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• W4238200314 abstract "The inclusion of pelvic lymphatic irradiation in the treatment of prostate cancer for some patients has been suggested in RTOG 9413. The purpose of this study is to examine the feasibility of lymphatic irradiation with IMRT. A series of 5 patients were planned to deliver 76 Gy to the prostate and proximal seminal vesicles and 56 Gy to the distal seminal vesicles and 3 subsets of pelvic lymph nodes: (1) periprostatic and periseminal vesicle, (2) subset 1, obturator, external and internal iliac and (3) subsets 1, 2, and the presacral nodes. Differences in target coverage, critical structure sparing, and radiation safety issues are analyzed with respect to our current treatment for high risk patients (subset 1). All plans were generated using the Corvus inverse planning system (NOMOS Corp. Sewickley, PA) using similar input parameters and attempts were made to meet our clinical acceptance criteria. These criteria included 95% of each PTV receiving the prescription dose or higher. Rectal constraints included that no more than 17% and 35% receives ≥65 Gy and ≥40 Gy, respectively. Bladder constraints included that no more than 25% and 50% receives ≥65 Gy (B65) and ≥40 Gy (B40), respectively. For this study we have adopted the same criteria for the adjacent bowel (including sigmoid colon and any bowel within the pelvis) as used for the rectum. Plans were generated for SMLC delivery at 10 MV on 2 accelerators using minimum beamlet sizes of 1 × 1 cm2, 5 × 5 mm2 and 5 × 10 mm2. All target and critical structure criteria were met for the treatment subset 1 with all 3 beamlet sizes. However, significant variance was found in the average modified modulation scaling factors (MSFmod) with respect to our clinical factor of 3.95 derived from the treatment of prostate patients of all stages. Factors found were 3.8, 7.1, and 4.9 for 1 × 1 cm2, 5 × 5 mm2 and 5 × 10 mm2 beamlets, respectively. All target and critical structure criteria were met for subset 2 except for B40. Values of 60.1%, 61.3%, and 61.1% were found for 1 × 1 cm2, 5 × 5 mm2 and 5 × 10 mm2 beamlets, respectively. The MSFmod values for this subset were 4.9, 10.3, and 7.7 respectively. The inclusion of presacral nodes in subset 3 resulted in failure to meet the B40 criteria on average although the high dose criterion was consistently met. Values of B40 were 68.1%, 65.3%, and 65.6% while MSFmod values for this subset were 6.1, 12.6, and 8.1 for 1 × 1 cm2, 5 × 5 mm2 and 5 × 10 mm2 beamlets, respectively. It is notable that the amount of bowel receiving ≥40 Gy did not meet our criteria for the 1 × 1 cm2 beamlets with a value of 38%. Due to variable bladder filling the acceptance criteria for this structure are viewed as soft constraints at this institution and failure to meet our cutoff may or may not result in plan rejection. Additionally, coverage of the presacral nodes may not be warranted and was included for test purposes only. While our average values indicated the ability to adequately cover all targets we were unable to adequately cover the presacral nodes in 20% of the cases studied with the average dose received by 95% of the PTV for this structure being 54.8 Gy in these cases. Attempts at renormalization resulted in unacceptable hot spots. The MSFmod or ratio of MU required for IMRT vs. 3D CRT delivery, being directly related to increased accelerator head leakage, is of concern. These values were seen to increase as a function of increased lymphatic coverage and decrease in minimum beamlet size. No significant difference was found for the amount of non-target tissue receiving the lymphatic prescription dose of 56 Gy as a function of decreasing beamlet size. While it appears possible to treat the subset 2 lymphatics with IMRT and adhere to our normal acceptance criteria, we would suggest that caution be exercised with respect to the number of MU and resultant leakage radiation. Segment and MU reduction techniques and additional optimization algorithms are being investigated" @default.
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• W4238200314 date "2004-09-01" @default.
• W4238200314 modified "2023-09-27" @default.
• W4238200314 title "Pelvic lymphatic coverage in the treatment of prostate cancer with intensity modulated radiation therapy: A feasibility study" @default.
• W4238200314 doi "https://doi.org/10.1016/s0360-3016(04)01959-5" @default.
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