Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial

Paul Keall; Doan Trang Nguyen; Ricky O'Brien; Emily Hewson; Helen Ball; Per Poulsen; Jeremy Booth; Peter Greer; Perry Hunter; Lee Wilton; Regina Bromley; John Kipritidis; Thomas Eade; Andrew Kneebone; George Hruby; Trevor Moodie; Amy Hayden; Sandra Turner; Sankar Arumugam; Mark Sidhom; Nicholas Hardcastle; Shankar Siva; Keen-Hun Tai; Val Gebski; Jarad Martin

doi:10.1016/j.ijrobp.2020.03.014

Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial

Int J Radiat Oncol Biol Phys. 2020 Jul 1;107(3):530-538. doi: 10.1016/j.ijrobp.2020.03.014. Epub 2020 Mar 29.

Authors

Paul Keall¹, Doan Trang Nguyen², Ricky O'Brien³, Emily Hewson³, Helen Ball³, Per Poulsen⁴, Jeremy Booth⁵, Peter Greer⁶, Perry Hunter⁷, Lee Wilton⁷, Regina Bromley⁸, John Kipritidis⁸, Thomas Eade⁹, Andrew Kneebone⁹, George Hruby⁹, Trevor Moodie¹⁰, Amy Hayden¹⁰, Sandra Turner¹⁰, Sankar Arumugam¹¹, Mark Sidhom¹¹, Nicholas Hardcastle¹², Shankar Siva¹³, Keen-Hun Tai¹³, Val Gebski¹⁴, Jarad Martin⁶

Affiliations

¹ ACRF Image X Institute, University of Sydney, Sydney, Australia. Electronic address: paul.keall@sydney.edu.au.
² ACRF Image X Institute, University of Sydney, Sydney, Australia; School of Biomedical Engineering, University of Technology, Sydney, Sydney, Australia.
³ ACRF Image X Institute, University of Sydney, Sydney, Australia.
⁴ Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
⁵ Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia.
⁶ Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia; University of Newcastle, Newcastle, Australia.
⁷ Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia.
⁸ Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.
⁹ Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia.
¹⁰ Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia.
¹¹ Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Sydney, Australia.
¹² Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Institute of Medical Physics, University of Sydney, Sydney, Australia.
¹³ Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Australia.
¹⁴ NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.

PMID: 32234553
DOI: 10.1016/j.ijrobp.2020.03.014

Abstract

Purpose: Kilovoltage intrafraction monitoring (KIM) is a novel software platform implemented on standard radiation therapy systems and enabling real-time image guided radiation therapy (IGRT). In a multi-institutional prospective trial, we investigated whether real-time IGRT improved the accuracy of the dose patients with prostate cancer received during radiation therapy.

Methods and materials: Forty-eight patients with prostate cancer were treated with KIM-guided SABR with 36.25 Gy in 5 fractions. During KIM-guided treatment, the prostate motion was corrected for by either beam gating with couch shifts or multileaf collimator tracking. A dose reconstruction method was used to evaluate the dose delivered to the target and organs at risk with and without real-time IGRT. Primary outcome was the effect of real-time IGRT on dose distributions. Secondary outcomes included patient-reported outcomes and toxicity.

Results: Motion correction occurred in ≥1 treatment for 88% of patients (42 of 48) and 51% of treatments (121 of 235). With real-time IGRT, no treatments had prostate clinical target volume (CTV) D98% dose 5% less than planned. Without real-time IGRT, 13 treatments (5.5%) had prostate CTV D98% doses 5% less than planned. The prostate CTV D98% dose with real-time IGRT was closer to the plan by an average of 1.0% (range, -2.8% to 20.3%). Patient outcomes showed no change in the 12-month patient-reported outcomes compared with baseline and no grade ≥3 genitourinary or gastrointestinal toxicities.

Conclusions: Real-time IGRT is clinically effective for prostate cancer SABR.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Ablation Techniques*
Humans
Male
Middle Aged
Prostatic Neoplasms / radiotherapy*
Radiotherapy, Intensity-Modulated*
Time Factors
Treatment Outcome