[en] Background and Purpose: Dose escalation in order to improve the biochemical control in prostate cancer requires the application of irradiation techniques with high conformality. The dosimetric selectivity of three radiation modalities is compared: high-dose-rate brachytherapy (HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and helical tomotherapy (HT).
<br />Patients and Methods: Ten patients with prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after external-beam radiotherapy were investigated. For each patient, HDR-BT, IMRT and HT theoretical treatment plans were realized using common contour sets. A 10-Gy dose was prescribed to the planning target volume (PTV). The PTVs and critical organs’ dose-volume histograms obtained were compared using Student’s t-test.
<br />Results: HDR-BT delivers spontaneously higher mean doses to the PTV with smaller cold spots compared to IMRT and HT. 33% of the rectal volume received a mean HDR-BT dose of 3.86 ± 0.3 Gy in comparison with a mean IMRT dose of 6.57 ± 0.68 Gy and a mean HT dose of 5.58 ± 0.71 Gy (p < 0.0001). HDR-BT also enables to better spare the bladder. The hot spots inside the urethra are greater with HDR-BT. The volume of healthy tissue receiving 10% of the prescribed dose is reduced at least by a factor of 8 with HDR-BT (p < 0.0001).
<br />Conclusion: HDR-BT offers better conformality in comparison with HT and IMRT and reduces the volume of healthy tissue receiving a low dose. [fr] CONTEXTE ET OBJET: escalade de dose est nécessaire pour améliorer le contrôle biochimique de cancer de la prostate nécessite l'application de techniques d'irradiation avec conformality élevé. The dosimetric selectivity of three radiation modalities is compared: high-dose-rate brachytherapy (HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and helical tomotherapy (HT). La sélectivité dosimétrique de trois modalités de radiation est comparé: high-dose-curiethérapie taux (HDR-BT), l'intensité d'irradiation, la radiothérapie modulée (IMRT), et la tomothérapie hélicoïdale (HT). PATIENTS AND METHODS: Ten patients with prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after external-beam radiotherapy were investigated. PATIENTS ET MÉTHODES: Dix patients ayant un adénocarcinome de la prostate traités par un 10-Gy HDR-BT stimuler après radiothérapie externe ont été étudiés. For each patient, HDR-BT, IMRT and HT theoretical treatment plans were realized using common contour sets. Pour chaque patient, HDR-BT, IMRT plans de traitement et théoriques HT ont été réalisées en utilisant commune fixe contour. A 10-Gy dose was prescribed to the planning target volume (PTV). Une dose de 10 Gy a été prescrite au volume cible de planification (PTV). The PTVs and critical organs' dose-volume histograms obtained were compared using Student's t-test. Le PTVs organes et la dose critique »des histogrammes de volume obtenues ont été comparées en utilisant la Student's t-test. RESULTS: HDR-BT delivers spontaneously higher mean doses to the PTV with smaller cold spots compared to IMRT and HT. RÉSULTATS: HDR-BT rend spontanément des doses plus élevées signifient pour la PTV avec des taches plus petites à froid par rapport à IMRT et HT. 33% of the rectal volume received a mean HDR-BT dose of 3.86 + or - 0.3 Gy in comparison with a mean IMRT dose of 6.57 + or - 0.68 Gy and a mean HT dose of 5.58 + or - 0.71 Gy (p < 0.0001). 