A Prospective Trial of Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer: Long-term Outcomes Compared With Standard Image Guided IMRT

Michael H. Schild, Steven E. Schild, William W. Wong, Sujay A. Vora, Sameer R. Keole, Carlos E. Vargas, Thomas B. Daniels, Gary A. Ezzell, Ba D. Nguyen, Michael C. Roarke

Research output: Contribution to journalArticle

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Abstract

Purpose This report describes the long-term outcomes of a prospective trial of intensity modulated radiation therapy (IMRT), integrating a 111In capromab pendetide (ProstaScint) scan-directed simultaneous integrated boost (SIB) for localized prostate cancer. Methods and Materials Seventy-one patients with T1N0M0 to T4N0M0 prostate cancer were enrolled, and their ProstaScint and pelvic computed tomography scans were coregistered for treatment planning. The entire prostate received 75.6 Gy in 42 fractions with IMRT, whereas regions of increased uptake on ProstaScint scans received 82 Gy as an SIB. Patients with intermediate- and high-risk disease also received 6 months and 12 months of adjuvant hormonal therapy, respectively. Results The study enrolled 31 low-, 30 intermediate-, and 10 high-risk patients. The median follow-up was 120 months (range, 24-150 months). The 10-year biochemical control rates were 85% for the entire cohort and 84%, 84%, and 90% for patients with low-, intermediate-, and high-risk disease, respectively. The 10-year survival rate of the entire cohort was 69%. Pretreatment prostate-specific antigen level >10 ng/mL and boost volume of >10% of the prostate volume were significantly associated with poorer biochemical control and survival. The outcomes were compared with those of a cohort of 302 patients treated similarly but without the SIB and followed up for a median of 91 months (range, 6-138 months). The 5- and 10-year biochemical control rates were 86% and 61%, respectively, in patients without the SIB compared with 94% and 85%, respectively, in patients in this trial who received the SIB (P=.02). The cohort that received an SIB did not have increased toxicity. Conclusions The described IMRT strategy, integrating multiple imaging modalities to administer 75.6 Gy to the entire prostate with a boost dose of 82 Gy, was feasible. The addition of the SIB was associated with greater biochemical control but not toxicity. Modern imaging technology can be used to locally intensify the dose to tumors and spare normal tissues, producing very favorable long-term biochemical disease control.

Original languageEnglish (US)
Pages (from-to)1021-1025
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume97
Issue number5
DOIs
StatePublished - Apr 1 2017

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acceleration (physics)
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
Prostate
toxicity
Prostate-Specific Antigen
dosage
antigens
Survival Rate
Tomography
pretreatment
planning
Technology
therapy
tumors
tomography
Survival
Capromab Pendetide

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

A Prospective Trial of Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer : Long-term Outcomes Compared With Standard Image Guided IMRT. / Schild, Michael H.; Schild, Steven E.; Wong, William W.; Vora, Sujay A.; Keole, Sameer R.; Vargas, Carlos E.; Daniels, Thomas B.; Ezzell, Gary A.; Nguyen, Ba D.; Roarke, Michael C.

In: International Journal of Radiation Oncology Biology Physics, Vol. 97, No. 5, 01.04.2017, p. 1021-1025.

Research output: Contribution to journalArticle

Schild, Michael H. ; Schild, Steven E. ; Wong, William W. ; Vora, Sujay A. ; Keole, Sameer R. ; Vargas, Carlos E. ; Daniels, Thomas B. ; Ezzell, Gary A. ; Nguyen, Ba D. ; Roarke, Michael C. / A Prospective Trial of Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer : Long-term Outcomes Compared With Standard Image Guided IMRT. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 97, No. 5. pp. 1021-1025.
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abstract = "Purpose This report describes the long-term outcomes of a prospective trial of intensity modulated radiation therapy (IMRT), integrating a 111In capromab pendetide (ProstaScint) scan-directed simultaneous integrated boost (SIB) for localized prostate cancer. Methods and Materials Seventy-one patients with T1N0M0 to T4N0M0 prostate cancer were enrolled, and their ProstaScint and pelvic computed tomography scans were coregistered for treatment planning. The entire prostate received 75.6 Gy in 42 fractions with IMRT, whereas regions of increased uptake on ProstaScint scans received 82 Gy as an SIB. Patients with intermediate- and high-risk disease also received 6 months and 12 months of adjuvant hormonal therapy, respectively. Results The study enrolled 31 low-, 30 intermediate-, and 10 high-risk patients. The median follow-up was 120 months (range, 24-150 months). The 10-year biochemical control rates were 85{\%} for the entire cohort and 84{\%}, 84{\%}, and 90{\%} for patients with low-, intermediate-, and high-risk disease, respectively. The 10-year survival rate of the entire cohort was 69{\%}. Pretreatment prostate-specific antigen level >10 ng/mL and boost volume of >10{\%} of the prostate volume were significantly associated with poorer biochemical control and survival. The outcomes were compared with those of a cohort of 302 patients treated similarly but without the SIB and followed up for a median of 91 months (range, 6-138 months). The 5- and 10-year biochemical control rates were 86{\%} and 61{\%}, respectively, in patients without the SIB compared with 94{\%} and 85{\%}, respectively, in patients in this trial who received the SIB (P=.02). The cohort that received an SIB did not have increased toxicity. Conclusions The described IMRT strategy, integrating multiple imaging modalities to administer 75.6 Gy to the entire prostate with a boost dose of 82 Gy, was feasible. The addition of the SIB was associated with greater biochemical control but not toxicity. Modern imaging technology can be used to locally intensify the dose to tumors and spare normal tissues, producing very favorable long-term biochemical disease control.",
author = "Schild, {Michael H.} and Schild, {Steven E.} and Wong, {William W.} and Vora, {Sujay A.} and Keole, {Sameer R.} and Vargas, {Carlos E.} and Daniels, {Thomas B.} and Ezzell, {Gary A.} and Nguyen, {Ba D.} and Roarke, {Michael C.}",
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T1 - A Prospective Trial of Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Integrated Boost for Prostate Cancer

