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Bench-To-Bedside Advanced Imaging Technology Applications:Early Clinical Outcomes From the Phase II TROG 15.01SPARK Prostate Cancer SABR Trial

P Keall1*, H Ball1 , D Nguyen1 , R O'Brien1 , V Gebski1 , J Booth2 , T Eade2 , A Kneebone2 , T Moodie3 , A Hayden3 , S Turner3 , N Hardcastle4 , S Siva4 , S Arumugam5 , M Sidhom5 , P Greer6 , J Martin6 , (1) University of Sydney, Camperdown, NSW, (2) Royal North Shore Hospital, St Leonards, NSW,(3) Crown Princess Mary Cancer Centre, Westmead NSW, (4) Peter MacCallum Cancer Centre, Melbourne, VIC, (5) Liverpool Cancer Therapy Centre, Liverpool, NSW, (6) Calvary Mater Newcastle, Newcastle, NSW


(Tuesday, 7/31/2018) 10:30 AM - 11:00 AM

Room: Exhibit Hall | Forum 6

Purpose: One of the most difficult challenges for physicists developing advanced imaging technologies is to bridge the gap between physics experiments and patient care. Kilovoltage Intrafraction Monitoring – KIM – is an in-house developed advanced image guided radiotherapy technology that provides real-time translation and rotational target motion. The KIM technology has progressed to the multi-center phase II Trans-Tasman Radiation Oncology Group (TROG) 15.01 Stereotactic Prostate Adaptive Radiotherapy Utilizing KIM (SPARK) trial (NCT02397317). The purpose of this study was to measure the early clinical outcomes from the SPARK trial.

Methods: 48/48 patients with localized prostate cancer from five cancer centers have been recruited to the SPARK trial. All patients were treated with KIM-guided gating (38 patients) or KIM-guided MLC tracking (10 patients). The prescription dose was 36.25Gy in five fractions. Three clinical outcomes were measured (1) patient-reported outcomes using the Expanded Prostate Cancer Index Composite (EPIC) instrument, (2) prostate-specific antigen (PSA) and (3) physician-graded toxicity (CTCAE version 4) in the erectile dysfunction (ED), gastrointestinal (GI) and urinary domains. Biochemical failure was defined using the RTOG Phoenix definition. The 17/48 patients with ≥12 months of follow-up were included in this analysis.

Results: Patient reported outcomes at 12-months compared to pre-treatment showed no differences in quality of life in the urinary, bowel, sexual or hormonal domains. The mean PSA dropped from 5.5 ng/L at baseline to 1.3 ng/L at 12 months. There were no biochemical failures observed. The mean erectile dysfunction improved from 1.0 to 0.9. No GI or urinary toxicity grade ≥2 was observed. There was no GI toxicity and only one grade 1 urinary toxicity at 12 months follow-up.

Conclusion: Advanced imaging technology development from bench-to-bedside has been successfully achieved in a phase II prostate cancer SABR clinical trial. Early clinical outcomes are encouraging although longer follow up is needed.

Funding Support, Disclosures, and Conflict of Interest: This work is funded by Cancer Australia and the Australian Government NHMRC. One author is an inventor of a patent that has been licensed to Varian Medical Systems and Leo Cancer Care by Stanford University. Three authors are inventors of unlicensed patents.


Not Applicable / None Entered.


IM/TH- RT X-ray Imaging: General (most aspects)

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