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CyberKnife Ultra-Hypofractionated SBRT for Localized Prostate Cancer with Dose Escalation to the Dominant Intraprostatic Lesion: In Silico Planning Study
oleh: Giovanni Carlo Mazzola, Maria Giulia Vincini, Elena Rondi, Giuseppe Ronci, Sabrina Vigorito, Mattia Zaffaroni, Giulia Corrao, Salvatore Gallo, Dario Zerini, Stefano Durante, Francesco Alessandro Mistretta, Stefano Luzzago, Matteo Ferro, Andrea Vavassori, Federica Cattani, Gennaro Musi, Ottavio De Cobelli, Giuseppe Petralia, Roberto Orecchia, Giulia Marvaso, Barbara Alicja Jereczek-Fossa
Format: | Article |
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Diterbitkan: | MDPI AG 2023-06-01 |
Deskripsi
The aim is to evaluate the feasibility of ultra-hypofractionated (UH) SBRT with CyberKnife<sup>®</sup> (CK) radiosurgery (Accuray Inc., Sunnyvale, California, USA) for localized prostate cancer (PCa) with a concomitant focal boost to the dominant intraprostatic lesion (DIL). Patients with intermediate/high-risk PCa, with at least one visible DIL on multi-parametric MRI, were included. For each, two CK-SBRT in silico plans were calculated using 95% and 85% isodose lines (CK-95%, CK-85%) and compared with the UH-DWA plan delivered with VERO<sup>®</sup>. All plans simulated a SIB prescription of 40 Gy to PTV-DIL and 36.25 Gy to the whole prostate (PTV-prostate) in five fractions every other day. Fifteen patients were considered. All plans reached the primary planning goal (D95% > 95%) and compliance with organs at risk (OARs) constraints. DVH metrics median values increased (<i>p</i> < 0.05) from UH-DWA to CK-85%. The conformity index of PTV-DIL was 1.00 for all techniques, while for PTV-prostate was 0.978, 0.984, and 0.991 for UH-DWA, CK-95%, and CK-85%, respectively. The CK-85% plans were able to reach a maximum dose of 47 Gy to the DIL while respecting OARs constraints. CK-SBRT plus a focal boost to the DIL for localized PCa appears to be feasible. These encouraging dosimetric results are to be confirmed in upcoming clinical trials such as the phase-II “PRO-SPEED” IEO trial.