Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post Hoc Analysis of Patients Treated with Magnetic Resonance Imaging–Guided Prostate Stereotactic Body Radiation Therapy in a Phase 3 Randomized Trial
Emerging data suggest that trigone dosimetry may be more associated with poststereotactic body radiation therapy (SBRT) urinary toxicity than whole bladder dosimetry. We quantify the dosimetric effect of interfractional displacement and deformation of the whole bladder and trigone during prostate SB...
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| creator | Neilsen, Beth K. Ma, Ting Martin Akingbemi, Wisdom O. Neylon, Jack Casado, Maria C. Sharma, Sahil Sheng, Ke Ruan, Dan Low, Daniel A. Yang, Yingli Valle, Luca F. Steinberg, Michael L. Lamb, James M. Cao, Minsong Kishan, Amar U. |
| description | Emerging data suggest that trigone dosimetry may be more associated with poststereotactic body radiation therapy (SBRT) urinary toxicity than whole bladder dosimetry. We quantify the dosimetric effect of interfractional displacement and deformation of the whole bladder and trigone during prostate SBRT using on-board, pretreatment 0.35T magnetic resonance images (MRI).
Seventy-seven patients treated with MRI-guided prostate SBRT (40 Gy/5 fractions) on the MRI arm of a phase 3 single-center randomized trial were included. Bladder and trigone structures were contoured on images obtained from a 0.35T simulation MRI and 5 on-board pretreatment MRIs. Dice similarity coefficient (DSC) scores and changes in volume between simulation and daily treatments were calculated. Dosimetric parameters including Dmax, D0.03 cc, Dmean, V40 Gy, V39 Gy, V38 Gy, and V20 Gy for the bladder and trigone for the simulation and daily treatments were collected. Both physician-scored (Common Terminology Criteria for Adverse Events, version 4.03 scale) as well as patient-reported (International Prostate Symptom Scores and the Expanded Prostate Cancer Index Composite-26 scores) acute genitourinary (GU) toxicity outcomes were collected and analyzed.
The average treatment bladder volume was about 30% smaller than the simulation bladder volume; however, the trigone volume remained fairly consistent despite being positively correlated with total bladder volume. Overall, the trigone accounted for |
| doi_str_mv | 10.1016/j.ijrobp.2023.10.015 |
| format | Article |
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Seventy-seven patients treated with MRI-guided prostate SBRT (40 Gy/5 fractions) on the MRI arm of a phase 3 single-center randomized trial were included. Bladder and trigone structures were contoured on images obtained from a 0.35T simulation MRI and 5 on-board pretreatment MRIs. Dice similarity coefficient (DSC) scores and changes in volume between simulation and daily treatments were calculated. Dosimetric parameters including Dmax, D0.03 cc, Dmean, V40 Gy, V39 Gy, V38 Gy, and V20 Gy for the bladder and trigone for the simulation and daily treatments were collected. Both physician-scored (Common Terminology Criteria for Adverse Events, version 4.03 scale) as well as patient-reported (International Prostate Symptom Scores and the Expanded Prostate Cancer Index Composite-26 scores) acute genitourinary (GU) toxicity outcomes were collected and analyzed.
The average treatment bladder volume was about 30% smaller than the simulation bladder volume; however, the trigone volume remained fairly consistent despite being positively correlated with total bladder volume. Overall, the trigone accounted for <2% of the bladder volume. Median DSC for the bladder was 0.79, whereas the median DSC of the trigone was only 0.33. No statistically significant associations between our selected bladder and trigonal dosimetric parameters and grade ≥2 GU toxicity were identified, although numerically, patients with GU toxicity (grade ≥2) had higher intermediate doses to the bladder (V20 Gy and Dmean) and larger volumes exposed to higher doses in the trigone (V40 Gy, V39 Gy, and V38 Gy).
