TY - JOUR
T1 - Results of multiparametric transrectal ultrasound–based focal high-dose-rate dose escalation combined with supplementary external beam irradiation in intermediate- and high-risk localized prostate cancer patients
AU - Kovács, György
AU - Müller, Klaudia
AU - Soror, Tamer
AU - Melchert, Corinna
AU - Guo, Xiyuan
AU - Jocham, Dieter
AU - Merseburger, Axel
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Purpose Clinical results of a biologic information–based focused dose escalation combined with dose de-escalation for the whole organ in external beam radiotherapy + high-dose-rate brachytherapy (HDR-BT) boost application for localized prostate cancer in a consecutively treated patient cohort. Methods and Materials One hundred thirty patients were treated with external beam radiotherapy (50 Gy) complementary to two multiparametric transrectal ultrasound–guided 15 Gy HDR-BT fractions. Real-time multiparametric transrectal ultrasound–based biologic planning for high-dose-rate boost dose planning used the summation of gray scale and Doppler sonography imaging + biopsy information. Target subvolumes received HDR-BT dose escalation up to 60 Gy/fraction. Dose-volume histogram parameters, organ at risks doses, and toxicity results were investigated. Results The median followup was 4.3 years, the median age was 68.62 years, and the mean initial prostate-specific antigen was 18.69 ng/mL. Low-, intermediate-, and high-risk constituted 69%, 21%, and 10% of the patients, respectively. The mean peripheral dose was 3.9 Gy per fraction. Prostate-specific antigen nadir was in 93% of the patients ≤1 ng/mL. Quality parameters were as follows: D 90 : 6.58 Gy, V 100 : 30.36%, V 150 : 9.96%, V 200 : 3.16%, uD 0.1 : 7.34 Gy, uD 2 : 9.34 Gy, rD 01 : 10.56 Gy, and rD 2 : 8.32 Gy, respectively. We observed G1, G2, G3 urinary toxicity in 17/130, 11/130, and 2/130 patients, respectively. Rectal toxicity: G1 and G2 occurred in 19/130 and 2/130 patients with mean dose values G1: 8.2 Gy and G2: 8.76 Gy. Analysis of variance test resulted in no correlation between toxicities and any other investigated factors. Conclusions Focused extreme dose escalation with low prostate mean peripheral dose results in excellent long-term outcome data and very high focal boost doses and is causing no enhancement in late treatment toxicity.
AB - Purpose Clinical results of a biologic information–based focused dose escalation combined with dose de-escalation for the whole organ in external beam radiotherapy + high-dose-rate brachytherapy (HDR-BT) boost application for localized prostate cancer in a consecutively treated patient cohort. Methods and Materials One hundred thirty patients were treated with external beam radiotherapy (50 Gy) complementary to two multiparametric transrectal ultrasound–guided 15 Gy HDR-BT fractions. Real-time multiparametric transrectal ultrasound–based biologic planning for high-dose-rate boost dose planning used the summation of gray scale and Doppler sonography imaging + biopsy information. Target subvolumes received HDR-BT dose escalation up to 60 Gy/fraction. Dose-volume histogram parameters, organ at risks doses, and toxicity results were investigated. Results The median followup was 4.3 years, the median age was 68.62 years, and the mean initial prostate-specific antigen was 18.69 ng/mL. Low-, intermediate-, and high-risk constituted 69%, 21%, and 10% of the patients, respectively. The mean peripheral dose was 3.9 Gy per fraction. Prostate-specific antigen nadir was in 93% of the patients ≤1 ng/mL. Quality parameters were as follows: D 90 : 6.58 Gy, V 100 : 30.36%, V 150 : 9.96%, V 200 : 3.16%, uD 0.1 : 7.34 Gy, uD 2 : 9.34 Gy, rD 01 : 10.56 Gy, and rD 2 : 8.32 Gy, respectively. We observed G1, G2, G3 urinary toxicity in 17/130, 11/130, and 2/130 patients, respectively. Rectal toxicity: G1 and G2 occurred in 19/130 and 2/130 patients with mean dose values G1: 8.2 Gy and G2: 8.76 Gy. Analysis of variance test resulted in no correlation between toxicities and any other investigated factors. Conclusions Focused extreme dose escalation with low prostate mean peripheral dose results in excellent long-term outcome data and very high focal boost doses and is causing no enhancement in late treatment toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85007518252&partnerID=8YFLogxK
U2 - 10.1016/j.brachy.2016.11.005
DO - 10.1016/j.brachy.2016.11.005
M3 - Journal articles
C2 - 27964906
AN - SCOPUS:85007518252
SN - 1538-4721
VL - 16
SP - 277
EP - 281
JO - Brachytherapy
JF - Brachytherapy
IS - 2
ER -
