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Article ; Online: Prostate cancer radiotherapy and incidental testicular irradiation

Jennifer Le Guevelou / Thomas Zilli

Clinical and Translational Radiation Oncology, Vol 40, Iss , Pp 100611- (2023)

Impact on gonadal function

2023

Abstract: Incidental testicular irradiation during prostate cancer radiotherapy is rarely documented in literature and the long-term impact on gonadal function largely underreported. Here we present an overview of available data on incidental testicular ... ...

Abstract	Incidental testicular irradiation during prostate cancer radiotherapy is rarely documented in literature and the long-term impact on gonadal function largely underreported. Here we present an overview of available data on incidental testicular irradiation and radiation-induced hypogonadism during prostate cancer radiotherapy and discuss future technical developments to minimize testis irradiation.
Keywords	Prostate cancer ; Radiotherapy ; Testicles ; Testosterone levels ; Sexual toxicity ; Hypogonadism ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Stereotactic body radiation therapy for prostate cancer after surgical treatment of prostatic obstruction

Constance Huck / Vérane Achard / Priyamvada Maitre / Vedang Murthy / Thomas Zilli

Clinical and Translational Radiation Oncology, Vol 45, Iss , Pp 100709- (2024)

Impact on urinary morbidity and mitigation strategies

1481

Abstract: In the past decade, stereotactic body radiation therapy (SBRT) has emerged as a valid treatment option for patients with localized prostate cancer. Despite the promising results of ultra-hypofractionation in terms of tolerance and disease control, the ... ...

Abstract	In the past decade, stereotactic body radiation therapy (SBRT) has emerged as a valid treatment option for patients with localized prostate cancer. Despite the promising results of ultra-hypofractionation in terms of tolerance and disease control, the toxicity profile of SBRT for prostate cancer patients with a history of surgical treatment of benign prostate hyperplasia is still underreported. Here we present an overview of the available data on urinary morbidity for prostate cancer patients treated with SBRT after prior surgical treatments for benign prostate hyperplasia. Technical improvements useful to minimize toxicity and possible treatments for radiation-induced urethritis are discussed.
Keywords	Prostate cancer ; Radiotherapy ; Stereotactic body radiation therapy ; Transurethral resection ; Adenomectomy ; Toxicity ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Language	English
Publishing date	2024-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Urinary toxicity after salvage re-irradiation for prostate cancer local failure after definitive radiotherapy

Giovanna Dipasquale / Thomas Zilli / Claudio Fiorino / Vérane Achard / Michel Rouzaud / Raymond Miralbell

Journal of Contemporary Brachytherapy, Vol 14, Iss 3, Pp 222-

a clinical and dosimetric prognostic factors analysis

2022 Volume 226

Keywords	prostate cancer ; prognostic factors ; re-irradiation ; urinary toxicity ; Medicine ; R
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Termedia Publishing House
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Elective Nodal Irradiation for Oligorecurrent Nodal Prostate Cancer

Orane Lorton, MS Dipl Ing / Vérane Achard, MD, PhD / Nikolaos Koutsouvelis, MS / Maud Jaccard, MS, PhD / Frederik Vanhoutte, MS, PhD / Giovanna Dipasquale, MS / Piet Ost, MD, PhD / Thomas Zilli, MD

Advances in Radiation Oncology, Vol 8, Iss 6, Pp 101290- (2023)

Interobserver Variability in the PEACE V-STORM Randomized Phase 3 Trial

2023

Abstract: Purpose: Consistency in delineation of pelvic lymph node regions for prostate cancer elective nodal radiation therapy is still challenging despite current guidelines. The aim of this study was to evaluate the interobserver variability in elective lymph ... ...

