15, a urine flow rate of < 15 ml/min, and urethral andrectal radiation doses of > 210 and > 180 Gy, respectively, tended to have more common radiation reactions. Thus, brachytherapy is a reasonably safe treatment for PC.

  12. The effect of bowel preparation regime on interfraction rectal filling variation during image guided radiotherapy for prostate cancer.

    Science.gov (United States)

    Hosni, Ali; Rosewall, Tara; Craig, Timothy; Kong, Vickie; Bayley, Andrew; Berlin, Alejandro; Bristow, Robert; Catton, Charles; Warde, Padraig; Chung, Peter

    2017-03-09

    This study aimed to investigate the tolerability and impact of milk of magnesia (MoM) on interfraction rectal filling during prostate cancer radiotherapy. Two groups were retrospectively identified, each consisting of 40 patients with prostate cancer treated with radiotherapy to prostate+/-seminal vesicles, with daily image-guidance in 78Gy/39fractions/8 weeks. The first-group followed anti-flatulence diet with MoM started 3-days prior to planning-CT and continued during radiotherapy, while the second-group followed the same anti-flatulence diet only. The rectum between upper and lower limit of the clinical target volume (CTV) was delineated on planning-CT and on weekly cone-beam-CT (CBCT). Rectal filling was assessed by measurement of anterio-posterior diameter of the rectum at the superior and mid levels of CTV, rectal volume (RV), and average cross-sectional rectal area (CSA; RV/length). Overall 720 images (80 planning-CT and 640 CBCT images) from 80 patients were analyzed. Using linear mixed models, and after adjusting for baseline values at the time of planning-CT to test the differences in rectal dimensions between both groups over the 8-week treatment period, there were no significant differences in RV (p = 0.4), CSA (p = 0.5), anterio-posterior diameter of rectum at superior (p = 0.4) or mid level of CTV (p = 0.4). In the non-MoM group; 22.5% of patients had diarrhea compared to 60% in the MoM group, while 40% discontinued use of MoM by end of radiotherapy. The addition of MoM to antiflatulence diet did not reduce the interfraction variation in rectal filling but caused diarrhea in a substantial proportion of patients who then discontinued its use.

  13. Social comparisons and quality of life following a prostate cancer diagnosis.

    Science.gov (United States)

    Umstead, Kendall L; Kalia, Sarah S; Madeo, Anne C; Erby, Lori H; Blank, Thomas O; Visvanathan, Kala; Roter, Debra L

    2018-02-09

    The objective was to explore the relationships among cognitive appraisals of prostate cancer (challenge, threat, and harm/loss), social comparisons, and quality of life in men previously diagnosed. Design, Sample, & Methods: Men who had participated in prostate cancer support groups completed a cross-sectional questionnaire (N = 189). Multivariable linear regression was used to evaluate social comparisons as mediators of quality of life while controlling for uncertainty and optimism. Positive and negative social comparisons were parallel mediators of the relationships between challenge or threat appraisals and quality of life, while only negative social comparisons mediated the relationship between harm/loss appraisals and quality of life. These findings demonstrate the importance of social comparisons in accounting for the effect of cognitive appraisals of prostate cancer on quality of life among men in support groups. Implications for Psychosocial Providers: Interventions to improve quality of life could address reduction of maladaptive comparisons, a strategy that could be tailored based on the patient's appraisal of prostate cancer.

  14. Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy

    International Nuclear Information System (INIS)

    Monti, Carlos R.; Nakamura, Ricardo A.; Ferrigno, Robson; Rossi Junior, Aristides; Kawakami, Neusa S.; Trevisan, Felipe A.

    2006-01-01

    Objective: Assess the results of salvage conformal radiotherapy in patients with biochemical failure after radical prostatectomy and identify prognostic factors for biochemical recurrence and toxicity of the treatment. Materials and methods: From June 1998 to November 2001, 35 patients were submitted to conformal radiotherapy for PSA ≥ 0.2 ng/mL in progression after radical prostatectomy and were retrospectively analyzed. The mean dose of radiation in prostatic bed was of 77.4 Gy (68-81). Variables related to the treatment and to tumor were assessed to identify prognostic factors for biochemical recurrence after salvage radiotherapy. Results: The median follow-up was of 55 months (17-83). The actuarial survival rates free of biochemical recurrence and free of metastasis at a distance of 5 years were 79.7% e 84.7%, respectively. The actuarial global survival rate in 5 years was 96.1%.The actuarial survival rate free of biochemical recurrence in 5 years was 83.3% with PSA pre-radiotherapy ≤ 1, 100% when > 1 and ≤ 2, and 57.1% when > 2 (p = 0.023). Dose > 70 Gy in 30% of the bladder volume implied in more acute urinary toxicity (p = 0.035). The mean time for the development of late urinary toxicity was 21 months (12-51). Dose > 55 Gy in 50% bladder volume implied in more late urinary toxicity (p = 0.018). A patient presented late rectal toxicity of second grade. Conclusions: Conformal radiotherapy showed to be effective for the control of biochemical recurrence after radical prostatectomy. Patients with pre-therapy PSA < 2 ng/mL have more biochemical control. (author)

  15. Planning Target Margin Calculations for Prostate Radiotherapy Based on Intrafraction and Interfraction Motion Using Four Localization Methods

    International Nuclear Information System (INIS)

    Beltran, Chris; Herman, Michael G.; Davis, Brian J.

    2008-01-01

    Purpose: To determine planning target volume (PTV) margins for prostate radiotherapy based on the internal margin (IM) (intrafractional motion) and the setup margin (SM) (interfractional motion) for four daily localization methods: skin marks (tattoo), pelvic bony anatomy (bone), intraprostatic gold seeds using a 5-mm action threshold, and using no threshold. Methods and Materials: Forty prostate cancer patients were treated with external radiotherapy according to an online localization protocol using four intraprostatic gold seeds and electronic portal images (EPIs). Daily localization and treatment EPIs were obtained. These data allowed inter- and intrafractional analysis of prostate motion. The SM for the four daily localization methods and the IM were determined. Results: A total of 1532 fractions were analyzed. Tattoo localization requires a SM of 6.8 mm left-right (LR), 7.2 mm inferior-superior (IS), and 9.8 mm anterior-posterior (AP). Bone localization requires 3.1, 8.9, and 10.7 mm, respectively. The 5-mm threshold localization requires 4.0, 3.9, and 3.7 mm. No threshold localization requires 3.4, 3.2, and 3.2 mm. The intrafractional prostate motion requires an IM of 2.4 mm LR, 3.4 mm IS and AP. The PTV margin using the 5-mm threshold, including interobserver uncertainty, IM, and SM, is 4.8 mm LR, 5.4 mm IS, and 5.2 mm AP. Conclusions: Localization based on EPI with implanted gold seeds allows a large PTV margin reduction when compared with tattoo localization. Except for the LR direction, bony anatomy localization does not decrease the margins compared with tattoo localization. Intrafractional prostate motion is a limiting factor on margin reduction

  16. Postoperative radiotherapy for prostate cancer. Morbidity of local-only or local-plus-pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Waldstein, Cora; Poetter, Richard; Widder, Joachim; Goldner, Gregor [Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, General Hospital of Vienna, Vienna (Austria); Doerr, Wolfgang [Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, General Hospital of Vienna, Vienna (Austria); Medical University of Vienna, Christian-Doppler Laboratory for Medical Radiation Research for Radiooncology, Vienna (Austria)

    2018-01-15

    The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer. Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups. For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5-year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5-year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%. Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4-field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects. (orig.) [German] Ziel der vorgestellten Arbeit ist es, die Haeufigkeit frueher und spaeter Nebenwirkungen nach postoperativer Bestrahlung von Prostatakarzinompatienten zu analysieren. Verglichen wurden dabei die Nebenwirkungen von lokaler

  17. Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options

    International Nuclear Information System (INIS)

    Moreno, Antonio José Conde; Albiach, Carlos Ferrer; Soria, Rodrigo Muelas; Vidal, Verónica González; Gómez, Raquel García; Antequera, María Albert

    2014-01-01

    There are various subgroups of patients with metastatic prostate cancer: polymetastatic, oligometastatic, or oligo-recurrent cancers whose progression follows different courses and for whom there are different treatment options. Knowledge of tumor dissemination pathways and different genetic and epigenetic tumor profiles, as well as their evolution during disease progression, along with new diagnostic and therapeutic advances has allowed us to address these situations with local ablative treatments such as stereotactic body radiation therapy or stereotactic radiosurgery. These treatments provide high rates of local control with low toxicity in metastatic spread for primary cancers including those of pulmonary, digestive, and renal origin, while these types of treatments are still emerging for cancers of prostatic origin. There are several retrospective studies showing the effectiveness of such treatments in prostate cancer metastases, which has led to the emergence of prospective studies on the issue and even some phase II studies intended to prevent or delay systemic treatments such as chemotherapy. Here we collect together and review these past experiences and the studies currently underway. These types of radiotherapy treatments redefine how we approach extracranial metastatic disease and open up new possibilities for combination therapy with new systemic treatment agents

  18. Intensity-Modulated Radiotherapy Causes Fewer Side Effects than Three-Dimensional Conformal Radiotherapy When Used in Combination With Brachytherapy for the Treatment of Prostate Cancer

    International Nuclear Information System (INIS)

    Forsythe, Kevin; Blacksburg, Seth; Stone, Nelson; Stock, Richard G.

    2012-01-01

    Purpose: To measure the benefits of intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3D-CRT) when used in combination with brachytherapy for the treatment of prostate cancer. Methods and Materials: We conducted a retrospective review of all patients with localized prostate cancer who received external-beam radiotherapy (EBRT) in combination with brachytherapy with at least 1 year follow-up (n = 812). Combination therapy consisted of 103 Pd or 125 I implant, followed by a course of EBRT. From 1993 to March 2003 521 patients were treated with 3D-CRT, and from April 2003 to March 2009 291 patients were treated with IMRT. Urinary symptoms were prospectively measured with the International Prostate Symptom Score questionnaire with a single quality of life (QOL) question; rectal bleeding was assessed per the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. The Pearson χ 2 test was used to compare toxicities experienced by patients who were treated with either IMRT or 3D-CRT. Logistic regression analyses were also performed to rule out possible confounding factors. Results: Within the first 3 months after treatment, patients treated with 3D-CRT scored their urinary symptoms as follows: 19% mild, 44% moderate, and 37% severe; patients treated with IMRT scored their urinary symptoms as follows: 36% mild, 47% moderate, and 17% severe (p < 0.001). The 3D-CRT patients rated their QOL as follows: 35% positive, 20% neutral, and 45% negative; IMRT patients rated their QOL as follows: 51% positive, 18% neutral, and 31% negative (p < 0.001). After 1 year of follow-up there was no longer any difference in urinary morbidity between the two groups. Logistic regression confirmed the differences in International Prostate Symptom Score and QOL in the acute setting (p < 0.001 for both). Grade ≥2 rectal bleeding was reported by 11% of 3D-CRT patients and 7

  19. Evaluation of volume change in rectum and bladder during application of image-guided radiotherapy for prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Luna, J. A., E-mail: yosimoon13@hotmail.com [Departamento de Física, Universidad Nacional de Costa Rica, Heredia (Costa Rica); Rojas, J. I., E-mail: isaac.rojas@siglo21.cr [Centro Médico Radioterapia Siglo XX1, La Uruca (Costa Rica); PROXTRONICS CR, Ltda, Heredia (Costa Rica)

    2016-07-07

    All prostate cancer patients from Centro Médico Radioterapia Siglo XXI receive Volumetric Modulated Arc Therapy (VMAT). This therapy uses image-guided radiotherapy (IGRT) with the Cone Beam Computed Tomography (CBCT). This study compares the planned dose in the reference CT image against the delivered dose recalculate in the CBCT image. The purpose of this study is to evaluate the anatomic changes and related dosimetric effect based on weekly CBCT directly for patients with prostate cancer undergoing volumetric modulated arc therapy (VMAT) treatment. The collected data were analyzed using one-way ANOVA.

  20. Neoadjuvant androgen deprivation and prostate gland shrinkage during conformal radiotherapy

    International Nuclear Information System (INIS)

    Sanguineti, Giuseppe; Marcenaro, Michela; Franzone, Paola; Foppiano, Franca; Vitale, Vito

    2003-01-01

    Purpose: The shrinking effect of 3-month neoadjuvant androgen deprivation (NAD) on preradiotherapy prostate gland volume is well documented. However, recently, it has been shown that the cancerous prostate gland keeps shrinking up to 12 months after NAD start. Thus, if such a reduction is not taken into account, a larger than planned portion of the surrounding normal tissues might shift in the high-dose region during conformal radiotherapy (3DCRT) course. The present study was undertaken to quantify this issue. Materials and Methods: Prostate gland volume reduction between planning CT (plCT) and the last week of 3DCRT (tmtCT) was prospectively assessed in 33 consecutive patients with localized prostate carcinoma. The median time interval between plCT and tmtCT was 2.5 months (2.1-2.7 months). A single observer was asked to draw on each slice prostate gland volume as appropriate. The observer was 'blind' to the timing of CT (plCT vs. tmtCT). In order to estimate intra-observer variability, prostate gland delineation was repeated twice for each data set. Mean prostate gland change, plCT and tmtCT cumulative dose volume histogram (DVH) calculations for the rectum were analyzed for each patient. Results were correlated to AD status and its duration before plCT. Means were compared by non-parametric rank tests. Results: Based on an internal protocol, 14 patients (42%) did not receive AD, while 19 patients (58%) had undergone neoadjuvant and concomitant AD. The median duration of AD before plCT ranged from 0.2 to 6 months (median: 2.9 months). Although individual data were highly variable, compared to plCT volume, mean prostate gland volume change at the end of 3DCRT was similar for patients receiving (-7.3%) or not (-7%) androgen deprivation (P=0.77). However, within the group of patients treated with hormones, patients starting AD within 3 months from plCT had a significantly larger reduction in prostate volume (-14.2%) than patients with longer NAD duration (-1.1%, P

  1. Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

    International Nuclear Information System (INIS)

    Katz, Alan; Ferrer, Montserrat; Suárez, José Francisco

    2012-01-01

    As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT

  2. Radiotherapy-induced plasticity of prostate cancer mobilizes stem-like non-adherent, Erk signaling-dependent cells

    Czech Academy of Sciences Publication Activity Database

    Kyjacová, Lenka; Hubáčková, Soňa; Krejčíková, Kateřina; Strauss, R; Hanzlíková, Hana; Dzijak, Rastislav; Imrichová, Terezie; Šímová, Jana; Reiniš, Milan; Bartek, Jiří; Hodný, Zdeněk

    -, July (2014) ISSN 1350-9047 R&D Projects: GA ČR GA13-17658S; GA MZd NT14461 Grant - others:Danish Research Council(DK) DFF-1331-00262B; Lundbeck Foundation(DK) (R93-A8990; European Commission DDResponse 259893 Institutional support: RVO:68378050 Keywords : Radiotherapy * induced plasticity * prostate cancer * Erk Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 8.184, year: 2014

  3. Synergistic Effects of NDRG2 Overexpression and Radiotherapy on Cell Death of Human Prostate LNCaP Cells.

    Science.gov (United States)

    Alizadeh Zarei, M; Takhshid, M A; Behzad Behbahani, A; Hosseini, S Y; Okhovat, M A; Rafiee Dehbidi, Gh R; Mosleh Shirazi, M A

    2017-09-01

    Radiation therapy is among the most conventional cancer therapeutic modalities with effective local tumor control. However, due to the development of radio-resistance, tumor recurrence and metastasis often occur following radiation therapy. In recent years, combination of radiotherapy and gene therapy has been suggested to overcome this problem. The aim of the current study was to explore the potential synergistic effects of N-Myc Downstream-Regulated Gene 2 (NDRG2) overexpression, a newly identified candidate tumor suppressor gene, with radiotherapy against proliferation of prostate LNCaP cell line. In this study, LNCaP cells were exposed to X-ray radiation in the presence or absence of NDRG2 overexpression using plasmid PSES- pAdenoVator-PSA-NDRG2-IRES-GFP. The effects of NDRG2 overexpression, X-ray radiation or combination of both on the cell proliferation and apoptosis of LNCaP cells were then analyzed using MTT assay and flow cytometery, respectively. Results of MTT assay showed that NDRG2 overexpression and X-ray radiation had a synergistic effect against proliferation of LNCaP cells. Moreover, NDRG2 overexpression increased apoptotic effect of X-ray radiation in LNCaP cells synergistically. Our findings suggested that NDRG2 overexpression in combination with radiotherapy may be an effective therapeutic option against prostate cancer.

  4. Long-term outcomes from dose-escalated image-guided intensity-modulated radiotherapy with androgen deprivation: encouraging results for intermediate- and high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Wilcox SW

    2014-08-01

    Full Text Available Shea W Wilcox,1,4 Noel J Aherne,2,4 Linus C Benjamin,1 Bosco Wu,1 Thomaz de Campos Silva,3 Craig S McLachlan,4 Michael J McKay,3,5 Andrew J Last,1 Thomas P Shakespeare1–4 1North Coast Cancer Institute, Port Macquarie, NSW, Australia; 2North Coast Cancer Institute, Coffs Harbour, NSW, Australia; 3North Coast Cancer Institute, Lismore, NSW, Australia; 4The University of New South Wales, Rural Clinical School, Sydney, NSW, Australia; 5The University of Sydney, Sydney, NSW, Australia Purpose: Dose-escalated (DE radiotherapy in the setting of localized prostate cancer has been shown to improve biochemical disease-free survival (bDFS in several studies. In the same group of patients, androgen deprivation therapy (ADT has been shown to confer a survival benefit when combined with radiotherapy doses of up to 70 Gy; however, there is currently little long-term data on patients who have received high-dose intensity-modulated radiotherapy (IMRT with ADT. We report the long-term outcomes in a large cohort of patients treated with the combination of DE image-guided IMRT (IG-IMRT and ADT. Methods and materials: Patients with localized prostate cancer were identified from a centralized database across an integrated cancer center. All patients received DE IG-IMRT, combined with ADT, and had a minimum follow up of 12 months post-radiotherapy. All relapse and toxicity data were collected prospectively. Actuarial bDFS, metastasis-free survival, prostate cancer-specific survival, and multivariate analyses were calculated using the SPSS v20.0 statistical package. Results: Seven hundred and eighty-two eligible patients were identified with a median follow up of 46 months. Overall, 4.3% of patients relapsed, 2.0% developed distant metastases, and 0.6% died from metastatic prostate cancer. At 5-years, bDFS was 88%, metastasis-free survival was 95%, and prostate cancer-specific survival was 98%. Five-year grade 2 genitourinary and gastrointestinal toxicity was 2

  5. Combined radio- and hormone therapy of the prostate carcinoma

    International Nuclear Information System (INIS)

    Papic, R.

    1979-08-01

    Intention of this study is to detect in 49 patients suffering from prostate carcinomas, effects and side effects of radiotherapy. According to the present results, there is not any doubt that prostate carcinomas are radiosensitive. In all patients radiotherapy induced a prostate shrinkage and an increasing of consistency. It resulted that a prostate biopsy must be carried out in order to control the success of therapy. The success of the treatment depends upon tumour spreading and on its degree of differentiation. Within the observation period only in four cases metastasation of the prostate carcinoma occurred after radiotherapy. According to literature, the 5-year survival rate with an organ-defined prostate carcinoma ranges between 70 and 80% when radiotherapeutic methods are applied. The same authors indicate a 5-year survival rate between 42 and 48% for scattered carcinomas. Only minor side effects are provoked by radiotherapy. In 75% of the patients pollakisuria and dysuria resulted. After irradiation was finished, the symptoms disappeared and did not cause in any case any late complications. In 12% of the cases proctitic pain occurred during irradiation, which in 6% remained even after the treatment was terminated. We could prove unequivocally on our patients that passage impairments caused by a prostate carcinoma are improved by radiotherapy. Finally it can be said that this treatment is applicable for curing carcinoma which is localised on the prostate. In the case of an undefined, scattered carcinoma radiotherapy combined with hormone therapy is the treatment of choice. With regards to undesired side effects radiotherapy is superior to other therapeutic measures. (orig./MG) [de

  6. Strategies for Online Organ Motion Correction for Intensity-Modulated Radiotherapy of Prostate Cancer: Prostate, Rectum, and Bladder Dose Effects

    International Nuclear Information System (INIS)

    Rijkhorst, Erik-Jan; Lakeman, Annemarie; Nijkamp, Jasper; Bois, Josien de; Herk, Marcel van; Lebesque, Joos V.; Sonke, Jan-Jakob

    2009-01-01

    Purpose: To quantify and evaluate the accumulated prostate, rectum, and bladder dose for several strategies including rotational organ motion correction for intensity-modulated radiotherapy (IMRT) of prostate cancer using realistic organ motion data. Methods and Materials: Repeat computed tomography (CT) scans of 19 prostate patients were used. Per patient, two IMRT plans with different uniform margins were created. To quantify prostate and seminal vesicle motion, repeat CT clinical target volumes (CTVs) were matched onto the planning CTV using deformable registration. Four different strategies, from online setup to full motion correction, were simulated. Rotations were corrected for using gantry and collimator angle adjustments. Prostate, rectum, and bladder doses were accumulated for each patient, plan, and strategy. Minimum CTV dose (D min ), rectum equivalent uniform dose (EUD, n = 0.13), and bladder surface receiving ≥78 Gy (S78), were calculated. Results: With online CTV translation correction, a 7-mm margin was sufficient (i.e., D min ≥ 95% of the prescribed dose for all patients). A 4-mm margin required additional rotational correction. Margin reduction lowered the rectum EUD(n = 0.13) by ∼2.6 Gy, and the bladder S78 by ∼1.9%. Conclusions: With online correction of both translations and rotations, a 4-mm margin was sufficient for 15 of 19 patients, whereas the remaining four patients had an underdosed CTV volume <1%. Margin reduction combined with online corrections resulted in a similar or lower dose to the rectum and bladder. The more advanced the correction strategy, the better the planned and accumulated dose agreed.

