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Effects of gold fiducial marker implantation on tumor control and toxicity in external beam radiotherapy of prostate cancer Cover

Effects of gold fiducial marker implantation on tumor control and toxicity in external beam radiotherapy of prostate cancer

Radiology and Oncology
Volume 57 (2023): Issue 1 (March 2023)
By: ,  ,  ,   and    
Open Access
|Jan 2023
Figures & tables

Figures & Tables

Table 1

Patient characteristics

GFM%No GFM%
n41100%20100%
cT category
12356%1680%
21844%420%
iPSA in μg/l, median (IQR)7 (5.3/8.7)5.9 (4.4/10.6)
Gleason score
62663%1890%
7a1229%15%
7b37%15%
Risk group
Low risk1639%1050%
Intermediate risk2561%1050%
ADT prescribed1434%315%
Median duration of ADT in months (IQR)9 (3/18)6 (6/8)
Median age at RT (IQR)74 (70/77)72 (67/72)
Median follow-up in months (IQR)72 (49/84)68 (36/86.5)

[i] ADT = androgen deprivation therapy; cT = clinical tumor extension; GFM = gold fiducial markers; iPSA = initial prostate-specific antigen; IQR = interquartile range; RT = radiotherapy low risk = PSA < 10 μg/L and Gleason Score 6; intermediate risk = PSA ≥ 10 μg/L or Gleason Score 7a/b

Figure 1

Biochemical no evidence of disease (bNED) rates of patients with and without gold fiducial marker (GMF) implantation (p = 0.61).

Table 2

Maximum acute side effects in patients with and without gold fiducial marker implantation

GradeGold fiducial markersNo gold fiducial markersGold fiducial markersNo gold fiducial markers
027%15%17%5%
166%65%44%55%
27%20%39%40%

[i] No significant differences for acute gastrointestinal and genitourinary side effects were detected (p = 0.15 and p = 0.58, respectively).

Table 3

Maximum late side effects in patients with and without gold fiducial marker implantation

GradeGold fiducial markersNo gold fiducial markersGold fiducial markersNo gold fiducial markers
059%50%37%35%
112%15%27%25%
224%35%34%35%
35%0%2%5%

[i] No significant differences for late gastrointestinal and genitourinary side effects were detected (p = 0.64 and p = 0.80, respectively).

Table 4

Dose-volume histograms for patients with and without gold fiducial markers (GFM)

GFMNo GFM
PTV prostate cm3median (IQR)124.72 (98.68–152.83)157.12 (128.34–173.66)
PTV Dmax/D1 median (IQR)81.55 (80.55 – 82.75)81.15 (80.46–82.06)
PTV Dmean median (IQR)78.10 (77.41–78.70)78.10 (77.00–78.43)
CTV prostate cm3median (IQR)44.14 (34.75– 64.70)43.91 (34.40– 55.42)
CTV Dmax/D1 median (IQR)81.24 (80.64– 82.57)81.22 (80.35– 81.85)
CTV Dmean median (IQR)78.58 (77.97–79.47)78.63 (77.94–79.04)
CTV Dmin median (IQR)76.00 (75.36–76.32)76.49 (75.88–77.05)
Rectal volume median (IQR)113.02 (100.22–134.55)114.53 (105.57–136.38)
Rectal Dmax median (IQR)80.06 (78.88– 81.98)80.24 (79.23–81.25)
Rectal Dmean median (IQR)35.99 (32.94–39.61)39.30 (37.81–42.99)
Rectal V70 Gy % median (IQR)11.41 (9.41–13.04)16.12 (14.55–18.66)
Rectal V70 Gy cm3median (IQR)13.21 (11.33–15.93)18.66 (16.55–21.39)
Rectal V60 Gy % median (IQR)19.95 (16.39–22.37)25.25 (23.77–29.26)
Rectal V60 Gy cm3median (IQR)23.36 (19.93–25.98)29.23 (26.74–33.13)
Bladder volume median (IQR)196.93 (113.66–282.94)155.76 (127.30–296.44)
Bladder Dmax/D1 median (IQR)78.78 (77.01–80.53)79.53 80.44(77.04) –
Bladder Dmean median (IQR)21.11 (16.92–30.06)28.10 (18.99–35.20)
Bladder V70 Gy % median (IQR)7.50 (5.44–11.78)9.43 (6.06–14.02)
Bladder (IQR) V70 Gy cm3median14.14 (10.53–21.16)19.01 (12.00–22.20)
Bladder V50 Gy % median (IQR)17.14 (12.00–26,40)20.81 30.86(13.60) –
Bladder (IQR) V50 Gy cm3median34.00 (23.17–42.23)37.58 (27.16–44.42)
Bladder V30 Gy % median (IQR)28.24 (21.74–41.73)41.31 (25.78–51.83)
Bladder V30 Gy cm3median (IQR)58.71 (43.43– 78.57)65.38 (48.97–83.61)

