Haleem Khan - Academia.edu (original) (raw)

Papers by Haleem Khan

Research paper thumbnail of Retroperitoneal bleeding after L4–L5 diskectomy in a patient with crossed-fused renal ectopia: Treatment by selective embolization

Cardiovascular and Interventional Radiology, 1996

We present a complication of L4-L5 disk surgery and its treatment by interventional radiology whi... more We present a complication of L4-L5 disk surgery and its treatment by interventional radiology which has not previously been reported. An accessory inferior polar artery of a crossed-fused renal ectopia was injured and the bleeding was successfully managed by selective embolization.

Research paper thumbnail of Salvage Radiotherapy after Radical Prostatectomy: Dose-Adapted Treatment to a Target Volume Defined from Typical Patterns of Loco-regional Failure on Endorectal MRI and/or PET-CT

International Journal of Radiation Oncology*Biology*Physics, 2011

Research paper thumbnail of Enhancement of computed tomography liver contrast using iomeprol-containing liposomes and detection of small liver tumors in rats

Academic Radiology, 1995

Rationale and Objectives. We evaluated iomeprol-containing liposomes (Lipiom), a new contrast med... more Rationale and Objectives. We evaluated iomeprol-containing liposomes (Lipiom), a new contrast medium for computed tomography (CT) liver scanning, in an animal model of chemically induced hepatocellular carcinomas and other liver tumors in rats.

Research paper thumbnail of Endorectal MRI assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant radiotherapy in patients at high risk for local failure

International Journal of Radiation OncologyBiologyPhysics

To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after... more To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after radical prostatectomy for prostate cancer to help to reassess the clinical target volume (CTV) for adjuvant postprostatectomy radiotherapy. Sixty patients undergoing an endorectal MRI before salvage radiotherapy were selected. Spatial coordinates of the relapses were assessed using two reference points: the inferior border of the pubic symphysis (point 1) and the urethro-vesical anastomosis (point 2). Every lesion on MRI was delineated on the planning computed tomography and center of mass coordinates were plotted in two separate diagrams (along the x, y, and z axes) with the urethro-vesical anastomosis as the coordinate origin. An "ideal" CTV was constructed, centered at a point defined by the mathematical means of each of the three coordinates with dimensions defined as twice 2 standard deviations in each of the three axes. The dosimetric impact of the new CTV definition was...

Research paper thumbnail of 4041 POSTER 18F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low PSA values (

Research paper thumbnail of 653 POSITIVE RESPONSE TO BEVACIZUMAB WITH SELECTIVE BLADDER CONSERVATION IN RECURRENT AND METASTATIC BLADDER CANCER

European Urology Supplements, 2011

To investigate the safety, immune responses and overall survival of personalized peptide vaccine ... more To investigate the safety, immune responses and overall survival of personalized peptide vaccine (PPV) administration in advanced urothelial carcinoma (UC) patients who failed the standard therapy such as operation, chemotherapy and irradiation.

Research paper thumbnail of The effect of contrast material on transcranial Doppler evaluation of normal middle cerebral artery peak systolic velocity

AJNR. American journal of neuroradiology, 2000

Several recent studies have shown that sonographic contrast agents may affect transcranial Dopple... more Several recent studies have shown that sonographic contrast agents may affect transcranial Doppler evaluation of the arterial peak systolic velocity (PSV). Some investigators reported an increase in PSV, and others reported no change in PSV compared with baseline values. This study was conducted to determine the effect of sonographic contrast agent on PSV measured in normal middle cerebral arteries. Continuous spectral Doppler sonography was performed on the right middle cerebral artery of 20 participants with angiographically proven normal intracranial vasculature. Videotaping was performed in each case from the initiation of the administration of contrast medium until the effect of the contrast agent on the PSV subsided. The PSV values were normalized for each participant, were pooled, and were plotted as a function of time. PSV increased in all participants after the administration of contrast material; the mean maximum increase was 24+/-7.4% (mean +/- standard deviation) (range,...

