Reduction of postradiation therapy urinary toxicity via intrafractional megavoltage-kilovoltage prostate location monitoring Journal Article
| Authors: | Zhang, P.; Happersett, L.; Burleson, S.; Oh, J. H.; Elsayegh, A.; Leong, B.; Thor, M.; Damato, A.; Jackson, A.; Cervino, L.; Deasy, J. O.; Zelefsky, M. |
| Article Title: | Reduction of postradiation therapy urinary toxicity via intrafractional megavoltage-kilovoltage prostate location monitoring |
| Abstract: | Purpose: We hypothesized that an in-house developed system using megavoltage and kilovoltage image guidance (MKIG) to ensure correct prostate positioning during stereotactic body radiation therapy (SBRT) could potentially avoid unwanted doses to nontarget tissues, leading to reduced toxicities. Methods and Materials: We built a 3-dimensional MKIG platform that accurately tracks prostate implanted fiducials in real time and clinically translated the system to replace a commercial approach, intrafraction motion review (IMR), which only tracks fiducials in the 2-dimensional kilovoltage views. From 2017 to 2019, 150 patients with prostate cancer were treated with SBRT and monitored using MKIG. The motion trace of the fiducials alerts therapists to interrupt and reposition the prostate when displacement exceeds a 1.5 mm threshold. A comparison cohort of 121 patients was treated with the same dose regimen and treatment technique but managed by IMR. Statistics of intrafractional patient shifts and delivery time were collected to evaluate the workflow efficacy. The incidence of grade ≥2 urinary toxicities was analyzed to assess clinical complications. The median follow-up time was 3.7 years (0.2-8.2 years). Results: MKIG treatments had more treatment shifts (1.09 vs 0.28) and a longer average delivery time per fraction (579 ± 205 seconds vs 357 ± 117 seconds) than IMR treatments. Three-quarters (75%) of shifts resulting from MKIG were ≤3 mm, versus 51% in IMR, indicating that MKIG detected and corrected smaller deviations. The incidence of grade ≥2 urinary toxicity was lower in the MKIG than the IMR cohort: 10.7% versus 19.8% (P = .047). On multivariate analysis of late urinary toxicity, only high (>7) preradiation therapy international prostate symptom score (P < .043) and the use of MKIG were selected (P < .029). Conclusions: Automated and quantitative MKIG introduced minimal workflow impact and was superior to IMR in localizing the prostate during SBRT, which correlated with a clinically significant reduction in late urinary toxicity. Further clinical testing using randomized trials will be required to validate the impact on outcomes. © 2024 Elsevier Inc. |
| Keywords: | aged; aged, 80 and over; middle aged; major clinical study; radiation dose; follow up; radiotherapy; incidence; radiation injury; radiation response; prostate cancer; prostatic neoplasms; prostate; statistical analysis; radiation dose fractionation; prostate tumor; radiosurgery; urology; irradiation; scoring system; radiation injuries; imaging; multivariate analysis; stereotactic body radiation therapy; prevention and control; radiation toxicity; adverse event; delivery time; image guided radiotherapy; fiducial markers; procedures; megavoltage; urinary tract disease; workflow; organs at risk; intrafraction motion; radiotherapy, image-guided; fiducial marker; international prostate symptom score; fiducials; very elderly; humans; human; male; article; image guidances; motion tracking; % reductions; intrafraction motion review; dose fractionation, radiation; work-flows; location monitoring; postradiation therapy; megavoltage and kilovoltage image guidance |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 121 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-01-01 |
| Start Page: | 261 |
| End Page: | 268 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2024.07.2325 |
| PUBMED: | 39147205 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK authors: Pengpeng Zhang -- Source: Scopus |
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