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- W2077359229 abstract "The aim of this analysis was to evaluate the impact of a spacer on the dose distribution, applying 3D RT and IMRT planning techniques. The injection of a spacer gel (10ml) was performed under transrectal ultrasound guidance after dissecting the space between prostate and rectum with a saline/lidocaine solution in 18 patients with prostate cancer (PSA<20ng/ml, Gleason score <3+4). 3D RT (0°, 90°, 180°, 270° gantry angles) and IMRT (180°, 105°, 45°, 315°, 255° gantry angles) treatment plans were compared based on a CT before and after injection with the same objectives, respectively. A total dose of 78Gy was prescribed to the PTV (minimum 74.1Gy in 99% of PTV). The following objectives were used for inverse IMRT planning: maximum dose of 50Gy to 50%, 70Gy to 20% of rectal volume (constraint: 76Gy maximum dose); maximum dose of 55Gy to 50%, 70Gy to 30% of bladder volume. NTCP for grade 3 or worse rectum and bladder toxicity were computed applying the Lyman-Kutcher-Burman model with Emami parameters. Values for the PTV and bladder did not change significantly after injection of the spacer. Significant advantages (p<0.01) resulted in respect of all presented rectum values comparing pre spacer with post spacer plans for both techniques. Rectal NTCP reached the lowest percentage after spacer injection irrespectively of the technique, with a reduction by 54% and 78% for the IMRT and 3D RT techniques, respectively. Significantly (p<0.01) higher EUD, Dmean, and V76 for the PTV were reached with IMRT vs. 3D RT plans, with a smaller rectum V76 but larger V50. The best compliance with all rectal objectives and constraints resulted after IMRT post spacer planning (94% of patients after IMRT vs. 67% after 3D RT planning; p = 0.04). The injection of a spacer between the prostate and anterior rectal wall is associated with considerably lower doses to the rectum and consequentially lower EUD and NTCP values irrespectively of the radiotherapy technique. Advantages of the forward in comparison to the applied inverse planning technique regarding rectal dose distribution suggest room for improvement in the optimization process, with potential advantages of strictly lateral beams (PTV does not adhere in a concave shape to the rectum with a spacer) and more rigorous planning objectives.Tabled 1Median values for target and organs at riskIMRTIMRT3D RT3D RTpre spacerpost spacerpre spacerpost spacerPTV EUD/Gy77.877.877.177.2 Dmean/Gy77.978.077.277.3 V76/%93.295.684.186.3Rectum EUD/Gy62.358.660.755.1 Dmean/Gy43.235.643.738.9 V76/%0.904.00.3 V50/%39.831.331.019.3 NTCP≥gr.3/%6.53.04.51.0Bladder EUD/Gy41.043.542.644.2 Dmean/Gy29.834.430.535.9 V76/%8.810.64.75.3 V50/%26.830.526.129.5 NTCP≥gr.3/%0000 Open table in a new tab" @default.
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- W2077359229 date "2011-10-01" @default.
- W2077359229 modified "2023-09-27" @default.
- W2077359229 title "Application of a Spacer between Prostate and Anterior Rectal Wall to Optimize Radiotherapy of Localized Prostate Cancer: Comparison of Three-dimensional Conformal (3D RT) and Intensity Modulated (IMRT) Treatment Planning Techniques" @default.
- W2077359229 doi "https://doi.org/10.1016/j.ijrobp.2011.06.643" @default.
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