A Prospective Three–Dimensional Analysis about the Impact of Differences in the Clinical Target Volume in Prostate Cancer Irradiation on Normal–Tissue Exposure

Abstract

Reduction of the CTV to the prostate only, or to the prostate + proximal seminal vesicles led to significant rectal and bladder dose sparing compared to irradiation of the prostate + entire seminal vesicles. In patients with a higher risk for seminal vesicles involvement, irradiation of the prostate + proximal seminal vesicles should be preferred. In case of a need for irradiation of the entire seminal vesicles, patients should be informed about a higher risk for chronic rectal toxicity and, possibly, for bladder complications.

Second Tumors after Oncologic Treatment

“…Similarly, the risk for rectal and bladder tumors is increased after radiotherapy for cervix cancer [17]. In these circumstances, a reduction of late effects, e.g., by more conformal treatments [16,19,21], may reduce the risk for second cancers.…”

Transabdominal Ultrasonography, Computed Tomography and Electronic Portal Imaging for 3-Dimensional Conformal Radiotherapy for Prostate Cancer

“…However, when such approach is applied, the volume of the irradiated normal structures must be reduced in order to limit normal tissue injury [5,9,12,14,15,18]. The main limitations in margin reduction are the setup errors and organ-motion (prostate motion due to rectum and bladder filling).…”

Laparoscopic Seminal Vesicle and Pelvic Lymph Node Resection before High-Dose Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer

“…Furthermore, Kestin et al [15] exposed that among patients presenting SV involvement after radical prostatectomy (all risk groups taken together), only 7% had an SV involvement beyond 1 cm and 1% beyond 2 cm. In order to reduce the rectal irradiated volume, the authors proposed to include, within the CTV, only the proximal (2-2.5 cm) part of the SV, especially for high-risk patients [27]; Hille et al confirmed those data [12].…”