Conversion and validation of rectal constraints for prostate carcinoma receiving hypofractionated carbon-ion radiotherapy with a local effect model

Radiation Oncology

Kambiz Shahnazi¹  Yinxiangzi Sheng¹  Weiwei Wang¹  Zhijie Huang¹  Jingfang Zhao²  Qing Zhang³  Zhengshan Hong³  Ping Li³  Guo-Liang Jiang³ 

[1] Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai Key Laboratory of Radiation Oncology (20dz226100), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, 201315, Shanghai, China;Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai Key Laboratory of Radiation Oncology (20dz226100), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, 201315, Shanghai, China;Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Xuhui District, 270 Dongan Road, 200032, Shanghai, China;Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center; Shanghai Key Laboratory of Radiation Oncology (20dz226100), Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 4365 Kangxin Road, Pudong District, 201315, Shanghai, China;

关键词: Carbon ion radiotherapy;    MKM;    LEM;    Hypofractionated CIRT;    Prostate carcinoma;   

DOI  :  10.1186/s13014-021-01801-w

来源: Springer

【 摘 要 】

BackgroundThe study objective was to establish the local effect model (LEM) rectum constraints for 12-, 8-, and 4-fraction carbon-ion radiotherapy (CIRT) in patients with localized prostate carcinoma (PCA) using microdosimetric kinetic model (MKM)-defined and LEM-defined constraints for 16-fraction CIRT.MethodsWe analyzed 40 patients with PCA who received 16- or 12-fraction CIRT at our center. Linear-quadratic (LQ) and RBE-conversion models were employed to convert the constraints into various fractionations and biophysical models. Based on them, the MKM LQ strategy converted MKM rectum constraints for 16-fraction CIRT to 12-, 8-, and 4-fraction CIRT using the LQ model. Then, MKM constraints were converted to LEM using the RBE-conversion model. Meanwhile the LEM LQ strategy converted MKM rectum constraints for 16-fraction CIRT to LEM using the RBE-conversion model. Then, LEM constraints were converted from 16-fraction constraints to the rectum constraints for 12-, 8-, and 4-fraction CIRT using the LQ model. The LEM constraints for 16- and 12-fraction CIRT were evaluated using rectum doses and clinical follow-up. To adapt them for the MKM LQ strategy, CNAO LEM constraints were first converted to MKM constraints using the RBE-conversion model.ResultsThe NIRS (i.e. DMKM|v, V-20%, 10%, 5%, and 0%) and CNAO rectum constraints (i.e. DLEM|v, V-10 cc, 5 cc, and 1 cc) were converted for 12-fraction CIRT using the MKM LQ strategy to LEM 37.60, 49.74, 55.27, and 58.01 Gy (RBE), and 45.97, 51.70, and 55.97 Gy (RBE), and using the LEM LQ strategy to 39.55, 53.08, 58.91, and 61.73 Gy (RBE), and 49.14, 55.30, and 59.69 Gy (RBE). We also established LEM constraints for 8- and 4-fraction CIRT. The 10-patient RBE-conversion model was comparable to 30-patient model. Eight patients who received 16-fraction CIRT exceeded the corresponding rectum constraints; the others were within the constraints. After a median follow-up of 10.8 months (7.1–20.8), No ≥ G1 late rectum toxicities were observed.ConclusionsThe LEM rectum constraints from the MKM LQ strategy were more conservative and might serve as the reference for hypofractionated CIRT. However, Long-term follow-up plus additional patients is necessary.

【 授权许可】

CC BY