Research paper thumbnail of Twinkling artifact on intracerebral color Doppler sonography

AJNR. American journal of neuroradiology, 1999

Transcranial Doppler sonography shows potential as a noninvasive technique for long-term follow-u... more Transcranial Doppler sonography shows potential as a noninvasive technique for long-term follow-up of treated intracranial saccular aneurysms. This technical note describes a color Doppler artifact related to microcoil architecture that might represent a potential pitfall in transcranial Doppler sonographic evaluation of aneurysmal cavity thrombosis, since it may be wrongly interpreted as residual flow or aneurysmal cavity recanalization.

Research paper thumbnail of 167 Endorectal mri assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant post-prostatectomy radiotherapy in patients at high-risk for local failure

Radiotherapy and Oncology, 2006

Research paper thumbnail of 4041 POSTER 18F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low PSA values (<1 ng/ml) after radical prostatectomy

Research paper thumbnail of Outcome of Pregnancy in Renal Allograft Recipients: SIUT Experience

Transplantation Proceedings, 2006

Research paper thumbnail of FIRST CASE OF PEDIATRIC LIVING RELATED INTESTINAL TRANSPLANTATION

Research paper thumbnail of High-dose-rate brachytherapy boost to the dominant intra-prostatic tumor region: Hemi-irradiation of prostate cancer

The Prostate, 2011

To assess the feasibility, toxicity, and outcome of prostate hemi-irradiation with a high-dose-ra... more To assess the feasibility, toxicity, and outcome of prostate hemi-irradiation with a high-dose-rate brachytherapy (HDR-BT) boost for patients presumed to harbor dominant intra-prostatic tumors in a single lobe. After 3D conformal external radiotherapy (3DCRT) to 64-64.4 Gy, 77 patients with non-metastatic locally aggressive prostate cancer have been treated from 2000 to 2004, with HDR-BT using temporary open MRI-guided (192) Ir implants, to escalate the dose in the boost region. Twenty patients (26%) had one lobe involvement (i.e., one sided endorectal MRI, rectal examination, and biopsies) and were boosted to one side of the gland only. A dose of 12, 14, and 16 Gy in two fractions was delivered to 5, 6, and 9 patients, respectively. After a median follow-up 69 months, no differences in late rectal toxicity were observed between the unilaterally and bilaterally irradiated cohorts. Although, grade 2 late urinary toxicity was worse in the hemi-irradiated group (P = 0.03), severe grade ≥3 late urinary toxicity at 5 years was not different: 10% versus 8.8% in the unilaterally and bilaterally irradiated cohorts, respectively. Grade 4 late urinary toxicity, however, was exclusively observed in patients boosted to both lobes (5/57, 8.8%). Five-year biochemical relapse-free survival was 79.7% versus 70.5% for the unilateral and bilateral boost groups, respectively (P = 0.99). Prostate hemi-irradiation with a HDR-BT boost to the dominant tumor region may be considered when rectal examination, MRI, and biopsies suggest one lobe involvement. Nevertheless, strict dosimetric optimization is needed in order to further reduce the risk of late severe toxicity.

Research paper thumbnail of Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence

Nuklearmedizin, 2008

Keywords 18 F-fluorocholine, 3-phase PET/CT, prostate cancer recurrence , rising PSA Summary Aim:... more Keywords 18 F-fluorocholine, 3-phase PET/CT, prostate cancer recurrence , rising PSA Summary Aim: Contribution of 3-phase 18 F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA. Patients, methods: Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n = 30) or surgery (n = 17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of 18 F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUV max determined for suspicious lesions. Biopsies were obtained from 13 patients. Results: Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUV max increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUV max on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA ≥ 2 ng/ml (n = 34) and in 4/13 patients presenting PSA values <2 ng/ml. Conclusion: 18 F-fluorocholine 3-phase PET/CT showed a progressively increasing SUV max in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity. Nuklearmedizin 2009; 48: ■■ prepublished online: ■

Research paper thumbnail of Knowledge, Perceptions and Practices of Registered Dietitians in the Dietetic Practice Group, Consultant Dietitians in Health Care Facilities, Regarding the American Dietetic Association's Standardized Language to Document the Nutrition Care Process

Journal of the American Dietetic Association, 2009

Research paper thumbnail of 10.49 Comparison between the effectiveness of gated SPECT and nonuniform attenuation correction

Journal of Nuclear Cardiology, 2001

Research paper thumbnail of Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis?

