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. 2008 Jan 11:3:3.
doi: 10.1186/1748-717X-3-3.

Does intensity modulated radiation therapy (IMRT) prevent additional toxicity of treating the pelvic lymph nodes compared to treatment of the prostate only?

Matthias Guckenberger  1 , Kurt Baier, Anne Richter, Dirk Vordermark, Michael Flentje
Affiliations

Does intensity modulated radiation therapy (IMRT) prevent additional toxicity of treating the pelvic lymph nodes compared to treatment of the prostate only?

Matthias Guckenberger et al. Radiat Oncol. .

Abstract

Background: To evaluate the risk of rectal, bladder and small bowel toxicity in intensity modulated radiation therapy (IMRT) of the prostate only compared to additional irradiation of the pelvic lymphatic region.

Methods: For ten patients with localized prostate cancer, IMRT plans with a simultaneous integrated boost (SIB) were generated for treatment of the prostate only (plan-PO) and for additional treatment of the pelvic lymph nodes (plan-WP). In plan-PO, doses of 60 Gy and 74 Gy (33 fractions) were prescribed to the seminal vesicles and to the prostate, respectively. Three plans-WP were generated with prescription doses of 46 Gy, 50.4 Gy and 54 Gy to the pelvic target volume; doses to the prostate and seminal vesicles were identical to plan-PO. The risk of rectal, bladder and small bowel toxicity was estimated based on NTCP calculations.

Results: Doses to the prostate were not significantly different between plan-PO and plan-WP and doses to the pelvic lymph nodes were as planned. Plan-WP resulted in increased doses to the rectum in the low-dose region </= 30 Gy, only, no difference was observed in the mid and high-dose region. Normal tissue complication probability (NTCP) for late rectal toxicity ranged between 5% and 8% with no significant difference between plan-PO and plan-WP. NTCP for late bladder toxicity was less than 1% for both plan-PO and plan-WP. The risk of small bowel toxicity was moderately increased for plan-WP.

Discussion: This retrospective planning study predicted similar risks of rectal, bladder and small bowel toxicity for IMRT treatment of the prostate only and for additional treatment of the pelvic lymph nodes.

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Figures

Figure 1
Figure 1
Composition of the target volumes PTV-1, PTV-2 and PTV-LAG.
Figure 2
Figure 2
Schematic protocols of plan-PO and plan-WP (dose prescription of 50.4 Gy to PTV-LAG).
Figure 3
Figure 3
Representative dose distributions for plan-PO.
Figure 4
Figure 4
Representative dose distributions for plan-WP.
Figure 5
Figure 5
Dose-volume histogram of the rectal volume for plan-PO and plan-WP.
Figure 6
Figure 6
Dose-volume histogram of the rectal wall for plan-PO and plan-WP.
Figure 7
Figure 7
Dose-volume histogram of the bladder volume for plan-PO and plan-WP.
Figure 8
Figure 8
Dose-volume histogram of the bladder wall for plan-PO and plan-WP.
See this image and copyright information in PMC

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