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Multicenter Study
. 2012 Jul;53(4):608-14.
doi: 10.1093/jrr/rrs016. Epub 2012 Jun 6.

Surveillance on interfacility differences in dose-prescription policy of intensity-modulated radiation therapy plans for prostate cancer

Takashi Mizowaki  1 , Kazuo Hatano, Masahiro Hiraoka
Affiliations
Multicenter Study

Surveillance on interfacility differences in dose-prescription policy of intensity-modulated radiation therapy plans for prostate cancer

Takashi Mizowaki et al. J Radiat Res. 2012 Jul.

Abstract

Intensity-modulated radiation therapy (IMRT) has recently become popular in Japan. Prostate cancer is indisputably one of the main targets of IMRT. However, the current status and interfacility differences in dose-prescription policies for prostate IMRT are unknown. Therefore, a nationwide survey of 43 institutions that had implemented prostate IMRT was conducted by sending a questionnaire regarding the above-mentioned issues. Thirty-three institutions (77%) had responded to the questionnaire by the end of October 2010. A total of 5245 patients with localized prostate cancer had been treated with IMRT by the end of 2009. Regular multileaf collimator-based techniques were the most common beam delivery method. Dose-prescription policies were divided into four major categories: isocenter-based (@isocenter), dose delivered to 95% of the planning target volume (PTV) (D95)-based (D95@PTV), mean dose to the PTV-based (Mean@PTV), and mean dose to the clinical target volume (CTV)-based (@CTV). The mean doses of the CTV and PTV, and the volume of the PTV receiving 95% of the dose (V95) were significantly higher with the D95@PTV policy than with the other prescription policies. Low-dose areas and hot spots were observed within the PTV in plans with @isocenter and @CTV policies. In conclusion, there are currently considerable differences among institutions in Japan regarding target doses for prostate IMRT. The D95@PTV prescription policy resulted in significant dose escalation compared with the other policies. These differences should be taken into consideration when interpreting treatment outcomes and creating multi-institutional protocols in the future.

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Figures

Figure 1.
Figure 1.
Number of institutions that started prostate IMRT each year from 2000 to 2009.
Figure 2.
Figure 2.
Mean dose (a) and D95 (b) of CTV according to different dose-prescription policies.
Figure 3.
Figure 3.
Mean dose (a), D95 (b), V90 (c) and maximum dose (d) of PTV according to the different dose-prescription policies.
See this image and copyright information in PMC

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