Journal of Hepatology, 1996

Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction... more Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy.

Research paper thumbnail of Endorectal MRI assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant radiotherapy in patients at high risk for local failure

International Journal of Radiation Oncology*Biology*Physics, 2007

Purpose: To assess the role of endorectal magnetic resonance imaging (MRI) in defining local rela... more Purpose: To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after radical prostatectomy for prostate cancer to help to reassess the clinical target volume (CTV) for adjuvant postprostatectomy radiotherapy. Methods and Materials: Sixty patients undergoing an endorectal MRI before salvage radiotherapy were selected. Spatial coordinates of the relapses were assessed using two reference points: the inferior border of the pubic symphysis (point 1) and the urethro-vesical anastomosis (point 2). Every lesion on MRI was delineated on the planning computed tomography and center of mass coordinates were plotted in two separate diagrams (along the x, y, and z axes) with the urethro-vesical anastomosis as the coordinate origin. An "ideal" CTV was constructed, centered at a point defined by the mathematical means of each of the three coordinates with dimensions defined as twice 2 standard deviations in each of the three axes. The dosimetric impact of the new CTV definition was evaluated in six adjuvantly treated patients. Results: The ideal CTV center of mass was located at coordinates 0 (x), ؊5 (y), and ؊3 (z) mm with SDs of 6 (x), 6 (y), and 9 (z) mm, respectively. The CTV size was 24 (x) ؋ 24 (y) ؋ 36 (z) mm. Significant rectal sparing was observed with the new CTV. Conclusions: A CTV with an approximately cylindrical shape (ϳ4 ؋ 3 cm) centered 5 mm posterior and 3 mm inferior to the urethro-vesical anastomosis was defined. Such CTV may reduce the irradiation of normal nontarget tissue in the pelvis potentially improving treatment tolerance.

Research paper thumbnail of Partial Volume High-dose-rate Brachytherapy Boost for Localized Prostate Cancer: Toxicity and Outcome

International Journal of Radiation Oncology*Biology*Physics, 2010

Research paper thumbnail of Hypofractionated Boost With High-Dose-Rate Brachytherapy and Open Magnetic Resonance Imaging–Guided Implants for Locally Aggressive Prostate Cancer: A Sequential Dose-Escalation Pilot Study

International Journal of Radiation Oncology*Biology*Physics, 2009

To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate pa... more To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate partial-volume high-dose-rate brachytherapy (HDR-BT) schedule in a group of selected patients with nonmetastatic, locally aggressive prostatic tumors. After conventional fractionated three-dimensional conformal external radiotherapy to 64-64.4 Gy, 77 patients with nonmetastatic, locally aggressive (e.g., perineural invasion and/or Gleason score 8-10) prostate cancer were treated from June 2000 to August 2004, with HDR-BT using temporary open MRI-guided (192)Ir implants, to escalate the dose in the boost region. Nineteen, 21, and 37 patients were sequentially treated with 2 fractions of 6 Gy, 7 Gy, and 8 Gy each, respectively. Neoadjuvant androgen deprivation was given to 62 patients for 6-24 months. Acute and late toxicity were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring system. All 77 patients completed treatment as planned. Only 2 patients presented with Grade &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =3 acute urinary toxicity. The 3-year probability of Grade &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =2 late urinary and low gastrointestinal toxicity-free survival was 91.4% +/- 3.4% and 94.4% +/- 2.7%, respectively. Rates of 3-year biochemical disease-free survival (bDFS) and disease-specific survival were 87.1% +/- 4.1% and 100%, respectively. Boosting a partial volume of the prostate with hypofractionated HDR-BT for aggressive prostate cancer was feasible and showed limited long-term toxicity, which compared favorably with other dose-escalation methods in the literature. Preliminary bDFS was encouraging if one considers the negatively selected population of high-risk patients in this study.

