Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 5/2019

01-05-2019 | Original Article

Dosimetric and volumetric effects in clinical target volume and organs at risk during postprostatectomy radiotherapy

Authors: Ahmed Gawish, Ahmed Ali Chughtai, Prof.Dr.med. Michael J Eble

Published in: Strahlentherapie und Onkologie | Issue 5/2019

Login to get access

Abstract

Purpose

To assess the reproducibility of the dose–volume distribution of the initial simulation CT, generated using volumetric modulated arc therapy (VMAT) planning, during the radiotherapy of the prostatic bed based on weekly cone beam CTs (CBCT).

Methods

Twenty-three patients, after radical prostatectomy were treated with adjuvant or salvage radiotherapy between July and December 2016 and considered for this evaluation. Weekly CBCT scans (n = 138) were imported into the treatment planning system, and the clinical tumor volume (CTV), the rectum and the bladder were contoured. The initially calculated dose distribution and the dose–volume histograms generated from weekly CBCTs were compared. The prostatic fossa dose coverage was assessed by the proportion of the CTV fully encompassed by the 95% and 98% isodose lines. Rectal and bladder volumes receiving 50, 60 and 65 Gy during the treatment were compared to the initial plan, with statistical significance determined using the one-sample t‑test.

Results

Marked variations in the total organ volume of the rectum and the bladder were observed. The correlation between rectum volume and V50 was not significant (p = 0.487), while the bladder volume and V50 demonstrated a significant correlation. There was no correlation between urinary bladder volume and CTV. The change in rectal volume correlated significantly with CTV. The dose coverage (D98% and D95%) to the prostatic bed could be achieved for all patients due to the ventral shift in the volume differences of the rectum.

