title: Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: early results of a phase I NCI study.
abstract: BACKGROUND
  To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI.
  
  
  METHODS
  Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm.
  
  
  RESULTS
  Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity.
  
  
  CONCLUSIONS
  These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.
authors: Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, USA. singhanu@yahoo.com
authors: Anurag K
authors: AK
authors: Singh
authors: Peter
authors: P
authors: Guion
authors: Nancy
authors: N
authors: Sears-Crouse
authors: Karen
authors: K
authors: Ullman
authors: Sharon
authors: S
authors: Smith
authors: Paul S
authors: PS
authors: Albert
authors: Gabor
authors: G
authors: Fichtinger
authors: Peter L
authors: PL
authors: Choyke
authors: Sheng
authors: S
authors: Xu
authors: Jochen
authors: J
authors: Kruecker
authors: Bradford J
authors: BJ
authors: Wood
authors: Axel
authors: A
authors: Krieger
authors: Holly
authors: H
authors: Ning
mesh_terms: D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054547:National Cancer Institute (U.S.); D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology