Safety and feasibility of prostate stereotactic ablative radiotherapy using multi-modality imaging and flattening filter free

Duffton, A. et al. (2018) Safety and feasibility of prostate stereotactic ablative radiotherapy using multi-modality imaging and flattening filter free. British Journal of Radiology, 91, 20170625. (doi: 10.1259/bjr.20170625) (PMID:29338305) (PMCID:PMC5966012)

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OBJECTIVE: To investigate feasibility and safety of stereotactic ablative radiotherapy in the management of prostate cancer while employing MR/CT fusion for delineation, fiducial marker seeds for positioning and Varian RapidArc with flattening filter free (FFF) delivery. METHODS: 41 patients were treated for low-intermediate risk prostate cancer with initial prostate-specific antigen of ≤20 ng ml−1, Gleason score 6–7. Patients had MR/CT fusion for delineation of prostate ±seminal vesicles. CT/MR fusion images were used for delineation and planned using flattening filter free modality. Verification on treatment was cone beam CT imaging with fiducial markers for matching. Patients had Radiation Therapy Oncology Group scoring for genitourinary and gastointestinal symptoms at baseline, week 4, 10 and 18. RESULTS: Clinically acceptable plans were achieved for all patients, all plans achieved the objective clinical target volume D99% ≥ 95%, and for planning target volume D95% ≥ 95%. Rectum dose constraints were met for 95.1% for V18 Gy ≤ 35%, 80% V28 Gy ≤ 10%. A total of 32 (78.0%) plans achieved all rectum dose constraints. Grade 1 acute genitourinary symptoms were 53.7% of patients at baseline, 90.2% [95% CI (76.8–97.3%)] (p = 0.0005) at treatment 5, falling to 78.0% (62.4–89.4%) at week 4, and 75.0% (58.8–87.3%) by week 10 and 52.5% (36.1–68.5%) (p = 1.00) at week 18. Acute gastrointestinal symptoms were 5% at baseline, 46.3% [95% CI (30.7–62.6%)] at treatment 5, week 4 43.9% [95% CI (28.5–60.3%)], week 10 25.0% (11.1–42.3%), and declined slightly by week 18 [–20.095% CI (12.7–41.2)] p = 0.039. Overall 75.6% (31/41) of patients experienced Grade 1–2 toxicity during or after treatment. CONCLUSION: This planning and delivery technique is feasible, safe and efficient. A homogeneous dose can be delivered to prostate with confidence, whilst limiting high dose to nearby structures. The use of this technology can be applied safely within further randomized study protocols.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Duffton, Aileen and McLoone, Mr Philip and Foster, Dr John
Authors: Duffton, A., Sadozye, A., Devlin, L., MacLeod, N., Lamb, C., Smith, S., McLoone, P., Sankaralingam, M., Foster, J., Paterson, S., Keatings, S., and Dodds, D.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:British Journal of Radiology
Publisher:British Institute of Radiology
ISSN (Online):1748-880X
Published Online:01 February 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in British Journal of Radiology 91:20170625
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
565193Glasgow Cancer Research UK Centre (CORE)Karen VousdenCancer Research UK (CRUK)C596/A12797RI CANCER SCIENCES