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Strahlentherapie und Onkologie

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01-09-2013 | Case study

Treatment planning after hydrogel injection during radiotherapy of prostate cancer

Authors: Prof. Dr. M. Pinkawa, C. Bornemann, N. Escobar-Corral, M.D. Piroth, R. Holy, M.J. Eble

Published in: Strahlentherapie und Onkologie | Issue 9/2013

Abstract

Purpose

Imaging for treatment planning shortly after hydrogel injection is optimal for practical purposes, reducing the number of appointments. The aim was to evaluate the actual difference between early and late imaging.

Patients and methods

Treatment planning computed tomography (CT) was performed shortly after injection of 10 ml hydrogel (CT1) and 1–2 weeks later (CT2) for 3 patients. The hydrogel was injected via the transperineal approach after dissecting the space between the prostate and rectum with a saline/lidocaine solution of at least 20-ml. Hydrogel volume and distances between the prostate and rectal wall were compared. Intensity-modulated radiotherapy (IMRT) plans up to a dose of 78 Gy were generated (rectum V₇₀ < 20 %, rectum V₅₀ < 50 %; with the rectum including hydrogel volume for planning).

Results

A mean planning treatment volume of 104 cm³ resulted for a prostate volume of 37 cm³. Hydrogel volumes of 30 and 10 cm³ were determined in CT1 and CT2, respectively. Distances between the prostate and rectal wall at the levels of the base, middle, and apex were 1.7 cm, 1.6 cm, 1.5 cm in CT1 and 1.3 cm, 1.2 cm, 0.8 cm in CT2, respectively, corresponding to a mean decrease of 24, 25, and 47 %. A small overlap between the PTV and the rectum was found only in 1 patient in CT2 (0.2 cm³). The resulting mean rectum (without hydrogel) V₇₅, V₇₀, V₆₀, V₅₀ increased from 0 %, 0 %, 0.6 %, 10 % in CT1 to 0.1 %, 1.2 %, 6 %, 20 % in CT2, respectively.

Conclusion

Treatment planning based on imaging shortly after hydrogel injection overestimates the actual hydrogel volume during the treatment as a result of not-yet-absorbed saline solution and air bubbles.

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Title: Treatment planning after hydrogel injection during radiotherapy of prostate cancer
Authors: Prof. Dr. M. Pinkawa
C. Bornemann
N. Escobar-Corral
M.D. Piroth
R. Holy
M.J. Eble
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 9/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0388-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment planning after hydrogel injection during radiotherapy of prostate cancer

Abstract

Purpose

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

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