Impact of pelvic nodal irradiation with intensity-modulated radiotherapy on treatment of prostate cancer

Robert A. Price, Jean Michel Hannoun-Levi, Eric Horwitz, Mark Buyyounouski, Karen J. Ruth, C. M. Ma, Alan Pollack

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: The aim of this study was to evaluate the feasibility of treating the pelvic lymphatic regions during prostate intensity-modulated radiotherapy (IMRT) with respect to our routine acceptance criteria. Methods and Materials: A series of 10 previously treated prostate patients were randomly selected and the pelvic lymphatic regions delineated on the fused magnetic resonance/computed tomography data sets. A targeting progression was formed from the prostate and proximal seminal vesicles only to the inclusion of all pelvic lymphatic regions and presacral region resulting in 5 planning scenarios of increasing geometric difficulty. IMRT plans were generated for each stage for two accelerator manufacturers. Dose volume histogram data were analyzed with respect to dose to the planning target volumes, rectum, bladder, bowel, and normal tissue. Analysis was performed for the number of segments required, monitor units, "hot spots," and treatment time. Results: Both rectal endpoints were met for all targets. Bladder endpoints were not met and the bowel endpoint was met in 40% of cases with the inclusion of the extended and presacral lymphatics. A significant difference was found in the number of segments and monitor units with targeting progression and between accelerators, with the smaller beamlets yielding poorer results. Treatment times between the 2 linacs did not exhibit a clinically significant difference when compared. Conclusions: Many issues should be considered with pelvic lymphatic irradiation during IMRT delivery for prostate cancer including dose per fraction, normal structure dose/volume limits, planning target volumes generation, localization, treatment time, and increased radiation leakage. We would suggest that, at a minimum, the endpoints used in this work be evaluated before beginning IMRT pelvic nodal irradiation.

Original languageEnglish
Pages (from-to)583-592
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume66
Issue number2
DOIs
StatePublished - Oct 1 2006
Externally publishedYes

Fingerprint

Intensity-Modulated Radiotherapy
radiation therapy
Prostatic Neoplasms
cancer
Pelvis
planning
Prostate
dosage
irradiation
bladder
progressions
monitors
Urinary Bladder
accelerators
Lymphatic Irradiation
inclusions
rectum
Seminal Vesicles
Therapeutics
Rectum

Keywords

  • Intensity-modulated radiotherapy
  • Pelvic lymphatics
  • Whole pelvic radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Impact of pelvic nodal irradiation with intensity-modulated radiotherapy on treatment of prostate cancer. / Price, Robert A.; Hannoun-Levi, Jean Michel; Horwitz, Eric; Buyyounouski, Mark; Ruth, Karen J.; Ma, C. M.; Pollack, Alan.

In: International Journal of Radiation Oncology Biology Physics, Vol. 66, No. 2, 01.10.2006, p. 583-592.

Research output: Contribution to journalArticle

Price, Robert A. ; Hannoun-Levi, Jean Michel ; Horwitz, Eric ; Buyyounouski, Mark ; Ruth, Karen J. ; Ma, C. M. ; Pollack, Alan. / Impact of pelvic nodal irradiation with intensity-modulated radiotherapy on treatment of prostate cancer. In: International Journal of Radiation Oncology Biology Physics. 2006 ; Vol. 66, No. 2. pp. 583-592.
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