Penile bulb sparing in prostate cancer radiotherapy

Abstract

This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. A total of 17prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a65 cm3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed acaudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (Dmean) and maximum (Dmax) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p<0.05) than those of the CT-contoured PTV. For 6patients, the estimated PB Dmax (seven-field IMRT and IBT) for the adapted PTV was <70 Gy, whereas only 1patient fulfilled this criterium with the CT-based PTV. MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.