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      Simulation of an HDR “Boost” with Stereotactic Proton versus Photon Therapy in Prostate Cancer: A Dosimetric Feasibility Study

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          Abstract

          Purpose/Objectives

          To compare the dose escalation potential of stereotactic body proton therapy (SBPT) versus stereotactic body photon therapy (SBXT) using high-dose rate prostate brachytherapy (HDR-B) dose-prescription metrics.

          Patients and Methods

          Twenty-five patients previously treated with radiation for prostate cancer were identified and stratified by prostate size (≤ 50cc; n = 13, > 50cc; n = 12). Initial CT simulation scans were re-planned using SBXT and SBPT modalities using a prescription dose of 19Gy in 2 fractions. Target coverage goals were designed to mimic the dose distributions of HDR-B and maximized to the upper limit constraint for the rectum and urethra. Dosimetric parameters between SBPT and SBXT were compared using the signed-rank test and again after stratification for prostate size (≤ 50cm 3 and >50cm 3) using the Wilcoxon rank test.

          Results

          Prostate volume receiving 100% of the dose (V100) was significantly greater for SBXT (99%) versus SBPT (96%) ( P ≤ 0.01), whereas the median V125 (82% vs. 73%, P < 0.01) and V200 (12% vs. 2%, P < 0.01) was significantly greater for SBPT compared to SBXT. Median V150 was 49% for both cohorts ( P = 0.92). V125 and V200 were significantly correlated with prostate size. For prostates > 50cm 3, V200 was significantly greater with SBPT compared to SBXT (14.5% vs. 1%, P = 0.005), but not for prostates 50cm 3 (9% vs 4%, P = 0.11). Median dose to 2cm 3 of the bladder neck was significantly lower with SBPT versus SBXT (9.6 Gy vs. 14 Gy, P < 0.01).

          Conclusion

          SBPT and SBXT can be used to simulate an HDR-B boost for locally advanced prostate cancer. SBPT demonstrated greater dose escalation potential than SBXT. These results are relevant for future trial design, particularly in patients with high risk prostate cancer who are not amenable to brachytherapy.

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          Most cited references51

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          Stereotactic body radiation therapy: the report of AAPM Task Group 101.

          Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.
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            Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): An Analysis of Survival Endpoints for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to a Dose-Escalated External Beam Boost for High- and Intermediate-risk Prostate Cancer.

            To report the primary endpoint of biochemical progression-free survival (b-PFS) and secondary survival endpoints from ASCENDE-RT, a randomized trial comparing 2 methods of dose escalation for intermediate- and high-risk prostate cancer.
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              Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial.

              SpaceOAR, a Food and Drug Administration-approved hydrogel intended to create a rectal-prostate space, was evaluated in a single-blind phase III trial of image guided intensity modulated radiation therapy. A total of 222 men were randomized 2:1 to the spacer or control group and received 79.2 Gy in 1.8-Gy fractions to the prostate with or without the seminal vesicles. The present study reports the final results with a median follow-up period of 3 years.
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                Author and article information

                Journal
                Int J Part Ther
                ijpt
                Int J Part Ther
                IJPT
                International Journal of Particle Therapy
                The Particle Therapy Co-operative Group
                2331-5180
                Winter 2021
                13 November 2020
                : 7
                : 3
                : 11-23
                Affiliations
                [1 ]Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
                [2 ]Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
                [3 ]Department of Radiation Oncology, Emory University, Atlanta, GA, USA
                [4 ]Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
                Author notes
                Corresponding Author: Jill Remick, 1365 Clifton Rd #1-A, Atlanta, GA 30322, jill.remick@ 123456emory.edu , 518-330-2074
                Article
                THEIJPT-D-20-00029
                10.14338/IJPT-20-00029.1
                7886266
                33604412
                26e4f42c-2fe7-4e2a-bdc9-04ff14b8fe32
                ©Copyright 2020 The Author(s)

                Distributed under Creative Commons CC-BY ( https://creativecommons.org/licenses/cc-by/4.0/)

                History
                : 19 May 2020
                : 19 August 2020
                Categories
                Original Articles

                prostate cancer,brachytherapy,stereotactic radiation therapy,proton therapy

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