  7. Development and validation of a scoring system for late anorectal side-effects in patients treated with radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Petersen, Stine Elleberg; Bentzen, Lise; Emmertsen, Katrine J.; Laurberg, Søren; Lundby, Lilli; Høyer, Morten

    2014-01-01

    Purpose: To develop and validate a scoring system for evaluation of long term anorectal dysfunction following radiotherapy for prostate cancer. Materials and methods: Patients treated for prostate cancer with radiotherapy filled in questionnaires on anorectal function and quality of life. Items for the condensed anorectal dysfunction score (RT-ARD) were identified and weighted by binomial regression analysis. The score was tested in a separate patient material by receiver operating characteristic (ROC) analysis and correlations to quality of life domains. Results: A total of 309 patients participated in the study. The items selected were “incontinence for solid stool”, “ability to defer defecation”, “unproductive call to stool”, “clustering of stool”, and “mucus in stool.” Patients were grouped into three categories according to the RT-ARD score; 0–8 (no RT-ARD), 9–23 (minor RT-ARD), 24–45 (major RT-ARD). ROC analyses revealed high sensitivity (91%) and specificity (85%) for major RT-ARD. The prediction model demonstrated a perfect fit in 60%, moderate fit in 36% and no fit in 4%. There was good correlation between the RT-ARD score and quality of life. Conclusions: The RT-ARD score is a validated and simple instrument for evaluation of anorectal dysfunction following radiotherapy for prostate cancer, and the RT-ARD score correlates to the patient’s quality of life

  8. Treatment-Planning Study of Prostate Cancer Intensity-Modulated Radiotherapy With a Varian Clinac Operated Without a Flattening Filter

    International Nuclear Information System (INIS)

    Vassiliev, Oleg N.; Kry, Stephen F.; Kuban, Deborah A.; Salehpour, Mohammad; Mohan, Radhe; Titt, Uwe

    2007-01-01

    Purpose: To assess the feasibility of intensity-modulated radiotherapy for prostate cancer using photon beams from an accelerator operated without a flattening filter; and to determine potential benefits and drawbacks of using unflattened beams for this type of treatment. Methods and Materials: Intensity-modulated radiotherapy plans were generated for 10 patients with early-stage prostate cancer. For each patient, four plans were generated: with and without the flattening filter, at 6 and 18 MV. The prescription dose was 75.6 Gy to 98% of the planning target volume. The number of beams, their orientations, and optimization constraints were the same for all plans. Plans were generated with Eclipse 8.0 (Varian Medical Systems). Results: All the plans developed with unflattened beams were clinically acceptable. In terms of patient dose distributions, plans with unflattened beams were similar to the corresponding plans with flattened beams. Plans with unflattened beams required fewer monitor units (MUs) per plan: on average, by a factor of 2.0 at 6 MV and 2.6 at 18 MV, assuming that removal of the flattening filter was not followed by recalibration of MUs. Conclusions: Clinically acceptable intensity-modulated radiotherapy plans for prostate cancer can be developed with unflattened beams at both 6 and 18 MV. Dosimetrically, flattened and unflattened beams generated similar treatment plans. The plans with unflattened beams required substantially fewer MUs. The reduction in the number of MUs indicates corresponding reduction in beam-on time and in the amount of radiation outside the target

  9. The effect of aerobic exercise on treatment-related acute toxicity in men receiving radical external beam radiotherapy for localised prostate cancer.

    Science.gov (United States)

    Kapur, G; Windsor, P M; McCowan, C

    2010-09-01

    We retrospectively analysed acute radiation toxicity data for patients who had participated in a randomised controlled study in our centre in order to assess the impact of aerobic exercise on acute rectal and bladder morbidity during treatment. Data from 65 of 66 patients were analysed: 33 allocated into a control group (standard advice) and 33 into an exercise group (aerobic walking for 30 min at least three times per week) during 4 weeks of external beam radiotherapy; one patient in the exercise group withdrew after randomisation before starting radiotherapy. There was a trend towards less severe acute rectal toxicity in the exercise group with a statistically significant difference in mean toxicity scores over the 4 weeks of radiotherapy (P=0.004), with no significant difference in bladder toxicity scores between the two groups (P=0.123). The lack of an association for severity of bladder toxicity could be attributed to the confounding effect of lower urinary tract symptoms from their prostate cancer. Keeping active and being asked to adhere to a well-defined exercise schedule appears to reduce the severity of rectal toxicity during radiotherapy to the prostate.

  10. Total Androgen Blockade Versus a Luteinizing Hormone-Releasing Hormone Agonist Alone in Men With High-Risk Prostate Cancer Treated With Radiotherapy

    International Nuclear Information System (INIS)

    Nanda, Akash; Chen, M.-H.; Moran, Brian J.; Braccioforte, Michelle H.; Dosoretz, Daniel; Salenius, Sharon; Katin, Michael; Ross, Rudi; D'Amico, Anthony V.

    2010-01-01

    Purpose: To assess whether short-course total androgen blockade vs. a luteinizing hormone-releasing hormone (LHRH) agonist alone affects the risk of prostate cancer-specific mortality (PCSM) in men with localized but high-risk disease treated with radiotherapy. Methods and Materials: The study cohort comprised 628 men with T1-T4, N0, M0 prostate cancer with high-risk disease (prostate-specific antigen level >20 ng/mL, Gleason score ≥8, or clinical category ≥T3) treated with 45 Gy of external beam radiotherapy followed by a brachytherapy boost in addition to receiving a median of 4.3 (interquartile range [IQR], 3.6-6.4) months of hormonal blockade with an LHRH agonist plus an antiandrogen or monotherapy with an LHRH agonist. Fine and Gray's multivariable regression analysis was used to determine whether combination androgen suppression therapy (AST) vs. monotherapy affected the risk of PCSM, adjusting for treatment year, duration of AST, age, and known prognostic factors. Results: After a median follow-up of 4.9 (IQR, 3.5-6.5) years, men receiving combination AST had a lower risk of PCSM than those treated with monotherapy (adjusted hazard ratio [AHR], 0.18; 95% confidence interval [CI], 0.04-0.90; p = 0.04). An increasing prostate-specific antigen level (AHR, 2.70; 95% CI, 1.64-4.45; p < 0.001) and clinical category T3/4 disease (AHR, 29.6; 95% CI, 2.88-303.5; p = 0.004) were also associated with an increased risk of PCSM. Conclusions: In men with localized but high-risk prostate cancer treated with external beam radiotherapy and brachytherapy, short-course AST with an LHRH agonist plus an antiandrogen is associated with a decreased risk of PCSM when compared with monotherapy with an LHRH agonist.

  11. Radiation therapy for prostatic cancer

    International Nuclear Information System (INIS)

    Kimura, Akira; Minowada, Shigeru; Tomoishi, Junzo; Kinoshita, Kenji; Matsuda, Tadayoshi

    1983-01-01

    A conformation radiotherapy system with collimators, whose openings can be controlled symmetrically by computerized techniques during rotational irradiation by a linear accelerator, has been developed for routine use in our hospital. Forty-four patients underwent radiation therapy, including this particular modality of radiotherapy, for prostatic cancer during the period of July 1976 through December 1981. Eight patients were classified as stage A, 10 stage B, 10 stage C, and 16 as stage D. Twenty-nine patients underwent conformation radiotherapy, two rotation radiotherapy, eight 2-port opposing technique radiotherapy, one 4-field radiotherapy, and four underwent a combination of 2-port opposing technique and conformation radiotherapy. Transient mild side effects such as diarrhea occurred in seven cases, while severe side effects such as rectal stricture or contracted bladder occurred in three cases. The latter occurred only in one case among 29 of conformation radiotherapy and in two among eight of 2-port opposing technique radiotherapy. The results of the treatment of short intervals in stage B, C, and D are as follows: prostatic size was reduced in 26 cases among 36, serum acid phosphatase level was reduced in 15 among 18 who had showed high acid phosphatase levels before treatment, although almost all cases underwent simultaneous hormonal therapy. The effects of radiotherapy alone were verified in two cases of stage B in which radiotherapy preceded hormonal therapy. Prostatic size and serum acid phosphatase level were reduced by radiotherapy alone. (author)

  12. Rapid Arc, helical tomotherapy, sliding window intensity modulated radiotherapy and three dimensional conformal radiation for localized prostate cancer: A dosimetric comparison

    Directory of Open Access Journals (Sweden)

    Rajesh A Kinhikar

    2014-01-01

    Full Text Available Objective: The objective of this study was to investigate the potential role of RapidArc (RA compared with helical tomotherapy (HT, sliding window intensity modulated radiotherapy (SW IMRT and three-dimensional conformal radiation therapy (3D CRT for localized prostate cancer. Materials and Methods: Prescription doses ranged from 60 Gy to planning target volume (PTV and 66.25 Gy for clinical target volume prostate (CTV-P over 25-30 fractions. PTV and CTV-P coverage were evaluated by conformity index (CI and homogeneity index (HI. Organ sparing comparison was done with mean doses to rectum and bladder. Results: CI 95 were 1.0 ± 0.01 (RA, 0.99 ± 0.01 (HT, 0.97 ± 0.02 (IMRT, 0.98 ± 0.02 (3D CRT for PTV and 1.0 ± 0.00 (RA, HT, SW IMRT and 3D CRT for CTV-P. HI was 0.11 ± 0.03 (RA, 0.16 ± 0.08 (HT, 0.12 ± 0.03 (IMRT, 0.06 ± 0.01 (3D CRT for PTV and 0.03 ± 0.00 (RA, 0.05 ± 0.01 (HT, 0.03 ± 0.01 (SW IMRT and 3D CRT for CTV-P. Mean dose to bladder were 23.68 ± 13.23 Gy (RA, 24.55 ± 12.51 Gy (HT, 19.82 ± 11.61 Gy (IMRT and 23.56 ± 12.81 Gy (3D CRT, whereas mean dose to rectum was 36.85 ± 12.92 Gy (RA, 33.18 ± 11.12 Gy (HT, IMRT and 38.67 ± 12.84 Gy (3D CRT. Conclusion: All studied intensity-modulated techniques yield treatment plans of significantly improved quality when compared with 3D CRT, with HT providing best organs at risk sparing and RA being the most efficient treatment option, reducing treatment time to 1.45-3.7 min and monitor unit to <400 for a 2 Gy fraction.

  13. Planning magnetic resonance imaging for prostate cancer intensity-modulated radiation therapy: Impact on target volumes, radiotherapy dose and androgen deprivation administration.

    Science.gov (United States)

    Horsley, Patrick J; Aherne, Noel J; Edwards, Grace V; Benjamin, Linus C; Wilcox, Shea W; McLachlan, Craig S; Assareh, Hassan; Welshman, Richard; McKay, Michael J; Shakespeare, Thomas P

    2015-03-01

    Magnetic resonance imaging (MRI) scans are increasingly utilized for radiotherapy planning to contour the primary tumors of patients undergoing intensity-modulated radiation therapy (IMRT). These scans may also demonstrate cancer extent and may affect the treatment plan. We assessed the impact of planning MRI detection of extracapsular extension, seminal vesicle invasion, or adjacent organ invasion on the staging, target volume delineation, doses, and hormonal therapy of patients with prostate cancer undergoing IMRT. The records of 509 consecutive patients with planning MRI scans being treated with IMRT for prostate cancer between January 2010 and July 2012 were retrospectively reviewed. Tumor staging and treatment plans before and after MRI were compared. Of the 509 patients, 103 (20%) were upstaged and 44 (9%) were migrated to a higher risk category as a result of findings at MRI. In 94 of 509 patients (18%), the MRI findings altered management. Ninety-four of 509 patients (18%) had a change to their clinical target volume (CTV) or treatment technique, and in 41 of 509 patients (8%) the duration of hormone therapy was changed because of MRI findings. The use of radiotherapy planning MRI altered CTV design, dose and/or duration of androgen deprivation in 18% of patients in this large, single institution series of men planned for dose-escalated prostate IMRT. This has substantial implications for radiotherapy target volumes and doses, as well as duration of androgen deprivation. Further research is required to investigate whether newer MRI techniques can simultaneously fulfill staging and radiotherapy contouring roles. © 2014 Wiley Publishing Asia Pty Ltd.

  14. A new fiducial marker for Image-guided radiotherapy of prostate cancer: Clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Hoejkjaer Larsen, Erik; Fabrin, Knud; Fisker, Rune V. (Dept. of Medical Physics, Oncology, Aalborg Hospital (Denmark))

    2008-08-15

    Background. A new fiducial marker for image guided radiotherapy (IGRT) based on a removable prostate stent made of Ni Ti has been developed during two previous clinical feasibility studies. The marker is currently being evaluated for IGRT treatment in a third clinical study. Method. The new marker is used to co-register MR and planning CT scans with high accuracy in the region around the prostate. The co-registered MR-CT volumes are used for delineation of GTV before planning. In each treatment session the IGRT system is used to position the patient before treatment. The IGRT system use a stereo pair of kV images matched to corresponding Digital Reconstructed Radiograms (DRR) from the planning CT scan. The match is done using mutual gray scale information. The pair of DRR's for positioning is created in the IGRT system with a threshold in the Look Up Table (LUT). The resulting match provides the necessary shift in couch coordinates to position the stent with an accuracy of 1-2 mm within the planned position. Results. At the present time 39 patients have received the new marker. Of the 39 one has migrated to the bladder. Deviations of more than 5 mm between CTV outlined on CT and MR are seen in several cases and in anterior-posterior (AP), left-right (LR) and cranial-caudal (CC) directions. Intra-fraction translation movements up to +/- 3 mm are seen as well. As the stent is also clearly visible on images taken with high voltage x-rays using electronic portal images devices (EPID), the positioning has been verified independently of the IGRT system. Discussion. The preliminary result of an on going clinical study of a Ni Ti prostate stent, potentially a new fiducial marker for image guided radiotherapy, looks promising. The risk of migration appears to be much lower compared to previous designs

  15. A new fiducial marker for Image-guided radiotherapy of prostate cancer: clinical experience.

    Science.gov (United States)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Højkjaer Larsen, Erik; Fabrin, Knud; Fisker, Rune V

    2008-01-01

    A new fiducial marker for image guided radiotherapy (IGRT) based on a removable prostate stent made of Ni Ti has been developed during two previous clinical feasibility studies. The marker is currently being evaluated for IGRT treatment in a third clinical study. The new marker is used to co-register MR and planning CT scans with high accuracy in the region around the prostate. The co-registered MR-CT volumes are used for delineation of GTV before planning. In each treatment session the IGRT system is used to position the patient before treatment. The IGRT system use a stereo pair of kV images matched to corresponding Digital Reconstructed Radiograms (DRR) from the planning CT scan. The match is done using mutual gray scale information. The pair of DRR's for positioning is created in the IGRT system with a threshold in the Look Up Table (LUT). The resulting match provides the necessary shift in couch coordinates to position the stent with an accuracy of 1-2 mm within the planned position. At the present time 39 patients have received the new marker. Of the 39 one has migrated to the bladder. Deviations of more than 5 mm between CTV outlined on CT and MR are seen in several cases and in anterior-posterior (AP), left-right (LR) and cranial-caudal (CC) directions. Intra-fraction translation movements up to +/- 3 mm are seen as well. As the stent is also clearly visible on images taken with high voltage x-rays using electronic portal images devices (EPID), the positioning has been verified independently of the IGRT system. The preliminary result of an on going clinical study of a Ni Ti prostate stent, potentially a new fiducial marker for image guided radiotherapy, looks promising. The risk of migration appears to be much lower compared to previous designs.

  16. A new fiducial marker for Image-guided radiotherapy of prostate cancer: Clinical experience

    International Nuclear Information System (INIS)

    Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Hoejkjaer Larsen, Erik; Fabrin, Knud; Fisker, Rune V.

    2008-01-01

    Background. A new fiducial marker for image guided radiotherapy (IGRT) based on a removable prostate stent made of Ni Ti has been developed during two previous clinical feasibility studies. The marker is currently being evaluated for IGRT treatment in a third clinical study. Method. The new marker is used to co-register MR and planning CT scans with high accuracy in the region around the prostate. The co-registered MR-CT volumes are used for delineation of GTV before planning. In each treatment session the IGRT system is used to position the patient before treatment. The IGRT system use a stereo pair of kV images matched to corresponding Digital Reconstructed Radiograms (DRR) from the planning CT scan. The match is done using mutual gray scale information. The pair of DRR's for positioning is created in the IGRT system with a threshold in the Look Up Table (LUT). The resulting match provides the necessary shift in couch coordinates to position the stent with an accuracy of 1-2 mm within the planned position. Results. At the present time 39 patients have received the new marker. Of the 39 one has migrated to the bladder. Deviations of more than 5 mm between CTV outlined on CT and MR are seen in several cases and in anterior-posterior (AP), left-right (LR) and cranial-caudal (CC) directions. Intra-fraction translation movements up to +/- 3 mm are seen as well. As the stent is also clearly visible on images taken with high voltage x-rays using electronic portal images devices (EPID), the positioning has been verified independently of the IGRT system. Discussion. The preliminary result of an on going clinical study of a Ni Ti prostate stent, potentially a new fiducial marker for image guided radiotherapy, looks promising. The risk of migration appears to be much lower compared to previous designs

  17. Long-Term Outcome and Toxicity of Salvage Brachytherapy for Local Failure After Initial Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Burri, Ryan J.; Stone, Nelson N.; Unger, Pam; Stock, Richard G.

    2010-01-01

    Purpose: To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer. Methods and Materials: Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with 103 Pd or 125 I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0. Results: Median follow-up was 86 months (range, 2-156). The median dose to 90% of the prostate volume was 122 Gy (range, 67-166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA) >10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age <70 years (p = 0.08) and PSA <6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA <6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Grade ≥2 toxicity (p = 0.03). Conclusion: With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA <6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.

  18. Assessment of accuracy and efficiency of atlas-based autosegmentation for prostate radiotherapy in a variety of clinical conditions.

    Science.gov (United States)

    Simmat, I; Georg, P; Georg, D; Birkfellner, W; Goldner, G; Stock, M

    2012-09-01

    The goal of the current study was to evaluate the commercially available atlas-based autosegmentation software for clinical use in prostate radiotherapy. The accuracy was benchmarked against interobserver variability. A total of 20 planning computed tomographs (CTs) and 10 cone-beam CTs (CBCTs) were selected for prostate, rectum, and bladder delineation. The images varied regarding to individual (age, body mass index) and setup parameters (contrast agent, rectal balloon, implanted markers). Automatically created contours with ABAS(®) and iPlan(®) were compared to an expert's delineation by calculating the Dice similarity coefficient (DSC) and conformity index. Demo-atlases of both systems showed different results for bladder (DSC(ABAS) 0.86 ± 0.17, DSC(iPlan) 0.51 ± 0.30) and prostate (DSC(ABAS) 0.71 ± 0.14, DSC(iPlan) 0.57 ± 0.19). Rectum delineation (DSC(ABAS) 0.78 ± 0.11, DSC(iPlan) 0.84 ± 0.08) demonstrated differences between the systems but better correlation of the automatically drawn volumes. ABAS(®) was closest to the interobserver benchmark. Autosegmentation with iPlan(®), ABAS(®) and manual segmentation took 0.5, 4 and 15-20 min, respectively. Automatic contouring on CBCT showed high dependence on image quality (DSC bladder 0.54, rectum 0.42, prostate 0.34). For clinical routine, efforts are still necessary to either redesign algorithms implemented in autosegmentation or to optimize image quality for CBCT to guarantee required accuracy and time savings for adaptive radiotherapy.

