title: Long-term results of a study using individualized planning target volumes for hypofractionated intensity-modulated radiotherapy boost for prostate cancer.
abstract: BACKGROUND
  This is the final report of a prospective phase I study which evaluated the feasibility, toxicities, and biochemical control in prostate cancer patients treated with a hypofractionated boost utilizing a fiducial marker-based daily image guidance strategy and small patient-specific PTV margins.
  
  
  METHODS
  Low- and intermediate-risk prostate cancer patients underwent transperineal ultrasound-guided implantation of three gold fiducial markers and were treated with three-dimensional conformal radiotherapy to 42 Gy (2 Gy/day). During the first nine fractions of treatment, pre- and post-treatment electronic portal imaging was performed to calculate intrafraction prostate motion. Patient-specific PTV margins were derived and a 30 Gy (3 Gy/day) intensity modulated radiotherapy boost was delivered (Total dose = 72 Gy in 31 fractions; EQD2 = 81 Gy, α/β = 1.4).
  
  
  RESULTS
  Thirty-three patients completed treatment and were followed for a median of 7.2 years (range, 1.2 - 9.5). Seven patients (21%) developed Radiation Therapy Oncology Group (RTOG) late grade 2 GI toxicity and 1 patient (3%) developed late grade 2 GU toxicity. No patients developed late grade 3 GI or GU toxicity. To date, nine patients developed PSA relapse according to the Phoenix criteria. The actuarial five, seven and nine year biochemical control (BC) rates were 87% (95% confidence interval: 69-95), 77% (95% confidence interval: 56-89) and 66% (95% confidence interval: 42-82).
  
  
  CONCLUSIONS
  Our study demonstrates that the use of prostate fiducial markers in combination with a daily online image guidance protocol permits reduced, patient-specific PTV margins in a hypofractionated treatment scheme. This treatment planning and delivery strategy was well tolerated in the intermediate time frame. The use of very small PTV margins did not result in excessive failures when compared to other radiation regimens of similar radiobiological intensity.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. william.chu@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. william.chu@sunnybrook.ca.
authors.forename: William
authors.initials: W
authors.lastname: Chu
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Andrew.Loblaw@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Andrew.Loblaw@sunnybrook.ca.
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Loblaw
authors.affiliation: Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Kelvin.Chan@sunnybrook.ca.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Gerard.Morton@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Gerard.Morton@sunnybrook.ca.
authors.forename: Gerard
authors.initials: G
authors.lastname: Morton
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. choo.c@mayo.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Choo
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Ewa.Szumacher@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Ewa.Szumacher@sunnybrook.ca.
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Cyril.Danjoux@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Cyril.Danjoux@sunnybrook.ca.
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Jean-Philippe.Pignol@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Jean-Philippe.Pignol@sunnybrook.ca.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pignol
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. Patrick.Cheung@sunnybrook.ca.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. Patrick.Cheung@sunnybrook.ca.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cheung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D057285:Precision Medicine; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D013997:Time Factors