Conclusion

Weekly CBCTs can be considered as adequate verification tools to assess the interfractional variability of the CTV and organs at risk. The proven volume changes in the urinary bladder and the rectum do not compromise the final delivered dose in the CTV.
Literature
1.
Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E, Crawford ED (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: Long-term follow up of a randomized clinical trial. J Urol 181(3):956–962CrossRefPubMedPubMedCentral
2.
Wiegel T, Bartkowiak D, Bottke D et al (2014) Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol 66:243–250CrossRefPubMed
3.
Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, Maréchal JM, Scalliet P, Haustermans K, Piérart M (2005) European Organization for Research and Treatment of Cancer. Postoperative radiotherapy after radical prostatectomy: A randomised controlled trial (EORTC trial 22911). Lancet 366(9485):572–578CrossRefPubMed
4.
Choo R, Hruby G, Hong J, Hong E, DeBoer G, Danjoux C et al (2002) Positive resection margin and/or pathologic T3 adenocarcinoma of prostate with undetectable postoperative prostate-specific antigen after radical prostatectomy: To irradiate or not? Int J Radiat Oncol Biol Phys 52(3):674–680CrossRefPubMed
5.
Cozzarini C, Bolognesi A, Ceresoli GL, Fiorino C, Rossa A, Bertini R et al (2004) Role of postoperative radiotherapy after pelvic lymphadenectomy and radical retropubic prostatectomy: A single institute experience of 415 patients. Int J Radiat Oncol Biol Phys 59(3):674–683CrossRefPubMed
6.
Cozzarini C, Fiorino C, Mandelli D, Campagnoli E, Fallini M, Reni M et al (2000) 3D conformal radiotherapy significantly reduces toxicity of post-prostatectomy adjuvant of salvage irradiation. Int J Radiat Oncol Biol Phys 48(3):248CrossRef
7.
Pearlstein KA, Chen RC (2013) Comparing dosimetric, morbidity, quality of life, and cancer control outcomes after 3D conformal, intensitymodulated, and proton radiation therapy for prostate cancer. Semin Radiat Oncol 23:182–190CrossRefPubMed
8.
Alongi F, Fogliata A, Navarria P, Tozzi A, Mancosu P, Lobefalo F, Reggiori G, Clivio A, Cozzi L, Scorsetti M (2012) Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Report of feasibility and acute toxicity. Strahlenther Onkol 188:990–996CrossRefPubMed
9.
Cozzarini C, Fiorino C, Di Muzio N, Alongi F, Broggi S, Cattaneo M, Montorsi F, Rigatti P, Calandrino R, Fazio F (2007) Significant reduction of acute toxicity following pelvic irradiation with helical tomotherapy in patients with localized prostate cancer. Radiother Oncol 84:164–170CrossRefPubMed
10.
Otto K (2008) Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 35(1):310–317CrossRefPubMed
11.
Huang K, Palma DA, Scott D et al (2012) Inter- and intrafraction uncertainty in prostate bed image-guided radiotherapy. Int J Radiat Oncol Biol Phys 84:402–407CrossRefPubMed
12.
Klayton T, Price R, Buyyounouski MK, Sobczak M, Greenberg R, Li J, Keller L, Sopka D, Kutikov A, Horwitz EM (2012) Prostate bed motion during intensity-modulated radiotherapy treatment. Int J Radiat Oncol Biol Phys 84:130–136CrossRefPubMedPubMedCentral
13.
Verma V, Chen S, Zhou S et al (2016) Prostate bed target interfractional motion using RTOG consensus definitions and daily CT on rails. Strahlenther Onkol 193(1):38–45CrossRefPubMed
14.
Alongi F, Di Muzio N (2009) Image-guided radiation therapy: A new era for the radiation oncologist? Int J Clin Oncol 14:568–569CrossRefPubMed
15.
Schulze D, Liang J, Yan D, Zhang T (2009) Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization. Radiother Oncol 90(3):367–376CrossRefPubMed
16.
Rudat V, Nour A, Hammoud M, Alaradi A, Mohammed A (2016) Image-guided intensity-modulated radiotherapy of prostate cancer: Analysis of interfractional errors and acute toxicity. Strahlenther Onkol 192:109–117CrossRefPubMed
17.
Wang W, Wu Q, Yan D (2010) Quantitative evaluation of cone-beam computed tomography in target volume definition for offline image-guided radiation therapy of prostate cancer. Radiother Oncol 94(1):71–75CrossRefPubMed
18.
19.
Onozato Y, Kadoya N, Fujita Y, Arai K, Dobashi S, Takeda K et al (2013) Evaluation of on-board kV cone beam CT-based dose calculation using deformable image registration and modification of HU values. Int J Radiat Oncol Biol Phys 87(2):711–712CrossRef
20.
Marchant TE, Moore CJ, Rowbottom CG, Mackay RI, Williams PC (2008) Shading correction algorithm for improvement of cone-beam CT images in radiotherapy. Phys Med Biol 53(20):5719CrossRefPubMed
21.
Kupelian PA, Langen KM, Zeidan OA, Meeks SL, Willoughby TR, Wagner TH et al (2006) Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 66(3):876–882CrossRefPubMed
22.