[i] CTV = clinical target volume; GFM = gold fiducial marker; IQR = interquartile range; PTV = planning target volume; RT = radiotherapy

Table 5

Uni- and multivariable Cox regression of biochemical no evidence of disease (bNED) and overall survival (OS)

bNEDp-valueexp(HR)exp(HR) (95% conf.)p-valueexp(HR)exp(HR) (95% conf.)
Use of GFM0.6031.7880.200–16.018---
Age at RT0.9600.9960.857–1.157---
PTV prostate0.7891.0030.980–1.027---
PTV Dmax/D10.5561.1330.747–1.719---
PTV Dmean0.9600.9780.410–2.332---
CTV prostate0.0061.0201.006–1.0350.8620.9960.947–1.046
CTV Dmax/D10.0140.8140.690–0.9600.2242.5830.560–11.925
CTV Dmean0.0050.8580.770–0.9560.2980.1880.008–4.393
CTV Dmin0.0050.8750.797–0.9600.4532.0670.310–13.770
p-valueexp(HR)exp(HR) (95% conf.)
Use of GFM0.5641.9070.213–17.063---
Age at RT0.2351.1490.913–1.446---
PTV Prostate0.7231.0040.984–1.024---
PTV Dmax/D10.3000.7050.364–1.366---
PTV Dmean0.1530.4260.132–1.373---
CTV Prostate0.8331.0020.980–1.025---
CTV Dmax/D10.7750.9640.747–1.242---
CTV Dmean0.9460.9920.791–1.245---
CTV Dmin0.8791.0240.758–1.383---

[i] bNED = biochemical no evidence of disease; CTV = clinical target volume; GFM = gold fiducial marker; HR = hazard ratio; OS = overall survival; PTV = planning target volume; RT = radiotherapy

Table 6

Uni- and multivariable Cox regression of the onset of late gastrointestinal or genitourinary toxicity grade 2 or higher

Variablep-valueexp(HR)exp(HR) (95% conf.)p-valueexp(HR)exp(HR) (95% conf.)
Use of GFM0.890.9360.368–2.378---
Acute GI grade 20.092.6420.875–7.981---
Age at RT0.031.1241.010–1.2520.1011.0920.983-1.213
PTV prostate0.060.9870.974–1.000---
PTV Dmax/D10.761.0370.824–1.305---
PTV Dmean0.491.1580.767–1.747---
CTV prostate0.030.9660.936–0.9960.0730.9720.942–1.003
CTV Dmax/D10.551.0560.884–1.263---
CTV Dmean0.511.0900.843–1.410---
CTV Dmin0.641.0420.877–1.236---
Rectal Volume0.291.0070.994–1.020---
Rectal Dmax0.291.1250.906–1.397---
Rectal Dmean0.250.9510.973–1.036---
Rectal V70 Gy %0.590.9710.875–1.078---
Rectal V70 Gy cm30.421.0400.945–1.144---
Rectal V60 Gy %0.420.9690.899–1.046---
Rectal V60 Gy cm30.501.0240.955–1.099---
Variablep-valueexp(HR)exp(HR) (95% conf.)
Use of GFM0.931.0410.441–2.459---
Acute GU grade 20.092.0420.892–4.673---
Age at RT0.501.0260.952–1.106---
PTV prostate0.291.0060.995–1.017---
PTV Dmax/D10.140.8080.611–1.068---
PTV Dmean0.040.5730.342–0.961---
CTV prostate0.930.9990.989–1.010---
CTV Dmax/D10.931.0060.895–1.130---
CTV Dmean0.671.0250.916–1.147---
CTV Dmin CTV0.581.0350.918–1.165---
Bladder volume0.720.9990.997–1.002---
Bladder Dmax/D10.240.9730.696–1.094---
Bladder Dmean0.890.9970.960–1.036--–
Bladder V70 Gy %0.490.9770.913–1.045---
Bladder V70 Gy cm30.230.9690.921–1.020---
Bladder V50 Gy %0.540.9880.951–1.027---
Bladder V50 Gy cm30.290.9850.957–1.013---
Bladder V30 Gy %0.790.9970.974–1.020---
Bladder V30 Gy cm30.700.9970.980–1.014---

[i] CTV = clinical target volume; GFM = gold fiducial marker; GI = gastrointestinal; GU = genitourinary; PTV = planning target volume; RT = radiotherapy

DOI: https://doi.org/10.2478/raon-2023-0004 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 95 - 102
Submitted on: Jul 13, 2022
Accepted on: Oct 26, 2022
Published on: Jan 19, 2023
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
prostate cancer,
IGRT,
fiducials,
tumor control,
toxicity
Related subjects:
Medicine,
Clinical medicine,
Radiology

© 2023 Matthias Moll, Magdalena Weiß, Vladimir Stanisav, Alexandru Zaharie, Gregor Goldner, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 57 (2023): Issue 1 (March 2023)
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