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Mixed-beam approach for high-risk prostate cancer: Carbon-ion boost followed by photon intensity-modulated radiotherapy. Dosimetric and geometric evaluations (AIRC IG-14300) |
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| Institution: | 1. Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;2. Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;3. Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Str. Campeggi, 53, 27100, Pavia, Italy;4. Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy;5. Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy;6. Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;7. Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;8. Scientific Directorate, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China;2. State Key Laboratory of Nuclear Physics and Technology, Peking University, Beijing 100871, China;3. Institute of Radiation Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstr, 85764 Neuherberg, Germany;4. Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China;1. Department of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy;2. Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy;3. Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy;4. Department of Oncology and Hematoncology, University of Milan, Milan, Italy;5. Department of Urology, IEO, European Institute of Oncology, IRCCS, Milan, Italy;1. Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA;2. Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;3. Department of Radiology, Taishan Medical University, Taian, China;4. Department of Radiation Oncology, University of California San Diego, La Jolla, CA;1. Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan;2. Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, Yamagata, Japan;3. Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan;4. Department of Radiology, University of Yamanashi, Yamanashi, Japan;5. Kanagawa Cancer Center, Yokohama, Japan;6. Department of Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan;1. National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba-shi, Japan;2. Department of Radiology, The University of Tokyo Hospital, Japan;3. Department of Radiotherapy, Mitsui Memorial Hospital, Japan;1. Division of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy;2. Division of Radiation Oncology, Sichuan Cancer Center, Chengdu, China;3. Medical Physics, University Hospital Maggiore della Carità, Novara, Italy;4. Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy |
| Abstract: | Background and purposeThe aim was to evaluate dosimetric uncertainties of a mixed beam approach for patients with high-risk prostate cancer (PCa). The treatment consists of a carbon ion radiotherapy (CIRT) boost followed by whole-pelvis intensity-modulated RT (IMRT).Materials and methodsPatients were treated with a CIRT boost of 16.6 Gy/4 fractions followed by whole-pelvis IMRT of 50 Gy/25 fractions, with consequent long term androgen deprivation therapy. Deformable computed tomography image registration (DIR) was performed and corresponding doses were used for plan sum. A comparative IMRT photon plan was obtained as whole-pelvis IMRT of 50 Gy/25 fractions followed by a boost of 28 Gy/14 fractions. DIR performances were evaluated through structure-related and image characteristics parameters.ResultsUntil now, five patients out of ten total enrolled ended the treatment. Dosimetric parameters were lower in CIRT + IMRT than IMRT-only plans for all organs at risk (OARs) except femoral heads.Regarding DIR evaluation, femoral heads were the less deformed OAR. Penile bulb, bladder and anal canal showed intermediate deformation. Rectum was the most deformed. DIR algorithms were patient (P)-dependent, as performances were the highest for P3 and P4, intermediate for P2 and P5, and the lowest for P1.ConclusionsCIRT allows better OARs sparing while increasing the efficacy due to the higher radio-biological effect of carbon ions. However, a mixed beam approach could introduce DIR problems in multi-centric treatments with different operative protocols. The development of this prospective trial will lead to more mature data concerning the clinical impact of implementing DIR procedures in dose accumulation applications for high-risk PCa treatments. |
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