  19. Quality of life in locally advanced prostate cancer patients who underwent hormonal treatment combined with radiotherapy

    International Nuclear Information System (INIS)

    Koga, Hirofumi; Naito, Seiji; Fukui, Iwao; Tsukamoto, Taiji; Matsuoka, Naoki; Fujimoto, Hiroyuki

    2004-01-01

    The aim of this study is to estimate the feasibility of quality of life (QOL) research and to evaluate the QOL prospectively in locally advanced prostate cancer patients treated with hormonal treatment combined with radiotherapy. The treatment schedule was that patients with decreasing prostatic specific antigen (PSA) levels below 10 ng/ml after receiving 6 months of neoadjuvant hormonal treatment were randomly divided into two groups; one group was the continuous hormonal treatment group and the other was the intermittent hormonal treatment group. Both groups received a total dose of 72 Gy external beam radiotherapy with concomitant hormonal treatment followed by 6 months of adjuvant hormonal treatment following radiotherapy. At 14 months, patients either underwent continuous or intermittent hormonal treatment according to the random allocation. QOL was assessed at baseline, and at 6, 8, 14, and 20 months after treatment using functional assessment of cancer treatment-general (FACT-G), P with the other 3 items comprising bother of urination, bother of bowel movement, and bother of sexual activity. Between January 2000 and June 2003, a total of 188 patients were enrolled in this study. The rate of collection of baseline QOL sheets was 98.0%. The rate of answer to questions of QOL sheets was 99.0%. At baseline, the average score of FACT-G, P was 120.7 and the maximum score was more than twice the minimum score. Dysfunction of urination and bowel movement was correlated with the bother of urination and bowel movement, respectively. On the other hand, dysfunction of sexual activity was not correlated with the bother of sexual activity. In June 2003, all of the QOL sheets at baseline, and at 6, 8, and 14 months were completely collected from a total of 72 patients. Although QOL at 8 months was significantly affected compared with QOL at baseline and at 6 months, QOL at 14 months was significantly improved compared with that at 8 months and there was no significant

  20. The predictive value of 2-year posttreatment biopsy after prostate cancer radiotherapy for eventual biochemical outcome

    International Nuclear Information System (INIS)

    Vance, Waseet; Tucker, Susan L.; Crevoisier, Renaud de; Kuban, Deborah A.; Cheung, M. Rex

    2007-01-01

    Purpose: To determine the value of a 2-year post-radiotherapy (RT) prostate biopsy for predicting eventual biochemical failure in patients who were treated for localized prostate cancer. Methods and Materials: This study comprised 164 patients who underwent a planned 2-year post-RT prostate biopsy. The independent prognostic value of the biopsy results for forecasting eventual biochemical outcome and overall survival was tested with other factors (the Gleason score, 1992 American Joint Committee on Cancer tumor stage, pretreatment prostate-specific antigen level, risk group, and RT dose) in a multivariate analysis. The current nadir + 2 (CN + 2) definition of biochemical failure was used. Patients with rising prostate-specific antigen (PSA) or suspicious digital rectal examination before the biopsy were excluded. Results: The biopsy results were normal in 78 patients, scant atypical and malignant cells in 30, carcinoma with treatment effect in 43, and carcinoma without treatment effect in 13. Using the CN + 2 definition, we found a significant association between biopsy results and eventual biochemical failure. We also found that the biopsy status provides predictive information independent of the PSA status at the time of biopsy. Conclusion: A 2-year post-RT prostate biopsy may be useful for forecasting CN + 2 biochemical failure. Posttreatment prostate biopsy may be useful for identifying patients for aggressive salvage therapy

  1. A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam [Automated Scheduling, Optimisation and Planning Research Group, School of Computer Science, University of Nottingham, Nottingham NG8 1BB (United Kingdom); Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB (United Kingdom)

    2011-12-15

    Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

  2. A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam

    2011-01-01

    Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

  3. Exploring Genetic Attributions Underlying Radiotherapy-Induced Fatigue in Prostate Cancer Patients.

    Science.gov (United States)

    Hashemi, Sepehr; Fernandez Martinez, Juan Luis; Saligan, Leorey; Sonis, Stephen

    2017-09-01

    Despite numerous proposed mechanisms, no definitive pathophysiology underlying radiotherapy-induced fatigue (RIF) has been established. However, the dysregulation of a set of 35 genes was recently validated to predict development of fatigue in prostate cancer patients receiving radiotherapy. To hypothesize novel pathways, and provide genetic targets for currently proposed pathways implicated in RIF development through analysis of the previously validated gene set. The gene set was analyzed for all phenotypic attributions implicated in the phenotype of fatigue. Initially, a "directed" approach was used by querying specific fatigue-related sub-phenotypes against all known phenotypic attributions of the gene set. Then, an "undirected" approach, reviewing the entirety of the literature referencing the 35 genes, was used to increase analysis sensitivity. The dysregulated genes attribute to neural, immunological, mitochondrial, muscular, and metabolic pathways. In addition, certain genes suggest phenotypes not previously emphasized in the context of RIF, such as ionizing radiation sensitivity, DNA damage, and altered DNA repair frequency. Several genes also associated with prostate cancer depression, possibly emphasizing variable radiosensitivity by RIF-prone patients, which may have palliative care implications. Despite the relevant findings, many of the 35 RIF-predictive genes are poorly characterized, warranting their investigation. The implications of herein presented RIF pathways are purely theoretical until specific end-point driven experiments are conducted in more congruent contexts. Nevertheless, the presented attributions are informative, directing future investigation to definitively elucidate RIF's pathoetiology. This study demonstrates an arguably comprehensive method of approaching known differential expression underlying a complex phenotype, to correlate feasible pathophysiology. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All

  4. Patient-reported lower urinary tract symptoms, urinary incontinence, and quality of life after external beam radiotherapy for localized prostate cancer - 15 years' follow-up. A comparison with age-matched controls

    International Nuclear Information System (INIS)

    Fransson, Per

    2008-01-01

    Background. To prospectively examine the urinary toxicity and quality of life (QOL) in patients 15 years after external beam radiotherapy (EBRT) for localized prostate cancer (LPC) and compare the outcomes with results for age-matched controls. Material and methods. Urinary symptoms were assessed using the symptom-specific Prostate Cancer Symptom Scale (PCSS) questionnaire, and QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC)'s Quality of Life Questionnaire (QLQ-C30). Both questionnaires were sent to the surviving 41 patients (25%) and the PCSS questionnaire was sent to 69 age-matched controls for comparison. Results. The response rate was 71% in the patient group and 59% in the control group. Two patients and four controls were excluded due to other cancer diagnoses, resulting in a total of 27 patients and 37 controls for inclusion in the analyses. The mean age in both groups was 78 years. In the patient group, incontinence had increased between the 8-year (mean=0.6) and the 15-year follow-up (mean=2.1; p=0.038). No other differences in urinary problems were seen between these two follow-ups. Increased incontinence, stress incontinence, and pain while urinating were reported by the patients in comparison with the controls at 15 years. Role function was worse in the patient group (mean=67.3) compared with the controls (mean=82.4; p=0.046). The patients also reported more appetite loss, diarrhea, nausea/vomiting, and pain than the controls. Conclusion. EBRT for LPC has divergent effects on urinary symptoms and QOL in comparison with age-matched controls. In our patient population, urinary incontinence increased between 8 and 15 years of follow-up. Otherwise, no differences in urinary symptoms were seen between 4 and 15 years. Incontinence, stress incontinence, and pain while urinating were increased after EBRT in comparison with the controls. Conventional EBRT did not result in a major deterioration in QOL 15 years after

  5. Effect of Gold Nanoparticles on Prostate Dose Distribution under Ir-192 Internal and 18 MV External Radiotherapy Procedures Using Gel Dosimetry and Monte Carlo Method

    Directory of Open Access Journals (Sweden)

    Khosravi H.

    2015-03-01

    Full Text Available Background: Gel polymers are considered as new dosimeters for determining radiotherapy dose distribution in three dimensions. Objective: The ability of a new formulation of MAGIC-f polymer gel was assessed by experimental measurement and Monte Carlo (MC method for studying the effect of gold nanoparticles (GNPs in prostate dose distributions under the internal Ir-192 and external 18MV radiotherapy practices. Method: A Plexiglas phantom was made representing human pelvis. The GNP shaving 15 nm in diameter and 0.1 mM concentration were synthesized using chemical reduction method. Then, a new formulation of MAGIC-f gel was synthesized. The fabricated gel was poured in the tubes located at the prostate (with and without the GNPs and bladder locations of the phantom. The phantom was irradiated to an Ir-192 source and 18 MV beam of a Varian linac separately based on common radiotherapy procedures used for prostate cancer. After 24 hours, the irradiated gels were read using a Siemens 1.5 Tesla MRI scanner. The absolute doses at the reference points and isodose curves resulted from the experimental measurement of the gels and MC simulations following the internal and external radiotherapy practices were compared. Results: The mean absorbed doses measured with the gel in the presence of the GNPs in prostate were 15% and 8 % higher than the corresponding values without the GNPs under the internal and external radiation therapies, respectively. MC simulations also indicated a dose increase of 14 % and 7 % due to presence of the GNPs, for the same experimental internal and external radiotherapy practices, respectively. Conclusion: There was a good agreement between the dose enhancement factors (DEFs estimated with MC simulations and experiment gel measurements due to the GNPs. The results indicated that the polymer gel dosimetry method as developed and used in this study, can be recommended as a reliable method for investigating the DEF of GNPs in internal

  6. Effect of Gold Nanoparticles on Prostate Dose Distribution under Ir-192 Internal and 18 MV External Radiotherapy Procedures Using Gel Dosimetry and Monte Carlo Method.

    Science.gov (United States)

    Khosravi, H; Hashemi, B; Mahdavi, S R; Hejazi, P

    2015-03-01

    Gel polymers are considered as new dosimeters for determining radiotherapy dose distribution in three dimensions. The ability of a new formulation of MAGIC-f polymer gel was assessed by experimental measurement and Monte Carlo (MC) method for studying the effect of gold nanoparticles (GNPs) in prostate dose distributions under the internal Ir-192 and external 18MV radiotherapy practices. A Plexiglas phantom was made representing human pelvis. The GNP shaving 15 nm in diameter and 0.1 mM concentration were synthesized using chemical reduction method. Then, a new formulation of MAGIC-f gel was synthesized. The fabricated gel was poured in the tubes located at the prostate (with and without the GNPs) and bladder locations of the phantom. The phantom was irradiated to an Ir-192 source and 18 MV beam of a Varian linac separately based on common radiotherapy procedures used for prostate cancer. After 24 hours, the irradiated gels were read using a Siemens 1.5 Tesla MRI scanner. The absolute doses at the reference points and isodose curves resulted from the experimental measurement of the gels and MC simulations following the internal and external radiotherapy practices were compared. The mean absorbed doses measured with the gel in the presence of the GNPs in prostate were 15% and 8 % higher than the corresponding values without the GNPs under the internal and external radiation therapies, respectively. MC simulations also indicated a dose increase of 14 % and 7 % due to presence of the GNPs, for the same experimental internal and external radiotherapy practices, respectively. There was a good agreement between the dose enhancement factors (DEFs) estimated with MC simulations and experiment gel measurements due to the GNPs. The results indicated that the polymer gel dosimetry method as developed and used in this study, can be recommended as a reliable method for investigating the DEF of GNPs in internal and external radiotherapy practices.

  7. Measurement of weekly prostate specific antigen levels in patients receiving pelvic radiotherapy for nonprostatic malignancies

    International Nuclear Information System (INIS)

    Vijayakumar, Srinivasan; Quadri, S. Farhat; Sen, Saunak; Vaida, Florin; Ignacio, Lani; Weichselbaum, R. R.

    1995-01-01

    Purpose: To study the response of nonmalignant prostatic tissue to ionizing irradiation in terms of the resultant changes in serum prostate specific antigen (PSA) levels. Methods and Materials: Weekly serum PSA values were determined during radiotherapy (RT) in nine patients ('treatment group') without clinical evidence of prostate cancer (PC), and who received pelvic RT for other indications. Slopes for the rate of change in PSA was determined using model: log PSA = β0 + β1 * week + β2 * week 2 + error. These results are compared with 17 normal volunteers ('control group') who were not exposed to ionizing irradiation. An attempt is made to compare any similarities and differences in subsets of 64 T1-T4N0M0 PC patients who received pelvic RT. Results: An elevation in the serum PSA levels were noted in eight of nine patients in the 'treatment group' with a median time of 4.2 weeks to reach the maximum serum PSA values. After an initial increase, PSA values declined. In some patients, manifold increase in PSA was noted, for example, from 1.8 to 13.5 ng/ml and 3.3 to 9.8 ng/ml in two patients. The PSA increase ranged from 50-650%. The median slope was 0.601 week -1 (range 0.192-3.045 week -1 ). No such increases were seen in the 'control group' (median slope = 0.03 week -1 ; range, 0.18-0.13 week -1 ). When differences between the mean increase/decrease for each week compared to pretreatment values were analyzed, the irradiated group had statistically significant elevations in the PSA for weeks 3 (p = 0.034), 4 (p = 0.035), and 5 (p 0.024). A similar trend of increasing PSA levels during radiotherapy was noted in prostate cancer patients whose initial PSA values were ≤ 20 ng/ml: whereas positive slopes (i.e., increasing PSA levels during radiotherapy course) was seen in 7.1% of those with > 20 ng/ml preradiotherapy PSA values, such trends were seen in 52.7% of those with ≤ 20 ng/ml preradiotherapy PSA values. Conclusions: (a) Incidental exposure of noncancerous

  8. Measurement of weekly prostate specific antigen levels in patients receiving pelvic radiotherapy for nonprostatic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Vijayakumar, Srinivasan; Quadri, S Farhat; Sen, Saunak; Vaida, Florin; Ignacio, Lani; Weichselbaum, R R

    1995-04-30

    Purpose: To study the response of nonmalignant prostatic tissue to ionizing irradiation in terms of the resultant changes in serum prostate specific antigen (PSA) levels. Methods and Materials: Weekly serum PSA values were determined during radiotherapy (RT) in nine patients ('treatment group') without clinical evidence of prostate cancer (PC), and who received pelvic RT for other indications. Slopes for the rate of change in PSA was determined using model: log PSA = {beta}0 + {beta}1{sup *}week + {beta}2{sup *}week{sup 2} + error. These results are compared with 17 normal volunteers ('control group') who were not exposed to ionizing irradiation. An attempt is made to compare any similarities and differences in subsets of 64 T1-T4N0M0 PC patients who received pelvic RT. Results: An elevation in the serum PSA levels were noted in eight of nine patients in the 'treatment group' with a median time of 4.2 weeks to reach the maximum serum PSA values. After an initial increase, PSA values declined. In some patients, manifold increase in PSA was noted, for example, from 1.8 to 13.5 ng/ml and 3.3 to 9.8 ng/ml in two patients. The PSA increase ranged from 50-650%. The median slope was 0.601 week{sup -1} (range 0.192-3.045 week{sup -1}). No such increases were seen in the 'control group' (median slope = 0.03 week{sup -1}; range, 0.18-0.13 week{sup -1}). When differences between the mean increase/decrease for each week compared to pretreatment values were analyzed, the irradiated group had statistically significant elevations in the PSA for weeks 3 (p = 0.034), 4 (p = 0.035), and 5 (p 0.024). A similar trend of increasing PSA levels during radiotherapy was noted in prostate cancer patients whose initial PSA values were {<=} 20 ng/ml: whereas positive slopes (i.e., increasing PSA levels during radiotherapy course) was seen in 7.1% of those with > 20 ng/ml preradiotherapy PSA values, such trends were seen in 52.7% of those with {<=} 20 ng/ml preradiotherapy PSA values

  9. Three-dimensional conformal external beam radiotherapy compared with permanent prostate implantation in low-risk prostate cancer based on endorectal magnetic resonance spectroscopy imaging and prostate-specific antigen level

    International Nuclear Information System (INIS)

    Pickett, Barby; Kurhanewicz, John; Pouliot, Jean; Weinberg, Vivian; Shinohara, Katsuto; Coakley, Fergus; Roach, Mack

    2006-01-01

    Purpose: To evaluate the metabolic response by comparing the time to resolution of spectroscopic abnormalities (TRSA) and the time to prostate-specific antigen level in low-risk prostate cancer patients after treatment with three-dimensional conformal external beam radiotherapy (3D-CRT) compared with permanent prostate implantation (PPI). Recent studies have suggested that the treatment of low-risk prostate cancer yields similar results for patients treated with 3D-CRT or PPI. Methods and Materials: A total of 50 patients, 25 in each group, who had been treated with 3D-CRT or PPI, had undergone endorectal magnetic resonance spectroscopy imaging before and/or at varying times after therapy. The 3D-CRT patients had received radiation doses of ≥72 Gy compared with 144 Gy for the PPI patients. The spectra from all usable voxels were examined for detectable levels of metabolic signal, and the percentages of atrophic and cancerous voxels were tabulated. Results: The median time to resolution of the spectroscopic abnormalities was 32.2 and 24.8 months and the time to the nadir prostate-specific antigen level was 52.4 and 38.0 months for the 3D-CRT and PPI patients, respectively. Of the 3D-CRT patients, 92% achieved negative endorectal magnetic resonance spectroscopy imaging findings, with 40% having complete metabolic atrophy. All 25 PPI patients had negative endorectal magnetic resonance spectroscopy imaging findings, with 60% achieving complete metabolic atrophy. Conclusion: The results of this study suggest that metabolic and biochemical responses of the prostate are more pronounced after PPI. Our results have not proved PPI is more effective at curing prostate cancer, but they have demonstrated that it may be more effective at destroying prostate metabolism

  10. Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy

    International Nuclear Information System (INIS)

    Lépinoy, Alexis; Cochet, Alexandre; Cueff, Adèle; Cormier, Luc; Martin, Etienne; Maingon, Philippe; Bosset, Jean François; Brunotte, François; Créhange, Gilles

    2014-01-01

    Introduction: The purpose of this study was to describe the pattern of nodal relapse with 18 F-fluoro-choline (FCH) Positron Emission Tomography/Computerized Tomography (PET/CT) in prostate cancer patients after radiotherapy. Materials and methods: Eighty-three patients had a FCH PET/CT at time of biochemical failure. Of 65 patients with positive findings, 33 had positive nodes. This analysis included 31 patients who had undergone prior prostate-only radiotherapy with or without a prior radical prostatectomy. Each FCH positive node was assigned to a lymph node station with respect to the CTV defined by the RTOG guidelines (CTV RTOG ). 3D mapping was performed after each node was manually placed in a reference planning CT scan after automatic co-registration of the two scans based on bone anatomy. Eighteen patients (58%) underwent focal salvage FCH PET-guided stereotactic radiotherapy with no hormones. Results: Fourteen patients (45.2%) had a relapse outside the CTV RTOG . Of the 17 patients with a positive node inside the CTV RTOG , 15 had a single node (88.2%) while seven patients out of the 13 evaluable patients (53.9%) who had a relapse outside the CTV RTOG had ⩾2 positive nodes on FCH PET/CT (OR = 8.75, [95% CI: 1.38–54.80], p = 0.020). Relapses that occurred outside the CTV RTOG involved the proximal common iliac (19.3%) and lower periaortic nodes (19.3%) up to L2–L3. Conclusion: 3D mapping of nodal relapses evaluated with FCH PET/CT suggests that with IMRT the upper field limit of pelvic radiotherapy could be extended to L2–L3 safely to cover 95% of nodal stations at risk of an occult relapse

  11. Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radical radiotherapy

    Directory of Open Access Journals (Sweden)

    V. A. Solodkiy

    2016-01-01

    Full Text Available Studies salvage interstitial radiation therapy for recurrent prostate cancer, launched at the end of the XX century. In recent years, more and more attention is paid to high-dose-rate brachytherapy (HDR-BT as a method of treating local recurrence.The purpose of research – preliminary clinical results of salvage high-dose-rate brachytherapy applied in cases of suspected local recurrence or of residual tumour after radiotherapy.Preliminary findings indicate the possibility of using HDR-BT, achieving local tumor control with low genitourinary toxicity.