33% du volume rectale reçu une dose moyenne HDR BT de 3,86 + ou - 0,3 Gy en comparaison avec une dose de modulation d'intensité moyenne de 6,57 + ou - 0,68 Gy et une dose moyenne de 5,58 HT + ou - 0,71 Gy (p <0,0001 ). HDR-BT also enables to better spare the bladder. HDR-BT permet également de mieux épargner la vessie. The hot spots inside the urethra are greater with HDR-BT. Les points chauds à l'intérieur de l'urètre sont plus importants avec le HDR-BT. The volume of healthy tissue receiving 10% of the prescribed dose is reduced at least by a factor of 8 with HDR-BT (p < 0.0001). Le volume des tissus sains ayant reçu 10% de la dose prescrite est réduite au minimum par un facteur de 8 avec le HDR-BT (p <0,0001). CONCLUSION: HDR-BT offers better conformality in comparison with HT and IMRT and reduces the volume of healthy tissue receiving a low dose. CONCLUSION: HDR-BT offre une meilleure conformality en comparaison avec HT et IMRT et réduit le volume de tissus sains recevant une dose faible
Biver, Sylvie; CHU Fort de France - Martinique - France > Radiothérapie-oncologie
JANSEN, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Radiothérapie
LENAERTS, Eric ; Centre Hospitalier Universitaire de Liège - CHU > Radiothérapie
De Patoul, Nathalie; Université Catholique de Louvain - UCL > Hopital Saint Luc > Radiothérapie-oncologie
Vynckier, Stefaan; Université Catholique de Louvain - UCL > Hopital Saint Luc > Radiothérapie-oncologie
COUCKE, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > Radiothérapie
Scalliet, Pierre; Université Catholique de Louvain - UCL > Hopital Saint Luc > Radiothérapie-oncologie
Nickers, Philippe
Language :
English
Title :
A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy
Alternative titles :
[fr] Une sélectivité intercomparaison dosimétrique de la curiethérapie HDR, modulation d'intensité et de la tomothérapie hélicoïdale dans la radiothérapie du cancer de la prostate [nl] Ein dosimetrischer Vergleich von HDR-Brachytherapie, IMRT und helikaler Tomotherapie bei der Radiotherapie des Prostatakarzinoms
Publication date :
2009
Journal title :
Strahlentherapie und Onkologie
ISSN :
0179-7158
eISSN :
1439-099X
Publisher :
Urban & Vogel, Munchen, Germany
Volume :
185
Issue :
11
Pages :
736-742
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Hintergrund und Ziel: Eine Dosiseskalation zur Steigerung der biochemischen Kontrollraten beim Prostatakarzinom erfordert die Anwendung von Bestrahlungstechniken, die eine hohe Dosiskonformität ermöglichen. Verglichen wird die dosimetrische Selektivität von drei Bestrahlungsmodalitäten: High-Dose-Rate-Brachytherapie (HDR-BT), intensitätsmodulierte Radiotherapie (IMRT) und helikale Tomotherapie (HT).
<br />Patienten und Methodik: Zehn Patienten mit einem Adenokarzinom der Prostata, die im Anschluss an eine perkutane Radiotherapie einen Boost von 10 Gy in Form einer HDR-BT erhielten, wurden untersucht. Für jeden dieser Patienten wurden Bestrahlungspläne für eine HDR-BT, eine IMRT und eine HT unter Anwendung gemeinsamer Konturierungsverfahren erstellt. Für das Planungszielvolumen (PTV) wurden 10 Gy verordnet. Die ermittelten jeweiligen PTV und Dosis-Volumen-Histogramme für die kritischen Organe wurden mittels Student-t-Test miteinander verglichen.
<br />Ergebnisse: Die HDR-BT führt zu höheren mittleren Dosen im PTV mit kleineren Cold Spots als die IMRT oder HT. 33% des bestrahlten Volumens des Rektums erhielten bei der HDR-BT eine mittlere Dosis von 3,86 ± 0,3 Gy im Vergleich zu 6,57 ± 0,68 Gy bei der IMRT und 5,58 ± 0,71 Gy bei der HT (p < 0,0001). Die HDR-BT ermöglicht eine bessere Schonung der Harnblase. Die Dosisspitzen (Hot Spots) an der Urethra sind jedoch bei der HDR-BT höher. Das Volumen des gesunden Gewebes, das 10% der vorgeschriebenen Dosis erhält, wird bei Anwendung der HDR-BT etwa um den Faktor 8 verringert (p < 0,0001).
<br />Schlussfolgerung: Die HDR-BT führt zu einer günstigeren Dosiskonformität im Vergleich zur HT und zur IMRT und reduziert so das mit einer niedrigen Dosis belastete Volumen gesunden Gewebes.
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