Prostate radiotherapyDose-escalation using intensity-modulated radiotherapy for prostate cancer – Evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost
Section snippets
Imaging
PET-CT (Phillips Gemini TF 16) with 18F-choline was performed in 12 consecutive prostate cancer patients for treatment planning. Patients presented with the histological result and no evidence of metastases. After a choline-poor diet for 5 days the patients have fasted at least for 6 h before PET acquisition. Whole body image acquisition in supine patient position followed 1 h after the injection of 178–355 MBq 18F-choline and hydration with 250 ml electrolyte solution and 10 mg furosemide,
Results
GTVPET and GTVPET + margins have been found to be significantly larger for high risk vs. intermediate/low risk patients (mean GTVPET of 9 cm3 vs. 3 cm3 and mean GTVPET + margins of 25 cm3 vs. 12 cm3; p = 0.03, respectively). Both volumes were likewise larger for patients with a T-stage >2a vs. ⩽2a (defined before PET-CT; mean GTVPET of 11 cm3 vs. 3 cm3 and mean GTVPET + margins of 28 cm3 vs. 13 cm3; p < 0.01) and a biopsy Gleason score >6 vs. ⩽6 (mean GTVPET of 8 cm3 vs. 3 cm3 and mean GTVPET + margins of 24 cm3 vs.
Discussion
Advances in radiotherapy treatment techniques, including IMRT and IGRT, and imaging modalities offer new opportunities for an individualized treatment of prostate cancer patients. A dose-volume effect is a well-known radiobiological phenomenon – larger doses are needed for local control of larger tumour volumes [29]. Specifically for prostate cancer, the problem of local recurrences exactly at the primary localization before treatment has been reported [10]. Furthermore, a dose–response
Conclusions
Treatment planning with a simultaneous integrated boost allows an individually adapted dose escalation. The boost volume, as defined by a tumour-to-background uptake ratio >2 in a PET-CT with choline, was found to correlate with several well-established prognostic parameters. The therapeutic ratio can be improved by a considerable dose escalation to the macroscopic tumour site without considerably increasing the NTCP for the rectum and bladder. In contrast to a minor impact of the prescription
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2017, PET ClinicsCitation Excerpt :Of articles that reported PET/CT-guided planning of EBRT, most used radiolabeled choline PET/CT.18 Six articles evaluated localized prostate cancer and reported 178 patients with PET/CT-guided planning of a boost to GTVPET.18 In 3 articles, Pinkawa and colleagues27–29 simultaneously integrated a boost with 80 Gy for the GTVPET with a dose of 76 Gy for the whole prostate. The small boost did not increase toxicity for normal organs at risk.