  12. A Comparison of daily megavoltage CT and ultrasound image guided radiation therapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Peng Cheng; Kainz, Kristofer; Lawton, Colleen; Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226 (United States)

    2008-12-15

    In order to quantify the differences between ultrasound-imaging and megavoltage-CT (MVCT) daily prostate localization in prostate-cancer radiotherapy and their dosimetric impacts, daily shifts were analyzed for a total of 140 prostate cancer patients; 106 positioned using ultrasound-based imaging [B-mode Acquisition and Targeting (BAT)], and 34 using the MVCT from a TomoTherapy Hi-Art unit. The shifts indicated by the two systems were compared statistically along the right/left (R/L), superior/inferior (S/I), and anterior/posterior (A/P) directions. The systematic and random variations among the daily alignments were calculated. Margins to account for these shifts were estimated. The mean shifts and standard deviations along the R/L, S/I, and A/P directions were -0.11{+-}3.80, 0.67{+-}4.67, and 2.71{+-}6.31 mm for BAT localizations and -0.98{+-}5.13, 0.27{+-}3.35, and 1.00{+-}4.22 mm for MVCT localizations, respectively. The systematic and random variations in daily shifts based on MVCT were generally smaller than those based on BAT, especially along the A/P direction. A t-test showed this difference to be statistically significant. The planning target volume margins in the A/P direction estimated to account for daily variations were 8.81 and 14.66 mm based on MVCT and BAT data, respectively. There was no statistically significant difference in the daily prostate movement pattern between the first few fractions and the remaining fractions. Dosimetric comparison of MVCT and BAT prostate alignments was performed for seven fractions from a patient. The degradation from the plan caused by the MVCT alignment is trivial, while that by BAT is substantial. The MVCT technique results in smaller variations in daily shifts than ultrasound imaging, indicating that MVCT is more reliable and precise for prostate localization. Ultrasound-based localization may overestimate the daily prostate motion, particularly in the A/P direction, negatively impacting prostate dose coverage

  13. A Comparison of daily megavoltage CT and ultrasound image guided radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Peng Cheng; Kainz, Kristofer; Lawton, Colleen; Li, X. Allen

    2008-01-01

    In order to quantify the differences between ultrasound-imaging and megavoltage-CT (MVCT) daily prostate localization in prostate-cancer radiotherapy and their dosimetric impacts, daily shifts were analyzed for a total of 140 prostate cancer patients; 106 positioned using ultrasound-based imaging [B-mode Acquisition and Targeting (BAT)], and 34 using the MVCT from a TomoTherapy Hi-Art unit. The shifts indicated by the two systems were compared statistically along the right/left (R/L), superior/inferior (S/I), and anterior/posterior (A/P) directions. The systematic and random variations among the daily alignments were calculated. Margins to account for these shifts were estimated. The mean shifts and standard deviations along the R/L, S/I, and A/P directions were -0.11±3.80, 0.67±4.67, and 2.71±6.31 mm for BAT localizations and -0.98±5.13, 0.27±3.35, and 1.00±4.22 mm for MVCT localizations, respectively. The systematic and random variations in daily shifts based on MVCT were generally smaller than those based on BAT, especially along the A/P direction. A t-test showed this difference to be statistically significant. The planning target volume margins in the A/P direction estimated to account for daily variations were 8.81 and 14.66 mm based on MVCT and BAT data, respectively. There was no statistically significant difference in the daily prostate movement pattern between the first few fractions and the remaining fractions. Dosimetric comparison of MVCT and BAT prostate alignments was performed for seven fractions from a patient. The degradation from the plan caused by the MVCT alignment is trivial, while that by BAT is substantial. The MVCT technique results in smaller variations in daily shifts than ultrasound imaging, indicating that MVCT is more reliable and precise for prostate localization. Ultrasound-based localization may overestimate the daily prostate motion, particularly in the A/P direction, negatively impacting prostate dose coverage and rectal

  14. Biochemical failure as single abnormality in patients with prostate cancer following radical treatment with external radiotherapy: follow-up without immediate treatment

    Directory of Open Access Journals (Sweden)

    Sergio L. Faria

    2004-08-01

    Full Text Available INTRODUCTION: Biochemical failure has been defined as 3 consecutive increases in PSA following curative treatment of prostate cancer. The appropriate management in such cases is controversial. The most usual treatment has been early introduction of hormones. Such patients will live for many years and hormone therapy causes important secondary effects and increases costs. The guideline in our Department of Radiotherapy has been to follow up, with no initial therapy, cases with low PSA and short PSA doubling time. The present study reports this experience. MATERIALS AND METHODS: 528 patients with localized prostate cancer were treated by radical approach between 1992 and 1999, with external radiotherapy, with or without adjuvant hormone therapy. After a median follow-up of 77 months, there were 207 (39% cases with biochemical failure, 78 of which were followed without therapy after the identification of biochemical failure. All of them were asymptomatic patients and had negative radiographic examinations or did not have imaging exams requested since they presented a favorable outcome. The follow-up included at least 2 annual visits with physical examination and PSA. RESULTS: Of the 78 patients with biochemical failure followed without initial therapy, 7 died from other causes than prostate cancer and the remaining 71 cases were alive and asymptomatic in the last follow-up. Prognostic factors previous to radiotherapy such as stage and Gleason score were not considered when deciding for follow-up without initial therapy in these cases. The most significant aspects considered for this decision were low PSA value (median PSA on the last visit for the 78 cases was only 3.9 ng/mL and a slow PSA doubling time (in the present experience the median PSA doubling time was 22.5 months. CONCLUSION: There seems to be space for expectant management, without initial hormone therapy, in patients with prostate cancer who present biochemical failure and are

  15. Cone beam CT dose reduction in prostate radiotherapy using Likert scale methods.

    Science.gov (United States)

    Langmack, Keith A; Newton, Louise A; Jordan, Suzanne; Smith, Ruth

    2016-01-01

    To use a Likert scale method to optimize image quality (IQ) for cone beam CT (CBCT) soft-tissue matching for image-guided radiotherapy of the prostate. 23 males with local/locally advanced prostate cancer had the CBCT IQ assessed using a 4-point Likert scale (4 = excellent, no artefacts; 3 = good, few artefacts; 2 = poor, just able to match; 1 = unsatisfactory, not able to match) at three levels of exposure. The lateral separations of the subjects were also measured. The Friedman test and Wilcoxon signed-rank tests were used to determine if the IQ was associated with the exposure level. We used the point-biserial correlation and a χ(2) test to investigate the relationship between the separation and IQ. The Friedman test showed that the IQ was related to exposure (p = 2 × 10(-7)) and the Wilcoxon signed-rank test demonstrated that the IQ decreased as exposure decreased (all p-values <0.005). We did not find a correlation between the IQ and the separation (correlation coefficient 0.045), but for separations <35 cm, it was possible to use the lowest exposure parameters studied. We can reduce exposure factors to 80% of those supplied with the system without hindering the matching process for all patients. For patients with lateral separations <35 cm, the exposure factors can be reduced further to 64% of the original values. Likert scales are a useful tool for measuring IQ in the optimization of CBCT IQ for soft-tissue matching in radiotherapy image guidance applications.

  16. Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

    Directory of Open Access Journals (Sweden)

    Katz Alan

    2012-11-01

    Full Text Available Abstract Background As the long-term efficacy of stereotactic body radiation therapy (SBRT becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Methods Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients or SBRT (n = 216 American patients. QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. Results The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Conclusions Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment

  17. Genome Wide Association Study to Identify SNPs and CNPs Associated with Development of Radiation Injury in Prostate Cancer Patients Treated with Radiotherapy

    Science.gov (United States)

    2012-10-01

    association tests, we obtained low genomic inflation factors of 1.02 for the ED patients and 1.00 for the urinary morbidity patients, suggesting...study (GWAS) to identify genetic factors associated with urinary morbidity following radiotherapy for prostate cancer. Methods: Prostate cancer...increased urinary frequency, incomplete bladder emptying, weak urinary stream and incontinence , as well as more serious events such as bladder necrosis or

  18. A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma.

    Science.gov (United States)

    Windsor, Phyllis M; Nicol, Kathleen F; Potter, Joan

    2004-08-01

    Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental. Aerobic walking improves physical functioning and has been an intervention for chemotherapy-related fatigue. A prospective, randomized, controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma. Sixty-six men were randomized before they received radical radiotherapy for localized prostate carcinoma, with 33 men randomized to an exercise group and 33 men randomized to a control group. Outcome measures were fatigue and distance walked in a modified shuttle test before and after radiotherapy. There were no significant between group differences noted with regard to fatigue scores at baseline (P = 0.55) or after 4 weeks of radiotherapy (P = 0.18). Men in the control group had significant increases in fatigue scores from baseline to the end of radiotherapy (P = 0.013), with no significant increases observed in the exercise group (P = 0.203). A nonsignificant reduction (2.4%) in shuttle test distance at the end of radiotherapy was observed in the control group; however, in the exercise group, there was a significant increase (13.2%) in distance walked (P = 0.0003). Men who followed advice to rest and take things easy if they became fatigued demonstrated a slight deterioration in physical functioning and a significant increase in fatigue at the end of radiotherapy. Home-based, moderate-intensity walking produced a significant improvement in physical functioning with no significant increase in fatigue. Improved physical functioning may be necessary to combat radiation fatigue.

  19. Different rectal toxicity tolerance with and without simultaneous conventionally-fractionated pelvic lymph node treatment in patients receiving hypofractionated prostate radiotherapy

    International Nuclear Information System (INIS)

    McDonald, Andrew M; Baker, Christopher B; Popple, Richard A; Shekar, Kiran; Yang, Eddy S; Jacob, Rojymon; Cardan, Rex; Kim, Robert Y; Fiveash, John B

    2014-01-01

    To investigate added morbidity associated with the addition of pelvic elective nodal irradiation (ENI) to hypofractionated radiotherapy to the prostate. Two-hundred twelve patients, treated with hypofractionated radiotherapy to the prostate between 2004 and 2011, met the inclusion criteria for the analysis. All patients received 70 Gy to the prostate delivered over 28 fractions and 103 (49%) received ENI consisting of 50.4 Gy to the pelvic lymphatics delivered simultaneously in 1.8 Gy fractions. The mean dose-volume histograms were compared between the two subgroups defined by use of ENI, and various dose-volume parameters were analyzed for effect on late lower gastrointestinal (GI) and genitourinary (GU) toxicity. Acute grade 2 lower GI toxicity occurred in 38 (37%) patients receiving ENI versus 19 (17%) in those who did not (p = 0.001). The Kaplan-Meier estimate of grade ≥ 2 lower GI toxicity at 3 years was 15.3% for patients receiving ENI versus 5.3% for those who did not (p = 0.026). Each rectal isodose volume was increased for patients receiving ENI up to 50 Gy (p ≤ 0.021 for each 5 Gy increment). Across all patients, the absolute V 70 of the rectum was the only predictor of late GI toxicity. When subgroups, defined by the use of ENI, were analyzed separately, rectal V 70 was only predictive of late GI toxicity for patients who received ENI. For patients receiving ENI, V 70 > 3 cc was associated with an increased risk of late GI events. Elective nodal irradiation increases the rates of acute and late GI toxicity when delivered simultaneously with hypofractioanted prostate radiotherapy. The use of ENI appears to sensitize the rectum to hot spots, therefore we recommend added caution to minimize the volume of rectum receiving 100% of the prescription dose in these patients

  20. Different rectal toxicity tolerance with and without simultaneous conventionally-fractionated pelvic lymph node treatment in patients receiving hypofractionated prostate radiotherapy.

    Science.gov (United States)

    McDonald, Andrew M; Baker, Christopher B; Popple, Richard A; Shekar, Kiran; Yang, Eddy S; Jacob, Rojymon; Cardan, Rex; Kim, Robert Y; Fiveash, John B

    2014-06-03

    To investigate added morbidity associated with the addition of pelvic elective nodal irradiation (ENI) to hypofractionated radiotherapy to the prostate. Two-hundred twelve patients, treated with hypofractionated radiotherapy to the prostate between 2004 and 2011, met the inclusion criteria for the analysis. All patients received 70 Gy to the prostate delivered over 28 fractions and 103 (49%) received ENI consisting of 50.4 Gy to the pelvic lymphatics delivered simultaneously in 1.8 Gy fractions. The mean dose-volume histograms were compared between the two subgroups defined by use of ENI, and various dose-volume parameters were analyzed for effect on late lower gastrointestinal (GI) and genitourinary (GU) toxicity. Acute grade 2 lower GI toxicity occurred in 38 (37%) patients receiving ENI versus 19 (17%) in those who did not (p = 0.001). The Kaplan-Meier estimate of grade ≥ 2 lower GI toxicity at 3 years was 15.3% for patients receiving ENI versus 5.3% for those who did not (p = 0.026). Each rectal isodose volume was increased for patients receiving ENI up to 50 Gy (p ≤ 0.021 for each 5 Gy increment). Across all patients, the absolute V70 of the rectum was the only predictor of late GI toxicity. When subgroups, defined by the use of ENI, were analyzed separately, rectal V70 was only predictive of late GI toxicity for patients who received ENI. For patients receiving ENI, V70 > 3 cc was associated with an increased risk of late GI events. Elective nodal irradiation increases the rates of acute and late GI toxicity when delivered simultaneously with hypofractioanted prostate radiotherapy. The use of ENI appears to sensitize the rectum to hot spots, therefore we recommend added caution to minimize the volume of rectum receiving 100% of the prescription dose in these patients.

  1. Reduced rectal toxicity with ultrasound-based image guided radiotherapy using BAT trademark (B-mode acquisition and targeting system) for prostate cancer

    International Nuclear Information System (INIS)

    Bohrer, Markus; Schroeder, Peter; Welzel, Grit; Wertz, Hansjoerg; Lohr, Frank; Wenz, Frederik; Mai, Sabine Kathrin

    2008-01-01

    To evaluate the effect of image guided radiotherapy with stereotactic ultrasound BAT (B-mode acquisition and targeting system) on rectal toxicity in conformal radiotherapy of prostate cancer. Patients and Methods 42 sequential patients with prostate cancer undergoing radiotherapy before and after the introduction of BAT were included. Planning computed tomography (CT) was performed with empty rectum and moderately filled bladder. The planning target volume (PTV) included the prostate and seminal vesicles with a safety margin of 1.5 cm in anterior and lateral direction. In posterior direction the anterior 1/3 of the rectum circumference were included. Total dose was 66 Gy and a boost of 4 Gy excluding the seminal vesicles. 22 patients (BAT group) were treated with daily stereotactic ultrasound positioning, for the other 20 patients (NoBAT group) an EPID (electronic portal imaging device) was performed once a week. Acute and late genito-urinary (GU) and rectal toxicity and PSA values were evaluated after 1.5, 3, 6, 9 and 12 months. The total median follow up of toxicity was 3 years in the BAT group and 4 years in the NoBAT group. Results In the NoBAT group significant more rectal toxicity occurred, while in GU toxicity no difference was seen. Two patients in the NoBAT group showed late rectal toxicity grade 3, no toxicity > grade 2 occurred in the BAT group. There was no significant difference in PSA reduction between the groups. Conclusion Without BAT significant more acute and a trend to more late rectal toxicity was found. With regard to dose escalation this aspect is currently evaluated with a larger number of patients using intensity-modulated radiotherapy (IMRT). (orig.)

  2. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression

    Energy Technology Data Exchange (ETDEWEB)

    Kil, Whoon Jong; Nichols, Romaine C. Jr. [Dept. of Radiation Oncology, Univ. of Florida, Gainesville (United States); Univ. of Florida Proton Therapy Inst., Jacksonville (United States)], e-mail: rnichols@floridaproton.org; And others

    2013-04-15

    Background: To investigate post-treatment changes in serum testosterone in low- and intermediate-risk prostate cancer patients treated with hypofractionated passively scattered proton radiotherapy. Material and methods: Between April 2008 and October 2011, 228 patients with low- and intermediate-risk prostate cancer were enrolled into an institutional review board-approved prospective protocol. Patients received doses ranging from 70 Cobalt Gray Equivalent (CGE) to 72.5 CGE at 2.5 CGE per fraction using passively scattered protons. Three patients were excluded for receiving androgen deprivation therapy (n = 2) or testosterone supplementation (n = 1) before radiation. Of the remaining 226 patients, pretreatment serum testosterone levels were available for 217. Of these patients, post-treatment serum testosterone levels were available for 207 in the final week of treatment, 165 at the six-month follow-up, and 116 at the 12-month follow-up. The post-treatment testosterone levels were compared with the pretreatment levels using Wilcoxon's signed-rank test for matched pairs. Results: The median pretreatment serum testosterone level was 367.7 ng/dl (12.8 nmol/l). The median changes in post-treatment testosterone value were as follows: +3.0 ng/dl (+0.1 nmol/l) at treatment completion; +6.0 ng/dl (+0.2 nmol/l) at six months after treatment; and +5.0 ng/dl (0.2 nmol/l) at 12 months after treatment. None of these changes were statistically significant. Conclusion: Patients with low- and intermediate-risk prostate cancer treated with hypofractionated passively scattered proton radiotherapy do not experience testosterone suppression. Our findings are consistent with physical measurements demonstrating that proton radiotherapy is associated with less scatter radiation exposure to tissues beyond the beam paths compared with intensity-modulated photon radiotherapy.

  3. Late gastrointestinal and urogenital side-effects after radiotherapy – Incidence and prevalence. Subgroup-analysis within the prospective Austrian–German phase II multicenter trial for localized prostate cancer

    International Nuclear Information System (INIS)

    Schmid, Maximilian P.; Pötter, Richard; Bombosch, Valentin; Sljivic, Samir; Kirisits, Christian; Dörr, Wolfgang; Goldner, Gregor

    2012-01-01

    Purpose: In general late side-effects after prostate cancer radiotherapy are presented by the use of actuarial incidence rates. The aim of this analysis was to describe additional relevant aspects of late side effects after prostate cancer radiotherapy. Materials and methods: All 178 primary prostate-cancer patients were treated within the Austrian–German multicenter trial by three-dimensional radiotherapy up to a local dose of 70 Gy (low/intermediate-risk) or 74 Gy (high-risk), respectively. Late gastrointestinal/urogenital (GI/GU) side-effects were prospectively assessed by the use of EORTC/RTOG score. Maximum side-effects, actuarial incidence rate and prevalence rates, initial appearance and duration of ⩾grade 2 toxicity were evaluated. Results: Median follow-up was 74 months. Late GI/GU side-effects ⩾grade 2 were detected in 15% (27/178) and 22% (40/178). The corresponding 5-year actuarial incidence rates for GI/GU side-effects were 19% and 23%, whereas the prevalence was 1–2% and 2–7% after 5 years, respectively. Late side effects ⩾grade 2 appeared within 5 years after radiotherapy in all patients with GI side-effects (27/27) and in 85% (34/40) of the patients with GU side-effects, respectively and lasted for less than 3 years in 90% (GI) and 98% (GU). Conclusions: This study demonstrates that the majority of late GI and GU side effects after primary external beam radiotherapy for prostate cancer are transient. Using only actuarial incidence rates for reporting side effects may lead to misinterpretation or overestimation. The combination of incidence and prevalence rates provides a more comprehensive view on the complex issue of late side effects.

  4. Retrospective evaluation of positional movements of patients with prostate cancer submitted to IGRT (radiotherapy guided by image)

    International Nuclear Information System (INIS)

    Rocha, N.K.S.; Filipov, D.; Soboll, D.S.

    2017-01-01

    It is a retrospective study that analyzed positional fluctuations of 29 patients submitted to prostate radiotherapy, using IGRT. The minimum and maximum averages of the lateral, longitudinal and vertical displacements were calculated, obtaining a general average of the displacements that remained close to zero and one the most evident variation between the lateral and vertical axes

  5. Analysis of the testicular dose in patients undergoing radiotherapy for carcinoma of the prostate; Analisis de las dosis testiculares en pacientes sometidos a tratamiento radioterapico de carcinoma de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Bejar Navarro, M. J.; Ordonez Marquez, J.; Hervas Moron, A.; Alvarez Rodriguez, S.; Garcia-Galloway, E.; Sanchez Casanueva, R.; Polo Rubio, A.; Rodriguez-Patron, R.; Yanowsky, K.; Gomez Dos Santos, V.

    2013-07-01

    The objectives of this work are: -Studying comparatively the doses received in testes in patients undergoing radiotherapy of prostate carcinoma with external beam radiation and brachytherapy of low rate using I-125 seeds. -Compare doses due to images of verification using Cone Beam CT (CBCT), with doses of radiotherapy treatment itself. -Determine the seminal alterations and cytogenetic after treatment with ionizing radiation (RTE or BQT) in patients diagnosed with prostate cancer and its relation with testicular dose. (Author)

  6. Assessment of accuracy and efficiency of atlas-based autosegmentation for prostate radiotherapy in a variety of clinical conditions

    Energy Technology Data Exchange (ETDEWEB)

    Simmat, I. [Medical Univ. Vienna/AKH Vienna (Austria). Div. of Medical Radiation Physics; Georg, P.; Georg, D.; Goldner, G.; Stock, M. [Medical Univ. Vienna/AKH Vienna (Austria). Div. of Medical Radiation Physics; Medical Univ. Vienna (Austria). Christian Doppler Lab. for Medical Radiation Research for Radiation Oncology; Birkfellner, W. [Medical Univ. Vienna (Austria). Center for Medical Physics and Biomedical Engineering; Medical Univ. Vienna (Austria). Christian Doppler Lab. for Medical Radiation Research for Radiation Oncology

    2012-09-15

    Background and purpose: The goal of the current study was to evaluate the commercially available atlas-based autosegmentation software for clinical use in prostate radiotherapy. The accuracy was benchmarked against interobserver variability. Material and methods: A total of 20 planning computed tomographs (CTs) and 10 cone-beam CTs (CBCTs) were selected for prostate, rectum, and bladder delineation. The images varied regarding to individual (age, body mass index) and setup parameters (contrast agent, rectal balloon, implanted markers). Automatically created contours with ABAS {sup registered} and iPlan {sup registered} were compared to an expert's delineation by calculating the Dice similarity coefficient (DSC) and conformity index. Results: Demo-atlases of both systems showed different results for bladder (DSC{sub ABAS} 0.86 {+-} 0.17, DSC{sub iPlan} 0.51 {+-} 0.30) and prostate (DSC{sub ABAS} 0.71 {+-} 0.14, DSC{sub iPlan} 0.57 {+-} 0.19). Rectum delineation (DSC{sub ABAS} 0.78 {+-} 0.11, DSC{sub iPlan} 0.84 {+-} 0.08) demonstrated differences between the systems but better correlation of the automatically drawn volumes. ABAS {sup registered} was closest to the interobserver benchmark. Autosegmentation with iPlan {sup registered}, ABAS {sup registered} and manual segmentation took 0.5, 4 and 15-20 min, respectively. Automatic contouring on CBCT showed high dependence on image quality (DSC bladder 0.54, rectum 0.42, prostate 0.34). Conclusion: For clinical routine, efforts are still necessary to either redesign algorithms implemented in autosegmentation or to optimize image quality for CBCT to guarantee required accuracy and time savings for adaptive radiotherapy. (orig.)

