Abstract
Materials and Methods This prospective single-arm study enrolled 15 men treated with IG-IMRT for localized prostate cancer. All participants received a dedicated 3 Tesla MRI examination of the prostate in addition to a pelvic CT examination for treatment planning. Two volumetric modulated arc therapy (VMAT) plans with a prescription dose of 79.2 Gy were designed using identical constraints based on CT- and MRI-defined consensus volumes. The volume of rectum exposed to 70 Gy or more was compared using the Wilcoxon paired signed rank test. Results For CT-based treatment plans, the median volume of rectum receiving 70 Gy or more was 9.3 cubic centimeters (cc) (IQR 7.0 to 10.2) compared with 4.9 cc (IQR 4.1 to 7.8) for MRI-based plans. This resulted in a median volume reduction of 2.1 cc (IQR 0.5 to 5.3, P < .001). Conclusions Using MRI to plan prostate IG-IMRT to a dose of 79.2 Gy reduces the volume of rectum receiving radiation dose in excess of tolerance (70 Gy or more) and should be considered in men who are at high risk for late rectal toxicity and are not good candidates for other rectal sparing techniques such as hydrogel spacer. This trial is registered with NCT02470910.
Highlights
Curative treatment of prostate cancer with radiation therapy can cause long-term urinary, bowel, and sexual side effects that may significantly impact quality of life [1,2,3,4]
Rectal Dose on computed tomography (CT)- versus magnetic resonance imaging (MRI)-Based Radiotherapy Plans. e volume of rectum receiving high dose radiotherapy was significantly lower when MRI-based radiation therapy planning was used compared to CT-based planning (Figure 1 and Table 1)
We did not find that MRI-based planning significantly improved the Normal Tissue Complication Probability (NTCP); differences in NTCP for MRI versus CT-based plans trended in favor of MRI-based planning, likely reflecting the benefits observed in the high dose range
Summary
Curative treatment of prostate cancer with radiation therapy can cause long-term urinary, bowel, and sexual side effects that may significantly impact quality of life [1,2,3,4]. E current study was undertaken to formally demonstrate in a clinical trial setting that image-guided intensity-modulated radiation therapy (IG-IMRT) planning using magnetic resonance imaging (MRI) can reduce the volume of rectum exceeding 70 Gy, a validated metric that predicts the risk of late rectal toxicity. Using MRI to plan prostate IG-IMRT to a dose of 79.2 Gy reduces the volume of rectum receiving radiation dose in excess of tolerance (70 Gy or more) and should be considered in men who are at high risk for late rectal toxicity and are not good candidates for other rectal sparing techniques such as hydrogel spacer. Using MRI to plan prostate IG-IMRT to a dose of 79.2 Gy reduces the volume of rectum receiving radiation dose in excess of tolerance (70 Gy or more) and should be considered in men who are at high risk for late rectal toxicity and are not good candidates for other rectal sparing techniques such as hydrogel spacer. is trial is registered with NCT02470910
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