Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: Early results of a phase I NCI study

Anurag K. Singh, Peter Guion, Nancy Sears-Crouse, Karen Ullman, Sharon Smith, Paul S. Albert, Gabor Fichtinger, Peter L. Choyke, Sheng Xu, Jochen Kruecker, Bradford J. Wood, Axel Krieger, Holly Ning

Research output: Contribution to journalArticle

Abstract

Background: To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI. Methods: Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm. Results: Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity. Conclusion: These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.

Original languageEnglish (US)
Article number36
JournalRadiation Oncology
Volume2
Issue number1
DOIs
StatePublished - Sep 18 2007
Externally publishedYes

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Biopsy
Prostate
Fiducial Markers
Magnetic Resonance Imaging
Gold
Prostatic Neoplasms
Seeds
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT : Early results of a phase I NCI study. / Singh, Anurag K.; Guion, Peter; Sears-Crouse, Nancy; Ullman, Karen; Smith, Sharon; Albert, Paul S.; Fichtinger, Gabor; Choyke, Peter L.; Xu, Sheng; Kruecker, Jochen; Wood, Bradford J.; Krieger, Axel; Ning, Holly.

In: Radiation Oncology, Vol. 2, No. 1, 36, 18.09.2007.

Research output: Contribution to journalArticle

Singh, AK, Guion, P, Sears-Crouse, N, Ullman, K, Smith, S, Albert, PS, Fichtinger, G, Choyke, PL, Xu, S, Kruecker, J, Wood, BJ, Krieger, A & Ning, H 2007, 'Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: Early results of a phase I NCI study', Radiation Oncology, vol. 2, no. 1, 36. https://doi.org/10.1186/1748-717X-2-36
Singh, Anurag K. ; Guion, Peter ; Sears-Crouse, Nancy ; Ullman, Karen ; Smith, Sharon ; Albert, Paul S. ; Fichtinger, Gabor ; Choyke, Peter L. ; Xu, Sheng ; Kruecker, Jochen ; Wood, Bradford J. ; Krieger, Axel ; Ning, Holly. / Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT : Early results of a phase I NCI study. In: Radiation Oncology. 2007 ; Vol. 2, No. 1.
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AU - Sears-Crouse, Nancy

AU - Ullman, Karen

AU - Smith, Sharon

AU - Albert, Paul S.

AU - Fichtinger, Gabor

AU - Choyke, Peter L.

AU - Xu, Sheng

AU - Kruecker, Jochen

AU - Wood, Bradford J.

AU - Krieger, Axel

AU - Ning, Holly

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N2 - Background: To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI. Methods: Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm. Results: Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity. Conclusion: These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.

AB - Background: To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI. Methods: Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm. Results: Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity. Conclusion: These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.

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