  7. Assessment of accuracy and efficiency of atlas-based autosegmentation for prostate radiotherapy in a variety of clinical conditions

    International Nuclear Information System (INIS)

    Simmat, I.; Georg, P.; Georg, D.; Goldner, G.; Stock, M.; Medical Univ. Vienna; Birkfellner, W.; Medical Univ. Vienna

    2012-01-01

    Background and purpose: The goal of the current study was to evaluate the commercially available atlas-based autosegmentation software for clinical use in prostate radiotherapy. The accuracy was benchmarked against interobserver variability. Material and methods: A total of 20 planning computed tomographs (CTs) and 10 cone-beam CTs (CBCTs) were selected for prostate, rectum, and bladder delineation. The images varied regarding to individual (age, body mass index) and setup parameters (contrast agent, rectal balloon, implanted markers). Automatically created contours with ABAS registered and iPlan registered were compared to an expert's delineation by calculating the Dice similarity coefficient (DSC) and conformity index. Results: Demo-atlases of both systems showed different results for bladder (DSC ABAS 0.86 ± 0.17, DSC iPlan 0.51 ± 0.30) and prostate (DSC ABAS 0.71 ± 0.14, DSC iPlan 0.57 ± 0.19). Rectum delineation (DSC ABAS 0.78 ± 0.11, DSC iPlan 0.84 ± 0.08) demonstrated differences between the systems but better correlation of the automatically drawn volumes. ABAS registered was closest to the interobserver benchmark. Autosegmentation with iPlan registered , ABAS registered and manual segmentation took 0.5, 4 and 15-20 min, respectively. Automatic contouring on CBCT showed high dependence on image quality (DSC bladder 0.54, rectum 0.42, prostate 0.34). Conclusion: For clinical routine, efforts are still necessary to either redesign algorithms implemented in autosegmentation or to optimize image quality for CBCT to guarantee required accuracy and time savings for adaptive radiotherapy. (orig.)

  8. Linked statistical shape models for multi-modal segmentation: application to prostate CT-MR segmentation in radiotherapy planning

    Science.gov (United States)

    Chowdhury, Najeeb; Chappelow, Jonathan; Toth, Robert; Kim, Sung; Hahn, Stephen; Vapiwala, Neha; Lin, Haibo; Both, Stefan; Madabhushi, Anant

    2011-03-01

    We present a novel framework for building a linked statistical shape model (LSSM), a statistical shape model (SSM) that links the shape variation of a structure of interest (SOI) across multiple imaging modalities. This framework is particularly relevant in scenarios where accurate delineations of a SOI's boundary on one of the modalities may not be readily available, or difficult to obtain, for training a SSM. We apply the LSSM in the context of multi-modal prostate segmentation for radiotherapy planning, where we segment the prostate on MRI and CT simultaneously. Prostate capsule segmentation is a critical step in prostate radiotherapy planning, where dose plans have to be formulated on CT. Since accurate delineations of the prostate boundary are very difficult to obtain on CT, pre-treatment MRI is now beginning to be acquired at several medical centers. Delineation of the prostate on MRI is acknowledged as being significantly simpler to do compared to CT. Hence, our framework incorporates multi-modal registration of MRI and CT to map 2D boundary delineations of prostate (obtained from an expert radiation oncologist) on MR training images onto corresponding CT images. The delineations of the prostate capsule on MRI and CT allows for 3D reconstruction of the prostate shape which facilitates the building of the LSSM. We acquired 7 MRI-CT patient studies and used the leave-one-out strategy to train and evaluate our LSSM (fLSSM), built using expert ground truth delineations on MRI and MRI-CT fusion derived capsule delineations on CT. A unique attribute of our fLSSM is that it does not require expert delineations of the capsule on CT. In order to perform prostate MRI segmentation using the fLSSM, we employed a regionbased approach where we deformed the evolving prostate boundary to optimize a mutual information based cost criterion, which took into account region-based intensity statistics of the image being segmented. The final prostate segmentation was then

  9. Patient-reported lower urinary tract symptoms, urinary incontinence, and quality of life after external beam radiotherapy for localized prostate cancer - 15 years' follow-up. A comparison with age-matched controls

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, Per (Dept. of Radiation Sciences, Oncology, Umeaa Univ., Umeaa (Sweden))

    2008-06-15

    Background. To prospectively examine the urinary toxicity and quality of life (QOL) in patients 15 years after external beam radiotherapy (EBRT) for localized prostate cancer (LPC) and compare the outcomes with results for age-matched controls. Material and methods. Urinary symptoms were assessed using the symptom-specific Prostate Cancer Symptom Scale (PCSS) questionnaire, and QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC)'s Quality of Life Questionnaire (QLQ-C30). Both questionnaires were sent to the surviving 41 patients (25%) and the PCSS questionnaire was sent to 69 age-matched controls for comparison. Results. The response rate was 71% in the patient group and 59% in the control group. Two patients and four controls were excluded due to other cancer diagnoses, resulting in a total of 27 patients and 37 controls for inclusion in the analyses. The mean age in both groups was 78 years. In the patient group, incontinence had increased between the 8-year (mean=0.6) and the 15-year follow-up (mean=2.1; p=0.038). No other differences in urinary problems were seen between these two follow-ups. Increased incontinence, stress incontinence, and pain while urinating were reported by the patients in comparison with the controls at 15 years. Role function was worse in the patient group (mean=67.3) compared with the controls (mean=82.4; p=0.046). The patients also reported more appetite loss, diarrhea, nausea/vomiting, and pain than the controls. Conclusion. EBRT for LPC has divergent effects on urinary symptoms and QOL in comparison with age-matched controls. In our patient population, urinary incontinence increased between 8 and 15 years of follow-up. Otherwise, no differences in urinary symptoms were seen between 4 and 15 years. Incontinence, stress incontinence, and pain while urinating were increased after EBRT in comparison with the controls. Conventional EBRT did not result in a major deterioration in QOL 15 years

  10. Dose perturbation due to the presence of a prostatic urethral stent in patients receiving pelvic radiotherapy: an in vitro study.

    Science.gov (United States)

    Gez, E; Cederbaum, M; Yachia, D; Bar-Deroma, R; Kuten, A

    1997-01-01

    Temporary metallic intraprostatic stent is a new alternative treatment for patients with urinary obstructive syndrome caused by prostate cancer. Definitive radiotherapy is a treatment of choice for localized prostate cancer. This study evaluates in vitro the effect of a urethral intraprostatic metallic stent on the dose absorbed by the surrounding tissue. The study was designed to mimic the conditions under which the prostatic stent is placed in the body during pelvic irradiation. A urethral stent composed of a 50% nickel-50% titanium alloy (Uracoil-InStent) was imbedded in material mimicking normal tissue (bolus) at a simulated body depth of 10 cm. The distribution of the absorbed dose of irradiation was determined by film dosimetry using Kodak X-Omat V film. Irradiation was done in a single field at the isocenter of a 6 MV linear accelerator with a field size of 7 x 7 cm. The degree of film blackening was in direct proportion to the absorbed dose. The measurements showed an increase in dose of up to 20% immediately before the stent and a decrease of up to 18% immediately after the stent. These changes occurred within a range of 1-3 mm from both sides of the stent. In practice, irradiation in prostate cancer is given by two pairs of opposed co-axial fields; a total of four fields (Box Technique). The dose perturbations are partly cancelled in a pair of opposed beams resulting in a net variation of +/- 4%; therefore, the presence of the intraprostatic stent should not influence radiotherapy planning for prostate cancer.

  11. Evidence-based estimate of appropriate radiotherapy utilization rate for prostate cancer

    International Nuclear Information System (INIS)

    Foroudi, Farshad; Tyldesley, Scott; Barbera, Lisa; Huang, Jenny; Mackillop, William J.

    2003-01-01

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. The objective of this study was to use an evidence-based approach to estimate the proportion of incident cases of prostate cancer that should receive RT at any point in the evolution of the illness. Methods and Materials: A systematic review of the literature was undertaken to identify indications for RT for prostate cancer and to ascertain the level of evidence that supported each indication. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of prostate cancer patients. The effect of sampling error on the estimated appropriate rate of RT was calculated mathematically, and the effect of systematic error using alternative sources of information was estimated by sensitivity analysis. Results: It was estimated that 61.2% ±5.6% of prostate cancer cases develop one or more indications for RT at some point in the course of the illness. The plausible range for this rate was 57.3%-69.8% on sensitivity analysis. Of all prostate cancer patients, 32.2%±3.8% should receive RT in their initial treatment and 29.0% ± 4.1% later for recurrence or progression. The proportion of cases that ever require RT is risk grouping dependent; 43.9%±2.2% in low-risk disease, 68.7%± .5% in intermediate-risk disease; and 79.0% ± 3.8% in high-risk locoregional disease. For metastatic disease, the predicted rate was 66.4%±0.3%. Conclusion: This method provides a rational starting point for the long-term planning of radiation services and for the audit of access to RT at the population level. By completing such evaluations in major cancer sites, it will be possible to estimate the appropriate RT rate for the cancer population as a whole

  12. The specific role of radiotherapy in the management of prostate carcinoma at different stages of tumor development

    International Nuclear Information System (INIS)

    Huber, J.

    1987-01-01

    The study described here was based on the case reports of 135 patients of the Radiological Department at Kiel's University Hospital, who were treated for carcinomas of the prostate at any time during the period between 1965 and 1980. It was the aim of these evaluations to define the particular role of radiotherapy in the management of carcinomas of the prostate and to compare it to that of other methods of treatment (hormones, surgery). Percutaneous local irradiation of the carcinoma or irradiation of metastases were the criteria of inclusion into this retrospective study. The stage of the tumour was a decisive factor in the final analysis of the results. (orig.) [de

  13. MRI before and after external beam intensity-modulated radiotherapy of patients with prostate cancer: The feasibility of monitoring of radiation-induced tissue changes using a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence

    International Nuclear Information System (INIS)

    Franiel, Tobias; Luedemann, Lutz; Taupitz, Matthias; Boehmer, Dirk; Beyersdorff, Dirk

    2009-01-01

    Purpose: To identify and quantify suitable pharmacokinetic MRI parameters for monitoring tissue changes after external beam intensity-modulated radiotherapy of prostate cancer. Material and methods: Six patients with biopsy-proven prostate cancer (initial PSA, 6.0-81.4 ng/ml) underwent MRI at 1.5 T using a combined endorectal/body phased-array coil and a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (T1/T2*w; 1.65 s temporal resolution). MRI was performed before and immediately after radiotherapy, at 3 months and at 1 year. Perfusion, blood volume, mean transit time, delay, dispersion, interstitial volume, and extraction coefficient were calculated in prostate cancer and normal prostate for all four time points using a sequential 3-compartment model. Results: Prostate cancer and normal prostate tissue showed a statistically significant decrease in perfusion (p = 0.006, p = 0.001) and increase in extraction coefficient (p = 0.004, p 3 min, p = 0.028) and a smaller extraction coefficient (0.42 vs. 0.64, p = 0.028). Conclusions: Two pharmacokinetic parameters, perfusion and extraction coefficient, appear to be suitable candidates for monitoring the response to percutaneous intensity-modulated radiotherapy of prostate cancer.

  14. Magnetic resonance only workflow and validation of dose calculations for radiotherapy of prostate cancer

    DEFF Research Database (Denmark)

    Lübeck Christiansen, Rasmus; Jensen, Henrik R.; Brink, Carsten

    2017-01-01

    Background: Current state of the art radiotherapy planning of prostate cancer utilises magnetic resonance (MR) for soft tissue delineation and computed tomography (CT) to provide an electron density map for dose calculation. This dual scan workflow is prone to setup and registration error....... This study evaluates the feasibility of an MR-only workflow and the validity of dose calculation from an MR derived pseudo CT. Material and methods: Thirty prostate cancer patients were CT and MR scanned. Clinical treatment plans were generated on CT using a single 18 MV arc volumetric modulated arc therapy...... was successfully delivered to one patient, including manually performed daily IGRT. Conclusions: Median gamma pass rates were high for pseudo CT and proved superior to uniform density. Local differences in dose calculations were concluded not to have clinical relevance. Feasibility of the MR-only workflow...

  15. The radiobiology of prostate cancer including new aspects of fractionated radiotherapy

    International Nuclear Information System (INIS)

    Fowler, Jack F.

    2005-01-01

    Total radiation dose is not a reliable measure of biological effect when dose-per-fraction or dose-rate is changed. Large differences in biological effectiveness (per gray) are seen between the 2 Gy doses of external beam radiotherapy and the large boost doses given at high dose-rate from afterloading sources. The effects are profoundly different in rapidly or slowly proliferating tissues, that is for most tumors versus late complications. These differences work the opposite way round for prostate tumors versus late complications compared with most other types of tumor. Using the Linear-Quadratic formula it is aimed to explain these differences, especially for treatments of prostate cancer. The unusually slow growth rate of prostate cancers is associated with their high sensitivity to increased fraction size, so a large number of small fractions, such as 35 or 40 'daily' doses of 2 Gy, is not an optimum treatment. Theoretical modeling shows a stronger enhancement of tumor effect than of late complications for larger (and fewer) fractions, in prostate tumors uniquely. Biologically Effective Doses and Normalized Total Doses (in 2 Gy fraction equivalents) are given for prostate tumor, late rectal reactions, and - a new development - acute rectal mucosa. Tables showing the change of fraction-size sensitivity (the alpha/beta ratio) with proliferation rates of tissues lead to the association of slow cell doubling times in prostate tumors with small alpha/beta ratios. Clinical evidence to confirm this biological expectation is reviewed. The alpha/beta ratios of prostate tumors appear to be as low as 1.5 Gy (95% confidence interval 1.3-1.8 Gy), in contrast with the value of about 10 Gy for most other types of tumor. The important point is that alpha/beta ratio=1.5 Gy appears to be significantly less than the alpha/beta ratio=3 Gy for late complications in rectal tissues. Such differences are also emerging from recent clinical results. From this important difference stems

  16. Radiotherapy in prostate cancer treatment: Results of the patterns of care study in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ah Ram; Park, Won [Division for Urologic Cancer, Korean Radiation Oncology Group, Seoul (Korea, Republic of)

    2017-03-15

    The purpose of this study was to describe treatment patterns of radiotherapy (RT) for prostate cancer in Korea. A questionnaire about radiation treatment technique and principles in 2013 was sent to 83 radiation oncologists and data from 57 hospitals were collected analyzed to find patterns of RT for prostate cancer patients in Korea. The number of patients with prostate cancer treated with definitive RT ranged from 1 to 72 per hospital in 2013. RT doses and target volumes increased according to risk groups but the range of radiation doses was wide (60 to 81.4 Gy) and the fraction size was diverse (1.8 to 5 Gy). Intensity-modulated radiation therapy was used for definitive treatment in 93.8% of hospitals. Hormonal therapy was integrated with radiation for intermediate (63.2%) and high risk patients (77.2%). Adjuvant RT after radical prostatectomy was performed in 46 hospitals (80.7%). Indications of adjuvant RT included positive resection margin, seminal vesicle invasion, and capsular invasion. The total dose for adjuvant RT ranged from 50 to 72 Gy in 24–39 fractions. Salvage RT was delivered with findings of consecutive elevations in prostate-specific antigen (PSA), PSA level over 0.2 ng/mL, or clinical recurrence. The total radiation doses ranged from 50 to 80 Gy with a range of 1.8 to 2.5 Gy per fraction for salvage RT. This nationwide patterns of care study suggests that variable radiation techniques and a diverse range of dose fractionation schemes are applied for prostate cancer treatment in Korea. Standard guidelines for RT in prostate cancer need to be developed.

  17. A criterion-based audit of the technical quality of external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Brundage, Michael; Danielson, Brita; Pearcey, Robert; Bass, Brenda; Pickles, Tom; Bahary, Jean-Paul; Peng, Yingwei; Wallace, David; Mackillop, William

    2013-01-01

    Purpose: To evaluate the technical quality of external beam radiotherapy for prostate cancer in Canada. Methods: This was a multi-institution, retrospective study of a random sample of patients undergoing radiotherapy (RT) for prostate cancer in Canada. Patterns of care were determined by abstracting details of the patients’ management from original records. The quality of patient’s technical care was measured against a previously published, comprehensive suite of quality indicators. Results: 32 of the 37 RT centres participated. The total study population of 810 patients included 25% low-risk, 44% intermediate-risk, and 28% high-risk cases. 649 received external beam RT (EBRT) only, for whom compliance with 12 indicators of the quality of pre-treatment assessment ranged from 56% (sexual function documented) to 96% (staging bone scan obtained in high-risk patients). Compliance with treatment-related indicators ranged from 78% (dose to prostate ⩾74 Gy in intermediate risk patients not receiving hormone therapy) to 100% (3DCRT or IMRT plan). Compliance varied among centres; no centre demonstrated 100% compliance on all indicators and every centre was 100% compliant on at least some indicators. The number of assessment-related indicators (n = 13) with which a given centre was 100% compliant ranged from 4 to 11 (median 7) and the number of the treatment-specific indicators (n = 8) with which a given centre was 100% compliant ranged from 6 to 8 (median 8). ADT therapy was utilised in most high-risk cases (191, 92.3%). Conclusions: While patterns of prostate cancer care in Canada vary somewhat, compliance on the majority of quality indicators is very high. However, all centres showed room for improvement on several indicators and few individual patients received care that met target benchmarks on all quality measures. This variation is particularly important for indicators such as delivered dose where impact on disease outcome is known to exist, and suggests that

  18. Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland. A survey on patterns of practice

    Energy Technology Data Exchange (ETDEWEB)

    Panje, Cedric M. [Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland); Universitaetsspital Zuerich, Department of Radiation Oncology, Zurich (Switzerland); Dal Pra, Alan [Inselspital Bern, Department of Radiation Oncology, Bern (Switzerland); Zilli, Thomas [Hopitaux Universitaires de Geneve, Department of Radiation Oncology, Geneva (Switzerland); Zwahlen, Daniel R. [Kantonsspital Graubuenden, Department of Radiation Oncology, Chur (Switzerland); Papachristofilou, Alexandros [Universitaetsspital Basel, Department of Radiation Oncology, Basel (Switzerland); Herrera, Fernanda G. [Centre Hospitalier Universitaire Vaudois, Department of Radiation Oncology, Lausanne (Switzerland); Matzinger, Oscar [Hopital Riviera-Chablais, Department of Radiation Oncology, Vevey (Switzerland); Plasswilm, Ludwig; Putora, Paul Martin [Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland)

    2015-10-15

    External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer. Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration. Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland. Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers. Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool. Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed. The most commonly prescribed radiation dose was 78 Gy (range 70-80 Gy) across all risk groups. ADT was recommended for intermediate-risk patients for 6 months in over 80 % of the centers, and for high-risk patients for 2 or 3 years in over 90 % of centers. For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39 % in any clinical scenario. Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96 % of the centers. Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer. In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines. (orig.) [German] Die Radiotherapie (RT) ist als Monotherapie oder in Kombination mit einer Androgendeprivationstherapie (ADT) eine etablierte Behandlungsoption fuer das lokalisierte und lokal fortgeschrittene Prostatakarzinom. Trotz der guten Evidenzlage durch zahlreiche

  19. A Comparison of In-Room Computerized Tomography Options for Detection of Fiducial Markers in Prostate Cancer Radiotherapy

    International Nuclear Information System (INIS)

    Owen, Rebecca; Foroudi, Farshad; Kron, Tomas; Milner, Alvin; Cox, Jennifer; Cramb, Jim; Zhu Li; Duchesne, Gillian

    2010-01-01

    Purpose: To compare volumetric in-room computed tomography (CT) and kilovoltage (kV) cone-beam CT (CBCT) to planar imaging with respect to their ability to localize fiducial markers (FMs) for radiotherapy of prostate cancer. Methods and Materials: Image guidance options from two linear accelerators were compared in terms of identifying the center of gravity (COG) of FMs from the isocenter: a Siemens Primatom, where the couch is rotated 180 degrees from the treatment isocenter to the in-room CT vs. electronic portal imaging (EPI); and a Varian OBI system, where kV CBCT, EPI, and planar kV radiographs were compared. In all, 387 image pairs (CBCT = 133; CT = 254) from 18 patients were analyzed. A clinical tolerance of 3 mm was predefined as the acceptable threshold for agreement. Results: COG location on in-room CT and EPI was in agreement 96.9%, 85.8%, and 89.0% of the time in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, respectively, vs. 99.2%, 91.7%, and 93.2% for the CBCT and EPI analysis. The CBCT vs. kV radiographs were in agreement 100% (LR), 85.4% (SI), and 88.5% (AP), and EPI vs. kV radiographs were in agreement 100% (LR), 94.6% (SI), and 91.5% (AP) of the time. Conclusion: Identification of FMs on volumetric or planar images was found to be not equivalent (±3 mm) using either linear accelerator. Intrafraction prostate motion, interpretation of FM location, and spatial properties of images are contributing factors. Although in-room CT has superior image quality, the process of realigning the treatment couch to acquire a CT introduces an error, highlighting the benefits of a single isocentric system.

