Change in prostate volume during extreme hypo-fractionation analysed with MRI

Radiation Oncology

Per Nilsson⁴  Anders Widmark²  Camilla Thellenberg-Karlsson²  Oskar Hagberg¹  Elisabeth Kjellén³  Adalsteinn Gunnlaugsson³ 

[1] Department of Epidemiology, Skåne University Hospital, Lund University, 22185 Lund, Sweden;Department of Oncology and Department of Radiation Sciences, Umeå University Hospital, SE-901 85 Umeå, Sweden;Department of Oncology, Skåne University Hospital, Lund University, 22185 Lund, Sweden;Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, 22185 Lund, Sweden

关键词: Volume change;    Swelling;    Radiotherapy;    Prostate cancer;    MRI;    Hypo-fractionation;   

Others  :  815029
DOI  :  10.1186/1748-717X-9-22

 received in 2013-08-11, accepted in 2014-01-03,  发布年份 2014

【 摘 要 】

Background

Hypo-fractionated external beam radiotherapy with narrow CTV-PTV margins is increasingly applied for prostate cancer. This demands a precise target definition and knowledge on target location and extension during treatment. It is unclear how increase in fraction size affects changes in prostate volume during treatment. Our aim was to study prostate volume changes during extreme hypo-fractionation (7 × 6.1 Gy) by using sequential MRIs.

Methods

Twenty patients treated with extreme hypo-fractionation were recruited from an on-going prospective randomized phase III trial. An MRI scan was done before start of treatment, at mid treatment and at the end of radiotherapy. The prostate was delineated at each MRI and the volume and maximum extension in left-right, anterior-posterior and cranial-caudal directions were measured.

Results

There was a significant increase in mean prostate volume (14%) at mid treatment as compared to baseline. The prostate volume remained enlarged (9%) at the end of radiotherapy. Prostate swelling was most pronounced in the anterior-posterior and cranial-caudal directions.

Conclusions

Extreme hypo-fractionation induced a significant prostate swelling during treatment that was still present at the time of last treatment fraction. Our results indicate that prostate swelling is an important factor to take into account when applying treatment margins during short extreme hypo-fractionation, and that tight margins should be applied with caution.

