title: Three-dimensional ultrasound-based image-guided hypofractionated radiotherapy for intermediate-risk prostate cancer: results of a consecutive case series.
abstract: External beam radiotherapy (EBRT) is a standard of care in the treatment of prostate cancer. Hypofractionation is a valid option either radiobiologically and logistically in this context. Image-guidance procedures are strongly needed to provide ballistic precision to radiation delivery. The Clarity platform allows for the acquisition of three-dimensional ultrasound scans (3D-US) to perform image-guided radiotherapy. We treated a consecutive series of intermediate-risk prostate cancer patients (according to NCCN stratification) with a hypofractionated schedule (70.2 Gy/26 fractions at 2.7 Gy/daily to the prostate gland excluding the seminal vesicles at 62.1 Gy) under 3D-US guidance with the Clarity platform. The 3-year biochemical-relapse-free survival, distant-metastases-free, cancer-specific and overall survival were 98.6% (CI: 91.1-99.6%), 98.6% (CI: 91.1-99.6%), 97.5% (CI: 94.5-99.1%), and 94.3% (CI: 90.4-96.7%), respectively. Maximum detected acute GU toxicity was G0 in 22 patients (29.7%), G1 in 30 (22.7%), G2 in 19 (25.6%), G3 in 3 (4%). Maximum detected acute GI toxicity at the end of EBRT was G0 in 42 patients (56.8%), G1 in 22 (29.7%), G2 in 9 (12.1%), G3 in 1 (1.4%). The 3-year actuarial rates of ≥ G2 late toxicities were 6.1% for genito-urinary and 8.9% for gastrointestinal. The whole image-guidance workflow resulted in being robust and reliable. EBRT delivered employing a hypofractionated schedule under 3D-US-based image guidance proved to be a safe and effective treatment approach with consistent biochemical control and a mild toxicity profile. Hence, it has been transferred into daily clinical practice in our Department.
authors.affiliation: Department of Oncology, Radiation Oncology, University of Torino , Turin , Italy, 1.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Fernando
authors.initials: F
authors.lastname: Munoz
authors.forename: Mario
authors.initials: M
authors.lastname: Levis
authors.forename: Christian
authors.initials: C
authors.lastname: Fiandra
authors.forename: Alessia
authors.initials: A
authors.lastname: Guarneri
authors.forename: Francesco
authors.initials: F
authors.lastname: Moretto
authors.forename: Sara
authors.initials: S
authors.lastname: Bartoncini
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.forename: Serena
authors.initials: S
authors.lastname: Badellino
authors.forename: Cristina
authors.initials: C
authors.lastname: Piva
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Trino
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruggieri
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Filippi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 3D Ultrasounds; Clarity; Hypofractionation; IGRT; Prostate cancer Radiotherapy; Radiation