Research paper thumbnail of Retroperitoneal bleeding after L4–L5 diskectomy in a patient with crossed-fused renal ectopia: Treatment by selective embolization

Cardiovascular and Interventional Radiology, 1996

We present a complication of L4-L5 disk surgery and its treatment by interventional radiology whi... more We present a complication of L4-L5 disk surgery and its treatment by interventional radiology which has not previously been reported. An accessory inferior polar artery of a crossed-fused renal ectopia was injured and the bleeding was successfully managed by selective embolization.

Research paper thumbnail of Salvage Radiotherapy after Radical Prostatectomy: Dose-Adapted Treatment to a Target Volume Defined from Typical Patterns of Loco-regional Failure on Endorectal MRI and/or PET-CT

International Journal of Radiation Oncology*Biology*Physics, 2011

Research paper thumbnail of Enhancement of computed tomography liver contrast using iomeprol-containing liposomes and detection of small liver tumors in rats

Academic Radiology, 1995

Rationale and Objectives. We evaluated iomeprol-containing liposomes (Lipiom), a new contrast med... more Rationale and Objectives. We evaluated iomeprol-containing liposomes (Lipiom), a new contrast medium for computed tomography (CT) liver scanning, in an animal model of chemically induced hepatocellular carcinomas and other liver tumors in rats.

Research paper thumbnail of Endorectal MRI assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant radiotherapy in patients at high risk for local failure

International Journal of Radiation OncologyBiologyPhysics

To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after... more To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after radical prostatectomy for prostate cancer to help to reassess the clinical target volume (CTV) for adjuvant postprostatectomy radiotherapy. Sixty patients undergoing an endorectal MRI before salvage radiotherapy were selected. Spatial coordinates of the relapses were assessed using two reference points: the inferior border of the pubic symphysis (point 1) and the urethro-vesical anastomosis (point 2). Every lesion on MRI was delineated on the planning computed tomography and center of mass coordinates were plotted in two separate diagrams (along the x, y, and z axes) with the urethro-vesical anastomosis as the coordinate origin. An "ideal" CTV was constructed, centered at a point defined by the mathematical means of each of the three coordinates with dimensions defined as twice 2 standard deviations in each of the three axes. The dosimetric impact of the new CTV definition was...

Research paper thumbnail of 4041 POSTER 18F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low PSA values (

Research paper thumbnail of 653 POSITIVE RESPONSE TO BEVACIZUMAB WITH SELECTIVE BLADDER CONSERVATION IN RECURRENT AND METASTATIC BLADDER CANCER

European Urology Supplements, 2011

To investigate the safety, immune responses and overall survival of personalized peptide vaccine ... more To investigate the safety, immune responses and overall survival of personalized peptide vaccine (PPV) administration in advanced urothelial carcinoma (UC) patients who failed the standard therapy such as operation, chemotherapy and irradiation.

Research paper thumbnail of The effect of contrast material on transcranial Doppler evaluation of normal middle cerebral artery peak systolic velocity

AJNR. American journal of neuroradiology, 2000

Several recent studies have shown that sonographic contrast agents may affect transcranial Dopple... more Several recent studies have shown that sonographic contrast agents may affect transcranial Doppler evaluation of the arterial peak systolic velocity (PSV). Some investigators reported an increase in PSV, and others reported no change in PSV compared with baseline values. This study was conducted to determine the effect of sonographic contrast agent on PSV measured in normal middle cerebral arteries. Continuous spectral Doppler sonography was performed on the right middle cerebral artery of 20 participants with angiographically proven normal intracranial vasculature. Videotaping was performed in each case from the initiation of the administration of contrast medium until the effect of the contrast agent on the PSV subsided. The PSV values were normalized for each participant, were pooled, and were plotted as a function of time. PSV increased in all participants after the administration of contrast material; the mean maximum increase was 24+/-7.4% (mean +/- standard deviation) (range,...

