Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning
IntroductionAdvances in multiparametric MRI (mpMRI) combining anatomic and functional imaging can accurately identify foci of adenocarcinoma within the prostate, offering the possibility of partial gland therapy. We performed tandem prospective pilot trials to investigate the feasibility of focal pr...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.744130/full |
| _version_ | 1818671086353514496 |
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| author | Elisha Fredman Bryan Traughber Bryan Traughber Michael Kharouta Tarun Podder Simon Lo Lee Ponsky Gregory MacLennan Raj Paspulati Bradley Ellis Mitchell Machtay Mitchell Machtay Rodney Ellis Rodney Ellis |
| author_facet | Elisha Fredman Bryan Traughber Bryan Traughber Michael Kharouta Tarun Podder Simon Lo Lee Ponsky Gregory MacLennan Raj Paspulati Bradley Ellis Mitchell Machtay Mitchell Machtay Rodney Ellis Rodney Ellis |
| author_sort | Elisha Fredman |
| collection | DOAJ |
| description | IntroductionAdvances in multiparametric MRI (mpMRI) combining anatomic and functional imaging can accurately identify foci of adenocarcinoma within the prostate, offering the possibility of partial gland therapy. We performed tandem prospective pilot trials to investigate the feasibility of focal prostate SBRT (f-SBRT) based on correlating diagnostic mpMRI and biopsies with confirmatory pathology in treatment planning.Materials and MethodsPatients with pathologic focal Gleason 6–7 disease and a corresponding PIRADS 4–5 lesion on mpMRI underwent targeted and comprehensive biopsies using MRI/ultrasound fusion under electromagnetic sensor navigation. After rigorous analysis for imaging biopsy concordance, five of 18 patients were eligible to proceed to f-SBRT. Chi-squared test was used for differences from expected outcomes, and concordance was estimated with binomial distribution theory and Wilson’s method.ResultsSix patients had Gleason 6 and 12 had Gleason 3 + 4 disease (mean PSA: 5.8 ng/ml, range: 2.2–8.4). Absolute concordance was 43.8% (95% CI: 0.20, 0.64). Patterns of discordance included additional sites of ipsilateral disease, bilateral disease, and negative target. Five were upstaged to a new NCCN risk category necessitating treatment escalation. The five patients with concordant pathology completed three-fraction f-SBRT with sparing of the surrounding normal structures (including contralateral neurovascular bundle), with no reported grade 2+ toxicities and favorable PSA responses (mean: 41% decrease).ConclusionsOn our pilot trials of f-SBRT planning using rigorous imaging and pathology concordance, image-guided confirmatory biopsies frequently revealed additional disease, suggesting the need for caution in partial-gland therapy. For truly focal disease, f-SBRT provided excellent dosimetry, minimal toxicity, and encouraging biochemical response. Clinical Trial Registration: www.clinicaltrials.gov, NCT02681614; NCT02163317. |
| first_indexed | 2024-12-17T07:18:25Z |
| format | Article |
| id | doaj.art-63b042a01bf346c69c7fad084981fc17 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T07:18:25Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-63b042a01bf346c69c7fad084981fc172022-12-21T21:58:50ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-09-011110.3389/fonc.2021.744130744130Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment PlanningElisha Fredman0Bryan Traughber1Bryan Traughber2Michael Kharouta3Tarun Podder4Simon Lo5Lee Ponsky6Gregory MacLennan7Raj Paspulati8Bradley Ellis9Mitchell Machtay10Mitchell Machtay11Rodney Ellis12Rodney Ellis13Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Penn State University, Milton Hershey Medical Center, Hershey, PA, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, United StatesDepartment of Urology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Pathology, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Penn State University, Milton Hershey Medical Center, Hershey, PA, United StatesDepartment of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United StatesDepartment of Radiation Oncology, Penn State University, Milton Hershey Medical Center, Hershey, PA, United StatesIntroductionAdvances in multiparametric MRI (mpMRI) combining anatomic and functional imaging can accurately identify foci of adenocarcinoma within the prostate, offering the possibility of partial gland therapy. We performed tandem prospective pilot trials to investigate the feasibility of focal prostate SBRT (f-SBRT) based on correlating diagnostic mpMRI and biopsies with confirmatory pathology in treatment planning.Materials and MethodsPatients with pathologic focal Gleason 6–7 disease and a corresponding PIRADS 4–5 lesion on mpMRI underwent targeted and comprehensive biopsies using MRI/ultrasound fusion under electromagnetic sensor navigation. After rigorous analysis for imaging biopsy concordance, five of 18 patients were eligible to proceed to f-SBRT. Chi-squared test was used for differences from expected outcomes, and concordance was estimated with binomial distribution theory and Wilson’s method.ResultsSix patients had Gleason 6 and 12 had Gleason 3 + 4 disease (mean PSA: 5.8 ng/ml, range: 2.2–8.4). Absolute concordance was 43.8% (95% CI: 0.20, 0.64). Patterns of discordance included additional sites of ipsilateral disease, bilateral disease, and negative target. Five were upstaged to a new NCCN risk category necessitating treatment escalation. The five patients with concordant pathology completed three-fraction f-SBRT with sparing of the surrounding normal structures (including contralateral neurovascular bundle), with no reported grade 2+ toxicities and favorable PSA responses (mean: 41% decrease).ConclusionsOn our pilot trials of f-SBRT planning using rigorous imaging and pathology concordance, image-guided confirmatory biopsies frequently revealed additional disease, suggesting the need for caution in partial-gland therapy. For truly focal disease, f-SBRT provided excellent dosimetry, minimal toxicity, and encouraging biochemical response. Clinical Trial Registration: www.clinicaltrials.gov, NCT02681614; NCT02163317.https://www.frontiersin.org/articles/10.3389/fonc.2021.744130/fullprostateradiationSBRTMRIfocal |
| spellingShingle | Elisha Fredman Bryan Traughber Bryan Traughber Michael Kharouta Tarun Podder Simon Lo Lee Ponsky Gregory MacLennan Raj Paspulati Bradley Ellis Mitchell Machtay Mitchell Machtay Rodney Ellis Rodney Ellis Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning Frontiers in Oncology prostate radiation SBRT MRI focal |
| title | Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning |
| title_full | Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning |
| title_fullStr | Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning |
| title_full_unstemmed | Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning |
| title_short | Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning |
| title_sort | focal prostate stereotactic body radiation therapy with correlative pathological and radiographic based treatment planning |
| topic | prostate radiation SBRT MRI focal |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.744130/full |
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