  20. Prospective assessment of the quality of life before, during and after image guided intensity modulated radiotherapy for prostate cancer

    DEFF Research Database (Denmark)

    Sveistrup, Joen; Mortensen, Ole Steen; Bjørner, Jakob B.

    2016-01-01

    BACKGROUND: Radiotherapy (RT) in combination with androgen deprivation therapy (ADT) for prostate cancer (PCa) carries a risk of gastrointestinal (GI) and genitourinary toxicity, which might affect the quality of life (QoL). The purpose of this study was to assess the QoL in patients with PCa bef...

  1. Concurrent segmentation of the prostate on MRI and CT via linked statistical shape models for radiotherapy planning

    International Nuclear Information System (INIS)

    Chowdhury, Najeeb; Toth, Robert; Chappelow, Jonathan; Kim, Sung; Motwani, Sabin; Punekar, Salman; Lin Haibo; Both, Stefan; Vapiwala, Neha; Hahn, Stephen; Madabhushi, Anant

    2012-01-01

    Purpose: Prostate gland segmentation is a critical step in prostate radiotherapy planning, where dose plans are typically formulated on CT. Pretreatment MRI is now beginning to be acquired at several medical centers. Delineation of the prostate on MRI is acknowledged as being significantly simpler to perform, compared to delineation on CT. In this work, the authors present a novel framework for building a linked statistical shape model (LSSM), a statistical shape model (SSM) that links the shape variation of a structure of interest (SOI) across multiple imaging modalities. This framework is particularly relevant in scenarios where accurate boundary delineations of the SOI on one of the modalities may not be readily available, or difficult to obtain, for training a SSM. In this work the authors apply the LSSM in the context of multimodal prostate segmentation for radiotherapy planning, where the prostate is concurrently segmented on MRI and CT. Methods: The framework comprises a number of logically connected steps. The first step utilizes multimodal registration of MRI and CT to map 2D boundary delineations of the prostate from MRI onto corresponding CT images, for a set of training studies. Hence, the scheme obviates the need for expert delineations of the gland on CT for explicitly constructing a SSM for prostate segmentation on CT. The delineations of the prostate gland on MRI and CT allows for 3D reconstruction of the prostate shape which facilitates the building of the LSSM. In order to perform concurrent prostate MRI and CT segmentation using the LSSM, the authors employ a region-based level set approach where the authors deform the evolving prostate boundary to simultaneously fit to MRI and CT images in which voxels are classified to be either part of the prostate or outside the prostate. The classification is facilitated by using a combination of MRI-CT probabilistic spatial atlases and a random forest classifier, driven by gradient and Haar features

  2. Association of genetic variants in VEGF-A with clinical recurrence in prostate cancer patients treated with definitive radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Langsenlehner, T.; Thurner, E.M.; Kapp, K.S. [Medical University of Graz, Department of Therapeutic Radiology and Oncology, Graz (Austria); Renner, W. [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz (Austria); Gerger, A. [Medical University of Graz, Division of Oncology, Department of Internal Medicine, Graz (Austria); Langsenlehner, U. [GKK Outpatient Department, Division of Internal Medicine, Graz (Austria)

    2014-04-15

    Vascular endothelial growth factor-A (VEGF-A), a key regulator of tumor-induced angiogenesis, is critical for tumor growth and metastasization. The goal of the present study was to evaluate the prognostic value of VEGF single nucleotide polymorphisms (SNPs) and haplotypes for clinical recurrence after definitive radiotherapy for prostate cancer. The association of seven VEGF-A polymorphisms and their haplotypes with clinical recurrence (defined as the occurrence of local recurrence and/or distant metastases) in 496 prostate cancer patients treated with definitive radiotherapy were investigated. Genotypes were determined by 5'-nuclease (TaqMan) assays; haplotypes were analyzed using the Haploview program. Within a median follow-up time of 80 months, 44 patients (9%) developed clinical recurrences. Haplotype analysis showed two separate blocks of high-linkage disequilibrium, formed by five polymorphisms (-2578C > A, -2489C > T, -1498C > T, -634G > C, -7C > T) upstream of the coding sequence (CCCCC, ATTGC, CCCGC, ATTGT) and two polymorphisms (936C > T, 1612G > A) downstream of the coding sequence (CA, CG, TG). Carriers of at least 1 copy of the ATTGC haplotype were at higher risk of recurrence (hazard ratio [HR] 3.83; 95%CI 1.48-9.90, p=0.006); for carriers of 2 copies, the HR was 4.85 (95%CI 1.72-13.6; p=0.003). In multivariate analysis, patients harboring at least one copy of the ATTGC haplotype remained at increased risk of recurrence (HR 3.63, 95%CI 1.38-9.55, p=0.009); in patients carrying 2 copies, the HR was 4.72 (95%CI 1.64-13.6, p=0.004). Our findings indicate that the VEGF-A ATTGC haplotype may predict clinical recurrence in prostate cancer patients treated with radiotherapy. (orig.)

  3. SU-E-T-547: A Method to Correlate Treatment Planning Issue with Clinical Analysis for Prostate Stereotactic Body Radiotherapy (SBRT)

    International Nuclear Information System (INIS)

    Li, K; Jung, E; Newton, J; Cornell, D; Able, A

    2014-01-01

    Purpose: In this study, the algorithms and calculation setting effect and contribution weighing on prostate Volumetric Modulated Arc Therapy (VMAT) based SBRT were evaluated for clinical analysis. Methods: A low risk prostate patient under SBRT was selected for the treatment planning evaluation. The treatment target was divided into low dose prescription target volume (PTV) and high Dose PTV. Normal tissue constraints include urethra and femur head, and rectum was separated into anterior, lateral and posterior parts. By varying the constraint limit of treatment plan calculation setting and algorithms, the effect on dose coverage and normal tissue dose constraint parameter carried effective comparison for the nominal prescription and constraint. For each setting, their percentage differences to the nominal value were calculated with geometric mean and harmonic mean. Results: In the arbitrary prostate SBRT case, 14 variables were selected for this evaluation by using nominal prescription and constraint. Six VMAT planning settings were anisotropic analytic algorithm stereotactic beam with and without couch structure in grid size of 1mm and 2mm, non stereotactic beam, Acuros algorithm . Their geometry means of the variable sets for these plans were 112.3%, 111.9%, 112.09%, 111.75%, 111.28%, and 112.05%. And the corresponding harmonic means were 2.02%, 2.16%, 3.15%, 4.74%, 5.47% and 5.55%. Conclusions: In this study, the algorithm difference shows relatively larger harmonic mean between prostate SBRT VMAT plans. This study provides a methodology to find sensitive combined variables related to clinical analysis, and similar approach could be applied to the whole treatment procedure from simulation to treatment in radiotherapy for big clinical data analysis

  4. SU-E-T-547: A Method to Correlate Treatment Planning Issue with Clinical Analysis for Prostate Stereotactic Body Radiotherapy (SBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Li, K; Jung, E; Newton, J [Associates In Medical Physics, Lanham, MD (United States); John R Marsh Cancer Center, Hagerstown, MD (United States); Cornell, D [John R Marsh Cancer Center, Hagerstown, MD (United States); Able, A [Associates In Medical Physics, Lanham, MD (United States)

    2014-06-01

    Purpose: In this study, the algorithms and calculation setting effect and contribution weighing on prostate Volumetric Modulated Arc Therapy (VMAT) based SBRT were evaluated for clinical analysis. Methods: A low risk prostate patient under SBRT was selected for the treatment planning evaluation. The treatment target was divided into low dose prescription target volume (PTV) and high Dose PTV. Normal tissue constraints include urethra and femur head, and rectum was separated into anterior, lateral and posterior parts. By varying the constraint limit of treatment plan calculation setting and algorithms, the effect on dose coverage and normal tissue dose constraint parameter carried effective comparison for the nominal prescription and constraint. For each setting, their percentage differences to the nominal value were calculated with geometric mean and harmonic mean. Results: In the arbitrary prostate SBRT case, 14 variables were selected for this evaluation by using nominal prescription and constraint. Six VMAT planning settings were anisotropic analytic algorithm stereotactic beam with and without couch structure in grid size of 1mm and 2mm, non stereotactic beam, Acuros algorithm . Their geometry means of the variable sets for these plans were 112.3%, 111.9%, 112.09%, 111.75%, 111.28%, and 112.05%. And the corresponding harmonic means were 2.02%, 2.16%, 3.15%, 4.74%, 5.47% and 5.55%. Conclusions: In this study, the algorithm difference shows relatively larger harmonic mean between prostate SBRT VMAT plans. This study provides a methodology to find sensitive combined variables related to clinical analysis, and similar approach could be applied to the whole treatment procedure from simulation to treatment in radiotherapy for big clinical data analysis.

  5. The proportion of prostate biopsy tissue with Gleason pattern 4 or 5 predicts for biochemical and clinical outcome after radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    D'Ambrosio, David J.; Hanlon, Alexandra L.; Al-Saleem, Tahseen; Feigenberg, Steven J.; Horwitz, Eric M.; Uzzo, Robert G.; Pollack, Alan; Buyyounouski, Mark K.

    2007-01-01

    Purpose: To investigate the prognostic utility of the proportion of prostate biopsy tissue containing Gleason pattern 4 or 5 (GP4/5) after definitive radiotherapy (RT) for prostate cancer. Methods and Materials: A total of 568 patients with T1c-3 Nx/0 prostate cancer who received three-dimensional conformal RT alone between May 1989 and August 2001 were studied. There were 161 men with Gleason score 7-10 disease. The GP4/5 was defined as the percentage of biopsy tissue containing Gleason pattern 4 or 5. A Cox proportional hazards model was used for univariate and multivariate analyses (MVA) for biochemical failure (BF) (American Society of Therapeutic Radiology and Oncology definition) and distant metastasis (DM). A recursive partitioning analysis was done using the results of the MVA to identify a cutpoint for GP4/5. Results: The median follow-up was 46 (range, 13-114) months and median RT dose was 76 (range, 65-82) Gy. On MVA, increasing initial prostate-specific antigen (p = 0.0248) decreasing RT dose (continuous, p = 0.0022), T stage (T1/2 vs. T3) (p = 0.0136) and GP4/5 (continuous, p < 0.0001) were significant predictors of BF in a model also containing GS. GP4/5 was the only significant predictor of DM in the same model (p < 0.0001). Conclusion: The GP4/5 in prostate biopsy specimens is a predictor of BF and DM after RT independent of Gleason score. This parameter should be reported by the pathologist when reviewing prostatic biopsy specimens

  6. Design of a technique for the radiotherapy treatment of patients of prostate with bilateral prosthetic hip; Diseno de una tecnica para el tratamiento radioterapico de pacientes de prostata con protesis bilateral de cadera

    Energy Technology Data Exchange (ETDEWEB)

    Camacho, C.; Perez-Alija, J.; Olivares, S.; Loscos, S.; Pedro, A.

    2013-07-01

    The design of the plan of treatment of patients who have to undergo radical radiotherapy of prostate and that incorporate some sort of hip prosthesis is usually complex. the case of a patient's prostatic bed with bilateral hip prosthesis to assess radical radiotherapy to the 70Gy in bed. The objective of this paper is to present the chosen technique designed for this treatment. (Author)

  7. Quality indicators for prostate radiotherapy: are patients disadvantaged by receiving treatment in a 'generalist' centre?

    Science.gov (United States)

    Freeman, Amanda R; Roos, Daniel E; Kim, Laurence

    2015-04-01

    The purpose of this retrospective review was to evaluate concordance with evidence-based quality indicator guidelines for prostate cancer patients treated radically in a 'generalist' (as distinct from 'sub-specialist') centre. We were concerned that the quality of treatment may be lower in a generalist centre. If so, the findings could have relevance for many radiotherapy departments that treat prostate cancer. Two hundred fifteen consecutive patients received external beam radiotherapy (EBRT) and/or brachytherapy between 1.10.11 and 30.9.12. Treatment was deemed to be in line with evidence-based guidelines if the dose was: (i) 73.8-81 Gy at 1.8-2.0 Gy/fraction for EBRT alone (eviQ guidelines); (ii) 40-50 Gy (EBRT) for EBRT plus high-dose rate (HDR) brachytherapy boost (National Comprehensive Cancer Network (NCCN) guidelines); and (iii) 145 Gy for low dose rate (LDR) I-125 monotherapy (NCCN). Additionally, EBRT beam energy should be ≥6 MV using three-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), and high-risk patients should receive neo-adjuvant androgen-deprivation therapy (ADT) (eviQ/NCCN). Treatment of pelvic nodes was also assessed. One hundred four high-risk, 84 intermediate-risk and 27 low-risk patients (NCCN criteria) were managed by eight of nine radiation oncologists. Concordance with guideline doses was confirmed in: (i) 125 of 136 patients (92%) treated with EBRT alone; (ii) 32 of 34 patients (94%) treated with EBRT + HDR BRT boost; and (iii) 45 of 45 patients (100%) treated with LDR BRT alone. All EBRT patients were treated with ≥6 MV beams using 3D-CRT (78%) or IMRT (22%). 84%, 21% and 0% of high-risk, intermediate-risk and low-risk patients received ADT, respectively. Overall treatment modality choice (including ADT use and duration where assessable) was concordant with guidelines for 176/207 (85%) of patients. The vast majority of patients were treated concordant with evidence-based guidelines suggesting that

  8. Prostate-Specific Natural Health Products (Dietary Supplements) Radiosensitize Normal Prostate Cells

    International Nuclear Information System (INIS)

    Hasan, Yasmin; Schoenherr, Diane; Martinez, Alvaro A.; Wilson, George D.; Marples, Brian

    2010-01-01

    Purpose: Prostate-specific health products (dietary supplements) are taken by cancer patients to alleviate the symptoms linked with poor prostate health. However, the effect of these agents on evidence-based radiotherapy practice is poorly understood. The present study aimed to determine whether dietary supplements radiosensitized normal prostate or prostate cancer cell lines. Methods and Materials: Three well-known prostate-specific dietary supplements were purchased from commercial sources available to patients (Trinovin, Provelex, and Prostate Rx). The cells used in the study included normal prostate lines (RWPE-1 and PWR-1E), prostate tumor lines (PC3, DU145, and LNCaP), and a normal nonprostate line (HaCaT). Supplement toxicity was assessed using cell proliferation assays [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] and cellular radiosensitivity using conventional clonogenic assays (0.5-4Gy). Cell cycle kinetics were assessed using the bromodeoxyuridine/propidium iodide pulse-labeling technique, apoptosis by scoring caspase-3 activation, and DNA repair by assessing γH2AX. Results: The cell growth and radiosensitivity of the malignant PC3, DU145, and LNcaP cells were not affected by any of the dietary prostate supplements (Provelex [2μg/mL], Trinovin [10μg/mL], and Prostate Rx [50 μg/mL]). However, both Trinovin (10μg/mL) and Prostate Rx (6μg/mL) inhibited the growth rate of the normal prostate cell lines. Prostate Rx increased cellular radiosensitivity of RWPE-1 cells through the inhibition of DNA repair. Conclusion: The use of prostate-specific dietary supplements should be discouraged during radiotherapy owing to the preferential radiosensitization of normal prostate cells.

  9. Co-targeting androgen receptor and DNA for imaging and molecular radiotherapy of prostate cancer: in vitro studies.

    Science.gov (United States)

    Han, Guang; Kortylewicz, Zbigniew P; Enke, Thomas; Baranowska-Kortylewicz, Janina

    2014-12-01

    The androgen receptor (AR) axis, the key growth and survival pathway in prostate cancer, remains a prime target for drug development. 5-Radioiodo-3'-O-(17β-succinyl-5α-androstan-3-one)-2'-deoxyuridin-5'-yl phosphate (RISAD-P) is the AR-seeking reagent developed for noninvasive assessment of AR and proliferative status, and for molecular radiotherapy of prostate cancer with Auger electron-emitting radionuclides. RISAD-P radiolabeled with 123I, 124I, and 125I were synthesized using a common stannylated precursor. The cellular uptake, subcellular distribution, and radiotoxicity of 123I-, 124I-, and (125) IRISAD-P were measured in LNCaP, DU145, and PC-3 cell lines expressing various levels of AR. The uptake of RISAD-P by prostate cancer cells is proportional to AR levels and independent of the radionuclide. The intracellular accumulation of radioactivity is directly proportional to the extracellular concentration of RISAD-P and the duration of exposure. Initially, RISAD-P is trapped in the cytoplasm. Within 24 hr, radioactivity is associated exclusively with DNA. The RISAD-P radiotoxicity is determined by the radionuclide; however, the cellular responses are directly proportional to the AR expression levels. LNCaP cells expressing high levels of AR are killed at the rate of up to 60% per day after a brief 1 hr RISAD-P treatment. For the first time, the AR expression in PC-3 and DU 145 cells, generally reported as AR-negative, was quantitated by the ultra sensitive RISAD-P-based method. RISAD-P is a theranostic drug, which targets AR. Its subcellular metabolite participates in DNA synthesis. RISAD-P is a promising candidate for imaging of the AR expression and tumor proliferation as well as molecular radiotherapy of prostate cancer. © 2014 Wiley Periodicals, Inc.

  10. Radiotherapy of intensity modulated VS conformational in the treatment of carcinoma of the prostate. A dosimetric comparison; Radioterapia de intensidad modulada VS conformacional en el tratamiento de carcinoma de prostata. Una camparacion dosimetrica

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Martin, G.; Garcia Vicente, F.; Zapatero Laborda, A.; Bermudez Luna, R.; Roch Gonzalez, M.; Perez Gonzalez, L.; Torres Escobar, J. J.

    2013-07-01

    The intensity modulated (IMRT) radiation therapy is a technique of high conformation which, by its nature, has as one of its main directions prostate cancer radiotherapy treatment. The purpose of this work is presents results of the dosimetric indicators collected in our hospital a number of patients of carcinoma of the prostate with standard three-dimensional Conformal technique (3D-CRT) and IMRT. Aims to demonstrate and quantify with a statistical methodology that, establishing an adequate Protocol of IMRT, significant reductions in risk organ doses can be obtained by keeping the same prescription to the white volume. (Author)

  11. A comparison of CT- and ultrasound-based imaging to localize the prostate for external beam radiotherapy

    International Nuclear Information System (INIS)

    McNair, Helen A.; Mangar, Stephen A.; Coffey, Jerome; Shoulders, Beverley; Hansen, Vibeke N.; Norman, Andrew; Staffurth, John; Sohaib, S. Aslam; Warrington, Alan P.; Dearnaley, David P.

    2006-01-01

    Purpose: This study assesses the accuracy of NOMOS B-mode acquisition and targeting system (BAT) compared with computed tomography (CT) in localizing the prostate. Methods and Materials: Twenty-six patients were CT scanned, and the prostate was localized by 3 observers using the BAT system. The BAT couch shift measurements were compared with the CT localization. Six of the patients had gold markers present in the prostate, and the prostate movement determined by BAT was compared with the movement determined by the gold markers. Results: Using the BAT system, the 3 observers determined the prostate position to be a mean of 1-5 mm over all directions with respect to the CT. The proportion of readings with a difference >3 mm between the observers was in the range of 25% to 44%. The prostate movement based on gold markers was an average of 3-5 mm different from that measured by BAT. The literature assessing the accuracy and reproducibility on BAT is summarized and compared with our findings. Conclusions: We have found that there are systematic differences between the BAT-defined prostate position compared with that estimated on CT using gold grain marker seeds

  12. Radical External Beam Radiotherapy for Clinically Localized Prostate Cancer in Japan: Changing Trends in the Patterns of Care Process Survey

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Kazuhiko, E-mail: kogawa@med.u-ryukyu.ac.jp [Department of Radiology, University of the Ryukyus, Okinawa (Japan); Nakamura, Katsumasa [Department of Clinical Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Sasaki, Tomonari [Department of Radiation Oncology, National Kyushu Center, Fukuoka (Japan); Onishi, Hiroshi [Department of Radiology, Yamanashi University, Yamanashi (Japan); Koizumi, Masahiko [Department of Radiation Oncology, Osaka University, Osaka (Japan); Araya, Masayuki [Department of Radiology, Yamanashi University, Yamanashi (Japan); Mukumoto, Nobutaka; Teshima, Teruki [Department of Medical Physics and Engineering, Osaka University, Osaka (Japan); Mitsumori, Michihide [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto (Japan)

    2011-12-01

    Purpose: To delineate changing trends in radical external beam radiotherapy (EBRT) for prostate cancer in Japan. Methods and Materials: Data from 841 patients with clinically localized prostate cancer treated with EBRT in the Japanese Patterns of Care Study (PCS) from 1996 to 2005 were analyzed. Results: Significant increases in the proportions of patients with stage T1 to T2 disease and decrease in prostate-specific antigen values were observed. Also, there were significant increases in the percentages of patients treated with radiotherapy by their own choice. Median radiation doses were 65.0 Gy and 68.4 Gy from 1996 to 1998 and from 1999 to 2001, respectively, increasing to 70 Gy from 2003 to 2005. Moreover, conformal therapy was more frequently used from 2003 to 2005 (84.9%) than from 1996 to 1998 (49.1%) and from 1999 to 2001 (50.2%). On the other hand, the percentage of patients receiving hormone therapy from 2003 to 2005 (81.1%) was almost the same as that from 1996 to 1998 (86.3%) and from 1999 to 2001 (89.7%). Compared with the PCS in the United States, patient characteristics and patterns of treatments from 2003 to 2005 have become more similar to those in the United States than those from 1996 to 1998 and those from 1999 to 2001. Conclusions: This study indicates a trend toward increasing numbers of patients with early-stage disease and increasing proportions of patients treated with higher radiation doses with advanced equipment among Japanese prostate cancer patients treated with EBRT during 1996 to 2005 survey periods. Patterns of care for prostate cancer in Japan are becoming more similar to those in the United States.