Research paper thumbnail of Twinkling artifact on intracerebral color Doppler sonography

AJNR. American journal of neuroradiology, 1999

Transcranial Doppler sonography shows potential as a noninvasive technique for long-term follow-u... more Transcranial Doppler sonography shows potential as a noninvasive technique for long-term follow-up of treated intracranial saccular aneurysms. This technical note describes a color Doppler artifact related to microcoil architecture that might represent a potential pitfall in transcranial Doppler sonographic evaluation of aneurysmal cavity thrombosis, since it may be wrongly interpreted as residual flow or aneurysmal cavity recanalization.

Research paper thumbnail of 167 Endorectal mri assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant post-prostatectomy radiotherapy in patients at high-risk for local failure

Radiotherapy and Oncology, 2006

Research paper thumbnail of 4041 POSTER 18F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low PSA values (<1 ng/ml) after radical prostatectomy

Research paper thumbnail of Outcome of Pregnancy in Renal Allograft Recipients: SIUT Experience

Transplantation Proceedings, 2006

Research paper thumbnail of FIRST CASE OF PEDIATRIC LIVING RELATED INTESTINAL TRANSPLANTATION

Research paper thumbnail of High-dose-rate brachytherapy boost to the dominant intra-prostatic tumor region: Hemi-irradiation of prostate cancer

The Prostate, 2011

To assess the feasibility, toxicity, and outcome of prostate hemi-irradiation with a high-dose-ra... more To assess the feasibility, toxicity, and outcome of prostate hemi-irradiation with a high-dose-rate brachytherapy (HDR-BT) boost for patients presumed to harbor dominant intra-prostatic tumors in a single lobe. After 3D conformal external radiotherapy (3DCRT) to 64-64.4 Gy, 77 patients with non-metastatic locally aggressive prostate cancer have been treated from 2000 to 2004, with HDR-BT using temporary open MRI-guided (192) Ir implants, to escalate the dose in the boost region. Twenty patients (26%) had one lobe involvement (i.e., one sided endorectal MRI, rectal examination, and biopsies) and were boosted to one side of the gland only. A dose of 12, 14, and 16 Gy in two fractions was delivered to 5, 6, and 9 patients, respectively. After a median follow-up 69 months, no differences in late rectal toxicity were observed between the unilaterally and bilaterally irradiated cohorts. Although, grade 2 late urinary toxicity was worse in the hemi-irradiated group (P = 0.03), severe grade ≥3 late urinary toxicity at 5 years was not different: 10% versus 8.8% in the unilaterally and bilaterally irradiated cohorts, respectively. Grade 4 late urinary toxicity, however, was exclusively observed in patients boosted to both lobes (5/57, 8.8%). Five-year biochemical relapse-free survival was 79.7% versus 70.5% for the unilateral and bilateral boost groups, respectively (P = 0.99). Prostate hemi-irradiation with a HDR-BT boost to the dominant tumor region may be considered when rectal examination, MRI, and biopsies suggest one lobe involvement. Nevertheless, strict dosimetric optimization is needed in order to further reduce the risk of late severe toxicity.

Research paper thumbnail of Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence

Nuklearmedizin, 2008

Keywords 18 F-fluorocholine, 3-phase PET/CT, prostate cancer recurrence , rising PSA Summary Aim:... more Keywords 18 F-fluorocholine, 3-phase PET/CT, prostate cancer recurrence , rising PSA Summary Aim: Contribution of 3-phase 18 F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA. Patients, methods: Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n = 30) or surgery (n = 17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of 18 F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUV max determined for suspicious lesions. Biopsies were obtained from 13 patients. Results: Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUV max increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUV max on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA ≥ 2 ng/ml (n = 34) and in 4/13 patients presenting PSA values <2 ng/ml. Conclusion: 18 F-fluorocholine 3-phase PET/CT showed a progressively increasing SUV max in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity. Nuklearmedizin 2009; 48: ■■ prepublished online: ■

Research paper thumbnail of Knowledge, Perceptions and Practices of Registered Dietitians in the Dietetic Practice Group, Consultant Dietitians in Health Care Facilities, Regarding the American Dietetic Association's Standardized Language to Document the Nutrition Care Process

Journal of the American Dietetic Association, 2009

Research paper thumbnail of 10.49 Comparison between the effectiveness of gated SPECT and nonuniform attenuation correction

Journal of Nuclear Cardiology, 2001

Research paper thumbnail of Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis?