Abstract	Purpose: Consistency in delineation of pelvic lymph node regions for prostate cancer elective nodal radiation therapy is still challenging despite current guidelines. The aim of this study was to evaluate the interobserver variability in elective lymph node delineation in the PEACE V - STORM randomized phase 2 trial for oligorecurrent nodal prostate cancer. Methods and Materials: Twenty-three centers were asked to delineate the elective pelvic nodal clinical target volume (CTV) of a postoperative oligorecurrent nodal prostate cancer benchmark case using a modified Radiation Therapy Oncology Group (RTOG) 2009 template (upper limit at the L4/L5 interspace). Overall, intersection and overflow volumes, Dice coefficient, Hausdorff distance, and count maps merged with computed tomography images were analyzed. Results: The mean volume including the 23 nodal CTVs was 430.4 ± 64.1 cm3, larger than the modified RTOG 2009 CTV reference volume (386.1 cm3). The intersection common volume between the modified reference RTOG 2009 and the 23 nodal CTVs was estimated at 83.9%, whereas the overflow volume was 23.4%, mainly located at the level of the presacral and the upper limit of the L4/L5 interspace. The mean Dice coefficient was 0.79 ± 0.02, whereas the mean Hausdorff distance was 27 ± 4.4 mm. Conclusions: In salvage radiation therapy treatment of oligorecurrent nodal prostate cancer, variations in elective lymph node volume delineation were mainly observed in the presacral and common iliac areas. Routine implementation and diffusion of available contouring guidelines together with a constant evaluation and evidence-based updating are expected to further decrease the existing variability in pelvic node contouring.
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Personalised versus non-individualised case-based CME

Herman Stoevelaar / Amit Bahl / Nicky Helsen / Nele R.M. Michels / Louis Smets / Mark J. Speakman / Johan Stranne / Jaan Toelen / Frank Van der Aa / Luc Van Ruysevelt / Jessa Yperman / Thomas Zilli / Bertrand F. Tombal / Martin C. Michel

Journal of European CME, Vol 11, Iss

A randomised pilot study

2022 Volume 1

Abstract: The PinPoint Case Platform (PPCP) offers independent online case-based CME. To align with personal learning needs, a functionality of needs assessments (“QuickScan”) was developed, directing users to follow personalised case journeys. A randomised study ... ...

Abstract	The PinPoint Case Platform (PPCP) offers independent online case-based CME. To align with personal learning needs, a functionality of needs assessments (“QuickScan”) was developed, directing users to follow personalised case journeys. A randomised study was conducted, comparing its effectiveness, time efficiency and user experience with a format of non-individualised case-based learning. Forty-two residents in urology from five European countries were randomly assigned to follow non-individualised case-based learning (control group) or a needs assessment plus personalised case journeys on different topics in prostate cancer. After performing a pre- and post-assessment, both groups showed a similar increase in test scores (Mann-Whitney U = 247; p = .113), but the time needed for completing the learning exercise was significantly lower in the group with the personalised approach (median: 45 vs 90 minutes; Mann-Whitney U = 97.5; p = .0141). The quality of the two learning methods was similarly well received by both groups. In conclusion, learners who followed personalised case journeys learned similarly effective but more time efficient than non-individualised case-based learners. Future studies should determine if these findings can be extrapolated to board-certified physicians following CME activities.
Keywords	Continuing medical education ; online CME ; case-based learning ; individualised learning ; prostate cancer ; Special aspects of education ; LC8-6691 ; Medicine (General) ; R5-920
Subject code	370
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Salvage reirradiation for local failure of prostate cancer after curative radiation therapy

Giovanna Dipasquale, MS / Thomas Zilli, MD / Claudio Fiorino, PhD / Michel Rouzaud, MS / Raymond Miralbell, MD

Advances in Radiation Oncology, Vol 3, Iss 4, Pp 673-

Association of rectal toxicity with dose distribution and normal-tissue complication probability models

2018 Volume 681

Abstract: Purpose: This study aimed to assess the impact of radiation dose on rectal toxicity after salvage external beam radiation therapy (EBRT) with or without a brachytherapy boost for exclusive local failures after the primary EBRT for prostate cancer. ... ...

