Vol 26, No 2 (2021)
Research paper
Published online: 2021-03-04

open access

Page views 767
Article views/downloads 599
Get Citation

Connect on Social Media

Connect on Social Media

Comparative dosimetrical analysis of intensity-modulated arc therapy, CyberKnife therapy and image-guided interstitial HDR and LDR brachytherapy of low risk prostate cancer

Georgina Fröhlich12, Péter Ágoston13, Kliton Jorgo13, Gábor Stelczer1, Csaba Polgár13, Tibor Major13
Rep Pract Oncol Radiother 2021;26(2):196-202.

Abstract

Background: The objective of the study was to dosimetrically compare the intensity-modulated-arc-therapy (IMAT), CyberKnife therapy (CK), single fraction interstitial high-dose-rate (HDR) and low-dose-rate (LDR) brachytherapy (BT) in low-risk prostate cancer.

Materials and methods: Treatment plans of ten patients treated with CK were selected and additional plans using IMAT, HDR and LDR BT were created on the same CT images. The prescribed dose was 2.5/70 Gy in IMAT, 8/40 Gy in CK, 21 Gy in HDR and 145 Gy in LDR BT to the prostate gland. EQD2 dose-volume parameters were calculated for each technique and compared.

Results: EQD2 total dose of the prostate was significantly lower with IMAT and CK than with HDR and LDR BT, D90 was 79.5 Gy, 116.4 Gy, 169.2 Gy and 157.9 Gy (p < 0.001). However, teletherapy plans were more conformal than BT, COIN was 0.84, 0.82, 0.76 and 0.76 (p < 0.001), respectively. The D2 to the rectum and bladder were lower with HDR BT than with IMAT, CK and LDR BT, it was 66.7 Gy, 68.1 Gy, 36.0 Gy and 68.0 Gy (p = 0.0427), and 68.4 Gy, 78.9 Gy, 51.4 Gy and 70.3 Gy (p = 0.0091) in IMAT, CK, HDR and LDR BT plans, while D0.1 to the urethra was lower with both IMAT and CK than with BTs: 79.9 Gy, 88.0 Gy, 132.7 Gy and 170.6 Gy (p < 0.001). D2 to the hips was higher with IMAT and CK, than with BTs: 13.4 Gy, 20.7 Gy, 0.4Gy and 1.5 Gy (p < 0.001), while D2 to the sigmoid, bowel bag, testicles and penile bulb was higher with CK than with the other techniques.

Conclusions: HDR monotherapy yields the most advantageous dosimetrical plans, except for the dose to the urethra, where IMAT seems to be the optimal modality in the radiotherapy of low-risk prostate cancer.

