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Strahlentherapie und Onkologie

Published in:

01-04-2016 | Original Article

Prostate cancer treated with image-guided helical TomoTherapy® and image-guided LINAC-IMRT

Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity

Authors: Sonia Drozdz, Michael Schwedas, Henning Salz, Susan Foller, Thomas G. Wendt

Published in: Strahlentherapie und Onkologie | Issue 4/2016

Abstract

Background

We compared different image-guidance (IG) strategies for prostate cancer with high-precision IG intensity-modulated radiation therapy (IMRT) using TomoTherapy® (Accuray Inc., Madison, WI, USA) and linear accelerator (LINAC)-IMRT and their impact on planning target volume (PTV) margin reduction. Follow-up data showed reduced bladder toxicity in TomoTherapy patients compared to LINAC-IMRT. The purpose of this study was to quantify whether the treatment delivery technique and decreased margins affect reductions in bladder toxicity.

Patients and methods

Setup corrections from 30 patients treated with helical TomoTherapy and 30 treated with a LINAC were analyzed. These data were used to simulate three IG protocols based on setup error correction and a limited number of imaging sessions. For all patients, gastrointestinal (GI) and genitourinary (GU) toxicity was documented and correlated with the treatment delivery technique.

Results

For fiducial marker (FM)-based RT, a margin reduction of up to 3.1, 3.0, and 4.8 mm in the left–right (LR), superior–inferior (SI), and anterior-posterior (AP) directions, respectively, could be achieved with calculation of a setup correction from the first three fractions and IG every second day. Although the bladder volume was treated with mean doses of 35 Gy in the TomoTherapy group vs. 22 Gy in the LINAC group, we observed less GU toxicity after TomoTherapy.

Conclusion

Intraprostate FMs allow for small safety margins, help decrease imaging frequency after setup correction, and minimize the dose to bladder and rectum, resulting in lower GU toxicity. In addition, IMRT delivered with TomoTherapy helps to avoid hotspots in the bladder neck, a critical anatomic structure associated with post-RT urinary toxicity.

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Title: Prostate cancer treated with image-guided helical TomoTherapy® and image-guided LINAC-IMRT
Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity
Authors: Sonia Drozdz
Michael Schwedas
Henning Salz
Susan Foller
Thomas G. Wendt
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 4/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0935-y

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Prostate cancer treated with image-guided helical TomoTherapy® and image-guided LINAC-IMRT

Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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