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. 2020 Aug 7:15:60-65.
doi: 10.1016/j.phro.2020.07.006. eCollection 2020 Jul.

Focal salvage treatment for radiorecurrent prostate cancer: A magnetic resonance-guided stereotactic body radiotherapy versus high-dose-rate brachytherapy planning study

Thomas Willigenburg  1 , Ellis Beld  1 , Jochem Hes  1 , Jan J W Lagendijk  1 , Hans C J de Boer  1 , Marinus A Moerland  1 , Jochem R N van der Voort van Zyp  1
Affiliations

Focal salvage treatment for radiorecurrent prostate cancer: A magnetic resonance-guided stereotactic body radiotherapy versus high-dose-rate brachytherapy planning study

Thomas Willigenburg et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Magnetic resonance imaging (MRI)-guided focal salvage high-dose-rate brachytherapy (FS-HDR-BT) is one of the treatment options for radiorecurrent localized prostate cancer. However, due to the invasive nature of the treatment, not all patients are eligible. Magnetic resonance linear accelerator (MR-Linac) systems open up new treatment possibilities and could potentially replace FS-HDR-BT treatment. We conducted a planning study to investigate the feasibility of delivering a single 19 Gy dose to the recurrent lesion using a 1.5 Tesla MR-Linac system.

Materials and methods: Thirty patients who underwent FS-HDR-BT were included. The clinical target volume (CTV) encompassed the visible lesion plus a 5 mm margin. Treatment plans were created for a 1.5 Tesla MR-Linac system using a 1 mm planning target volume (PTV) margin. A dose of 19 Gy was prescribed to ≥ 95% of the PTV. In case this target could not be reached, i.e. when organs-at-risk (OAR) constraints were violated, a dose of ≥ 17 Gy to ≥ 90% of the PTV was accepted. MR-Linac plans were compared to clinical FS-HDR-BT plans.

Results: Target dose coverage was achieved in 14/30 (47%) FS-HDR-BT plans and 17/30 (57%) MR-Linac plans, with comparable median D95% and D90%. In FS-HDR-BT plans, a larger volume reached ≥ 150% of the prescribed dose. Urethra D10%, rectum D1cm3, and rectum D2cm3 were lower in the FS-HDR-BT plans, while bladder dose was comparable for both modalities.

Conclusion: Single fraction treatment of recurrent prostate cancer lesions may be feasible using stereotactic body radiotherapy (SBRT) on a MR-Linac system.

Keywords: Focal salvage high-dose-rate brachytherapy; MR-Linac; MRI-guided radiotherapy; Prostate cancer; Radiotherapy treatment planning; SBRT; Single fraction.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Different tumor locations treated with FS-HDR-BT. A: peripheral tumor, not near any of the organs-at-risk. B: central tumor adjacent to the urethra. C: peripheral/lateral tumor between rectum and urethra. D: central tumor between rectum and urethra. E: tumor adjacent to bladder and urethra. F: peripheral tumor adjacent to rectum and not near urethra. G: tumor in seminal vesicles, adjacent to rectum and/or bladder. H: tumor in base of the prostate, adjacent to rectum and bladder, without seminal vesicle involvement.
Fig. 2
Fig. 2
Example of dose distributions (with 50%, 100%, 150%, and 200% isodose-lines) in simulated MR-Linac plan (A) and clinically delivered FS-HDR-BT plan (B).
See this image and copyright information in PMC

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