The trigone exhibits little volume change, but considerable interfractional displacement/deformation. As a result, the relative volume of the trigone receiving high doses during prostate SBRT varies substantially between fractions, which could influence GU toxicity and may not be predicted by radiation planning dosimetry.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2023.10.015</identifier><identifier>PMID: 37871887</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Humans ; Male ; Prostate - diagnostic imaging ; Prostate - pathology ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - radiotherapy ; Radiation Exposure ; Radiosurgery - adverse effects ; Radiosurgery - methods ; Urinary Bladder - radiation effects</subject><ispartof>International journal of radiation oncology, biology, physics, 2024-03, Vol.118 (4), p.986-997</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-57c4296c3c14c897bb315773837cba67dbd6bee1e9bae9d23da61fc1448c7e6d3</citedby><cites>FETCH-LOGICAL-c362t-57c4296c3c14c897bb315773837cba67dbd6bee1e9bae9d23da61fc1448c7e6d3</cites><orcidid>0000-0002-4836-8483</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301623080215$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37871887$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neilsen, Beth K.</creatorcontrib><creatorcontrib>Ma, Ting Martin</creatorcontrib><creatorcontrib>Akingbemi, Wisdom O.</creatorcontrib><creatorcontrib>Neylon, Jack</creatorcontrib><creatorcontrib>Casado, Maria C.</creatorcontrib><creatorcontrib>Sharma, Sahil</creatorcontrib><creatorcontrib>Sheng, Ke</creatorcontrib><creatorcontrib>Ruan, Dan</creatorcontrib><creatorcontrib>Low, Daniel A.</creatorcontrib><creatorcontrib>Yang, Yingli</creatorcontrib><creatorcontrib>Valle, Luca F.</creatorcontrib><creatorcontrib>Steinberg, Michael L.</creatorcontrib><creatorcontrib>Lamb, James M.</creatorcontrib><creatorcontrib>Cao, Minsong</creatorcontrib><creatorcontrib>Kishan, Amar U.</creatorcontrib><title>Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post Hoc Analysis of Patients Treated with Magnetic Resonance Imaging–Guided Prostate Stereotactic Body Radiation Therapy in a Phase 3 Randomized Trial</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Emerging data suggest that trigone dosimetry may be more associated with poststereotactic body radiation therapy (SBRT) urinary toxicity than whole bladder dosimetry. We quantify the dosimetric effect of interfractional displacement and deformation of the whole bladder and trigone during prostate SBRT using on-board, pretreatment 0.35T magnetic resonance images (MRI).
Seventy-seven patients treated with MRI-guided prostate SBRT (40 Gy/5 fractions) on the MRI arm of a phase 3 single-center randomized trial were included. Bladder and trigone structures were contoured on images obtained from a 0.35T simulation MRI and 5 on-board pretreatment MRIs. Dice similarity coefficient (DSC) scores and changes in volume between simulation and daily treatments were calculated. Dosimetric parameters including Dmax, D0.03 cc, Dmean, V40 Gy, V39 Gy, V38 Gy, and V20 Gy for the bladder and trigone for the simulation and daily treatments were collected. Both physician-scored (Common Terminology Criteria for Adverse Events, version 4.03 scale) as well as patient-reported (International Prostate Symptom Scores and the Expanded Prostate Cancer Index Composite-26 scores) acute genitourinary (GU) toxicity outcomes were collected and analyzed.
The average treatment bladder volume was about 30% smaller than the simulation bladder volume; however, the trigone volume remained fairly consistent despite being positively correlated with total bladder volume. Overall, the trigone accounted for <2% of the bladder volume. Median DSC for the bladder was 0.79, whereas the median DSC of the trigone was only 0.33. No statistically significant associations between our selected bladder and trigonal dosimetric parameters and grade ≥2 GU toxicity were identified, although numerically, patients with GU toxicity (grade ≥2) had higher intermediate doses to the bladder (V20 Gy and Dmean) and larger volumes exposed to higher doses in the trigone (V40 Gy, V39 Gy, and V38 Gy).
