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Physical and clinical implications of radiotherapy treatment of prostate cancer using a full bladder protocol

Physikalische und klinische Implikationen der Behandlung bei gefüllter Blase in der Strahlentherapie des Prostatakarzinoms

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Abstract

Purpose

To assess the dosimetric and clinical implication when applying the full bladder protocol for the treatment of the localized prostate cancer (PCA).

Patients and Methods

A total of 26 consecutive patients were selected for the present study. Patients underwent two series of CT scans: the day of the simulation and after 40 Gy. Each series consisted of two consecutive scans: (1) full bladder (FB) and (2) empty bladder (EB). The contouring of clinical target volumes (CTVs) and organs at risk (OAR) were compared to evaluate organ motion. Treatment plans were compared by dose distribution and dose–volume histograms (DVH).

Results

CTV shifts were negligible in the laterolateral and superior–inferior directions (the maximum shift was 1.85 mm). Larger shifts were recorded in the anterior–posterior direction (95% CI, 0.83–4.41 mm). From the dosimetric point of view, shifts are negligible: the minimum dose to the CTV was 98.5% (median; 95%CI, 95–99%). The potential advantage for GU toxicity in applying the FB treatment protocol was measured: the ratio between full and empty bladder dose–volume points (selected from our protocol) is below 0.61, excluding the higher dose region where DVHs converge.

Conclusion

Having a FB during radiotherapy does not affect treatment effectiveness, on the contrary it helps achieve a more favorable DVH and lower GU toxicities.

Zusammenfassung

Ziel

Evaluierung der dosimetrischen und klinischen Implikationen bei Anwendung des Gefüllte-Blase-(FB-)Protokolls für die Behandlung des lokalisierten Prostatakarzinoms (PCA).

Patienten und Methoden

26 Patienten wurden für die vorliegende Studie ausgewählt. Sie unterzogen sich zwei Serien von CT-Scans: am Tag der Simulation und nach der Strahlendosis von 40 Gy. Jede Serie bestand aus zwei aufeinanderfolgenden Scans: mit gefüllter (FB) und mit leerer Blase (EB). Die Konturierung der CTVs und OARs wurden verglichen, um die Organbewegung abzuschätzen. Die Behandlungspläne wurden hinsichtlich Dosis und DVH verglichen.

Ergebnisse

Die CTV-Verschiebungen waren vernachlässigbar in laterolateraler und superior-inferiorer Richtung (maximale Verschiebung: 1,85 mm). Größere Verschiebungen wurden in anterior-posteriorer Richtung dokumentiert (0,83–4,41 mm; 95%-CI). In dosimetrischer Hinsicht sind die Verschiebungen geringfügig: Die minimale CTV-Dosis lag bei 98,5% (95– 99%, Median, 95% -CI). Der potentielle Vorteil hinsichtlich der GU-Toxizität bei Anwendung des FB-Behandlungsprotokolls war messbar: Das Verhältnis der Dosis-Volumen-Punkte (aus unserem Protokoll) bei gefüllter bzw. leerer Blase lag unter 0,61, mit Ausnahme der höheren Dosisbereiche, wo die DVHs konvergieren.

Schlussfolgerung

FB während der Strahlentherapie hat keinen Einfluss auf die Wirksamkeit der Behandlung, bewirkt jedoch günstigere DVHs und niedrigere GU-Toxizität.

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Authors and Affiliations

  1. Department of Medical Physics, Istituto Europeo di Oncologia, Milan, Italy

    Raffaella Cambria, Federica Cattani, Rosa Luraschi & Guido Pedroli

  2. Department of Radiation Oncology, Istituto Europeo di Oncologia, Milan, Italy

    Barbara A. Jereczek-Fossa, Dario Zerini & Roberto Orecchia

  3. Università degli Studi di Milano, Milan, Italy

    Barbara A. Jereczek-Fossa & Roberto Orecchia

  4. Unità operativa di radioterapia, Azienda Ospedaliera Sant’Anna, Como, Italy

    Flavia Serafini

  5. Istituto Europeo di Oncologia, Fisica Sanitaria, via Ripamonti 435, 20141, Milan, Italy

    Raffaella Cambria

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  1. Raffaella Cambria
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  2. Barbara A. Jereczek-Fossa
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  3. Dario Zerini
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  4. Federica Cattani
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  5. Flavia Serafini
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  6. Rosa Luraschi
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  7. Guido Pedroli
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Correspondence to Raffaella Cambria.

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Cambria, R., Jereczek-Fossa, B.A., Zerini, D. et al. Physical and clinical implications of radiotherapy treatment of prostate cancer using a full bladder protocol. Strahlenther Onkol 187, 799–805 (2011). https://doi.org/10.1007/s00066-011-2259-x

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  • DOI: https://doi.org/10.1007/s00066-011-2259-x

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