【 授权许可】

   
2014 Gunnlaugsson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Balter JM, Lam KL, Sandler HM, Littles JF, Bree RL, Ten Haken RK: Automated localization of the prostate at the time of treatment using implanted radiopaque markers: technical feasibility. Int J Radiat Oncol Biol Phys 1995, 33:1281-1286.
• [2]Balter JM, Chen GTY, Pelizzari CA, Krishnasamy S, Rubin S, Vijayakumar S: Online repositioning during treatment of the prostate: a study of potential limits and gains. Int J Radiat Oncol Biol Phys 1993, 27:137-143.
• [3]Ploeger LS, Frenay M, Betgen A, de Bois JA, Gilhuijs KG, van Herk M: Application of video imaging for improvement of patient set-up. Radiother Oncol 2003, 68:277-284.
• [4]Nyholm T, Nyberg M, Karlsson MG, Karlsson M: Systematisation of spatial uncertainties for comparison between a MR and a CT-based radiotherapy workflow for prostate treatments. Radiat Oncol 2009, 17(4):54.
• [5]Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR, Lee AK, Pollack A: Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008, 70:67-74.
• [6]Zelefsky MJ, Yamada Y, Fuks Z, Zhang Z, Hunt M, Cahlon O, Park J, Shippy A: Long-term results of conformal radiotherapy for prostate cancer: impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008, 71:1028-1033.
• [7]Zelefsky MJ, Chou JF, Pei X, Yamada Y, Kollmeier M, Cox B, Zhang Z, Schechter M, Cohen GN, Zaider M: Predicting biochemical tumor control after brachytherapy for clinically localized prostate cancer: the memorial Sloan-Kettering cancer center experience. Brachytherapy 2012, 11:245-249.
• [8]Michalski J, Winter K, Roach M, Markoe A, Sandler HM, Ryu J, Parliament M, Purdy JA, Valicenti RK, Cox JD: Clinical outcome of patients treated with 3D conformal radiation therapy (3D-CRT) for prostate cancer on RTOG 9406. Int J Radiat Oncol Biol Phys 2012, 83:363-370.
• [9]Schulz RJ, Kagan AR: Dose escalation in the radiation therapy of prostate cancer. Int J Radiat Oncol Biol Phys 2011, 80:1289-1291.
• [10]Fransson P, Bergstrom P, Lofroth P-O, Widmark A: Five-year prospective patient evaluation of bladder and bowel symptoms after dose-escalated radiotherapy for prostate cancer with the BeamCath technique. Int J Radiat Oncol Biol Phys 2006, 66:430-438.
• [11]van Herk M: Errors and margins in radiotherapy. Semin Radiat Oncol 2004, 14:52-64.
• [12]Ghilezan MJ, Jaffray DA, Siewerdsen JH, Van Herk M, Shetty A, Sharpe MB, Zafar Jafri S, Vicini FA, Matter RC, Brabbins DS, Martinez AA: Prostate gland motion assessed with cine-magnetic resonance imaging (cine-MRI). Int J Radiat Oncol Biol Phys 2005, 62:406-417.
• [13]Malone S, Crook JM, Kendal WS, Zanto JS: Respiratory-induced prostate motion: quantification and characterization. Int J Radiat Oncol Biol Phys 2000, 48:105-109.
• [14]Budiharto T, Slagmolen P, Haustermans K, Maes F, Junius S, Verstraete J, Oyen R, Hermans J, Van den Heuvel F: Intrafractional prostate motion during online image guided intensity-modulated radiotherapy for prostate cancer. Radiother Oncol 2011, 98:181-186.
• [15]Enmark M, Korreman S, Nystrom H: IGRT of prostate cancer; is the margin reduction gained from daily IG time-dependent? Acta Oncol 2006, 45:907-914.
• [16]Melancon AD, Daniel JC O, Zhang L, Kudchadker RJ, Kuban DA, Lee AK, Cheung RM, de Crevoisier R, Tucker SL, Newhauser WD, Mohan R, Dong L: Is a 3-mm intrafractional margin sufficient for daily image-guided intensity-modulated radiation therapy of prostate cancer? Radiother Oncol 2007, 85:251-259.
• [17]Engels B, Soete G, Verellen D, Storme G: Conformal arc radiotherapy for prostate cancer: Increased biochemical failure in patients with distended rectum on the planning computed tomogram despite image guidance by implanted markers. Int J Radiat Oncol Biol Phys 2009, 74:388-391.
• [18]International Commission of Radiation Units and Measurements: ICRU report 83: Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). Journal of the ICRU 2010, 10:1.
• [19]King BL, Butler WM, Merrick GS, Kurko BS, Reed JL, Murray BC, Wallner KE: Electromagnetic transponders indicate prostate size increase followed by decrease during the course of external beam radiation therapy. Int J Radiat Oncol Biol Phys 2010, 79:1350-1357.
• [20]Nichol AM, Brock KK, Lockwood GA, Moseley DJ, Rosewall T, Warde PR, Catton CN, Jaffray DA: A magnetic resonance imaging study of prostate deformation relative to implanted gold fiducial markers. Int J Radiat Oncol Biol Phys. 2007, 67:48-56.
• [21]Miralbell R, Roberts SA, Zubizarreta E, Hendry JH: Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: α/β = 1.4 (0.9-2.2) Gy. Int J Radiat Oncol Biol Phys 2012, 82:17-24.
• [22]Fowler J, Chappell R, Ritter M: Is alpha/beta for prostate tumours really low? Int J Radiat Oncol Biol Phys 2001, 50:1021-1031.
• [23]Kono Y, Kubota K, Aruga T, Ishibashi A, Morooka M, Ito K, Itami J, Kanemura M, Minowada S, Tanaka T: Swelling of the prostate gland by permanent brachytherapy may affect seed migration. Jpn J Clin Oncol 2010, 40:1159-1165.
• [24]Chung E, Stenmark MH, Evans C, Narayana V, McLaughlin PW: Greater post-implant swelling in small-volume prostate glands: Implications for dosimetry, treatment planning, and operating room technique. Int J Radiat Oncol Biol Phys 2012, 82:1944-1948.
• [25]ISRCTN: Phase III study of HYPO-fractionated radiotherapy of intermediate risk localised prostate cancer. http://www.controlled-trials.com/ISRCTN45905321 webcite
• [26]International Commission of Radiation Units and Measurements: Prescribing, Recording, and Reporting Photon-Beam Therapy. Bethesda; 1993. ICRU; 1993 (ISBN 0-913394-48-3)
• [27]International Commission on Radiation Units and Measurements: Prescribing, recording, and reporting photon beam therapy (supplement to ICRU report 50). Bethesda; 1999. ICRU; 1999 (ISBN 0-913394-61-0)
• [28]Sanguineti G, Marcenaro M, Franzone P, Foppiano F, Vitale V: Neoadjuvant androgen deprivation and prostate gland shrinkage during conformal radiotherapy. Radiother Oncol 2003, 66:151-157.
• [29]Smith W, Lewis C, Bauman G, Rodrigues G, D'Souza D, Ash R, Ho D, Venkatesan V, Downey D, Fenster A: Prostate volume contouring: a 3D analysis of segmentation using 3DTRUS, CT, and MR. Int J Radiat Oncol Biol Phys 2007, 67:1238-1247.
• [30]Jonsson JH, Karlsson MG, Karlsson M, Nyholm T: Treatment planning using MRI data: an analysis of the dose calculation accuracy for different treatment regions. Radiat Oncol 2010, 30:62.
• [31]Nyholm T, Jonsson J, Söderström K, Bergström P, Carlberg A, Frykholm G, Behrens CF, Geertsen PF, Trepiakas R, Hanvey S, Sadozye A, Ansari J, McCallum H, Frew J, McMenemin R, Zackrisson B: Radiat Oncol. 2013, 24:126. Epub ahead of print