Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial

Paul Keall*, Doan Trang Nguyen, Ricky O'Brien, Emily Hewson, Helen Ball, Per Poulsen, Jeremy Booth, Peter Greer, Perry Hunter, Lee Wilton, Regina Bromley, John Kipritidis, Thomas Eade, Andrew Kneebone, George Hruby, Trevor Moodie, Amy Hayden, Sandra Turner, Sankar Arumugam, Mark SidhomNicholas Hardcastle, Shankar Siva, Keen Hun Tai, Val Gebski, Jarad Martin

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review


Purpose: Kilovoltage intrafraction monitoring (KIM) is a novel software platform implemented on standard radiation therapy systems and enabling real-time image guided radiation therapy (IGRT). In a multi-institutional prospective trial, we investigated whether real-time IGRT improved the accuracy of the dose patients with prostate cancer received during radiation therapy. Methods and Materials: Forty-eight patients with prostate cancer were treated with KIM-guided SABR with 36.25 Gy in 5 fractions. During KIM-guided treatment, the prostate motion was corrected for by either beam gating with couch shifts or multileaf collimator tracking. A dose reconstruction method was used to evaluate the dose delivered to the target and organs at risk with and without real-time IGRT. Primary outcome was the effect of real-time IGRT on dose distributions. Secondary outcomes included patient-reported outcomes and toxicity. Results: Motion correction occurred in ≥1 treatment for 88% of patients (42 of 48) and 51% of treatments (121 of 235). With real-time IGRT, no treatments had prostate clinical target volume (CTV) D98% dose 5% less than planned. Without real-time IGRT, 13 treatments (5.5%) had prostate CTV D98% doses 5% less than planned. The prostate CTV D98% dose with real-time IGRT was closer to the plan by an average of 1.0% (range, –2.8% to 20.3%). Patient outcomes showed no change in the 12-month patient-reported outcomes compared with baseline and no grade ≥3 genitourinary or gastrointestinal toxicities. Conclusions: Real-time IGRT is clinically effective for prostate cancer SABR.

TidsskriftInternational Journal of Radiation Oncology Biology Physics
Sider (fra-til)530-538
Antal sider9
StatusUdgivet - 2020


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