title: Volumetric modulated arc therapy planning for primary prostate cancer with selective intraprostatic boost determined by 18F-choline PET/CT.
abstract: OBJECTIVE
  This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by (18)F-choline positron emission tomography/computed tomography (PET/CT).
  
  
  METHODS
  Thirty patients with localized prostate cancer underwent (18)F-choline PET/CT before treatment. Two VMAT plans, plan79 Gy and plan100-105 Gy, were compared for each patient. The whole-prostate planning target volume (PTVprostate) prescription was 79 Gy in both plans, but plan100-105 Gy added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, defined by 60% and 70% of maximum prostatic uptake on (18)F-choline PET (IDLsuv60% and IDLsuv70%, respectively, with IDLsuv70% nested inside IDLsuv60% to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP).
  
  
  RESULTS
  Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDLsuv60% adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan100-105 Gy had significantly higher TCP than plan79 Gy across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan100-105 Gy.
  
  
  CONCLUSIONS
  VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through simultaneous delivery of a steep radiation boost to a (18)F-choline PET-defined IDL.
authors.affiliation: Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kuang
authors.affiliation: Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Wu
authors.affiliation: Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii.
authors.forename: Emily
authors.initials: E
authors.lastname: Hirata
authors.affiliation: Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii.
authors.forename: Kyle
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii.
authors.forename: Miles
authors.initials: M
authors.lastname: Sato
authors.affiliation: Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii; John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. Electronic address: kwee@hawaii.edu.
authors.forename: Sandi A
authors.initials: SA
authors.lastname: Kwee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000512:Alpha Particles; D001610:Beta Particles; D002794:Choline / Q000031:analogs & derivatives; D005240:Feasibility Studies; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000473:pathology; D010413:Penis / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D005462:Fluorine Radioisotopes; C516370:fluoromethylcholine; D002794:Choline
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