Abstract	Purpose: This study aimed to assess the impact of radiation dose on rectal toxicity after salvage external beam radiation therapy (EBRT) with or without a brachytherapy boost for exclusive local failures after the primary EBRT for prostate cancer. Methods and materials: Fourteen patients with no severe residual late toxicity after primary EBRT ± brachytherapy were reirradiated after a median time interval of 6.1 years. The median normalized total dose in 2 Gy fractions (NTD2Gy, α/β ratio = 1.5 Gy for prostate cancer cells) was 74 Gy at primary EBRT and 85.1 Gy at reirradiation. Rectal dose-volume histograms (converted to NTD2Gy_alpha/beta = 3 Gy) and the corresponding normal-tissue complication probability (NTCP) values for gastrointestinal (GI) toxicity were evaluated for 2 groups: High GI toxicity (grade ≥3) and low GI toxicity (grade ≤2). Results: The 5-year grade ≥3 GI toxicity-free survival rate was 57.1%. The median rectal V70Gy and maximum dose to 1 cm3 (D1ccrect) at primary EBRT were both predictive for grade ≥3 GI toxicity (9% vs 0%; P = .04 and 72.2 Gy vs 66.8 Gy; P < .01, respectively). When adding primary radiation therapy (RT) and reirradiation plans, the median D1ccrect was 139.8 Gy versus 126.7 Gy (P < .01) for high and low GI toxicity groups. NTCP >10% at primary RT was predictive for high GI toxicity at reirradiation (P < .05). Conclusions: Even in the absence of residual toxicity after primary RT, rectal doses >70 Gy and NTCP >10% calculated for a first irradiation may be associated with a higher risk of developing high GI toxicity at reirradiation with a possible D1ccrect threshold of 130 Gy.
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	616
Language	English
Publishing date	2018-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mild hyperthermia by MR-guided focused ultrasound in an ex vivo model of osteolytic bone tumour

Pauline C. Guillemin / Laura Gui / Orane Lorton / Thomas Zilli / Lindsey A. Crowe / Stéphane Desgranges / Xavier Montet / Sylvain Terraz / Raymond Miralbell / Rares Salomir / Sana Boudabbous

Journal of Translational Medicine, Vol 17, Iss 1, Pp 1-

optimization of the spatio-temporal control of the delivered temperature

2019 Volume 19

Abstract: Abstract Background Magnetic resonance guided focused ultrasound was suggested for the induction of deep localized hyperthermia adjuvant to radiation- or chemotherapy. In this study we are aiming to validate an experimental model for the induction of ... ...

Abstract	Abstract Background Magnetic resonance guided focused ultrasound was suggested for the induction of deep localized hyperthermia adjuvant to radiation- or chemotherapy. In this study we are aiming to validate an experimental model for the induction of uniform temperature elevation in osteolytic bone tumours, using the natural acoustic window provided by the cortical breakthrough. Materials and methods Experiments were conducted on ex vivo lamb shank by mimicking osteolytic bone tumours. The cortical breakthrough was exploited to induce hyperthermia inside the medullar cavity by delivering acoustic energy from a phased array HIFU transducer. MR thermometry data was acquired intra-operatory using the proton resonance frequency shift (PRFS) method. Active temperature control was achieved via a closed-loop predictive controller set at 6 °C above the baseline. Several beam geometries with respect to the cortical breakthrough were investigated. Numerical simulations were used to further explain the observed phenomena. Thermal safety of bone heating was assessed by cross-correlating MR thermometry data with the measurements from a fluoroptic temperature sensor inserted in the cortical bone. Results Numerical simulations and MR thermometry confirmed the feasibility of spatio-temporal uniform hyperthermia (± 0.5 °C) inside the medullar cavity using a fixed focal point sonication. This result was obtained by the combination of several factors: an optimal positioning of the focal spot in the plane of the cortical breakthrough, the direct absorption of the HIFU beam at the focal spot, the “acoustic oven effect” yielded by the beam interaction with the bone, and a predictive temperature controller. The fluoroptical sensor data revealed no heating risks for the bone and adjacent tissues and were in good agreement with the PRFS thermometry from measurable voxels adjacent to the periosteum. Conclusion To our knowledge, this is the first study demonstrating the feasibility of MR-guided focused ultrasound hyperthermia inside the ...
Keywords	Adjuvant hyperthermia ; Osteolytic tumours ; MR-guided focused ultrasound ; Temperature control ; Medicine ; R
Subject code	616
Language	English
Publishing date	2019-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: ONE SHOT - single shot radiotherapy for localized prostate cancer