  13. Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer

    NARCIS (Netherlands)

    Madalinska, J. B.; Essink-Bot, M. L.; de Koning, H. J.; Kirkels, W. J.; van der Maas, P. J.; Schröder, F. H.

    2001-01-01

    PURPOSE: The current study was undertaken within the framework of a screening trial to compare the health-related quality-of-life (HRQOL) outcomes of two primary treatment modalities for localized prostate cancer: radical prostatectomy and external-beam radiotherapy. PATIENTS AND METHODS: We

  14. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Langen, Katja M.; Zeidan, Omar A.; Meeks, Sanford L.; Willoughby, Twyla R.; Wagner, Thomas H.; Jeswani, Sam; Ruchala, Kenneth J.; Haimerl, Jason; Olivera, Gustavo H.

    2006-01-01

    Purpose: The aim of this work was to study the variations in delivered doses to the prostate, rectum, and bladder during a full course of image-guided external beam radiotherapy. Methods and Materials: Ten patients with localized prostate cancer were treated with helical tomotherapy to 78 Gy at 2 Gy per fraction in 39 fractions. Daily target localization was performed using intraprostatic fiducials and daily megavoltage pelvic computed tomography (CT) scans, resulting in a total of 390 CT scans. The prostate, rectum, and bladder were manually contoured on each CT by a single physician. Daily dosimetric analysis was performed with dose recalculation. The study endpoints were D95 (dose to 95% of the prostate), rV2 (absolute rectal volume receiving 2 Gy), and bV2 (absolute bladder volume receiving 2 Gy). Results: For the entire cohort, the average D95 (±SD) was 2.02 ± 0.04 Gy (range, 1.79-2.20 Gy). The average rV2 (±SD) was 7.0 ± 8.1 cc (range, 0.1-67.3 cc). The average bV2 (±SD) was 8.7 ± 6.8 cc (range, 0.3-36.8 cc). Unlike doses for the prostate, there was significant daily variation in rectal and bladder doses, mostly because of variations in volume and shape of these organs. Conclusion: Large variations in delivered doses to the rectum and bladder can be documented with daily megavoltage CT scans. Image guidance for the targeting of the prostate, even with intraprostatic fiducials, does not take into account the variation in actual rectal and bladder doses. The clinical impact of techniques that take into account such dosimetric parameters in daily patient set-ups should be investigated

  15. Prostate positioning using cone-beam computer tomography based on manual soft-tissue registration. Interobserver agreement between radiation oncologists and therapists

    Energy Technology Data Exchange (ETDEWEB)

    Jereczek-Fossa, B.A.; Pobbiati, C.; Fanti, P. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); University of Milan, Milan (Italy); Santoro, L. [European Institute of Oncology, Department of Epidemiology and Biostatistics, Milan (Italy); Fodor, C.; Zerini, D. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); Vigorito, S. [European Institute of Oncology, Department of Medical Physics, Milan (Italy); Baroni, G. [Politecnico di Milano, Department of Electronics Information and Bioengineering, Milan (Italy); De Cobelli, O. [European Institute of Oncology, Department of Urology, Milan (Italy); University of Milan, Milan (Italy); Orecchia, R. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); National Center for Oncological Hadrontherapy (CNAO) Foundation, Pavia (Italy); University of Milan, Milan (Italy)

    2014-01-15

    To check the interobserver agreement between radiation oncologists and therapists (RTT) using an on- and off-line cone-beam computer tomography (CBCT) protocol for setup verification in the radiotherapy of prostate cancer. The CBCT data from six prostate cancer patients treated with hypofractionated intensity-modulated radiotherapy (IMRT) were independently reviewed off-line by four observers (one radiation oncologist, one junior and two senior RTTs) and benchmarked with on-line CBCT positioning performed by a radiation oncologist immediately prior to treatment. CBCT positioning was based on manual soft-tissue registration. Agreement between observers was evaluated using weighted Cohen's kappa statistics. In total, 152 CBCT-based prostate positioning procedures were reviewed by each observer. The mean (± standard deviation) of the differences between off- and on-line CBCT-simCT registration translations along the three directions (antero-posterior, latero-lateral and cranio-caudal) and rotation around the antero-posterior axis were - 0.7 (3.6) mm, 1.9 (2.7) mm, 0.9 (3.6) mm and - 1.8 (5.0) degrees, respectively. Satisfactory interobserver agreement was found, being substantial (weighted kappa > 0.6) in 10 of 16 comparisons and moderate (0.41-0.60) in the remaining six comparisons. CBCT interpretation performed by RTTs is comparable to that of radiation oncologists. Our study might be helpful in the quality assurance of radiotherapy and the optimization of competencies. Further investigation should include larger sample sizes, a greater number of observers and validated methodology in order to assess interobserver variability and its impact on high-precision prostate cancer IGRT. In the future, it should enable the wider implementation of complex and evolving radiotherapy technologies. (orig.)

  16. Role of 11C-choline positron emission tomography/computed tomography in evaluating patients affected by prostate cancer with suspected relapse due to prostate-specific antigen elevation

    International Nuclear Information System (INIS)

    Bertagna, F.; Bosio, G.; Abuhilal, M.

    2011-01-01

    The aim of this study was to evaluate the accuracy of 11 C-choline positron emission tomography/computed tomography (PET/CT) in restaging patients affected by prostate cancer and suspected relapse due to prostate-specific antigen (PSA) increase. We also aimed to determine a PSA cutoff that is most suited to the study in terms of best compromise between sensitivity and specificity. Secondary endpoints were a comparison between 11 C-choline PET/CT and histological results, clinical findings, and radiological imaging (CT and magnetic resonance imaging). We retrospectively evaluated 210 patients (median±standard deviation (SD) age 70±7 years) affected by prostate cancer who underwent 11 C-choline PET/CT. 11 C-choline PET/CT imaging was positive in 116 (55.2%) patients and negative in 94 (44.8%). Receiver operating characteristic (ROC) analysis showed that the highest accuracy (sensitivity 76.8%, specificity 92.5%) for the whole population was achieved when the PSA level of 1.26 ng/ml level was used as the cutoff value for interpreting the results (P=0.0001 and the area under the ROC curve area under the curve (AUC)=0.897). For patients treated with surgery or surgery plus radiotherapy the cutoff was 0.81 ng/ml (sensitivity 73.2%, specificity 86.1%). For patients treated with radiotherapy alone, the cutoff was 2.0 ng/ml (sensitivity 81.8%, specificity 92.9%). Our results indicate that 11 C-choline PET/CT is a useful diagnostic tool in patients affected by prostate cancer and a relapsed PSA level. The highest accuracy for all patients is obtained with a PSA cutoff level of 1.26 ng/ml, above which the imaging study is performed (0.81 ng/ml for patients treated with surgery or surgery plus radiotherapy and 2.0 ng/ml for patients treated with radiotherapy alone). (author)

  17. Health-related quality of life and treatment outcomes for men with prostate cancer treated by combined external-beam radiotherapy and hormone therapy

    International Nuclear Information System (INIS)

    Hashine, Katsuyoshi; Azuma, Kouji; Koizumi, Takahiro; Sumiyoshi, Yoshiteru

    2005-01-01

    Health-related quality of life (HR-QOL) is important when considering the treatment options for prostate cancer. From 1992 to 1998, 57 patients were treated by radiotherapy plus hormone therapy (median age, 79 years; median prostate-specific antigen concentration, 15.0 ng/ml; median radiotherapy dosage, 60 Gy). General HR-QOL was measured by the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire, and a newly developed disease-specific QOL survey was used to assess urinary and bowel functions. QOL was also measured in a control group of patients admitted for prostate biopsy. The general HR-QOL scores in the radiation group ranged from 70.0 to 91.3, with sexual problems showing the lowest (i.e., worst) score (38.5). Compared with the control group, the scores in the radiation group were worse for physical function and sexual problems. For disease-specific QOL, the radiation group had worse urinary function than controls, but were more satisfied with their urinary function. There was no difference between the radiation group and controls in satisfaction with bowel function. When the control group was subdivided at into two groups: age 75 years or less, and age over 75 years, the QOL score in the radiation group was the same as that in the subgroup aged over 75 years. In subgroups of the radiation patients, according to survey period, there was no difference between the first and last surveys in longitudinal HR-QOL evaluations. The 5- and 10-year overall survival rates were 67.6% and 41.6%, respectively, and the 5- and 10-year cause-specific survival rates were 97.9% and 94.7%. The combination of radiotherapy and hormone therapy has a good outcome and patients do not experience poor HR-QOL, except for sexual problems. Moreover, the disease-specific QOL is good, especially for urinary bother. (author)

  18. Learning statistical correlation for fast prostate registration in image-guided radiotherapy

    International Nuclear Information System (INIS)

    Shi Yonghong; Liao Shu; Shen Dinggang

    2011-01-01

    Purpose: In adaptive radiation therapy of prostate cancer, fast and accurate registration between the planning image and treatment images of the patient is of essential importance. With the authors' recently developed deformable surface model, prostate boundaries in each treatment image can be rapidly segmented and their correspondences (or relative deformations) to the prostate boundaries in the planning image are also established automatically. However, the dense correspondences on the nonboundary regions, which are important especially for transforming the treatment plan designed in the planning image space to each treatment image space, are remained unresolved. This paper presents a novel approach to learn the statistical correlation between deformations of prostate boundary and nonboundary regions, for rapidly estimating deformations of the nonboundary regions when given the deformations of the prostate boundary at a new treatment image. Methods: The main contributions of the proposed method lie in the following aspects. First, the statistical deformation correlation will be learned from both current patient and other training patients, and further updated adaptively during the radiotherapy. Specifically, in the initial treatment stage when the number of treatment images collected from the current patient is small, the statistical deformation correlation is mainly learned from other training patients. As more treatment images are collected from the current patient, the patient-specific information will play a more important role in learning patient-specific statistical deformation correlation to effectively reflect prostate deformation of the current patient during the treatment. Eventually, only the patient-specific statistical deformation correlation is used to estimate dense correspondences when a sufficient number of treatment images have been acquired from the current patient. Second, the statistical deformation correlation will be learned by using a

  19. Validation of an online replanning technique for prostate adaptive radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Peng Cheng; Chen Guangpei; Ahunbay, Ergun; Wang Dian; Lawton, Colleen; Li, X Allen, E-mail: ali@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2011-06-21

    We have previously developed an online adaptive replanning technique to rapidly adapt the original plan according to daily CT. This paper reports the quality assurance (QA) developments in its clinical implementation for prostate cancer patients. A series of pre-clinical validation tests were carried out to verify the overall accuracy and consistency of the online replanning procedure. These tests include (a) phantom measurements of 22 individual patient adaptive plans to verify their accuracy and deliverability and (b) efficiency and applicability of the online replanning process. A four-step QA procedure was established to ensure the safe and accurate delivery of an adaptive plan, including (1) offline phantom measurement of the original plan, (2) online independent monitor unit (MU) calculation for a redundancy check, (3) online verification of plan-data transfer using an in-house software and (4) offline validation of actually delivered beam parameters. The pre-clinical validations demonstrate that the newly implemented online replanning technique is dosimetrically accurate and practically efficient. The four-step QA procedure is capable of identifying possible errors in the process of online adaptive radiotherapy and to ensure the safe and accurate delivery of the adaptive plans. Based on the success of this work, the online replanning technique has been used in the clinic to correct for interfractional changes during the prostate radiation therapy.

  20. Validation of an online replanning technique for prostate adaptive radiotherapy

    International Nuclear Information System (INIS)

    Peng Cheng; Chen Guangpei; Ahunbay, Ergun; Wang Dian; Lawton, Colleen; Li, X Allen

    2011-01-01

    We have previously developed an online adaptive replanning technique to rapidly adapt the original plan according to daily CT. This paper reports the quality assurance (QA) developments in its clinical implementation for prostate cancer patients. A series of pre-clinical validation tests were carried out to verify the overall accuracy and consistency of the online replanning procedure. These tests include (a) phantom measurements of 22 individual patient adaptive plans to verify their accuracy and deliverability and (b) efficiency and applicability of the online replanning process. A four-step QA procedure was established to ensure the safe and accurate delivery of an adaptive plan, including (1) offline phantom measurement of the original plan, (2) online independent monitor unit (MU) calculation for a redundancy check, (3) online verification of plan-data transfer using an in-house software and (4) offline validation of actually delivered beam parameters. The pre-clinical validations demonstrate that the newly implemented online replanning technique is dosimetrically accurate and practically efficient. The four-step QA procedure is capable of identifying possible errors in the process of online adaptive radiotherapy and to ensure the safe and accurate delivery of the adaptive plans. Based on the success of this work, the online replanning technique has been used in the clinic to correct for interfractional changes during the prostate radiation therapy.

  1. A Statistical Evaluation of Rules for Biochemical Failure After Radiotherapy in Men Treated for Prostate Cancer

    International Nuclear Information System (INIS)

    Bellera, Carine A.; Hanley, James A.; Joseph, Lawrence; Albertsen, Peter C.

    2009-01-01

    Purpose: The 'PSA nadir + 2 rule,' defined as any rise of 2 ng/ml above the current prostate-specific antigen (PSA) nadir, has replaced the American Society for Therapeutic Radiology and Oncology (ASTRO) rule, defined as three consecutive PSA rises, to indicate biochemical failure (BF) after radiotherapy in patients treated for prostate cancer. We propose an original approach to evaluate BF rules based on the PSAdt as the gold standard rule and on a simulation process allowing us to evaluate the BF rules under multiple settings (different frequency, duration of follow-up, PSA doubling time [PSAdt]). Methods and Materials: We relied on a retrospective, population-based cohort of individuals identified by the Connecticut Tumor Registry and treated for localized prostate cancer with radiotherapy. We estimated the 470 underlying true PSA trajectories, including the PSAdt, using a Bayesian hierarchical changepoint model. Next, we simulated realistic, sophisticated data sets that accurately reflect the systematic and random variations observed in PSA series. We estimated the sensitivity and specificity by comparing the simulated PSA series to the underlying true PSAdt. Results: For follow-up of more than 3 years, the specificity of the PSA nadir + 2 rule was systematically greater than that of the ASTRO criterion. In few settings, the nadir + 2 rule had a lower sensitivity than the ASTRO. The PSA nadir + 2 rule appeared less dependent on the frequency and duration of follow-up than the ASTRO. Conclusions: Our results provide some refinements to earlier findings as the BF rules were evaluated according to various parameters. In most settings, the PSA nadir + 2 rule outperforms the ASTRO criterion.

  2. Prostatic sarcoma after treatment of rectal cancer

    Directory of Open Access Journals (Sweden)

    Hill Andrew G

    2007-07-01

    Full Text Available Abstract Background The relationship between radiation exposure for treatment of cancer and occurrence of a second primary cancer at the irradiated site is well known. This phenomenon is however rare in prostate. Case presentation A 75-year-old farmer was treated for rectal cancer with preoperative 45 Gy of radiotherapy and abdominoperineal resection. Four years later he developed symptoms of bladder outlet obstruction and acute urinary retention. He underwent a transurethral resection of the prostate. Histological examination of the removed prostate tissue and immunohistochemistry revealed it to be a poorly differentiated sarcoma. Conclusion We believe this to be the first reported case of radiation-induced sarcoma following radiotherapy treatment for rectal cancer. Since radiotherapy plays a pivotal role in the contemporary treatment of rectal adenocarcinoma, it is relevant to be aware of the potential long-term carcinogenic complications of radiotherapy of the pelvis.

  3. Automatic localization of the prostate for on-line or off-line image-guided radiotherapy

    International Nuclear Information System (INIS)

    Smitsmans, Monique H.P.; Wolthaus, Jochem W.H.; Artignan, Xavier; Bois, Josien de; Jaffray, David A.; Lebesque, Joos V.; Herk, Marcel van

    2004-01-01

    Purpose: With higher radiation dose, higher cure rates have been reported in prostate cancer patients. The extra margin needed to account for prostate motion, however, limits the level of dose escalation, because of the presence of surrounding organs at risk. Knowledge of the precise position of the prostate would allow significant reduction of the treatment field. Better localization of the prostate at the time of treatment is therefore needed, e.g. using a cone-beam computed tomography (CT) system integrated with the linear accelerator. Localization of the prostate relies upon manual delineation of contours in successive axial CT slices or interactive alignment and is fairly time-consuming. A faster method is required for on-line or off-line image-guided radiotherapy, because of prostate motion, for patient throughput and efficiency. Therefore, we developed an automatic method to localize the prostate, based on 3D gray value registration. Methods and materials: A study was performed on conventional repeat CT scans of 19 prostate cancer patients to develop the methodology to localize the prostate. For each patient, 8-13 repeat CT scans were made during the course of treatment. First, the planning CT scan and the repeat CT scan were registered onto the rigid bony structures. Then, the delineated prostate in the planning CT scan was enlarged by an optimum margin of 5 mm to define a region of interest in the planning CT scan that contained enough gray value information for registration. Subsequently, this region was automatically registered to a repeat CT scan using 3D gray value registration to localize the prostate. The performance of automatic prostate localization was compared to prostate localization using contours. Therefore, a reference set was generated by registering the delineated contours of the prostates in all scans of all patients. Gray value registrations that showed large differences with respect to contour registrations were detected with a χ 2

  4. In vivo real-time rectal wall dosimetry for prostate radiotherapy

    International Nuclear Information System (INIS)

    Hardcastle, Nicholas; Cutajar, Dean L; Metcalfe, Peter E; Lerch, Michael L F; Tome, Wolfgang A; Rosenfeld, Anatoly B; Perevertaylo, Vladimir L

    2010-01-01

    Rectal balloons are used in external beam prostate radiotherapy to provide reproducible anatomy and rectal dose reductions. This is an investigation into the combination of a MOSFET radiation detector with a rectal balloon for real-time in vivo rectal wall dosimetry. The MOSFET used in the study is a radiation detector that provides a water equivalent depth of measurement of 70 μm. Two MOSFETs were combined in a face-to-face orientation. The reproducibility, sensitivity and angular dependence were measured for the dual MOSFET in a 6 MV photon beam. The dual MOSFET was combined with a rectal balloon and irradiated with hypothetical prostate treatments in a phantom. The anterior rectal wall dose was measured in real time and compared with the planning system calculated dose. The dual MOSFET showed angular dependence within ±2.5% in the azimuth and +2.5%/-4% in the polar axes. When compared with an ion chamber measurement in a phantom, the dual MOSFET agreed within 2.5% for a range of radiation path lengths and incident angles. The dual MOSFET had reproducible sensitivity for fraction sizes of 2-10 Gy. For the hypothetical prostate treatments the measured anterior rectal wall dose was 2.6 and 3.2% lower than the calculated dose for 3DCRT and IMRT plans. This was expected due to limitations of the dose calculation method used at the balloon cavity interface. A dual MOSFET combined with a commercial rectal balloon was shown to provide reproducible measurements of the anterior rectal wall dose in real time. The measured anterior rectal wall dose agreed with the expected dose from the treatment plan for 3DCRT and IMRT plans. The dual MOSFET could be read out in real time during the irradiation, providing the capability for real-time dose monitoring of the rectal wall dose during treatment.

  5. A semiautomatic tool for prostate segmentation in radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Schulz, Jörn; Skrøvseth, Stein Olav; Tømmerås, Veronika Kristine; Marienhagen, Kirsten; Godtliebsen, Fred

    2014-01-01

    Delineation of the target volume is a time-consuming task in radiotherapy treatment planning, yet essential for a successful treatment of cancers such as prostate cancer. To facilitate the delineation procedure, the paper proposes an intuitive approach for 3D modeling of the prostate by slice-wise best fitting ellipses. The proposed estimate is initialized by the definition of a few control points in a new patient. The method is not restricted to particular image modalities but assumes a smooth shape with elliptic cross sections of the object. A training data set of 23 patients was used to calculate a prior shape model. The mean shape model was evaluated based on the manual contour of 10 test patients. The patient records of training and test data are based on axial T1-weighted 3D fast-field echo (FFE) sequences. The manual contours were considered as the reference model. Volume overlap (Vo), accuracy (Ac) (both ratio, range 0-1, optimal value 1) and Hausdorff distance (HD) (mm, optimal value 0) were calculated as evaluation parameters. The median and median absolute deviation (MAD) between manual delineation and deformed mean best fitting ellipses (MBFE) was Vo (0.9 ± 0.02), Ac (0.81 ± 0.03) and HD (4.05 ± 1.3)mm and between manual delineation and best fitting ellipses (BFE) was Vo (0.96 ± 0.01), Ac (0.92 ± 0.01) and HD (1.6 ± 0.27)mm. Additional results show a moderate improvement of the MBFE results after Monte Carlo Markov Chain (MCMC) method. The results emphasize the potential of the proposed method of modeling the prostate by best fitting ellipses. It shows the robustness and reproducibility of the model. A small sample test on 8 patients suggest possible time saving using the model

  6. Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis.

