Proton vs. photon radiotherapy for MR-guided dose escalation of intraprostatic lesions

Autor:	Mukesh G. Harisinghani, Hsiao-Ming Lu, Alexei Trofimov, Jason A. Efstathiou, Maryam Moteabbed, Harald Paganetti
Rok vydání:	2021
Předmět:	Male Organs at Risk medicine.medical_treatment Rectum Lower risk Prostate cancer Prostate Proton Therapy medicine Humans Radiology Nuclear Medicine and imaging Pencil-beam scanning Proton therapy business.industry Equivalent dose Radiotherapy Planning Computer-Assisted Prostatic Neoplasms Radiotherapy Dosage Hematology General Medicine medicine.disease Magnetic Resonance Imaging Radiation therapy medicine.anatomical_structure Oncology Radiotherapy Intensity-Modulated Protons business Nuclear medicine
Zdroj:	Acta Oncologica. 60:1283-1290
ISSN:	1651-226X 0284-186X
Popis:	Dose escalation has been associated with improved biochemical control for prostate cancer. Focusing the high dose on the MRI-defined intraprostatic lesions (IL) could spare the surrounding organs at risk and hence allow further escalation. We compare treatment efficacy between state-of-the-art focally-boosted proton and photon-based radiotherapy, and investigate possible predictive guidelines regarding individualized treatment prescriptions.Ten prostate cancer patients with well-defined ILs were selected. Multiparametric MRI was used to delineate ILs, which were transferred to the planning CT via image registration. Pencil beam scanning proton therapy and volumetric modulated arc therapy treatment plans, were created for each patient. Each modality featured 6 plans: (1) moderately hypofractionated dose: 70 Gy to the prostate in 28 fractions, (2)-(6) plan 1 plus additional simultaneous-integrated-boost to ILs to 75.6, 81.2, 86.6, 98 and 112 Gy in 28 fractions. Equivalent dose to 2 Gy-per-fraction (EqD2) was used to calculate tumor control (TCP) and normal tissue complication probabilities (NTCP) for ILs and organs-at-risk.For both modalities, the maximum necessary dose to achieve TCP99% was 98 Gy for very high-risk ILs. For lower risk ILs lower doses were sufficient. NTCP was25% and 35% for protons and photons at the maximum dose escalation, respectively. For the cases and beam characteristics considered, proton therapy was dosimetrically superior when IL was4 cc or located2.5 mm from the rectum.This work demonstrated the potential role for proton therapy in the setting of prostate focal dose escalation. We propose that anatomical characteristic could be used as criteria to identify patients who would benefit from proton treatment.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::38dce18913eb18baa3e9ccac382cea39 https://doi.org/10.1080/0284186x.2021.1947523 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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