Postoperative Radiotherapy for Prostate Cancer

Pinkawa, Michael; Siluschek, Jaroslav; Gagel, Bernd; Piroth, Marc D.; Demirel, Cengiz Bekir; Asadpour, Branka; Eble, Michael J.

doi:10.1007/s00066-007-1588-2

Cited by 36 publications

(8 citation statements)

References 29 publications

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“…Pinkawa et al . has described decreasing bowel and rectal volumes during the course of treatment from urinary and bowel urgency [6]. Similarly, constipation or urinary retention that resolve or start during the course of treatment could further alter the direction of the forces exerted by the bladder and rectum, and account for some of the pattern changes observed during the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It has been utilized for the salvage or adjuvant treatment of post-prostatectomy patients [5-7]. Compared to three-dimensional conformal radiotherapy (3D-CRT), IMRT has the capacity of lowering the dose to the bladder especially when it is full [6]. IMRT can also reduce the dose to the rectum compared to 3D-CRT [8].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a number studies have described the setup shifts and organ motion observed in post-prostatectomy patients using various imaging techniques and intervals [6,7,9-13]. Thus far the total number of post-prostatectomy patients analyzed has been small, and further studies are needed to better characterize this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed

Cavalieri¹,

Liu²,

Ferreira

et al. 2011

Radiat Oncol

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BackgroundTo evaluate the daily total error shift patterns on post-prostatectomy patients undergoing image guided radiotherapy (IGRT) with a diagnostic quality computer tomography (CT) on rails system.MethodsA total of 17 consecutive post-prostatectomy patients receiving adjuvant or salvage IMRT using CT-on-rails IGRT were analyzed. The prostate bed's daily total error shifts were evaluated for a total of 661 CT scans.ResultsIn the right-left, cranial-caudal, and posterior-anterior directions, 11.5%, 9.2%, and 6.5% of the 661 scans required no position adjustments; 75.3%, 66.1%, and 56.8% required a shift of 1 - 5 mm; 11.5%, 20.9%, and 31.2% required a shift of 6 - 10 mm; and 1.7%, 3.8%, and 5.5% required a shift of more than 10 mm, respectively. There was evidence of correlation between the x and y, x and z, and y and z axes in 3, 3, and 3 of 17 patients, respectively. Univariate (ANOVA) analysis showed that the total error pattern was random in the x, y, and z axis for 10, 5, and 2 of 17 patients, respectively, and systematic for the rest. Multivariate (MANOVA) analysis showed that the (x,y), (x,z), (y,z), and (x, y, z) total error pattern was random in 5, 1, 1, and 1 of 17 patients, respectively, and systematic for the rest.ConclusionsThe overall daily total error shift pattern for these 17 patients simulated with an empty bladder, and treated with CT on rails IGRT was predominantly systematic. Despite this, the temporal vector trends showed complex behaviors and unpredictable changes in magnitude and direction. These findings highlight the importance of using daily IGRT in post-prostatectomy patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed

Cavalieri¹,

Liu²,

Ferreira

et al. 2011

Radiat Oncol

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“…head and neck [48], lung [49], breast [50], prostate [32,51,52] or other [53]. For radiotherapy of glioblastomas the feasibility and efficacy of IMRT planning with a simultaneous boost could be shown by Chan et al [54].…”

Section: Discussionmentioning

confidence: 99%

Integrated-boost IMRT or 3-D-CRT using FET-PET based auto-contoured target volume delineation for glioblastoma multiforme - a dosimetric comparison