Journal of Hepatology, 1996

Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction... more Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy.

Research paper thumbnail of Endorectal MRI assessment of local relapse after surgery for prostate cancer: A model to define treatment field guidelines for adjuvant radiotherapy in patients at high risk for local failure

International Journal of Radiation Oncology*Biology*Physics, 2007

Purpose: To assess the role of endorectal magnetic resonance imaging (MRI) in defining local rela... more Purpose: To assess the role of endorectal magnetic resonance imaging (MRI) in defining local relapse after radical prostatectomy for prostate cancer to help to reassess the clinical target volume (CTV) for adjuvant postprostatectomy radiotherapy. Methods and Materials: Sixty patients undergoing an endorectal MRI before salvage radiotherapy were selected. Spatial coordinates of the relapses were assessed using two reference points: the inferior border of the pubic symphysis (point 1) and the urethro-vesical anastomosis (point 2). Every lesion on MRI was delineated on the planning computed tomography and center of mass coordinates were plotted in two separate diagrams (along the x, y, and z axes) with the urethro-vesical anastomosis as the coordinate origin. An "ideal" CTV was constructed, centered at a point defined by the mathematical means of each of the three coordinates with dimensions defined as twice 2 standard deviations in each of the three axes. The dosimetric impact of the new CTV definition was evaluated in six adjuvantly treated patients. Results: The ideal CTV center of mass was located at coordinates 0 (x), ؊5 (y), and ؊3 (z) mm with SDs of 6 (x), 6 (y), and 9 (z) mm, respectively. The CTV size was 24 (x) ؋ 24 (y) ؋ 36 (z) mm. Significant rectal sparing was observed with the new CTV. Conclusions: A CTV with an approximately cylindrical shape (ϳ4 ؋ 3 cm) centered 5 mm posterior and 3 mm inferior to the urethro-vesical anastomosis was defined. Such CTV may reduce the irradiation of normal nontarget tissue in the pelvis potentially improving treatment tolerance.

Research paper thumbnail of Partial Volume High-dose-rate Brachytherapy Boost for Localized Prostate Cancer: Toxicity and Outcome

International Journal of Radiation Oncology*Biology*Physics, 2010

Research paper thumbnail of Hypofractionated Boost With High-Dose-Rate Brachytherapy and Open Magnetic Resonance Imaging–Guided Implants for Locally Aggressive Prostate Cancer: A Sequential Dose-Escalation Pilot Study

International Journal of Radiation Oncology*Biology*Physics, 2009

To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate pa... more To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate partial-volume high-dose-rate brachytherapy (HDR-BT) schedule in a group of selected patients with nonmetastatic, locally aggressive prostatic tumors. After conventional fractionated three-dimensional conformal external radiotherapy to 64-64.4 Gy, 77 patients with nonmetastatic, locally aggressive (e.g., perineural invasion and/or Gleason score 8-10) prostate cancer were treated from June 2000 to August 2004, with HDR-BT using temporary open MRI-guided (192)Ir implants, to escalate the dose in the boost region. Nineteen, 21, and 37 patients were sequentially treated with 2 fractions of 6 Gy, 7 Gy, and 8 Gy each, respectively. Neoadjuvant androgen deprivation was given to 62 patients for 6-24 months. Acute and late toxicity were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring system. All 77 patients completed treatment as planned. Only 2 patients presented with Grade &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =3 acute urinary toxicity. The 3-year probability of Grade &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =2 late urinary and low gastrointestinal toxicity-free survival was 91.4% +/- 3.4% and 94.4% +/- 2.7%, respectively. Rates of 3-year biochemical disease-free survival (bDFS) and disease-specific survival were 87.1% +/- 4.1% and 100%, respectively. Boosting a partial volume of the prostate with hypofractionated HDR-BT for aggressive prostate cancer was feasible and showed limited long-term toxicity, which compared favorably with other dose-escalation methods in the literature. Preliminary bDFS was encouraging if one considers the negatively selected population of high-risk patients in this study.