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BMC Cancer
Published in: BMC Cancer 1/2005

Open Access 01-12-2005 | Research article

Intensity modulated radiotherapy for high risk prostate cancer based on sentinel node SPECT imaging for target volume definition

Authors: Ute Ganswindt, Frank Paulsen, Stefan Corvin, Kai Eichhorn, Stefan Glocker, Ilse Hundt, Mattias Birkner, Markus Alber, Aristotelis Anastasiadis, Arnulf Stenzl, Roland Bares, Wilfried Budach, Michael Bamberg, Claus Belka

Published in: BMC Cancer | Issue 1/2005

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Abstract

Background

The RTOG 94-13 trial has provided evidence that patients with high risk prostate cancer benefit from an additional radiotherapy to the pelvic nodes combined with concomitant hormonal ablation. Since lymphatic drainage of the prostate is highly variable, the optimal target volume definition for the pelvic lymph nodes is problematic. To overcome this limitation, we tested the feasibility of an intensity modulated radiation therapy (IMRT) protocol, taking under consideration the individual pelvic sentinel node drainage pattern by SPECT functional imaging.

Methods

Patients with high risk prostate cancer were included. Sentinel nodes (SN) were localised 1.5–3 hours after injection of 250 MBq 99mTc-Nanocoll using a double-headed gamma camera with an integrated X-Ray device. All sentinel node localisations were included into the pelvic clinical target volume (CTV). Dose prescriptions were 50.4 Gy (5 × 1.8 Gy / week) to the pelvis and 70.0 Gy (5 × 2.0 Gy / week) to the prostate including the base of seminal vesicles or whole seminal vesicles. Patients were treated with IMRT. Furthermore a theoretical comparison between IMRT and a three-dimensional conformal technique was performed.

Results

Since 08/2003 6 patients were treated with this protocol. All patients had detectable sentinel lymph nodes (total 29). 4 of 6 patients showed sentinel node localisations (total 10), that would not have been treated adequately with CT-based planning ('geographical miss') only. The most common localisation for a probable geographical miss was the perirectal area. The comparison between dose-volume-histograms of IMRT- and conventional CT-planning demonstrated clear superiority of IMRT when all sentinel lymph nodes were included. IMRT allowed a significantly better sparing of normal tissue and reduced volumes of small bowel, large bowel and rectum irradiated with critical doses. No gastrointestinal or genitourinary acute toxicity Grade 3 or 4 (RTOG) occurred.

Conclusion

IMRT based on sentinel lymph node identification is feasible and reduces the probability of a geographical miss. Furthermore, IMRT allows a pronounced sparing of normal tissue irradiation. Thus, the chosen approach will help to increase the curative potential of radiotherapy in high risk prostate cancer patients.
Appendix
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Metadata
Title
Intensity modulated radiotherapy for high risk prostate cancer based on sentinel node SPECT imaging for target volume definition
Authors
Ute Ganswindt
Frank Paulsen
Stefan Corvin
Kai Eichhorn
Stefan Glocker
Ilse Hundt
Mattias Birkner
Markus Alber
Aristotelis Anastasiadis
Arnulf Stenzl
Roland Bares
Wilfried Budach
Michael Bamberg
Claus Belka
Publication date
01-12-2005
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2005
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-5-91

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