ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 29 of 60
Up
JMBS 2019, 4(6): 204–210
https://doi.org/10.26693/jmbs04.06.204
Clinical Medicine

Immediate Results of the Efficacy Evaluation of Conformal Radiotherapy using Individual Planning of the Treatment Volume for Locally Advanced Non-Metastatic Prostate Cancer

Trofymov A., Starenkiy V. Svynarenko A.
Abstract

Displacement of the prostate in the pelvis is one of the aspects that negatively affect the quality of external-beam radiotherapy for prostate cancer. The interfractional movement accounts for errors during the treatment of the prostate due to systematic inaccuracies and anatomical changes in the pelvis caused by the physiological filling of the hollow organs. This article presents the results of personalized treatment planning and monitoring of the treatment volume position during conformal radiotherapy (3D CRT) of locally advanced non-metastatic prostate cancer. Material and methods. This method of radiation treatment pre-planning was first tested at the State Institution “Grigoriev Institute for medical Radiology NAMS of Ukraine” and is used for treatment planning in patients with locally advanced non-metastatic prostate cancer undergoing a course of external-beam radiotherapy, as well as to monitor the position of the treatment volume in the interfractional period. Results and discussion. Treatment efficacy was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST v.1.1, 2009) based on CT findings, by assessing the response dynamics of the primary tumor, by determining the adverse effects of conformal external-beam radiotherapy (changes in the blood count, gastrointestinal and urinary disorders, as well as skin disorders) according to the Common Terminology Criteria for Adverse Events toxicity scale (CTCA 5.00, 2018). We considered specific negative reactions to radiation therapy from different organs and systems. Thus, in patients of the main group there was a slightly lower manifestation of hematological reactions in comparison with the control group: 9.5% in the main and 11.4% in the control. This difference, however, cannot be considered statistically significant, but it captures a certain trend. As for the radial epidermis, they did not develop infrequently in both groups (only 6.3% and 8.5% of cases). We should keep in mind that these undesirable effects could not and cannot be considered a limiting factor for radiotherapy. Radiation proctitis was significantly less in the main group than in the control group. Thus, in the case of individualized conformal therapy in patients, 15.8% of radiation proctitis was observed, and in the case of traditional therapy, this figure reached 28.6%. The difference of about 1.8 times is quite indicative (p = 0.0028, CP). Conclusion. The comparison was done with the method of conventional radiation therapy planning. Personalized conformal radiotherapy pre-planning demonstrated a significant increase in tumor regression from 51.0% to 74.7%. Besides, a significant decrease was recorded in the frequency of the most common and burdensome toxic effects of treatment – radiation cystitis and proctitis, 39.6% in the study group versus 71.4% in the control group.

Keywords: prostate cancer, conformal external beam radiation therapy, radiotherapy planning, target volume

Full text: PDF (Ukr) 327K

References
  1. Kulik A, Dąbkowski M. Prostate cancer radiotherapy. Contemp Oncol (Pozn). 2011; 15: 317-22.
  2. Hoskin PJ, Rojas AM, Ostler PJ, Hughes R, Lowe GJ, Bryant L. Quality of life after radical radiotherapy for prostate cancer: longitudinal study from a randomized trial of external beam radiotherapy
  3. alone or in combination with high dose rate brachytherapy. Clin
  4. Oncol (R Coll Radiol). 2013; 25(5): 321-7. https://www.ncbi.nlm.nih.gov/pubmed/23384799. https://doi.org/10.1016/j.clon.2013.01.001
  5. Pawlowski JM, Yang ES, Malcolm AW, Coffey CW, Ding GX. Reduction of dose delivered to organs at risk in prostate cancer via image-guided radiation therapy. International Journal of Radiation Oncology Biology Physics. 2010; 76(3): 924-34. https://www.ncbi.nlm.nih.gov/pubmed/20004528. https://doi.org/10.1016/j.ijrobp.2009.06.068
  6. Fu W, Yang Y, Yue NJ, Heron DE, Huq MS. A cone beam CT-guided online plan modification technique to correct interfractional anatomic changes for prostate cancer IMRT treatment. Phys Med Biol. 2009; 54(6): 1691-703. https://www.ncbi.nlm.nih.gov/pubmed/19242051. https://doi.org/10.1088/0031-9155/54/6/019
  7. Valdagni R, Kattan MW, Rancati T, Yu C, Vavassori V, Fellin G, et al. Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome. Int J Radiat Oncol Biol Phys. 2012; 82(5): 1957–66. https://www.ncbi.nlm.nih.gov/pubmed/21640511. https://doi.org/10.1016/j.ijrobp.2011.03.028
  8. Martinez AA, Gonzalez J, Ye H, Ghilezan M, Shetty S, Kernen K, et al. Dose escalation improves cancer-related events at 10 years for intermediate- and high risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 79(2): 363–70. https://www.ncbi.nlm.nih.gov/pubmed/21195875. https://doi.org/10.1016/j.ijrobp.2009.10.035
  9. Zapatero A, Roch M, Büchser D, Castro P, Fernández-Banda L, Pozo G, et al. Reduced late urinary toxicity with high-dose intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer. Clin Transl Oncol. 2017; 19(9): 1161–7. https://www.ncbi.nlm.nih.gov/pubmed/28374321. https://doi.org/10.1007/s12094-017-1655-9
  10. Murakami N, Itami J, Okuma K, Hiroshi M, Keiichi N, Tsukasa B, et al. Urethral dose and increment of international prostate symptom score (IPSS) in transperineal permanent interstitial implant (TPI) of prostate cancer. Strahlenther Onkol. 2008; 184(10): 515–9. https://www.ncbi.nlm.nih.gov/pubmed/19016040. https://doi.org/10.1007/s00066-008-1833-3
  11. Malik R, Jani AB, Liauw SL. External beam radiotherapy for prostate cancer: urinary outcomes for men with high International Prostate Symptom Scores (IPSS). Int J Radiat Oncol Biol Phys, 2011; 80(4): 1080–6. https://www.ncbi.nlm.nih.gov/pubmed/20643513. https://doi.org/10.1016/j.ijrobp.2010.03.040
  12. Schaake W, de Groot M, Krijnen WP, Langendijk JA, van den Bergh AC. Quality of life among prostate cancer patients: A prospective longitudinal population-based study. Radiother Oncol. 2013; 108(2): 299-305. https://www.ncbi.nlm.nih.gov/pubmed/23932157. https://doi.org/10.1016/j.radonc.2013.06.039
  13. Perez-Romasanta LA, Lozano-Martin E, Velasco-Jimenez J, Mendicote-León F, Sanz-Martín M, Torres-Donaire J, et al. CTV to PTV margins for prostate irradiation. Three-dimensional quantitative assessment of interfraction uncertainties using portal imaging and serial CT scans. Clin Transl Oncol. 2009; 11(9): 615-21. https://www.ncbi.nlm.nih.gov/pubmed/19776002
  14. Curtis W, Khan M, Magnelli A, Stephans K, Tendulkar R, Xia P. Relationship of imaging frequency and planning margin to account for intrafraction prostate motion: analysis based onreal-time monitoring data. Int J Radiat Oncol Biol Phys. 2013; 85(3): 700-6. https://www.ncbi.nlm.nih.gov/pubmed/22795802. https://doi.org/10.1016/j.ijrobp.2012.05.044