Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study
Background: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). Methods: Ten pati...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/30/1/58 |
| _version_ | 1797443970197880832 |
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| author | Dalia Ahmad Khalil Jörg Wulff Danny Jazmati Dirk Geismar Christian Bäumer Paul-Heinz Kramer Theresa Steinmeier Stefanie Schulze Schleithoff Stephan Tschirdewahn Boris Hadaschik Beate Timmermann |
| author_facet | Dalia Ahmad Khalil Jörg Wulff Danny Jazmati Dirk Geismar Christian Bäumer Paul-Heinz Kramer Theresa Steinmeier Stefanie Schulze Schleithoff Stephan Tschirdewahn Boris Hadaschik Beate Timmermann |
| author_sort | Dalia Ahmad Khalil |
| collection | DOAJ |
| description | Background: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). Methods: Ten patients with localized prostate cancer included in the ProRegPros study and treated at our center were investigated. All patients underwent placement of hydrogel rectum spacers before planning. Two planning CTs (with and without 120 cm<sup>3</sup> fluid-filled ERB) were applied for each patient. Dose prescription was set according to the h strategy, with 72 Gray (Gy)/2.4 Gy/5× weekly to prostate + 1 cm of the seminal vesicle, and 60 Gy/2 Gy/5× weekly to prostate + 2 cm of the seminal vesicle. Planning with two laterally opposed IMPT beams was performed in both CTs. Rectal dosimetry values including dose-volume statistics and normal tissue complication probability (NTCP) were compared for both plans (non-ERB plans vs. ERB plans). Results: For ERB plans compared with non-ERB, the reductions were 8.51 ± 5.25 Gy (RBE) (<i>p</i> = 0.000) and 15.76 ± 11.11 Gy (<i>p</i> = 0.001) for the mean and the median rectal doses, respectively. No significant reductions in rectal volumes were found after high dose levels. The use of ERB resulted in significant reduction in rectal volume after receiving 50 Gy (RBE), 40 Gy (RBE), 30 Gy (RBE), 20 Gy (RBE), and 10 Gy (RBE) with <i>p</i> values of 0.034, 0.008, 0.003, 0.001, and 0.001, respectively. No differences between ERB and non-ERB plans for the anterior rectum were observed. ERB reduced posterior rectal volumes in patients who received 30 Gy (RBE), 20 Gy (RBE), or 10 Gy (RBE), with <i>p</i> values of 0.019, 0.003, and 0.001, respectively. According to the NTCP models, no significant reductions were observed in mean or median rectal toxicity (late rectal bleeding ≥ 2, necrosis or stenosis, and late rectal toxicity ≥ 3) when using the ERB. Conclusion: ERB reduced rectal volumes exposed to intermediate or low dose levels. However, no significant reduction in rectal volume was observed in patients receiving high or intermediate doses. There was no benefit and also no disadvantage associated with the use of ERB for late rectal toxicity, according to available NTCP models. |
| first_indexed | 2024-03-09T13:04:51Z |
| format | Article |
| id | doaj.art-82748379d39740a7a5d9783a25d237d7 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T13:04:51Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
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| series | Current Oncology |
| spelling | doaj.art-82748379d39740a7a5d9783a25d237d72023-11-30T21:49:40ZengMDPI AGCurrent Oncology1198-00521718-77292023-01-0130175876810.3390/curroncol30010058Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison StudyDalia Ahmad Khalil0Jörg Wulff1Danny Jazmati2Dirk Geismar3Christian Bäumer4Paul-Heinz Kramer5Theresa Steinmeier6Stefanie Schulze Schleithoff7Stephan Tschirdewahn8Boris Hadaschik9Beate Timmermann10Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), 45147 Essen, GermanyFaculty of Physics, TU Dortmund University, 44227 Dortmund, GermanyDepartment of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), 45147 Essen, GermanyFaculty of Physics, TU Dortmund University, 44227 Dortmund, GermanyDepartment of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), 45147 Essen, GermanyFaculty of Physics, TU Dortmund University, 44227 Dortmund, GermanyDepartment of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), 45147 Essen, GermanyFaculty of Physics, TU Dortmund University, 44227 Dortmund, GermanyDepartment of Urology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Urology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), 45147 Essen, GermanyBackground: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). Methods: Ten patients with localized prostate cancer included in the ProRegPros study and treated at our center were investigated. All patients underwent placement of hydrogel rectum spacers before planning. Two planning CTs (with and without 120 cm<sup>3</sup> fluid-filled ERB) were applied for each patient. Dose prescription was set according to the h strategy, with 72 Gray (Gy)/2.4 Gy/5× weekly to prostate + 1 cm of the seminal vesicle, and 60 Gy/2 Gy/5× weekly to prostate + 2 cm of the seminal vesicle. Planning with two laterally opposed IMPT beams was performed in both CTs. Rectal dosimetry values including dose-volume statistics and normal tissue complication probability (NTCP) were compared for both plans (non-ERB plans vs. ERB plans). Results: For ERB plans compared with non-ERB, the reductions were 8.51 ± 5.25 Gy (RBE) (<i>p</i> = 0.000) and 15.76 ± 11.11 Gy (<i>p</i> = 0.001) for the mean and the median rectal doses, respectively. No significant reductions in rectal volumes were found after high dose levels. The use of ERB resulted in significant reduction in rectal volume after receiving 50 Gy (RBE), 40 Gy (RBE), 30 Gy (RBE), 20 Gy (RBE), and 10 Gy (RBE) with <i>p</i> values of 0.034, 0.008, 0.003, 0.001, and 0.001, respectively. No differences between ERB and non-ERB plans for the anterior rectum were observed. ERB reduced posterior rectal volumes in patients who received 30 Gy (RBE), 20 Gy (RBE), or 10 Gy (RBE), with <i>p</i> values of 0.019, 0.003, and 0.001, respectively. According to the NTCP models, no significant reductions were observed in mean or median rectal toxicity (late rectal bleeding ≥ 2, necrosis or stenosis, and late rectal toxicity ≥ 3) when using the ERB. Conclusion: ERB reduced rectal volumes exposed to intermediate or low dose levels. However, no significant reduction in rectal volume was observed in patients receiving high or intermediate doses. There was no benefit and also no disadvantage associated with the use of ERB for late rectal toxicity, according to available NTCP models.https://www.mdpi.com/1718-7729/30/1/58endorectal balloonproton therapyintensity-modulated therapyprostate cancerdose-escalated radiation therapyhypofractionated radiation therapy |
| spellingShingle | Dalia Ahmad Khalil Jörg Wulff Danny Jazmati Dirk Geismar Christian Bäumer Paul-Heinz Kramer Theresa Steinmeier Stefanie Schulze Schleithoff Stephan Tschirdewahn Boris Hadaschik Beate Timmermann Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study Current Oncology endorectal balloon proton therapy intensity-modulated therapy prostate cancer dose-escalated radiation therapy hypofractionated radiation therapy |
| title | Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study |
| title_full | Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study |
| title_fullStr | Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study |
| title_full_unstemmed | Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study |
| title_short | Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study |
| title_sort | is an endorectal balloon beneficial for rectal sparing after spacer implantation in prostate cancer patients treated with hypofractionated intensity modulated proton beam therapy a dosimetric and radiobiological comparison study |
| topic | endorectal balloon proton therapy intensity-modulated therapy prostate cancer dose-escalated radiation therapy hypofractionated radiation therapy |
| url | https://www.mdpi.com/1718-7729/30/1/58 |
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