The trigone exhibits little volume change, but considerable interfractional displacement/deformation. As a result, the relative volume of the trigone receiving high doses during prostate SBRT varies substantially between fractions, which could influence GU toxicity and may not be predicted by radiation planning dosimetry.</description><subject>Humans</subject><subject>Male</subject><subject>Prostate - diagnostic imaging</subject><subject>Prostate - pathology</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>Radiation Exposure</subject><subject>Radiosurgery - adverse effects</subject><subject>Radiosurgery - methods</subject><subject>Urinary Bladder - radiation effects</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk2P0zAQDQjEloV_gJCPcGiJ4yROOCB1P-hWWkS1WyRukWNPWleJHWwHtpz4D_xDfgmTdkGckCxZ43lv_N7oRdELGs9oTPM3u5neOVv3syROGD7NYpo9jCa04OWUZdnnR9EkZnk8ZQg-iZ56v4vjmFKePolOGC84LQo-efB62fVCBmIbsjQBXOOw0taIlpy1QilwRBhF1k5vrAFyoX3fCgkdmHBoXEBjXSdGCsFzI5Q-Fpd3vfWDgwPqdqg9fBlG0lwOAcgCjA52cNoItydre6elDvu3ZE5W1gdyZSWZo4a9136UtsKZSPaoA0QARb7psCUfxMZA0JLcgEfFRgJZdmKjzebXj5-LQSsErhzOQwq5RXNgw-hOkjOr9v9oXW_BiX5PtCGCrLbCA2HYNsp2-jsc3Iv2WfS4Ea2H5_f3afTp_eX6_Gp6_XGxPJ9fTyXLkzDNuEyTMpdM0lQWJa9rRjPOWcG4rEXOVa3yGoBCWQsoVcKUyGmD4LSQHHLFTqNXx7m9s7gyH6pOewltKwzYwVdJUdAkzVhZIDQ9QiW69A6aqne6w41WNK7GkFS76hiSagzJ-IohQdrL-x-GugP1l_QnFQh4dwQA-vyqwVVe4v4lKO1AhkpZ_f8ffgP0JNfR</recordid><startdate>20240315</startdate><enddate>20240315</enddate><creator>Neilsen, Beth K.</creator><creator>Ma, Ting Martin</creator><creator>Akingbemi, Wisdom O.</creator><creator>Neylon, Jack</creator><creator>Casado, Maria C.</creator><creator>Sharma, Sahil</creator><creator>Sheng, Ke</creator><creator>Ruan, Dan</creator><creator>Low, Daniel A.</creator><creator>Yang, Yingli</creator><creator>Valle, Luca F.</creator><creator>Steinberg, Michael L.</creator><creator>Lamb, James M.</creator><creator>Cao, Minsong</creator><creator>Kishan, Amar U.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4836-8483</orcidid></search><sort><creationdate>20240315</creationdate><title>Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post Hoc Analysis of Patients Treated with Magnetic Resonance Imaging–Guided Prostate Stereotactic Body Radiation Therapy in a Phase 3 Randomized Trial</title><author>Neilsen, Beth K. ; Ma, Ting Martin ; Akingbemi, Wisdom O. ; Neylon, Jack ; Casado, Maria C. ; Sharma, Sahil ; Sheng, Ke ; Ruan, Dan ; Low, Daniel A. ; Yang, Yingli ; Valle, Luca F. ; Steinberg, Michael L. ; Lamb, James M. ; Cao, Minsong ; Kishan, Amar U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-57c4296c3c14c897bb315773837cba67dbd6bee1e9bae9d23da61fc1448c7e6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Humans</topic><topic>Male</topic><topic>Prostate - diagnostic imaging</topic><topic>Prostate - pathology</topic><topic>Prostatic Neoplasms - diagnostic imaging</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>Radiation Exposure</topic><topic>Radiosurgery - adverse effects</topic><topic>Radiosurgery - methods</topic><topic>Urinary Bladder - radiation effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neilsen, Beth K.</creatorcontrib><creatorcontrib>Ma, Ting Martin</creatorcontrib><creatorcontrib>Akingbemi, Wisdom O.</creatorcontrib><creatorcontrib>Neylon, Jack</creatorcontrib><creatorcontrib>Casado, Maria C.</creatorcontrib><creatorcontrib>Sharma, Sahil</creatorcontrib><creatorcontrib>Sheng, Ke</creatorcontrib><creatorcontrib>Ruan, Dan</creatorcontrib><creatorcontrib>Low, Daniel A.</creatorcontrib><creatorcontrib>Yang, Yingli</creatorcontrib><creatorcontrib>Valle, Luca F.</creatorcontrib><creatorcontrib>Steinberg, Michael L.</creatorcontrib><creatorcontrib>Lamb, James M.</creatorcontrib><creatorcontrib>Cao, Minsong</creatorcontrib><creatorcontrib>Kishan, Amar U.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neilsen, Beth K.</au><au>Ma, Ting Martin</au><au>Akingbemi, Wisdom O.