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Dosimetric evaluation of whole-pelvis radiation therapy of prostate cancers: clinical experience

Published online by Cambridge University Press:  18 June 2020

Ernest Osei Open the ORCID record for Ernest Osei [Opens in a new window] ,
Hafsa Mansoor ,
Johnson Darko ,
Beverley Osei ,
Katrina Fleming  and
Ramana Rachakonda
Ernest Osei*
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
Hafsa Mansoor
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
Johnson Darko
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
Beverley Osei
Affiliation:
Department of Health Sciences, McMaster University, Hamilton, ON, Canada
Katrina Fleming
Affiliation:
Department of Radiation Therapy, Grand River Regional Cancer Centre, Kitchener, ON, Canada
Ramana Rachakonda
Affiliation:
Department of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, ON, Canada
*
Author for correspondence: Ernest Osei, Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada. E-mail: ernest.osei@grhosp.on.ca
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Abstract

Background:

The standard treatment modalities for prostate cancer include surgery, chemotherapy, hormonal therapy and radiation therapy or any combination depending on the stage of the tumour. Radiation therapy is a common and effective treatment modality for low-intermediate-risk patients with localised prostate cancer, to treat the intact prostate and seminal vesicles or prostate bed post prostatectomy. However, for high-risk patients with lymph node involvement, treatment with radiation will usually include treatment of the whole pelvis to cover the prostate and seminal vesicles or prostate bed and the pelvic lymph nodes followed by a boost delivery dose to the prostate and seminal vesicles or prostate bed.

Materials and Methods:

We retrospectively analysed the treatment plans for 179 prostate cancer patients treated at the cancer centre with the volumetric-modulated arc therapy (VMAT) technique via RapidArc using 6 MV photon beam. Patients were either treated with a total prescription dose of 78 Gy in 39 fractions for patients with intact prostate or 66 Gy in 33 fractions for post prostatectomy patients.

Results:

There were 114 (64%) patients treated with 78 Gy/39 and 65 (36%) treated with 66 Gy/34. The mean homogeneity index (HI), conformity index (CI) and uniformity index (UI) for the PTV-primary of patients treated with 78 Gy are 0.06 ± 0.01, 1.04 ± 0.01 and 0.99 ± 0.01, respectively, and the corresponding mean values for patients treated with 66 Gy are 0.06 ± 0.02, 1.05 ± 0.01 and 0.99 ± 0.01, respectively. The mean PTV-primary V95%, V100% and V105% are 99.5 ± 0.5%, 78.8 ± 12.2% and 0.1 ± 0.5%, respectively, for patients treated with 78 Gy and 99.3 ± 0.9%, 78.1 ± 10.6% and 0.1 ± 0.4%, respectively, for patients treated with 66 Gy. The rectal V50Gy, V65Gy, V66.6Gy, V70Gy, V75Gy and V80Gy are 26.8 ± 9.1%, 14.2 ± 5.3%, 13.1 ± 5.0%, 10.8 ± 4.3%, 6.9 ± 3.1% and 0.1 ± 0.1%, respectively, for patients treated with 78 Gy and 33.7 ± 8.4%, 14.1 ± 4.5%, 6.7 ± 4.5%, 0.0 ± 0.2%, 0.0% and 0.0%, respectively, for patients treated with 66 Gy.

Conclusion:

The use of VMAT technique for radiation therapy of high-risk prostate cancer patients is an efficient and reliable method for achieving superior dose conformity, uniformity and homogeneity to the PTV and minimal doses to the organs at risk. Results from this study provide the basis for the development and implementation of consistent treatment criteria in radiotherapy programs, have the potential to establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that reduces significant variations in the acceptability of treatment plans and potentially improve patient standard of care.

Keywords

dosimetryhigh-risk prostate cancertreatment planningVMATwhole-pelvis radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 433 - 447
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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