    Science.gov (United States)

    Ost, Piet; Jereczek-Fossa, Barbara Alicja; As, Nicholas Van; Zilli, Thomas; Muacevic, Alexander; Olivier, Kenneth; Henderson, Daniel; Casamassima, Franco; Orecchia, Roberto; Surgo, Alessia; Brown, Lindsay; Tree, Alison; Miralbell, Raymond; De Meerleer, Gert

    2016-01-01

    The literature on metastasis-directed therapy for oligometastatic prostate cancer (PCa) recurrence consists of small heterogeneous studies. This study aimed to reduce the heterogeneity by pooling individual patient data from different institutions treating oligometastatic PCa recurrence with stereotactic body radiotherapy (SBRT). We focussed on patients who were treatment naive, with the aim of determining if SBRT could delay disease progression. We included patients with three or fewer metastases. The Kaplan-Meier method was used to estimate distant progression-free survival (DPFS) and local progression-free survival (LPFS). Toxicity was scored using the Common Terminology Criteria for Adverse Events. In total, 163 metastases were treated in 119 patients. The median DPFS was 21 mo (95% confidence interval, 15-26 mo). A lower radiotherapy dose predicted a higher local recurrence rate with a 3-yr LPFS of 79% for patients treated with a biologically effective dose ≤100Gy versus 99% for patients treated with >100Gy (p=0.01). Seventeen patients (14%) developed toxicity classified as grade 1, and three patients (3%) developed grade 2 toxicity. No grade ≥3 toxicity occurred. These results should serve as a benchmark for future prospective trials. This multi-institutional study pools all of the available data on the use of stereotactic body radiotherapy for limited prostate cancer metastases. We concluded that this approach is safe and associated with a prolonged treatment progression-free survival. Copyright © 2015. Published by Elsevier B.V.

  7. Use of artificial neural networks to predict biological outcomes for patients receiving radical radiotherapy of the prostate

    International Nuclear Information System (INIS)

    Gulliford, Sarah L.; Webb, Steve; Rowbottom, Carl G.; Corne, David W.; Dearnaley, David P.

    2004-01-01

    Background and purpose: This paper discusses the application of artificial neural networks (ANN) in predicting biological outcomes following prostate radiotherapy. A number of model-based methods have been developed to correlate the dose distributions calculated for a patient receiving radiotherapy and the radiobiological effect this will produce. Most widely used are the normal tissue complication probability and tumour control probability models. An alternative method for predicting specific examples of tumour control and normal tissue complications is to use an ANN. One of the advantages of this method is that there is no need for a priori information regarding the relationship between the data being correlated. Patients and methods: A set of retrospective clinical data from patients who received radical prostate radiotherapy was used to train ANNs to predict specific biological outcomes by learning the relationship between the treatment plan prescription, dose distribution and the corresponding biological effect. The dose and volume were included as a differential dose-volume histogram in order to provide a holistic description of the available data. Results: It was shown that the ANNs were able to predict biochemical control and specific bladder and rectum complications with sensitivity and specificity of above 55% when the outcomes were dichotomised. It was also possible to analyse information from the ANNs to investigate the effect of individual treatment parameters on the outcome. Conclusion: ANNs have been shown to learn something of the complex relationship between treatment parameters and outcome which, if developed further, may prove to be a useful tool in predicting biological outcomes

  8. Cytoreductive prostate radiotherapy in oligometastatic prostate cancer: a single centre analysis of toxicity and clinical outcome.

    Science.gov (United States)

    Riva, Giulia; Marvaso, Giulia; Augugliaro, Matteo; Zerini, Dario; Fodor, Cristiana; Musi, Gennaro; De Cobelli, Ottavio; Orecchia, Roberto; Jereczek-Fossa, Barbara Alicja

    2017-01-01

    The current standard of care for patients with metastatic prostate cancer (mPCa) at diagnosis is androgen deprivation therapy (ADT) with or without anti-androgen and chemotherapy. The aim of this study was to define the role of a local radiotherapy (RT) treatment in the mPCa setting. We retrospectively reviewed data of patients with PCa and bone oligometastases at diagnosis treated in our institution with ADT followed by cytoreductive prostate-RT with or without RT on metastases. Biochemical and clinical failure (BF, CF), overall survival (OS) and RT-toxicity were assessed. We identified 22 patients treated with ADT and external-beam RT on primary between June 2008 and March 2016. All of them but four were also treated for bone metastases. RT on primary with moderately and extremely hypofractionated regimes started after 10.3 months (3.9-51.7) from ADT. After a median follow-up of 26.4 months (10.3-55.5), 20 patients are alive. Twelve patients showed BF after a median time of 23 months (14.5-104) and CF after a median of 23.6 months (15.3-106.1) from the start of ADT. Three patients became castration resistant, starting a new therapy; median time to castration resistance was 31.03 months (range: 29.9-31.5 months). According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC), only one patient developed acute grade 3 genitourinary toxicity. No late grade >2 adverse events were observed. Prostate RT in oligometastatic patients is safe and offers long-lasting local control. When compared to ADT alone, RT on primary seems to improve biochemical control and long-term survival; however, this hypothesis should be investigated in prospective studies. Further research is warranted.

  9. Image-guided and adaptive radiotherapy

    International Nuclear Information System (INIS)

    Louvel, G.; Chajon, E.; Henry, O.; Cazoulat, G.; Le Maitre, A.; Simon, A.; Bensadoun, R.J.; Crevoisier, R. de

    2012-01-01

    Image-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), re-planning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be 'monitored' and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of 'planning libraries' based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied. (authors)

  10. Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

    Science.gov (United States)

    Gawkowska-Suwinska, Marzena; Fijałkowski, Marek; Białas, Brygida; Szlag, Marta; Kellas-Ślęczka, Sylwia; Nowicka, Elżbieta; Behrendt, Katarzyna; Plewicki, Grzegorz; Smolska-Ciszewska, Beata; Giglok, Monika; Zajusz, Aleksander; Owczarek, Grzegorz

    2009-12-01

    The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

  11. The effect of oral sucralfate on the acute proctitis associated with prostate radiotherapy: a double-blind, randomized trial

    International Nuclear Information System (INIS)

    Kneebone, Andrew; Mameghan, Hedy; Bolin, Terry; Berry, Martin; Turner, Sandra; Kearsley, John; Graham, Peter; Fisher, Richard; Delaney, Geoff

    2001-01-01

    Purpose: Acute rectal complications occur in the majority of patients receiving external-beam radiotherapy for carcinoma of the prostate. Sucralfate has been proposed to reduce radiation-induced mucosal injury by forming a protective barrier on ulcer bases, binding local growth factors, and stimulating angiogenesis. However, there is conflicting clinical evidence as to whether sucralfate, taken prophylactically during radiotherapy, can ameliorate the symptoms of acute radiation proctitis. Methods and Materials: A double-blind randomized trial was conducted at four Radiation Oncology Departments in Sydney, Australia, between February 1995 and June 1997. A total of 338 patients with clinically localized prostate cancer receiving small volume radiotherapy, of whom 335 were evaluable, were randomized to receive either 3 g of oral sucralfate suspension or placebo twice a day during radiotherapy. Patients kept a daily record of their bowel symptoms and were graded according to the RTOG/EORTC acute toxicity criteria. Results: One hundred sixty-four patients received sucralfate and 171 received placebo. Both groups were well balanced with regard to patient, tumor, treatment factors, and baseline symptoms, except that the placebo group had a significantly more liquid baseline stool consistency score (p=0.004). Patients kept a daily diary of symptoms during radiotherapy. After adjusting for baseline values, there was no significant difference between the two groups with regard to stool frequency (p=0.41), consistency (p=0.20), flatus (p=0.25), mucus (p=0.54), and pain (p=0.73). However, there was more bleeding in the sucralfate group, with 64% of patients noticing rectal bleeding, compared with 47% in the placebo group (p=0.001). There was no significant difference between the two groups with respect to RTOG/EORTC acute toxicity (p=0.88; sucralfate 13%, 44%, 43% and placebo 15%, 44%, 40% for grade 0, 1, and 2, respectively). Conclusion: This study suggests that oral

  12. Sexual function after external-beam radiotherapy for prostate cancer: what do we know?

    Science.gov (United States)

    Incrocci, Luca

    2006-02-01

    Quality of life in general and sexual functioning in particular have become very important in cancer patients. Due to modern surgical techniques, improved quality of drugs for chemotherapy and very modern radiation techniques, more patients can be successfully treated without largely compromising sexual functioning. One can assume that because of the life-threatening nature of cancer, sexual activity is not important to patients and their partners, but this is not true. Prostate cancer has become the most common non-skin malignant neoplasm in older men in Western countries. In this paper, we discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. Data on the etiology of erectile dysfunction after external-beam radiotherapy for prostate cancer is reviewed, and the literature is been summarized. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices. Cancer affects quality of life and sexual function. The challenge for oncologists is to address this with compassion.

  13. Prostate cancer

    International Nuclear Information System (INIS)

    Spera, G.

    2010-01-01

    This work is about diagnosis, treatment and monitoring of prostate cancer. The techniques used are: transrectal ultrasound, laparascopy, bone scan, chest x-ray, radiography, chemoterapy and radiotherapy

  14. Synchronous prostate and rectal adenocarcinomas irradiation utilising volumetric modulated arc therapy

    OpenAIRE

    Ng, Sweet Ping; Tran, Thu; Moloney, Philip; Sale, Charlotte; Mathlum, Maitham; Ong, Grace; Lynch, Rod

    2015-01-01

    Abstract Cases of synchronous prostate and colorectal adenocarcinomas have been sporadically reported. There are case reports on patients with synchronous prostate and rectal cancers treated with external beam radiotherapy alone or combined with high?dose rate brachytherapy boost to the prostate. Here, we illustrate a patient with synchronous prostate and rectal cancers treated using the volumetric arc therapy (VMAT) technique. The patient was treated with radical radiotherapy to 50.4 Gy in 2...

  15. Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Huang, Eugene H.; Pollack, Alan; Levy, Larry; Starkschall, George; Lei Dong; Rosen, Isaac; Kuban, Deborah A.

    2002-01-01

    Purpose: To identify dosimetric, anatomic, and clinical factors that correlate with late rectal toxicity after three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Methods and Materials: We retrospectively analyzed the dose-volume histograms and clinical records of 163 Stage T1b-T3c prostate cancer patients treated between 1992 and 1999 with 3D-CRT, to a total isocenter dose of 74-78 Gy at The University of Texas M. D. Anderson Cancer Center. The median follow-up was 62 months (range 24-102). All late rectal complications were scored using modified Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria. The 6-year toxicity rate was assessed using Kaplan-Meier analysis and the log-rank test. A univariate proportional hazards regression model was used to test the correlation between Grade 2 or higher toxicity and the dosimetric, anatomic, and clinical factors. In a multivariate regression model, clinical factors were added to the dosimetric and anatomic variables to determine whether they significantly altered the risk of developing late toxicity. Results: At 6 years, the rate of developing Grade 2 or higher late rectal toxicity was 25%. A significant volume effect was observed at rectal doses of 60, 70, 75.6, and 78 Gy, and the risk of developing rectal complications increased exponentially as greater volumes were irradiated. Although the percentage of rectal volume treated correlated significantly with the incidence of rectal complications at all dose levels (p 3 of the rectum. Of the clinical variables tested, only a history of hemorrhoids correlated with rectal toxicity (p=0.003). Multivariate analysis showed that the addition of hemorrhoids increased the risk of toxicity for each dosimetric variable found to be significant on univariate analysis (p<0.05 for all comparisons). Conclusion: Dose-volume histogram analyses clearly indicated a volume effect on the probability of developing late rectal complications

  16. Converting from CT- to MRI-only-based target definition in radiotherapy of localized prostate cancer. A comparison between two modalities

    Energy Technology Data Exchange (ETDEWEB)

    Seppaelae, Tiina; Visapaeae, Harri; Collan, Juhani; Kapanen, Mika; Kouri, Mauri; Tenhunen, Mikko; Saarilahti, Kauko [University of Helsinki and Helsinki University Hospital, Comprehensive Cancer Center, POB 180, Helsinki (Finland); Beule, Annette [University of Helsinki and Helsinki University Hospital, HUS Medical Imaging Center, Radiology, POB 180, Helsinki (Finland)

    2015-11-15

    To investigate the conversion of prostate cancer radiotherapy (RT) target definition from CT-based planning into an MRI-only-based planning procedure. Using the CT- and MRI-only-based RT planning protocols, 30 prostate cancer patients were imaged in the RT fixation position. Two physicians delineated the prostate in both CT and T2-weighted MRI images. The CT and MRI images were coregistered based on gold seeds and anatomic borders of the prostate. The uncertainty of the coregistration, as well as differences in target volumes and uncertainty of contour delineation were investigated. Conversion of margins and dose constraints from CT- to MRI-only-based treatment planning was assessed. On average, the uncertainty of image coregistration was 0.4 ± 0.5 mm (one standard deviation, SD), 0.9 ± 0.8 mm and 0.9 ± 0.9 mm in the lateral, anterior-posterior and base-apex direction, respectively. The average ratio of the prostate volume between CT and MRI was 1.20 ± 0.15 (one SD). Compared to the CT-based contours, the MRI-based contours were on average 2-7 mm smaller in the apex, 0-1 mm smaller in the rectal direction and 1-4 mm smaller elsewhere. When converting from a CT-based planning procedure to an MRI-based one, the overall planning target volumes (PTV) are prominently reduced only in the apex. The prostate margins and dose constraints can be retained by this conversion. (orig.) [German] Ziel unserer Studie war es, die Umstellung der Strahlentherapieplanung des Prostatakarzinoms von CT-gestuetzter in ausschliesslich MR-gestuetzte Zieldefinition zu untersuchen. Bei 30 Patienten mit Prostatakarzinom wurden eine CT und eine MRT unter Planungsbedingungen durchgefuehrt. Zwei Untersucher konturierten die Prostata in CT- und T2-gewichteten MR-Bildern. Mit Hilfe der Position von Goldstiften und der anatomischen Grenzen der Prostata wurden die CT- und MR-Bilder koregistriert. Es wurden die Genauigkeit der Koregistrierung sowie die Unterschiede der Zielvolumina und der

  17. Comparison of hypo-fractional irradiation protocols used in the treatment of prostate cancer by external radiotherapy; Porovnanie hypofrakcionacnych ozarovacich protokolov pouzivanych v liecbe karcinomu prostaty pomocou externej radioterapie

    Energy Technology Data Exchange (ETDEWEB)

    Petruskova, B. [Univerzita Pavla Jozefa Safarika, Ustav fyzikalnych vied, Katedra jadrovej a subjadrovej fyziky, 04001 Kosice (Slovakia); Matula, P.; Koncik, J.; Jasencak, M. [Vychodoslovensky onkologicky ustav, a.s., 04001 Kosice (Slovakia)

    2013-04-16

    The main aim of this study is to compare two hypo-fractionated protocols used in the radiotherapy of prostate cancer in terms of late complications in normal tissue. 50 patients in first protocol were irradiated with the dose of 52,8 Gy in 16 fractions. 52 patients included in the second protocol were irradiated with the dose of 62 Gy in 20 fractions. Protocols were compared through dose-volume histograms (DVH) of rectum and bladder and radiobiological calculations with the use of Lyman-Kutcher-Burman model for Normal Tissue Complication Probability (NTCP). Results of NTCP were compared with real incidence of late toxicity for normal tissue. DVH of rectum and bladder for patients from second protocol have a better behavior then DVHs for patients from first protocol. NTCPs for first protocol are (12,5{+-}3,3)% and (1,6{+-}1,3)% for rectum and bladder, respectively. NTCPs for second protocol are (6,8{+-}3,0)% and (0,53{+-}0,9)% for rectum and bladder, respectively. From comparison of results of radiobiological calculations and real incidence had arisen a need of refinement of parameters of LKB model. (authors)

  18. Reporting Late Rectal Toxicity in Prostate Cancer Patients Treated With Curative Radiation Treatment

    International Nuclear Information System (INIS)

    Faria, Sergio L.; Souhami, Luis; Joshua, Bosede; Vuong, Te; Freeman, Carolyn R.

    2008-01-01

    Purpose: Long-term rectal toxicity is a concern for patients with prostate cancer treated with curative radiation. However, comparing results of late toxicity may not be straightforward. This article reviews the complexity of reporting long-term side effects by using data for patients treated in our institution with hypofractionated irradiation. Methods and Materials: Seventy-two patients with localized prostate cancer treated with hypofractionated radiotherapy alone to a dose of 66 Gy in 22 fractions were prospectively assessed for late rectal toxicity according to the Common Toxicity Criteria, Version 3, scoring system. Ninety percent of patients had more than 24 months of follow-up. Results are compared with data published in the literature. Results: We found an actuarial incidence of Grade 2 or higher late rectal toxicity of 27% at 30 months and a crude incidence of Grade 2 or higher late rectal toxicity of 18%. This was mostly severe toxicity documented during follow-up. The incidence of Grade 3 rectal toxicity at the last visit was 3% compared with 13% documented at any time during follow-up. Conclusion: Comparison of late toxicity after radiotherapy in patients with prostate cancer must be undertaken with caution because many factors need to be taken into consideration. Because accurate assessment of late toxicity in the evaluation of long-term outcome after radiotherapy in patients with localized prostate cancer is essential, there is a need to develop by consensus guidelines for assessing and reporting late toxicity in this group of patients

  19. Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Crevoisier, Renaud de; Tucker, Susan L.; Dong Lei; Mohan, Radhe; Cheung, Rex; Cox, James D.; Kuban, Deborah A.

    2005-01-01

    Purpose: To retrospectively test the hypothesis that rectal distension on the planning computed tomography (CT) scan is associated with an increased risk of biochemical and local failure among patients irradiated for prostate carcinoma when a daily repositioning technique based on direct prostate-organ localization is not used. Methods and Materials: This study included 127 patients who received definitive three-dimensional conformal radiotherapy for prostate cancer to a total dose of 78 Gy at University of Texas M.D. Anderson Cancer Center. Rectal distension was assessed by calculation of the average cross-sectional rectal area (CSA; defined as the rectal volume divided by length) and measuring three rectal diameters on the planning CT. The impact of rectal distension on biochemical control, 2-year prostate biopsy results, and incidence of Grade 2 or greater late rectal bleeding was assessed. Results: The incidence of biochemical failure was significantly higher among patients with distended rectums (CSA >11.2 cm 2 ) on the planning CT scan (p 0.0009, log-rank test). Multivariate analysis indicates that rectal distension and high-risk disease are independent risk factors for biochemical failure, with hazard ratios of 3.89 (95% C.I. 1.58 to 9.56, p = 0.003) and 2.45 (95% C.I. 1.18 to 5.08, p = 0.016), respectively. The probability of residual tumor without evidence of radiation treatment (as scored by the pathologist) increased significantly with rectal distension (p = 0.010, logistic analysis), and a lower incidence of Grade 2 or greater late rectal bleeding within 2 years was simultaneously observed with higher CSA values (p = 0.031, logistic analysis). Conclusions: We found strong evidence that rectal distension on the treatment-planning CT scan decreased the probability of biochemical control, local control, and rectal toxicity in patients who were treated without daily image-guided prostate localization, presumably because of geographic misses. Therefore, an

  20. Technology diffusion and diagnostic testing for prostate cancer.

    Science.gov (United States)

    Schroeck, Florian R; Kaufman, Samuel R; Jacobs, Bruce L; Skolarus, Ted A; Miller, David C; Weizer, Alon Z; Montgomery, Jeffrey S; Wei, John T; Shahinian, Vahakn B; Hollenbeck, Brent K

    2013-11-01

    While the dissemination of robotic prostatectomy and intensity modulated radiotherapy may fuel the increased use of prostatectomy and radiotherapy, these new technologies may also have spillover effects related to diagnostic testing for prostate cancer. Therefore, we examined the association of regional technology penetration with the receipt of prostate specific antigen testing and prostate biopsy. In this retrospective cohort study we included 117,857 men 66 years old or older from the 5% sample of Medicare beneficiaries living in Surveillance, Epidemiology and End Results (SEER) areas from 2003 to 2007. Regional technology penetration was measured as the number of providers performing robotic prostatectomy or intensity modulated radiotherapy per population in a health care market, ie hospital referral region. We assessed the association of technology penetration with the prostate specific antigen testing rate and prostate biopsy using generalized estimating equations. High technology penetration was associated with an increased rate of prostate specific antigen testing (442 vs 425/1,000 person-years, pimpact of technology penetration on prostate specific antigen testing and prostate biopsy was much less than the effect of age, race and comorbidity, eg the prostate specific antigen testing rate per 1,000 person-years was 485 vs 373 for men with only 1 vs 3+ comorbid conditions (ppenetration is associated with a slightly higher rate of prostate specific antigen testing and no change in the prostate biopsy rate. Collectively, our findings temper concerns that adopting new technology accelerates diagnostic testing for prostate cancer. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.