T2 - Long-term Outcomes Compared With Standard Image Guided IMRT

AU - Schild, Michael H.

AU - Schild, Steven E.

AU - Wong, William W.

AU - Vora, Sujay A.

AU - Keole, Sameer R.

AU - Vargas, Carlos E.

AU - Daniels, Thomas B.

AU - Ezzell, Gary A.

AU - Nguyen, Ba D.

AU - Roarke, Michael C.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Purpose This report describes the long-term outcomes of a prospective trial of intensity modulated radiation therapy (IMRT), integrating a 111In capromab pendetide (ProstaScint) scan-directed simultaneous integrated boost (SIB) for localized prostate cancer. Methods and Materials Seventy-one patients with T1N0M0 to T4N0M0 prostate cancer were enrolled, and their ProstaScint and pelvic computed tomography scans were coregistered for treatment planning. The entire prostate received 75.6 Gy in 42 fractions with IMRT, whereas regions of increased uptake on ProstaScint scans received 82 Gy as an SIB. Patients with intermediate- and high-risk disease also received 6 months and 12 months of adjuvant hormonal therapy, respectively. Results The study enrolled 31 low-, 30 intermediate-, and 10 high-risk patients. The median follow-up was 120 months (range, 24-150 months). The 10-year biochemical control rates were 85% for the entire cohort and 84%, 84%, and 90% for patients with low-, intermediate-, and high-risk disease, respectively. The 10-year survival rate of the entire cohort was 69%. Pretreatment prostate-specific antigen level >10 ng/mL and boost volume of >10% of the prostate volume were significantly associated with poorer biochemical control and survival. The outcomes were compared with those of a cohort of 302 patients treated similarly but without the SIB and followed up for a median of 91 months (range, 6-138 months). The 5- and 10-year biochemical control rates were 86% and 61%, respectively, in patients without the SIB compared with 94% and 85%, respectively, in patients in this trial who received the SIB (P=.02). The cohort that received an SIB did not have increased toxicity. Conclusions The described IMRT strategy, integrating multiple imaging modalities to administer 75.6 Gy to the entire prostate with a boost dose of 82 Gy, was feasible. The addition of the SIB was associated with greater biochemical control but not toxicity. Modern imaging technology can be used to locally intensify the dose to tumors and spare normal tissues, producing very favorable long-term biochemical disease control.

AB - Purpose This report describes the long-term outcomes of a prospective trial of intensity modulated radiation therapy (IMRT), integrating a 111In capromab pendetide (ProstaScint) scan-directed simultaneous integrated boost (SIB) for localized prostate cancer. Methods and Materials Seventy-one patients with T1N0M0 to T4N0M0 prostate cancer were enrolled, and their ProstaScint and pelvic computed tomography scans were coregistered for treatment planning. The entire prostate received 75.6 Gy in 42 fractions with IMRT, whereas regions of increased uptake on ProstaScint scans received 82 Gy as an SIB. Patients with intermediate- and high-risk disease also received 6 months and 12 months of adjuvant hormonal therapy, respectively. Results The study enrolled 31 low-, 30 intermediate-, and 10 high-risk patients. The median follow-up was 120 months (range, 24-150 months). The 10-year biochemical control rates were 85% for the entire cohort and 84%, 84%, and 90% for patients with low-, intermediate-, and high-risk disease, respectively. The 10-year survival rate of the entire cohort was 69%. Pretreatment prostate-specific antigen level >10 ng/mL and boost volume of >10% of the prostate volume were significantly associated with poorer biochemical control and survival. The outcomes were compared with those of a cohort of 302 patients treated similarly but without the SIB and followed up for a median of 91 months (range, 6-138 months). The 5- and 10-year biochemical control rates were 86% and 61%, respectively, in patients without the SIB compared with 94% and 85%, respectively, in patients in this trial who received the SIB (P=.02). The cohort that received an SIB did not have increased toxicity. Conclusions The described IMRT strategy, integrating multiple imaging modalities to administer 75.6 Gy to the entire prostate with a boost dose of 82 Gy, was feasible. The addition of the SIB was associated with greater biochemical control but not toxicity. Modern imaging technology can be used to locally intensify the dose to tumors and spare normal tissues, producing very favorable long-term biochemical disease control.

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