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Treatment planning after hydrogel injection during radiotherapy of prostate cancer

Behandlungsplanung nach Hydrogelinjektion während Strahlentherapie beim Prostatakarzinom

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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.

Zusammenfassung

Hintergrund

Die Bildgebung zur Bestrahlungsplanung kurz nach der Hydrogelinjektion ist aus praktischen Gründen wegen der geringen Terminanzahl optimal. Ziel der Studie war die Analyse von Unterschieden zwischen früher und später Bildgebung.

Fallberichte

Die Computertomographie zur Bestrahlungsplanung wurde kurz nach der Injektion von 10 ml Hydrogel (CT1) und 1–2 Wochen später (CT2) bei 3 Patienten durchgeführt. Das Hydrogel wurde transperineal nach Dissektion des Raums zwischen Prostata und Rektum mit ≥ 20 ml Kochsalz/Lidocain verabreicht. Das Hydrogelvolumen und die Abstände zwischen Prostata und Rektumwand wurden verglichen. IMRT-Pläne wurden mit einer Verschreibungsdosis von 78 Gy berechnet (Rektum V70 < 20 %, Rektum V50 < 50 %; Rektum einschließlich Hydrogel zur Planung).

Ergebnisse

Ein durchschnittliches Planungszielvolumen von 104 cm3 resultierte aus einem Prostatavolumen von 37 cm3. Hydrogelvolumina von 30 und 10 cm3 wurden in CT1 und CT2 bestimmt. Die Abstände zwischen Prostata und Rektumwand auf der Ebene von Basis, Mitte und Apex betrugen jeweils 1,7 cm/1,6 cm/1,5 cm in CT1 und 1,3 cm/1,2 cm/0,8 cm in CT2, entsprechend einer Abnahme von 24, 25 und 47 %. Eine geringe Überlappung zwischen PTV und Rektum fand sich nur bei einem einzigen Patienten in CT2 (0,2cm3). Die resultierenden durchschnittlichen Rektum-V75, -V70, -V60, -V50 (ohne Hydrogel) waren jeweils mit 0 %, 0 %, 0,6 %, 10 % in CT1 geringer als in CT2 mit jeweils 0,1 %, 1,2 %, 6 % und 20 %.

Schlussfolgerung

Die auf einer Bildgebung kurz nach der Hydrogelinjektion basierende Bestrahlungsplanung überschätzt das tatsächlich während der Behandlung vorhandene Hydrogelvolumen infolge noch nicht absorbierter Kochsalzlösung und Luftblasen.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, RWTH Aachen University, Pauwelsstr. 30, 52072, Aachen, Germany

    M. Pinkawa, C. Bornemann, N. Escobar-Corral, M.D. Piroth, R. Holy & M.J. Eble

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  1. M. Pinkawa
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  2. C. Bornemann
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  3. N. Escobar-Corral
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  4. M.D. Piroth
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  5. R. Holy
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  6. M.J. Eble
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Correspondence to M. Pinkawa.

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Pinkawa, M., Bornemann, C., Escobar-Corral, N. et al. Treatment planning after hydrogel injection during radiotherapy of prostate cancer. Strahlenther Onkol 189, 796–800 (2013). https://doi.org/10.1007/s00066-013-0388-0

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  • DOI: https://doi.org/10.1007/s00066-013-0388-0

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