The Dose Difference of Dominant Intraprostatic Lesions (DILs) Defined by Magnetic Resonance-Guided and Arc-based Intensity Modulated Radiation Therapy (IMRT), and the Association Between Dose Difference and Recurrent Prostate Cancer

Overview

Journal Asian Pac J Cancer Prev

Specialty Oncology

Date 2024 Sep 29

PMID 39342606

Authors

Amonlaya Amantakul

Thanat Kanthawang

Apichat Tantraworasin

Ekkasit Tharavichitkul

Affiliations

Soon will be listed here.

Abstract

Background: There is growing evidence that local recurrence after radiotherapy often occurs within the dominant intraprostatic lesions (DILs) in prostate cancer. This study aimed to evaluate the dose difference between DILs defined by Magnetic Resonance-guided and arc-based Intensity Modulated Radiation Therapy (IMRT) and to assess the association between the dose difference and biochemical recurrence-free survival.

Materials And Methods: Between 2015 and 2019, 48 prostate cancer patients with DILs visible from multiparametric Magnetic Resonance Imaging (mpMRI) underwent arc-based IMRT with 70 Gy (2.5 Gy each fraction) to the prostate gland. Pretreatment mpMRI DILs contoured the prostate gland retrospectively.

Results: Biochemical recurrence was 8.3%. There was a significant difference between the median dose of DILs from MRI-guided imaging, 69.22 Gy, and the median dose of the whole prostate from arc-based IMRT which was 67.09 Gy (p < 0.001*). The Kaplan-Meier survival curve compared by log-rank test showed an escalation dose of at least 2 Gy tends to improve biochemical recurrence-free survival. However, this tendency did not reach statistical significance (p = 0.2).

Conclusions: The dose distribution within DILs defined by mpMRI is significantly higher than the whole prostate dose from arc-based IMRT. Escalation doses in DILs tend to improve biochemical recurrence-free survival, further validation in larger patient cohorts with extended follow-up is warranted.

References

DAmico A, Chen M, Renshaw A, Loffredo M, Kantoff P . Interval to testosterone recovery after hormonal therapy for prostate cancer and risk of death. Int J Radiat Oncol Biol Phys. 2009; 75(1):10-5. DOI: 10.1016/j.ijrobp.2008.10.082. View

Zamboglou C, Klein C, Thomann B, Fassbender T, Rischke H, Kirste S . The dose distribution in dominant intraprostatic tumour lesions defined by multiparametric MRI and PSMA PET/CT correlates with the outcome in patients treated with primary radiation therapy for prostate cancer. Radiat Oncol. 2018; 13(1):65. PMC: 5898009. DOI: 10.1186/s13014-018-1014-1. View

Pucar D, Hricak H, Shukla-Dave A, Kuroiwa K, Drobnjak M, Eastham J . Clinically significant prostate cancer local recurrence after radiation therapy occurs at the site of primary tumor: magnetic resonance imaging and step-section pathology evidence. Int J Radiat Oncol Biol Phys. 2007; 69(1):62-9. DOI: 10.1016/j.ijrobp.2007.03.065. View

Siegel R, Miller K, Jemal A . Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1):7-30. DOI: 10.3322/caac.21590. View

Henry A, Pieters B, Siebert F, Hoskin P . GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol. 2022; 167:244-251. DOI: 10.1016/j.radonc.2021.12.047. View

Kerkmeijer L, Groen V, Pos F, Haustermans K, Monninkhof E, Smeenk R . Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial. J Clin Oncol. 2021; 39(7):787-796. DOI: 10.1200/JCO.20.02873. View

Arrayeh E, Westphalen A, Kurhanewicz J, Roach 3rd M, Jung A, Carroll P . Does local recurrence of prostate cancer after radiation therapy occur at the site of primary tumor? Results of a longitudinal MRI and MRSI study. Int J Radiat Oncol Biol Phys. 2012; 82(5):e787-93. PMC: 3285390. DOI: 10.1016/j.ijrobp.2011.11.030. View

Zietman A, Bae K, Slater J, Shipley W, Efstathiou J, Coen J . Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol. 2010; 28(7):1106-11. PMC: 2834463. DOI: 10.1200/JCO.2009.25.8475. View

Dearnaley D, Sydes M, Graham J, Aird E, Bottomley D, Cowan R . Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007; 8(6):475-87. DOI: 10.1016/S1470-2045(07)70143-2. View

10.

Kanesvaran R, Castro E, Wong A, Fizazi K, Chua M, Zhu Y . Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with prostate cancer. ESMO Open. 2022; 7(4):100518. PMC: 9434138. DOI: 10.1016/j.esmoop.2022.100518. View

11.

Mendez L, Ravi A, Chung H, Tseng C, Wronski M, Paudel M . Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high-dose-rate brachytherapy. Brachytherapy. 2017; 17(2):291-297. DOI: 10.1016/j.brachy.2017.10.001. View

12.

Fowler J . The radiobiology of prostate cancer including new aspects of fractionated radiotherapy. Acta Oncol. 2005; 44(3):265-76. DOI: 10.1080/02841860410002824. View

13.

Beckendorf V, Guerif S, Le Prise E, Cosset J, Bougnoux A, Chauvet B . 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys. 2010; 80(4):1056-63. DOI: 10.1016/j.ijrobp.2010.03.049. View

14.

Pathmanathan A, Alexander E, Huddart R, Tree A . The delineation of intraprostatic boost regions for radiotherapy using multimodality imaging. Future Oncol. 2016; 12(21):2495-2511. DOI: 10.2217/fon-2016-0129. View

15.

Lee W, Dignam J, Amin M, Bruner D, Low D, Swanson G . Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. J Clin Oncol. 2016; 34(20):2325-32. PMC: 4981980. DOI: 10.1200/JCO.2016.67.0448. View

16.

Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn P, Jager H . Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol. 2016; 17(4):464-474. DOI: 10.1016/S1470-2045(15)00567-7. View

17.

Roach 3rd M, Hanks G, Thames Jr H, Schellhammer P, Shipley W, Sokol G . Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006; 65(4):965-74. DOI: 10.1016/j.ijrobp.2006.04.029. View

18.

von Eyben F, Kiljunen T, Kangasmaki A, Kairemo K, von Eyben R, Joensuu T . Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion-A Systematic Review and Meta-Analysis. Clin Genitourin Cancer. 2016; 14(3):189-97. DOI: 10.1016/j.clgc.2015.12.005. View

19.

Arruda Viani G, Stefano E, Afonso S . Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys. 2009; 74(5):1405-18. DOI: 10.1016/j.ijrobp.2008.10.091. View

20.

Dearnaley D, Jovic G, Syndikus I, Khoo V, Cowan R, Graham J . Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2014; 15(4):464-73. DOI: 10.1016/S1470-2045(14)70040-3. View