Paul J Keall1, Emma Colvill2, Ricky O'Brien3, Vincent Caillet2, Thomas Eade4, Andrew Kneebone4, George Hruby4, Per R Poulsen5, Benjamin Zwan6, Peter B Greer7, Jeremy Booth2. 1. ACRF Image X Institute, University of Sydney, Sydney, Australia. Electronic address: paul.keall@sdney.edu.au. 2. ACRF Image X Institute, University of Sydney, Sydney, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia. 3. ACRF Image X Institute, University of Sydney, Sydney, Australia. 4. Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia. 5. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. 6. School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, Australia; Central Coast Cancer Centre, Gosford, Australia. 7. School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, Australia; Calvary Mater Newcastle, Newcastle, Australia.
Abstract
PURPOSE: To report on the primary and secondary outcomes of a prospective clinical trial of electromagnetic-guided multileaf collimator (MLC) tracking radiation therapy for prostate cancer. METHODS AND MATERIALS: Twenty-eight men with prostate cancer were treated with electromagnetic-guided MLC tracking with volumetric modulated arc therapy. A total of 858 fractions were delivered, with the dose per fraction ranging from 2 to 13.75 Gy. The primary outcome was feasibility, with success determined if >95% of fractions were successfully delivered. The secondary outcomes were (1) the improvement in beam-target geometric alignment, (2) the improvement in dosimetric coverage of the prostate and avoidance of critical structures, and (3) no acute grade ≥3 genitourinary or gastrointestinal toxicity. RESULTS: All 858 planned fractions were successfully delivered with MLC tracking, demonstrating the primary outcome of feasibility (P < .001). MLC tracking improved the beam-target geometric alignment from 1.4 to 0.90 mm (root-mean-square error). MLC tracking improved the dosimetric coverage of the prostate and reduced the daily variation in dose to critical structures. No acute grade ≥3 genitourinary or gastrointestinal toxicity was observed. CONCLUSIONS: Electromagnetic-guided MLC tracking radiation therapy for prostate cancer is feasible. The patients received improved geometric targeting and delivered dose distributions that were closer to those planned than they would have received without electromagnetic-guided MLC tracking. No significant acute toxicity was observed.
PURPOSE: To report on the primary and secondary outcomes of a prospective clinical trial of electromagnetic-guided multileaf collimator (MLC) tracking radiation therapy for prostate cancer. METHODS AND MATERIALS: Twenty-eight men with prostate cancer were treated with electromagnetic-guided MLC tracking with volumetric modulated arc therapy. A total of 858 fractions were delivered, with the dose per fraction ranging from 2 to 13.75 Gy. The primary outcome was feasibility, with success determined if >95% of fractions were successfully delivered. The secondary outcomes were (1) the improvement in beam-target geometric alignment, (2) the improvement in dosimetric coverage of the prostate and avoidance of critical structures, and (3) no acute grade ≥3 genitourinary or gastrointestinal toxicity. RESULTS: All 858 planned fractions were successfully delivered with MLC tracking, demonstrating the primary outcome of feasibility (P < .001). MLC tracking improved the beam-target geometric alignment from 1.4 to 0.90 mm (root-mean-square error). MLC tracking improved the dosimetric coverage of the prostate and reduced the daily variation in dose to critical structures. No acute grade ≥3 genitourinary or gastrointestinal toxicity was observed. CONCLUSIONS: Electromagnetic-guided MLC tracking radiation therapy for prostate cancer is feasible. The patients received improved geometric targeting and delivered dose distributions that were closer to those planned than they would have received without electromagnetic-guided MLC tracking. No significant acute toxicity was observed.
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Authors: Thomas Eade; George Hruby; Jeremy Booth; Regina Bromley; Lesley Guo; Andrew O'Toole; Andrew Le; Kenny Wu; May Whitaker; Krishan Rasiah; Venu Chalasani; Justin Vass; Carolyn Kwong; John Atyeo; Andrew Kneebone Journal: Adv Radiat Oncol Date: 2019-04-11