et al. 2009

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BackgroundBiological brain tumor imaging using O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET combined with inverse treatment planning for locally restricted dose escalation in patients with glioblastoma multiforme seems to be a promising approach.The aim of this study was to compare inverse with forward treatment planning for an integrated boost dose application in patients suffering from a glioblastoma multiforme, while biological target volumes are based on FET-PET and MRI data sets.MethodsIn 16 glioblastoma patients an intensity-modulated radiotherapy technique comprising an integrated boost (IB-IMRT) and a 3-dimensional conventional radiotherapy (3D-CRT) technique were generated for dosimetric comparison. FET-PET, MRI and treatment planning CT (P-CT) were co-registrated. The integrated boost volume (PTV1) was auto-contoured using a cut-off tumor-to-brain ratio (TBR) of ≥ 1.6 from FET-PET. PTV2 delineation was MRI-based. The total dose was prescribed to 72 and 60 Gy for PTV1 and PTV2, using daily fractions of 2.4 and 2 Gy.ResultsAfter auto-contouring of PTV1 a marked target shape complexity had an impact on the dosimetric outcome. Patients with 3-4 PTV1 subvolumes vs. a single volume revealed a significant decrease in mean dose (67.7 vs. 70.6 Gy). From convex to complex shaped PTV1 mean doses decreased from 71.3 Gy to 67.7 Gy. The homogeneity and conformity for PTV1 and PTV2 was significantly improved with IB-IMRT. With the use of IB-IMRT the minimum dose within PTV1 (61.1 vs. 57.4 Gy) and PTV2 (51.4 vs. 40.9 Gy) increased significantly, and the mean EUD for PTV2 was improved (59.9 vs. 55.3 Gy, p < 0.01). The EUD for PTV1 was only slightly improved (68.3 vs. 67.3 Gy). The EUD for the brain was equal with both planning techniques.ConclusionIn the presented planning study the integrated boost concept based on inversely planned IB-IMRT is feasible. The FET-PET-based automatically contoured PTV1 can lead to very complex geometric configurations, limiting the achievable mean dose in the boost volume. With IB-IMRT a better homogeneity and conformity, compared to 3D-CRT, could be achieved.

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“…Previous authors have reported that the PB moves independently of bony anatomy, [15][16][17][18][19] and in a number of these studies CBCT scans were used to assess this movement. 10,20,21 This has implications for daily image guidance techniques applied during radiotherapy treatment in post-prostatectomy patients.…”

Section: Discussionmentioning

confidence: 99%

Definition and visualisation of regions of interest in post‐prostatectomy image‐guided intensity modulated radiotherapy

Bell

Cox

Eade

et al. 2014

J of Medical Radiation Sci

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IntroductionStandard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV). The aims of this study are to define regions of interest (ROI) to be used in soft tissue matching image guidance and determine their visibility on planning CT (PCT) and CBCT.MethodsPublished CTV guidelines were used to select ROIs. The PCT scans (n = 23) and CBCT scans (n = 105) of 23 post-prostatectomy patients were reviewed. Details on ROI identification were recorded.ResultsEighteen patients had surgical clips. All ROIs were identified on PCTs at least 90% of the time apart from mesorectal fascia (MF) (87%) due to superior image quality. When surgical clips are present, the seminal vesicle bed (SVB) was only seen in 2.3% of CBCTs and MF was unidentifiable. Most other structures were well identified on CBCT. The anterior rectal wall (ARW) was identified in 81.4% of images and penile bulb (PB) in 68.6%. In the absence of surgical clips, the MF and SVB were always identified; the ARW was identified in 89.5% of CBCTs and PB in 73.7%.ConclusionsSurgical clips should be used as ROIs when present to define SVB and MF. In the absence of clips, SVB, MF and ARW can be used. RTs must have a strong knowledge of soft tissue anatomy and PPRT CTV to ensure coverage and enable soft tissue matching.

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Postoperative Radiotherapy for Prostate Cancer

Cited by 36 publications

References 29 publications

Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed

Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed

Integrated-boost IMRT or 3-D-CRT using FET-PET based auto-contoured target volume delineation for glioblastoma multiforme - a dosimetric comparison

Definition and visualisation of regions of interest in post‐prostatectomy image‐guided intensity modulated radiotherapy

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