</au><au>Neylon, Jack</au><au>Casado, Maria C.</au><au>Sharma, Sahil</au><au>Sheng, Ke</au><au>Ruan, Dan</au><au>Low, Daniel A.</au><au>Yang, Yingli</au><au>Valle, Luca F.</au><au>Steinberg, Michael L.</au><au>Lamb, James M.</au><au>Cao, Minsong</au><au>Kishan, Amar U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post Hoc Analysis of Patients Treated with Magnetic Resonance Imaging–Guided Prostate Stereotactic Body Radiation Therapy in a Phase 3 Randomized Trial</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2024-03-15</date><risdate>2024</risdate><volume>118</volume><issue>4</issue><spage>986</spage><epage>997</epage><pages>986-997</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Emerging data suggest that trigone dosimetry may be more associated with poststereotactic body radiation therapy (SBRT) urinary toxicity than whole bladder dosimetry. We quantify the dosimetric effect of interfractional displacement and deformation of the whole bladder and trigone during prostate SBRT using on-board, pretreatment 0.35T magnetic resonance images (MRI).
Seventy-seven patients treated with MRI-guided prostate SBRT (40 Gy/5 fractions) on the MRI arm of a phase 3 single-center randomized trial were included. Bladder and trigone structures were contoured on images obtained from a 0.35T simulation MRI and 5 on-board pretreatment MRIs. Dice similarity coefficient (DSC) scores and changes in volume between simulation and daily treatments were calculated. Dosimetric parameters including Dmax, D0.03 cc, Dmean, V40 Gy, V39 Gy, V38 Gy, and V20 Gy for the bladder and trigone for the simulation and daily treatments were collected. Both physician-scored (Common Terminology Criteria for Adverse Events, version 4.03 scale) as well as patient-reported (International Prostate Symptom Scores and the Expanded Prostate Cancer Index Composite-26 scores) acute genitourinary (GU) toxicity outcomes were collected and analyzed.
The average treatment bladder volume was about 30% smaller than the simulation bladder volume; however, the trigone volume remained fairly consistent despite being positively correlated with total bladder volume. Overall, the trigone accounted for <2% of the bladder volume. Median DSC for the bladder was 0.79, whereas the median DSC of the trigone was only 0.33. No statistically significant associations between our selected bladder and trigonal dosimetric parameters and grade ≥2 GU toxicity were identified, although numerically, patients with GU toxicity (grade ≥2) had higher intermediate doses to the bladder (V20 Gy and Dmean) and larger volumes exposed to higher doses in the trigone (V40 Gy, V39 Gy, and V38 Gy).
The trigone exhibits little volume change, but considerable interfractional displacement/deformation. As a result, the relative volume of the trigone receiving high doses during prostate SBRT varies substantially between fractions, which could influence GU toxicity and may not be predicted by radiation planning dosimetry.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37871887</pmid><doi>10.1016/j.ijrobp.2023.10.015</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-4836-8483</orcidid></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2024-03, Vol.118 (4), p.986-997 |
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| subjects | Humans Male Prostate - diagnostic imaging Prostate - pathology Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - radiotherapy Radiation Exposure Radiosurgery - adverse effects Radiosurgery - methods Urinary Bladder - radiation effects |
| title | Impact of Interfractional Bladder and Trigone Displacement and Deformation on Radiation Exposure and Subsequent Acute Genitourinary Toxicity: A Post Hoc Analysis of Patients Treated with Magnetic Resonance Imaging–Guided Prostate Stereotactic Body Radiation Therapy in a Phase 3 Randomized Trial |
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