Thomas Zilli / Marta Scorsetti / Daniel Zwahlen / Ciro Franzese / Robert Förster / Niccolò Giaj-Levra / Nikolaos Koutsouvelis / Aurelie Bertaut / Michel Zimmermann / Giuseppe Roberto D’Agostino / Filippo Alongi / Matthias Guckenberger / Raymond Miralbell

Radiation Oncology, Vol 13, Iss 1, Pp 1-

study protocol of a single arm, multicenter phase I/II trial

2018 Volume 8

Abstract: Abstract Background Stereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, ...

Abstract	Abstract Background Stereotactic body radiotherapy (SBRT) is an emerging treatment alternative for patients with localized prostate cancer. Promising results in terms of disease control and toxicity have been reported with 4 to 5 SBRT fractions. However, question of how far can the number of fractions with SBRT be reduced is a challenging research matter. As already explored by some authors in the context of brachytherapy, monotherapy appears to be feasible with an acceptable toxicity profile and a promising outcome. The aim of this multicenter phase I/II prospective trialis to demonstrate early evidence of safety and efficacy of a single-fraction SBRT approach for the treatment of localized disease. Methods Patients with low- and intermediate-risk localized prostate cancer without significant tumor in the transitional zone will be treated with a single SBRT fraction of 19 Gy to the whole prostate gland with urethra-sparing (17 Gy). Intrafractional motion will be monitored with intraprostatic electromagnetic transponders. The primary endpoint of the phase I part of the study will be safety as assessed by CTCAE 4.03 grading scale, while biochemical relapse-free survival will be the endpoint for the phase II. The secondary endpoints include acute and late toxicity, quality of life, progression-free survival, and prostate-cancer specific survival. Discussion This is the first multicenter phase I/II trial assessing the efficacy and safety of a single-dose SBRT treatment for patients with localized prostate cancer. If positive, results of ONE SHOT may help to design subsequent phase III trials exploring the role of SBRT monotherapy in the exclusive radiotherapy treatment of localized disease. Trial registration Clinicaltrials.gov identifier: NCT03294889; Registered 27 September 2017.
Keywords	Prostate cancer ; Stereotactic body radiotherapy ; Urethra-sparing ; Single fraction ; Quality of life ; Electromagnetic transponders ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	610
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Urethra-sparing stereotactic body radiotherapy for prostate cancer

Angèle Dubouloz / Michel Rouzaud / Lev Tsvang / Wilko Verbakel / Mikko Björkqvist / Nadine Linthout / Joana Lencart / Juan María Pérez-Moreno / Zeynep Ozen / Lluís Escude / Thomas Zilli / Raymond Miralbell

Radiation Oncology, Vol 13, Iss 1, Pp 1-

how much can the rectal wall dose be reduced with or without an endorectal balloon?

2018 Volume 8

Abstract: Abstract Background This is a dosimetric comparative study intended to establish appropriate low-to-intermediate dose-constraints for the rectal wall (Rwall) in the context of a randomized phase-II trial on urethra-sparing stereotactic body radiotherapy ( ...

