IMRT to escalate the dose to the prostate while treating the pelvic nodes

Matthew L. Cavey, John E. Bayouth, Martin Colman, Eugene J. Endres, Giuseppe Sanguineti

    Research output: Contribution to journalArticle

    50 Citations (Scopus)

    Abstract

    Background and Purpose: To assess and quantify the benefit of introducing intensity-modulated radiotherapy (IMRT) over conventional approaches to cover the pelvic nodes while escalating the dose to the prostate gland. Material and Methods: The pelvic lymphatics were planned to receive 50 Gy at 2 Gy per fraction by four-field box (4FB) technique and standard field blocks drawn on digitally reconstructed radiographs (DRR), 4FB with field blocks according to the position of pelvic nodes as contoured on serial planning CT slices, or IMRT. The lateral fields included three different variations of field blocks to assess the role of various degrees of rectal shielding. The boost consisted in 26 Gy in 13 fractions delivered via six-field three-dimensional conformal radiotherapy (3DCRT) or IMRT. By the combination of a pelvic treatment and boost, several plans were obtained for each patient, all normalized to be isoeffective with regard to prostate-planning target volume (PTV-P) coverage. Plans were compared with respect to dose-volume histogram (DVH) of pelvic nodes/seminal vesicles-PTV (PTV-PN/SV), rectum, bladder and intestinal cavity. Reported are the results obtained in eight patients. Results: Pelvic IMRT with a conformal boost provided superior sparing of both bladder and rectum over any of the 4FB plans with the same boost. For the rectum the advantage was around 10% at V70 and even larger for lower doses. Coverage of the pelvic nodes was adequate with initial IMRT with about 98% of the volume receiving 100% of the prescribed dose. An IMRT boost provided a gain in rectal sparing as compared to a conformal boost. However, the benefit was always greater with pelvic IMRT followed by a conformal boost as compared to 4FB with IMRT boost. Finally, the effect of utilizing an IMRT boost with initial pelvic IMRT was greater for the bladder than for the rectum (at V70, about 9% and 3% for the bladder and rectum, respectively). Conclusion: IMRT to pelvic nodes with a conformal boost allows dose escalation to the prostate while respecting current dose objectives in the majority of patients and it is dosimetrically superior to 4FB. An IMRT boost should be considered for patients who fail to meet bladder dose objectives.

    Original languageEnglish (US)
    Pages (from-to)431-441
    Number of pages11
    JournalStrahlentherapie und Onkologie
    Volume181
    Issue number7
    DOIs
    StatePublished - Jul 2005

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    Intensity-Modulated Radiotherapy
    Prostate
    Rectum
    Urinary Bladder
    Conformal Radiotherapy
    Seminal Vesicles

    Keywords

    • Dose escalation
    • IMRT
    • Whole-pelvis radiotherapy

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cancer Research
    • Radiological and Ultrasound Technology

    Cite this

    Cavey, M. L., Bayouth, J. E., Colman, M., Endres, E. J., & Sanguineti, G. (2005). IMRT to escalate the dose to the prostate while treating the pelvic nodes. Strahlentherapie und Onkologie, 181(7), 431-441. https://doi.org/10.1007/s00066-005-1384-9

    IMRT to escalate the dose to the prostate while treating the pelvic nodes. / Cavey, Matthew L.; Bayouth, John E.; Colman, Martin; Endres, Eugene J.; Sanguineti, Giuseppe.

    In: Strahlentherapie und Onkologie, Vol. 181, No. 7, 07.2005, p. 431-441.

    Research output: Contribution to journalArticle

    Cavey, ML, Bayouth, JE, Colman, M, Endres, EJ & Sanguineti, G 2005, 'IMRT to escalate the dose to the prostate while treating the pelvic nodes', Strahlentherapie und Onkologie, vol. 181, no. 7, pp. 431-441. https://doi.org/10.1007/s00066-005-1384-9
    Cavey, Matthew L. ; Bayouth, John E. ; Colman, Martin ; Endres, Eugene J. ; Sanguineti, Giuseppe. / IMRT to escalate the dose to the prostate while treating the pelvic nodes. In: Strahlentherapie und Onkologie. 2005 ; Vol. 181, No. 7. pp. 431-441.
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    abstract = "Background and Purpose: To assess and quantify the benefit of introducing intensity-modulated radiotherapy (IMRT) over conventional approaches to cover the pelvic nodes while escalating the dose to the prostate gland. Material and Methods: The pelvic lymphatics were planned to receive 50 Gy at 2 Gy per fraction by four-field box (4FB) technique and standard field blocks drawn on digitally reconstructed radiographs (DRR), 4FB with field blocks according to the position of pelvic nodes as contoured on serial planning CT slices, or IMRT. The lateral fields included three different variations of field blocks to assess the role of various degrees of rectal shielding. The boost consisted in 26 Gy in 13 fractions delivered via six-field three-dimensional conformal radiotherapy (3DCRT) or IMRT. By the combination of a pelvic treatment and boost, several plans were obtained for each patient, all normalized to be isoeffective with regard to prostate-planning target volume (PTV-P) coverage. Plans were compared with respect to dose-volume histogram (DVH) of pelvic nodes/seminal vesicles-PTV (PTV-PN/SV), rectum, bladder and intestinal cavity. Reported are the results obtained in eight patients. Results: Pelvic IMRT with a conformal boost provided superior sparing of both bladder and rectum over any of the 4FB plans with the same boost. For the rectum the advantage was around 10{\%} at V70 and even larger for lower doses. Coverage of the pelvic nodes was adequate with initial IMRT with about 98{\%} of the volume receiving 100{\%} of the prescribed dose. An IMRT boost provided a gain in rectal sparing as compared to a conformal boost. However, the benefit was always greater with pelvic IMRT followed by a conformal boost as compared to 4FB with IMRT boost. Finally, the effect of utilizing an IMRT boost with initial pelvic IMRT was greater for the bladder than for the rectum (at V70, about 9{\%} and 3{\%} for the bladder and rectum, respectively). Conclusion: IMRT to pelvic nodes with a conformal boost allows dose escalation to the prostate while respecting current dose objectives in the majority of patients and it is dosimetrically superior to 4FB. An IMRT boost should be considered for patients who fail to meet bladder dose objectives.",
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    AU - Sanguineti, Giuseppe

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