Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma: A comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy

Lucia Perna, Claudio Fiorino, Cesare Cozzarini, Sara Broggi, Giovanni Mauro Cattaneo, Francesco De Cobelli, Paola Mangili, Nadia Di Muzio, Riccardo Calandrino

Research output: Contribution to journalArticle

Abstract

Background and purpose: To assess the impact of using MRI and Helical Tomotherapy (HT) compared to 3DCRT and dynamic IMRT on the dose to the penile bulb (PB). Materials and methods: Eight patients diagnosed with prostate cancer entered a treatment protocol including CT and MRI simulation. The prostate apex was defined on both MRI and CT. Treatment plans (HT, Linac-IMRT, 3DCRT and conventional technique), were elaborated on both MRI and CT images. A dose of 71.4 Gy (2.55 Gy/fraction) was prescribed; it was requested that PTVs be covered by 95% isodose line. The mean dose and V50 of PB were evaluated. Results: PTV-MRI plans reduced PB mean dose and V50 compared to PTV-CT plans. This improvement, deriving also from the treatment modality, was 89% for 3DCRT, 99% for Linac-IMRT and 97% for HT (p <0.01), considering V50. Conventional plans resulted in a significantly higher mean PB dose/V50 compared to 3DCRT-PTV-CT (+27%/+38%), Linac-IMRT-PTV-CT (+42%/+57%) and HT-PTV-CT (+32%/+48%) (p <0.01). The comparison between conventional and PTV-MRI techniques showed a still larger increase: +73%/+93% 3DCRT; +86%/+99% Linac-IMRT; +56%/+99% HT (p <0.01). The PB mean dose reduction with Linac-IMRT compared to 3DCRT was 24% (p = 0.034) and 40% (p = 0.027) for PTV-CT and PTV-MRI, respectively. This gain remained significant even when comparing Linac-IMRT to HT: 21% (p = 0.07) PTV-CT and 68% (p = 0.00002) PTV-MRI. HT was superior to 3DCRT with respect to PTV-CT (average gain 4%, p = 0.044), whereas it resulted to be detrimental considering PTV-MRI (26 Gy vs 16.5 Gy), possibly due to the helical delivery of HT; however, in a patient where the distance bulb-PTV

Original languageEnglish
Pages (from-to)57-63
Number of pages7
JournalRadiotherapy and Oncology
Volume93
Issue number1
DOIs
Publication statusPublished - Oct 2009

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Intensity-Modulated Radiotherapy
Prostate
Carcinoma
Clinical Protocols
Prostatic Neoplasms
Therapeutics

Keywords

  • 3DCRT
  • Erectile dysfunction
  • IMRT
  • MRI treatment planning
  • Prostate radiotherapy
  • Tomotherapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{4f03d4a16b6049e8ac884327cab8833e,
title = "Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma: A comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy",
abstract = "Background and purpose: To assess the impact of using MRI and Helical Tomotherapy (HT) compared to 3DCRT and dynamic IMRT on the dose to the penile bulb (PB). Materials and methods: Eight patients diagnosed with prostate cancer entered a treatment protocol including CT and MRI simulation. The prostate apex was defined on both MRI and CT. Treatment plans (HT, Linac-IMRT, 3DCRT and conventional technique), were elaborated on both MRI and CT images. A dose of 71.4 Gy (2.55 Gy/fraction) was prescribed; it was requested that PTVs be covered by 95{\%} isodose line. The mean dose and V50 of PB were evaluated. Results: PTV-MRI plans reduced PB mean dose and V50 compared to PTV-CT plans. This improvement, deriving also from the treatment modality, was 89{\%} for 3DCRT, 99{\%} for Linac-IMRT and 97{\%} for HT (p <0.01), considering V50. Conventional plans resulted in a significantly higher mean PB dose/V50 compared to 3DCRT-PTV-CT (+27{\%}/+38{\%}), Linac-IMRT-PTV-CT (+42{\%}/+57{\%}) and HT-PTV-CT (+32{\%}/+48{\%}) (p <0.01). The comparison between conventional and PTV-MRI techniques showed a still larger increase: +73{\%}/+93{\%} 3DCRT; +86{\%}/+99{\%} Linac-IMRT; +56{\%}/+99{\%} HT (p <0.01). The PB mean dose reduction with Linac-IMRT compared to 3DCRT was 24{\%} (p = 0.034) and 40{\%} (p = 0.027) for PTV-CT and PTV-MRI, respectively. This gain remained significant even when comparing Linac-IMRT to HT: 21{\%} (p = 0.07) PTV-CT and 68{\%} (p = 0.00002) PTV-MRI. HT was superior to 3DCRT with respect to PTV-CT (average gain 4{\%}, p = 0.044), whereas it resulted to be detrimental considering PTV-MRI (26 Gy vs 16.5 Gy), possibly due to the helical delivery of HT; however, in a patient where the distance bulb-PTV",
keywords = "3DCRT, Erectile dysfunction, IMRT, MRI treatment planning, Prostate radiotherapy, Tomotherapy",
author = "Lucia Perna and Claudio Fiorino and Cesare Cozzarini and Sara Broggi and Cattaneo, {Giovanni Mauro} and {De Cobelli}, Francesco and Paola Mangili and {Di Muzio}, Nadia and Riccardo Calandrino",
year = "2009",
month = "10",
doi = "10.1016/j.radonc.2009.04.004",
language = "English",
volume = "93",
pages = "57--63",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma

T2 - A comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy

AU - Perna, Lucia

AU - Fiorino, Claudio

AU - Cozzarini, Cesare

AU - Broggi, Sara

AU - Cattaneo, Giovanni Mauro

AU - De Cobelli, Francesco

AU - Mangili, Paola

AU - Di Muzio, Nadia

AU - Calandrino, Riccardo

PY - 2009/10

Y1 - 2009/10

N2 - Background and purpose: To assess the impact of using MRI and Helical Tomotherapy (HT) compared to 3DCRT and dynamic IMRT on the dose to the penile bulb (PB). Materials and methods: Eight patients diagnosed with prostate cancer entered a treatment protocol including CT and MRI simulation. The prostate apex was defined on both MRI and CT. Treatment plans (HT, Linac-IMRT, 3DCRT and conventional technique), were elaborated on both MRI and CT images. A dose of 71.4 Gy (2.55 Gy/fraction) was prescribed; it was requested that PTVs be covered by 95% isodose line. The mean dose and V50 of PB were evaluated. Results: PTV-MRI plans reduced PB mean dose and V50 compared to PTV-CT plans. This improvement, deriving also from the treatment modality, was 89% for 3DCRT, 99% for Linac-IMRT and 97% for HT (p <0.01), considering V50. Conventional plans resulted in a significantly higher mean PB dose/V50 compared to 3DCRT-PTV-CT (+27%/+38%), Linac-IMRT-PTV-CT (+42%/+57%) and HT-PTV-CT (+32%/+48%) (p <0.01). The comparison between conventional and PTV-MRI techniques showed a still larger increase: +73%/+93% 3DCRT; +86%/+99% Linac-IMRT; +56%/+99% HT (p <0.01). The PB mean dose reduction with Linac-IMRT compared to 3DCRT was 24% (p = 0.034) and 40% (p = 0.027) for PTV-CT and PTV-MRI, respectively. This gain remained significant even when comparing Linac-IMRT to HT: 21% (p = 0.07) PTV-CT and 68% (p = 0.00002) PTV-MRI. HT was superior to 3DCRT with respect to PTV-CT (average gain 4%, p = 0.044), whereas it resulted to be detrimental considering PTV-MRI (26 Gy vs 16.5 Gy), possibly due to the helical delivery of HT; however, in a patient where the distance bulb-PTV

AB - Background and purpose: To assess the impact of using MRI and Helical Tomotherapy (HT) compared to 3DCRT and dynamic IMRT on the dose to the penile bulb (PB). Materials and methods: Eight patients diagnosed with prostate cancer entered a treatment protocol including CT and MRI simulation. The prostate apex was defined on both MRI and CT. Treatment plans (HT, Linac-IMRT, 3DCRT and conventional technique), were elaborated on both MRI and CT images. A dose of 71.4 Gy (2.55 Gy/fraction) was prescribed; it was requested that PTVs be covered by 95% isodose line. The mean dose and V50 of PB were evaluated. Results: PTV-MRI plans reduced PB mean dose and V50 compared to PTV-CT plans. This improvement, deriving also from the treatment modality, was 89% for 3DCRT, 99% for Linac-IMRT and 97% for HT (p <0.01), considering V50. Conventional plans resulted in a significantly higher mean PB dose/V50 compared to 3DCRT-PTV-CT (+27%/+38%), Linac-IMRT-PTV-CT (+42%/+57%) and HT-PTV-CT (+32%/+48%) (p <0.01). The comparison between conventional and PTV-MRI techniques showed a still larger increase: +73%/+93% 3DCRT; +86%/+99% Linac-IMRT; +56%/+99% HT (p <0.01). The PB mean dose reduction with Linac-IMRT compared to 3DCRT was 24% (p = 0.034) and 40% (p = 0.027) for PTV-CT and PTV-MRI, respectively. This gain remained significant even when comparing Linac-IMRT to HT: 21% (p = 0.07) PTV-CT and 68% (p = 0.00002) PTV-MRI. HT was superior to 3DCRT with respect to PTV-CT (average gain 4%, p = 0.044), whereas it resulted to be detrimental considering PTV-MRI (26 Gy vs 16.5 Gy), possibly due to the helical delivery of HT; however, in a patient where the distance bulb-PTV

KW - 3DCRT

KW - Erectile dysfunction

KW - IMRT

KW - MRI treatment planning

KW - Prostate radiotherapy

KW - Tomotherapy

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JO - Radiotherapy and Oncology

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