Langen KM, Lu W, Willoughby TR, Chauhan B, Meeks SL, Kupelian PA et al (2009) Dosimetric effect of prostate motion during helical tomotherapy. Int J Radiat Oncol Biol Phys 74(4):1134–1142CrossRefPubMed
23.
Pawlowski JM, Yang ES, Malcolm AW, Coffey CW, Ding GX (2010) Reduction of dose delivered to organs at risk in prostate cancer patients via image-guided radiation therapy. Int J Radiat Oncol Biol Phys 76(3):924–934CrossRefPubMed
24.
Sripadam R, Stratford J, Henry AM, Jackson A, Moore CJ, Price P (2009) Rectal motion can reduce CTV coverage and increase rectal dose during prostate radiotherapy: A daily cone-beam CT study. Radiother Oncol 90(3):312–317CrossRefPubMed
25.
Guckenberger M, Meyer J, Baier K, Vordermark D, Flentje M (2006) Distinct effects of rectum delineation methods in 3D-confromal vs. IMRT treatment planning of prostate cancer. Radiat Oncol 1(1):34CrossRefPubMedPubMedCentral
26.
Hatton JA, Greer PB, Tang C, Wright P, Capp A, Gupta S et al (2011) Does the planning dose-volume histogram represent treatment doses in image-guided prostate radiation therapy? Assessment with cone-beam computerised tomography scans. Radiother Oncol 98(2):162–168CrossRefPubMed
27.
Maggio A, Gabriele D, Garibaldi E et al (2017) Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy. Strahlenther Onkol 193:722–732CrossRefPubMed
28.
Poortmans P, Bossi A, Vandeputte K, Bosset M, Miralbell R, Maingon P et al (2007) Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol 84:121–127CrossRefPubMed
29.
30.
Marks LB, Yorke ED, Jackson A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:10–19CrossRef
31.
Ghilezan M, Yan D, Liang J, Jaffray D, Wong J, Martinez A (2004) Online image-guided intensity-modulated radiotherapy for prostate cancer: How much improvement can we expect? A theoretical assessment of clinical benefits and potential dose escalation by improving precision and accuracy of radiation delivery. Int J Radiat Oncol Biol Phys 60:1602–1610CrossRefPubMed
32.
Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO (2010) Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 76:123–129CrossRef
33.
Diot Q, Olsen C, Kavanagh B, Raben D, Miften M (2011) Dosimetric effect of online image-guided anatomical interventions for postprostatectomy cancer patients. Int J Radiat Oncol Biol Phys 79(2):623–632CrossRefPubMed
34.
Fiorino C, Foppiano F, Franzone P, Broggi S, Castellone P, Marcenaro M, Calandrino R, Sanguineti G (2005) Rectal and bladder motion during conformal radiotherapy after radical prostatectomy. Radiother Oncol 74:187–195CrossRefPubMed
35.
Padhani AR, Khoo VS, Suckling J, Husband JE, Leach MO, Dearnaley DP (1999) Evaluating the effect of rectal distension and rectal movement on prostate gland position using cine MRI. Int J Radiat Oncol Biol Phys 44:525–533CrossRefPubMed
36.
Murthy V, Shukla P, Adurkar P, Master Z, Mahantshetty U, Shrivastava SK (2011) Dose variation during hypofractionated image-guided radiotherapy for prostate cancer: Planned versus delivered. J Cancer Res Ther 7:162–167CrossRefPubMed
37.
Ghadjar P, Zelefsky MJ, Spratt DE et al (2014) Impact of dose to the bladder trigone on long-term urinary function after high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 88(2):339–344CrossRefPubMedPubMedCentral
38.
Frank SJ, Dong L, Kudchadker RJ et al (2008) Quantification of prostate and seminal vesicle interfraction variation during IMRT. Int J Radiat Oncol Biol Phys 71(3):813CrossRefPubMed
39.
Orlandini LC, Coppola M, Fulcheri C et al (2017) Dose tracking assessment for image-guided radiotherapy of the prostate bed and the impact on clinical workflow. Radiat Oncol 12:78CrossRefPubMedPubMedCentral
40.
Metadata
Title
Dosimetric and volumetric effects in clinical target volume and organs at risk during postprostatectomy radiotherapy
Authors
Ahmed Gawish
Ahmed Ali Chughtai
Prof.Dr.med. Michael J Eble
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 5/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1381-4

Other articles of this Issue 5/2019

Strahlentherapie und Onkologie 5/2019 Go to the issue

Case Study

A fatal case of Fournier’s gangrene during neoadjuvant radiotherapy for rectal cancer

Original Article

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

Original Article

Patient- versus physician-reported outcomes in prostate cancer patients receiving hypofractionated radiotherapy within a randomized controlled trial

Literatur kommentiert

Endokrine Funktionsstörungen nach Bestrahlung von Hirntumoren bei Kindern und jungen Erwachsenen

Review Article

Chemoradiotherapy for anal cancer: are we as good as we think?

Original Article

The value of pretreatment serum butyrylcholinesterase level as a novel prognostic biomarker in patients with cervical cancer treated with primary (chemo-)radiation therapy