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Reduced rectal toxicity with ultrasound-based image guided radiotherapy using BAT™ (B-mode acquisition and targeting system) for prostate cancer

Reduzierte Rektumtoxizität mit bildgestützter Radiotherapie mittels BAT™ (B-Mode Acquisition and Targeting-System) beim Prostatakarzinom

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Abstract

Purpose

To evaluate the effect of image guided radiotherapy with stereotactic ultrasound BAT (B-mode acquisition and targeting system) on rectal toxicity in conformal radiotherapy of prostate cancer.

Patients and Methods

42 sequential patients with prostate cancer undergoing radiotherapy before and after the introduction of BAT were included. Planning computed tomography (CT) was performed with empty rectum and moderately filled bladder. The planning target volume (PTV) included the prostate and seminal vesicles with a safety margin of 1.5 cm in anterior and lateral direction. In posterior direction the anterior 1/3 of the rectum circumference were included. Total dose was 66 Gy and a boost of 4 Gy excluding the seminal vesicles.

22 patients (BAT group) were treated with daily stereotactic ultrasound positioning, for the other 20 patients (NoBAT group) an EPID (electronic portal imaging device) was performed once a week. Acute and late genito-urinary (GU) and rectal toxicity and PSA values were evaluated after 1.5, 3, 6, 9 and 12 months. The total median follow up of toxicity was 3 years in the BAT group and 4 years in the NoBAT group.

Results

In the NoBAT group significant more rectal toxicity occurred, while in GU toxicity no difference was seen. Two patients in the NoBAT group showed late rectal toxicity grade 3, no toxicity > grade 2 occurred in the BAT group. There was no significant difference in PSA reduction between the groups.

Conclusion

Without BAT significant more acute and a trend to more late rectal toxicity was found. With regard to dose escalation this aspect is currently evaluated with a larger number of patients using intensity-modulated radiotherapy (IMRT).

Zusammenfassung

Hintergrund

Ziel dieser Auswertung war es, den Effekt der bildgebungsgestützen Strahlentherapie mittels stereotaktischem Ultraschall-BAT (B-mode Acqusition and Targeting-System) auf die Akut- und Spättoxizität am Rektum sowie auf den Verlauf der PSA-Werte zu ermitteln.

Patienten und Methodik

42 Patienten mit Prostatakarzinom wurden in die Auswertung eingeschlossen (Tabelle 1). Die Planung erfolgte standardisiert mit entleertem Rektum und moderat gefüllter Blase. Es wurde ein Planungszielvolumen (PTV) unter Einschluss der Prostata und Samenblasen mit einem Sicherheitsabstand lateral und anterior von 1,5 cm definiert. Posterior wurde maximal das vordere Rektumdrittel eingeschlossen. Die Gesamtdosis betrug 66 Gy mit einem Boost unter Ausschluss der Samenblasen mit nochmals 4 Gy.

Bei 22 Patienten erfolgte die tägliche Lagerungskontrolle mit stereotaktischem Ultraschall (BAT-Gruppe), bei den restlichen 20 (NoBAT-Gruppe) wurde einmal wöchentlich eine Verifikationsaufnahme (EPID) zur Lagerungskontrolle durchgeführt. Die Akuttoxizität und Spättoxizität an der Blase und am Rektum sowie der Verlauf der PSA-Werte nach 1,5, 3, 6, 9 und 12 Monaten wurden ermittelt. Der Beobachtungszeitraum der Patienten ohne BAT war 3–4 Jahre und mit BAT 2–3 Jahre.

Ergebnisse

In der NoBAT-Gruppe trat signifikant häufiger eine höhergradige Rektumtoxizität auf (Abbildungen 1 und 2), während sich bei der Blasentoxizität kein wesentlicher Unterschied in beiden Gruppen zeigte. Zwei Patienten aus der NoBAT-Gruppe hatten als Spättoxizität eine persistierende rektale Blutung. In der BAT-Gruppe fand sich keine Spättoxizität > Grad 2. Der Verlauf der PSA-Werte zeigte keinen relevanten Unterschied (Abbildung 3).

Schlussfolgerung

Ohne BAT trat signifikant mehr Akuttoxizität und tendenziell mehr Spättoxizität am Rektum auf. Dieser Aspekt wird insbesondere im Hinblick auf eine Dosiseskalation an einer größeren Patientengruppe mit intensitätsmodulierter Strahlentherapie (IMRT) evaluiert.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center, Mannheim, Germany

    Sabine Kathrin Mai

  2. Department of Radiation Oncology, University Medical Center, Theodor-Kutzer-Ufer, 68167, Mannheim, Germany

    Markus Bohrer M.D.

Authors
  1. Markus Bohrer M.D.
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  2. Peter Schröder
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  3. Grit Welzel
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  4. Hansjörg Wertz
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  5. Frank Lohr
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  6. Frederik Wenz
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  7. Sabine Kathrin Mai
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Correspondence to Markus Bohrer M.D..

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Bohrer, M., Schröder, P., Welzel, G. et al. Reduced rectal toxicity with ultrasound-based image guided radiotherapy using BAT™ (B-mode acquisition and targeting system) for prostate cancer. Strahlenther Onkol 184, 674–678 (2008). https://doi.org/10.1007/s00066-008-1837-z

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  • DOI: https://doi.org/10.1007/s00066-008-1837-z

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