Focal salvage treatment for radiorecurrent prostate cancer: A magnetic resonance-guided stereotactic body radiotherapy versus high-dose-rate brachytherapy planning study

Thomas Willigenburg; Ellis Beld; Jochem Hes; Jan J W Lagendijk; Hans C J de Boer; Marinus A Moerland; Jochem R N van der Voort van Zyp

doi:10.1016/j.phro.2020.07.006

Focal salvage treatment for radiorecurrent prostate cancer: A magnetic resonance-guided stereotactic body radiotherapy versus high-dose-rate brachytherapy planning study

Phys Imaging Radiat Oncol. 2020 Aug 7:15:60-65. doi: 10.1016/j.phro.2020.07.006. eCollection 2020 Jul.

Authors

Thomas Willigenburg¹, Ellis Beld¹, Jochem Hes¹, Jan J W Lagendijk¹, Hans C J de Boer¹, Marinus A Moerland¹, Jochem R N van der Voort van Zyp¹

Affiliation

¹ University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands.

Abstract

Background and purpose: Magnetic resonance imaging (MRI)-guided focal salvage high-dose-rate brachytherapy (FS-HDR-BT) is one of the treatment options for radiorecurrent localized prostate cancer. However, due to the invasive nature of the treatment, not all patients are eligible. Magnetic resonance linear accelerator (MR-Linac) systems open up new treatment possibilities and could potentially replace FS-HDR-BT treatment. We conducted a planning study to investigate the feasibility of delivering a single 19 Gy dose to the recurrent lesion using a 1.5 Tesla MR-Linac system.

Materials and methods: Thirty patients who underwent FS-HDR-BT were included. The clinical target volume (CTV) encompassed the visible lesion plus a 5 mm margin. Treatment plans were created for a 1.5 Tesla MR-Linac system using a 1 mm planning target volume (PTV) margin. A dose of 19 Gy was prescribed to ≥ 95% of the PTV. In case this target could not be reached, i.e. when organs-at-risk (OAR) constraints were violated, a dose of ≥ 17 Gy to ≥ 90% of the PTV was accepted. MR-Linac plans were compared to clinical FS-HDR-BT plans.

Results: Target dose coverage was achieved in 14/30 (47%) FS-HDR-BT plans and 17/30 (57%) MR-Linac plans, with comparable median D95% and D90%. In FS-HDR-BT plans, a larger volume reached ≥ 150% of the prescribed dose. Urethra D10%, rectum D1cm³, and rectum D2cm³ were lower in the FS-HDR-BT plans, while bladder dose was comparable for both modalities.

Conclusion: Single fraction treatment of recurrent prostate cancer lesions may be feasible using stereotactic body radiotherapy (SBRT) on a MR-Linac system.

Keywords: Focal salvage high-dose-rate brachytherapy; MR-Linac; MRI-guided radiotherapy; Prostate cancer; Radiotherapy treatment planning; SBRT; Single fraction.