Prostate radiotherapyVolumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer
Section snippets
Materials and methods
CT datasets of 9 patients with prostate cancer who received radical radiotherapy treatment in our department were randomly selected for this comparative planning study. The planning target volume (PTV) was defined as prostate and seminal vesicles plus a margin of 1.5 cm in lateral, anterior and craniocaudal direction. The anterior rectal wall was chosen as the posterior border of the PTV to provide a consistent basis for plan comparison. The rectum was divided into two parts: the anterior and
Results
The mean value for the PTV was 315 ml (range 246–363 ml). The values for the anterior rectum had a mean of 27 ml (range 13–46 ml) and those for posterior rectum had a mean of 30 ml (range 17–48 ml). Typical dose distributions for all approaches are displayed in Fig. 2. Table 1 shows an overview of all investigated parameters as mean values ± standard deviation (SD), also in the text mean values ± SD are provided. With a prescription dose of 76 Gy as the median dose in the PTV, the resulting mean doses for
Discussion
Dose escalation to the prostate improves local control; higher doses however, carry an elevated risk of late gastro-intestinal (GI) and genitourinary (GU) complications. While 3D-treatment planning has reduced side effects of prostate radiotherapy [27], dose escalation beyond 70 Gy, though improving tumor control has resulted in increased side effects [1], [2], [28]. Modern modulation techniques (IMRT) seem to provide excellent tumor control without an increase in side effects by increasing the
Conclusion
All studied intensity-modulated techniques yield treatment plans of significantly improved quality when compared to 3D-conformal treatments, with serial tomotherapy providing best OAR sparing and VMAT being the most efficient treatment option for the targets studied in our comparison, reducing treatment time to 1.8–3.7 min and MU to <400 for a 2 Gy fraction. The VMAT-presented paradigm forms the basis for the clinical treatments which we have initiated in December of 2008 and have been continuing
Financial support
This work was supported within the framework of a Research, Cooperation Agreement between the Department of Radiation Oncology, Mannheim, University Medical Center and Elekta.
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