Hypofractionated focal lesion ablative microboost for prostate cancer

KU Leuven
February 02 2016
Position Type
Full Time
The Laboratory of Experimental Radiotherapy has profiled itself as a translational research group which is very strongly tied to the clinical Department of Radiation Oncology. This intense collaboration allows the researchers to perform real #from bench to bedside, and back# research. The Medical Physics group concentrates its efforts on image guidance and the management of the adverse effects of organ motion in photon and proton radiation therapy.

The Laboratory for Experimental Radiotherapy is part of the Department of Oncology, which unites a core of fundamental and clinical cancer researchers at the KU Leuven and the University Hospitals of Leuven to create a stimulating and cutting edge technological environment for innovative cancer research.

Inradiotherapy, a paradigm shift is recently seen, moving from a"fractionated" to a "hypofractionated, ablative", more surgicallike, tumor irradiation. Here, the radiobiological aspects of healthy tissuesparing achieved with fractionated delivery are overruled by geometric aspectsof the dose distribution. The high dose needs to be confined to the tumoralone, demanding high precision and a refined geometrical distinction betweentarget and normal tissue. The required technology for such ablative treatmentshas become available with stereotactic body radiotherapy (SBRT) and motionmanagement (from real-time adaptive in tumor tracking/trailing tointra-fraction monitoring with triggering of the treatment sequence/beam).

Extreme hypofractionation (high irradiation doses in a limited number oftreatments) for prostate cancer has already shown excellent treatment outcomein terms of biochemical disease-free survival and toxicity so far. Extremehypofractionation may also have biological advantages since a higher dose perfraction and lower total prescribed dose is used. This treatment strategy isalso known as biological dose escalation.

Hypofractionated treatment using conventional radiotherapy techniqueswith standard fractionation schedules and aiming at the whole prostate gland is- although successful - limited due to an increased risk in normal tissuetoxicity. A focal boost strategy, which delivers the high dose only to theintraprostatic tumor nodule(s), could be an ideal solution. Currently, thisapproach is being tested in several randomized phase III trials in which ourinstitute is collaborating with renowned centers like the UMC Utrecht, theNetherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, and the RadboudUniversity Nijmegen medical center.

The goal of the present project is to investigate the feasibility andsafety of a simultaneous integrated focal SBRT boost to the macroscopic tumorin addition to whole gland prostate SBRT, applying advanced intra-fractionadaptive radiation therapy in the framework of a phase II trial.

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