| Autor: |
Gao, Linrui, Wei, Ran, Qin, Shirui, Tian, Yuan, Xia, Wenlong, Song, Yongwen, Wang, Shulian, Fang, Hui, Tang, Yu, Jing, Hao, Liu, Yueping, Tang, Yuan, Qi, Shunan, Chen, Bo, Li, Yexiong, Xing, Nianzeng, Lu, Ningning |
| Zdroj: |
Chronic Diseases and Translational Medicine (CDTM); March 2024, Vol. 10 Issue: 1 p51-61, 11p |
| Abstrakt: |
Magnetic resonance (MR)‐guided ultra‐hypofractionated radiotherapy with whole‐pelvic irradiation (UHF‐WPRT) is a novel approach to radiotherapy for patients with high‐risk (HR) and very high‐risk (VHR) prostate cancer (PCa). However, the inherent complexity of adaptive UHF‐WPRT might inevitably result in longer on‐couch time. We aimed to estimate the delivered dose, study the feasibility and safety of adaptive UHF‐WPRT on a 1.5‐Tesla MR‐Linac. Ten patients with clinical stage T3a‐4N0‐1M0‐1c PCa, who consecutively received UHF‐WPRT, were enrolled prospectively. The contours of the target and organ‐at‐risks on the position verification‐MR (PV‐MR), beam‐on 3D‐MR(Bn‐MR), and post‐MR (after radiotherapy delivery) were derived from the pre‐MR data by deformable image registration. The physician then manually adjusted them, and dose recalculation was performed accordingly. GraphPad Prism 9 (GraphPad Prism Software Inc.) was utilized for conducting statistical analyses. In total, we collected 188 MR scans (50 pre‐MR, 50 PV‐MR, 44 Bn‐MR, and 44 post‐MR scans). With median 59 min, the mean prostate clinical target volume (CTV)‐V100%was 98.59% ± 2.74%, and the mean pelvic CTVp‐V100%relative percentages of all scans was 99.60% ± 1.18%. The median V29 Gychange in the rectal wall was −2% (−18% to 20%). With a median follow‐up of 9 months, no patient had acute Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or more severe genitourinary (GU) or gastrointestinal (GI) toxicities (0%). UHF‐RT to the prostate and the whole pelvis with concomitant boost to positive nodes using an Adapt‐To‐Shape (ATS) workflow was technically feasible for patients with HR and VHR PCa, presenting only mild GU and GI toxicities. The estimated target dose during the beam‐on phase was clinically acceptable based on the 3D‐MR–based dosimetry analysis. Chinese Clinical Trial Registry ChiCTR2000033382. The dose distributions on each magnetic resonance imaging (MRI) scan. (A) A representative DVH plot with four plans and dose metrics on each MRI scan after re‐planning in one fraction. (B–I) Representative dose distributions of the prostate and pelvic of the Adapt‐To‐Shape (ATS) plan on Pre‐MR (B–E) and Beam‐on MR scan (F–I). Ultra‐hypofractionated radiotherapy to the prostate and the whole pelvis with concomitant boost to positive nodes and bone oligo‐metastases with Adapt‐To‐Shape workflow was technically feasible for prostate cancer patients, with only mild genitourinary and gastrointestinal toxicities.A slight decrease but reliable dose coverage of the prostate, pelvis, and metastatic lymph nodes during the beam‐on period was observed.The 3‐mm clinical target volume‐planning target volume margin applied seemed to be sufficient for the prostate and pelvis but might be inadequate for seminal vesicles in a small percentage of patients. Ultra‐hypofractionated radiotherapy to the prostate and the whole pelvis with concomitant boost to positive nodes and bone oligo‐metastases with Adapt‐To‐Shape workflow was technically feasible for prostate cancer patients, with only mild genitourinary and gastrointestinal toxicities. A slight decrease but reliable dose coverage of the prostate, pelvis, and metastatic lymph nodes during the beam‐on period was observed. The 3‐mm clinical target volume‐planning target volume margin applied seemed to be sufficient for the prostate and pelvis but might be inadequate for seminal vesicles in a small percentage of patients. |
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