Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control Journal Article
| Authors: | Munck af Rosenschold, P.; Zelefsky, M. J.; Apte, A. P.; Jackson, A.; Oh, J. H.; Shulman, E.; Desai, N.; Hunt, M.; Ghadjar, P.; Yorke, E.; Deasy, J. O. |
| Article Title: | Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control |
| Abstract: | Background: To determine if reduced dose delivery uncertainty is associated with daily image-guidance (IG) and Prostate Specific Antigen Relapse Free Survival (PRFS) in intensity-modulated radiotherapy (IMRT) of high-risk prostate cancer (PCa). Methods: Planning data for consecutive PCa patients treated with IMRT (n = 67) and IG-IMRT (n = 35) was retrieved. Using computer simulations of setup errors, we estimated the patient-specific uncertainty in accumulated treatment dose distributions for the prostate and for posterolateral aspects of the gland that are at highest risk for extra-capsular disease. Multivariate Cox regression for PRFS considering Gleason score, T-stage, pre-treatment PSA, number of elevated clinical risk factors (T2c+, GS7+ and PSA10+), nomogram-predicted risk of extra-capsular disease (ECD), and dose metrics was performed. Results: For IMRT vs. IG-IMRT, plan dosimetry values were similar, but simulations revealed uncertainty in delivered dose external to the prostate was significantly different, due to positioning uncertainties. A patient-specific interaction term of the risk of ECD and risk of low dose to the ECD (p = 0.005), and the number of elevated clinical risk factors (p = 0.008), correlate with reduced PRFS. Conclusions: Improvements in PSA outcomes for high-risk PCa using IG-IMRT vs. IMRT without IG may be due to improved dosimetry for ECD. © 2018 The Author(s). |
| Keywords: | radiotherapy; prostate cancer; imrt; image-guided; tumor control probability; high risk disease |
| Journal Title: | Radiation Oncology |
| Volume: | 13 |
| ISSN: | 1748-717X |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2018-04-12 |
| Start Page: | 64 |
| Language: | English |
| DOI: | 10.1186/s13014-018-0978-1 |
| PROVIDER: | scopus |
| PMCID: | PMC5898030 |
| PUBMED: | 29650035 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2018 -- Source: Scopus |
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