Abstract	Abstract Background This is a dosimetric comparative study intended to establish appropriate low-to-intermediate dose-constraints for the rectal wall (Rwall) in the context of a randomized phase-II trial on urethra-sparing stereotactic body radiotherapy (SBRT) for prostate cancer. The effect of plan optimization on low-to-intermediate Rwall dose and the potential benefit of an endorectal balloon (ERB) are investigated. Methods Ten prostate cancer patients, simulated with and without an ERB, were planned to receive 36.25Gy (7.25Gyx5) to the planning treatment volume (PTV) and 32.5Gy to the urethral planning risk volume (uPRV). Reference plans with and without the ERB, optimized with respect to PTV and uPRV coverage objectives and the organs at risk dose constraints, were further optimized using a standardized stepwise approach to push down dose constraints to the Rwall in the low to intermediate range in five sequential steps to obtain paired plans with and without ERB (Vm1 to Vm5). Homogeneity index for the PTV and the uPRV, and the Dice similarity coefficient (DSC) for the PTV were analyzed. Dosimetric parameters for Rwall including the median dose and the dose received by 10 to 60% of the Rwall, bladder wall (Bwall) and femoral heads (FHeads) were compared. The monitor units (MU) per plan were recorded. Results Vm4 reduced by half D30%, D40%, D50%, and Dmed for Rwall and decreased by a third D60% while HIPTV, HIuPRV and DSC remained stable with and without ERB compared to Vmref. HIPTV worsened at Vm5 both with and without ERB. No statistical differences were observed between paired plans on Rwall, Bwall except a higher D2% for Fheads with and without an ERB. Conclusions Further optimization to the Rwall in the context of urethra sparing prostate SBRT is feasible without compromising the dose homogeneity to the target. Independent of the use or not of an ERB, low-to-intermediate doses to the Rwall can be significantly reduced using a four-step sequential optimization approach.
Keywords	Stereotactic body radiotherapy ; Endorectal balloon ; Dosimetric optimization ; Prostate cancer ; Urethra sparing ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	610
Language	English
Publishing date	2018-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: First in-human radiation dosimetry of the gastrin-releasing peptide (GRP) receptor antagonist 68Ga-NODAGA-MJ9

Silvano Gnesin / Francesco Cicone / Periklis Mitsakis / Axel Van der Gucht / Sébastien Baechler / Raymond Miralbell / Valentina Garibotto / Thomas Zilli / John O. Prior

EJNMMI Research, Vol 8, Iss 1, Pp 1-

2018 Volume 10

Abstract: Abstract Background Gastrin-releasing peptide receptor antagonists have promise in theranostics of several highly incident tumours, including prostate and breast. This study presents the first human dosimetry of 68Ga-NODAGA-MJ9 in the first five ... ...

Abstract	Abstract Background Gastrin-releasing peptide receptor antagonists have promise in theranostics of several highly incident tumours, including prostate and breast. This study presents the first human dosimetry of 68Ga-NODAGA-MJ9 in the first five consecutive patients with recurrent prostate cancer included in a dual-tracer positron emission tomography (PET) protocol. Five male patients with biochemical relapse of prostate adenocarcinoma underwent four whole-body time-of-flight PET/CT scans within 2 h after tracer injection. To be used as input in OLINDA/EXM 2.0, time-integrated activity coefficients were derived from manually drawn regions of interest over the following body regions: brain, thyroid, lungs, heart, liver, gallbladder, spleen, stomach, kidneys, adrenals, red marrow, pancreas, intestines, urinary bladder and whole body. Organ absorbed doses and effective dose (ED) were calculated with OLINDA/EXM 2.0 using the NURBS voxelized phantoms adjusted to the ICRP-89 organ masses and ICRP103 tissue-weighting factors. Additional absorbed dose estimations were performed with OLINDA/EXM 1.1 to be comparable with similar previous publications. Results The body regions receiving the highest absorbed doses were the pancreas, the urinary bladder wall, the small intestine and the kidneys (260, 69.8, 38.8 and 34.8 μGy/MBq respectively). The ED considering a 30-min urinary voiding cycle was 17.6 μSv/MBq in male patients. The increment of voiding time interval produced a significant increase of absorbed doses in bladder, prostate and testes, as well as an increase of ED. ED also increased if calculated with OLINDA/EXM 1.1. These results have been discussed in view of similar publications on bombesin analogues or on other commonly used theranostic peptides. Conclusions The pancreas is the most irradiated organ after the injection of 68Ga-NODAGA-MJ9, followed by the urinary bladder wall, the small intestine and the kidneys. ED is in the same range of other common 68Ga-labelled peptides. Differences with similarly published ...
Keywords	Gastrin-releasing peptide receptor ; Bombesin ; Dosimetry ; PET/CT ; 68Ga-NODAGA-MJ9 ; OLINDA/EXM ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	610
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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