Article available in PDF format

View PDF Download PDF file

References

  1. Prostate cancer statistics. https://www.cancer.net/cancer-types/prostate-cancer/statistics.
  2. Georg D, Hopfgartner J, Gòra J, et al. Is there room for combined modality treatments? Dosimetric comparison of boost strategies for advanced head and neck and prostate cancer. J Radiat Res. 2013; 54 Suppl 1(12): i97–112.
  3. Vanneste BGL, Van Limbergen EJ, van Lin EN, et al. Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know? Biomed Res Int. 2016; 2016: 6829875.
  4. Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys. 2008; 70(1): 67–74.
  5. Vogelius IR, Bentzen SM. Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news? Int J Radiat Oncol Biol Phys. 2013; 85(1): 89–94.
  6. Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011; 84(1007): 967–996.
  7. Jackson WC, Silva J, Hartman HE, et al. Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6,000 Patients Treated On Prospective Studies. Int J Radiat Oncol Biol Phys. 2019; 104(4): 778–789.
  8. Kee DL, Gal J, Falk AT, et al. Brachytherapy versus external beam radiotherapy boost for prostate cancer: Systematic review with meta-analysis of randomized trials. Cancer Treat Rev. 2018; 70: 265–271.
  9. Fang FM, Wang YM, Wang CJ, et al. Comparison of the outcome and morbidity for localized or locally advanced prostate cancer treated by high-dose-rate brachytherapy plus external beam radiotherapy (EBRT) versus EBRT alone. Jpn J Clin Oncol. 2008; 38(7): 474–479.
  10. Morgan TM, Press RH, Cutrell PK, et al. Brachytherapy for localized prostate cancer in the modern era: a comparison of patient-reported quality of life outcomes among different techniques. J Contemp Brachytherapy. 2018; 10(6): 495–502.
  11. Ash D, Al-Qaisieh B, Bottomley D, et al. The impact of hormone therapy on post-implant dosimetry and outcome following Iodine-125 implant monotherapy for localised prostate cancer. Radiother Oncol. 2005; 75(3): 303–306.
  12. Murakami N, Itami J, Okuma K, 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): 515–519.
  13. Leszczyński W, Slosarek K, Szlag M. Comparison of dose distribution in IMRT and RapidArc technique in prostate radiotherapy. Rep Pract Oncol Radiother. 2012; 17(6): 347–351.
  14. Yang R, Zhao N, Liao A, et al. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer. Med Dosim. 2016; 41(3): 236–241.
  15. Andrzejewski P, Kuess P, Knäusl B, et al. Feasibility of dominant intraprostatic lesion boosting using advanced photon-, proton- or brachytherapy. Radiother Oncol. 2015; 117(3): 509–514.
  16. Morton GC, Hoskin PJ. Brachytherapy: current status and future strategies -- can high dose rate replace low dose rate and external beam radiotherapy? Clin Oncol (R Coll Radiol). 2013; 25(8): 474–482.
  17. Fuller DB, Naitoh J, Lee C, et al. Virtual HDR CyberKnife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. Int J Radiat Oncol Biol Phys. 2008; 70(5): 1588–1597.
  18. King CR. LDR vs. HDR brachytherapy for localized prostate cancer: the view from radiobiological models. Brachytherapy. 2002; 1(4): 219–226.
  19. Skowronek J, Piotrowski T. [Pulsed dose rate brachytherapy: a method description and review of clinical application]. Przegl Lek. 2002; 59(1): 31–36.
  20. Boehmer D, Maingon P, Poortmans P, et al. EORTC radiation oncology group. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol. 2006; 79(3): 259–269.
  21. Jorgo K, Ágoston P, Jánváry L, et al. [Stereotactic body radiation therapy with CyberKnife accelerator for low- and intermediate risk prostate cancer]. Magy Onkol. 2019; 63(1): 52–59.
  22. Jorgo K, Polgar C, Major T, et al. Acute and Late Toxicity after Moderate Hypofractionation with Simultaneous Integrated Boost (SIB) Radiation Therapy for Prostate Cancer. A Single Institution, Prospective Study. Pathol Oncol Res. 2020; 26(2): 905–912.
  23. Agoston P, Major T, Jorgo K, et al. SP-0350: HDR brachytherapy in one fraction vs LDR brachytherapy in the treatment of localized prostate cancer. Early results. Radiother Oncol. 2018; 127: S182–S183.
  24. Fröhlich G, Agoston P, Lövey J, et al. Dosimetric evaluation of high-dose-rate interstitial brachytherapy boost treatments for localized prostate cancer. Strahlenther Onkol. 2010; 186(7): 388–395.
  25. Agoston P, Major T, Fröhlich G, et al. Moderate dose escalation with single-fraction high-dose-rate brachytherapy boost for clinically localized intermediate- and high-risk prostate cancer: 5-year outcome of the first 100 consecutively treated patients. Brachytherapy. 2011; 10(5): 376–384.
  26. Agoston P, Major T, Fröhlich G, et al. [Permanent implant brachytherapy for early, organ-confined prostate cancer]. Magy Onkol. 2011; 55(3): 170–177.
  27. Major T, Agoston P, Fröhlich G, et al. Loose versus stranded seeds in permanent prostate brachytherapy: dosimetric comparison of intraoperative plans. Phys Med. 2014; 30(8): 909–913.
  28. Fowler JF. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989; 62(740): 679–694.
  29. Niemierko A. Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys. 1997; 24(1): 103–110.
  30. Nag S, Gupta N. A simple method of obtaining equivalent doses for use in HDR brachytherapy. Int J Radiat Oncol Biol Phys. 2000; 46(2): 507–513.
  31. Dasu A, Toma-Dasu I. Prostate alpha/beta revisited -- an analysis of clinical results from 14 168 patients. Acta Oncol. 2012; 51(8): 963–974.
  32. Baltas D, Kolotas C, Geramani K, et al. A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys. 1998; 40(2): 515–524.



Reports of Practical Oncology and Radiotherapy