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Pelvic Lymph Node Irradiation Including Pararectal Sentinel Nodes for Prostate Cancer Patients: Treatment Optimization Comparing Intensity Modulated X-rays, Volumetric Modulated Arc Therapy, and Intensity Modulated Proton Therapy.
Vees, Hansjörg; Dipasquale, Giovanna; Nouet, Philippe; Zilli, Thomas; Cozzi, Luca; Miralbell, Raymond.
Afiliação
  • Vees H; Service of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland Hansjorg.Vees@hcuge.ch.
  • Dipasquale G; Service of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
  • Nouet P; Service of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
  • Zilli T; Service of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
  • Cozzi L; Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland.
  • Miralbell R; Service of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
Technol Cancer Res Treat ; 14(2): 181-9, 2015 Apr.
Article em En | MEDLINE | ID: mdl-24694113
ABSTRACT
We aimed to assess the dosimetric impact of advanced delivery radiotherapy techniques using either intensity modulated x-ray beams (IMXT), volumetric modulated arc therapy (VMAT), or intensity modulated proton therapy (IMPT), for high-risk prostate cancer patients with sentinel nodes in the pararectal region. Twenty high-risk prostate cancer patients were included in a prospective trial evaluating sentinel nodes on pelvic SPECT acquisition. To be eligible for the dosimetric study, patients had to present with pararectal sentinel nodes usually not included in the clinical target volume encompassing the pelvic lymph nodes. Radiotherapy-plans including the prostate, the seminal vesicles, and the pelvic lymph nodes with the pararectal sentinel nodes were optimized for 6 eligible patients. IMXT and IMPT were delivered with 7 and 3 beams respectively and VMAT with 2 arcs. Results were assessed with Dose-Volume Histograms and predictive normal tissue complication probabilities (NTCPs) models between the three competing treatment modalities aiming to deliver a total dose of 50.4 Gy in 1.8 Gy daily fractions. Target coverage was optimized with IMPT when compared to IMXT and VMAT. Coverage of the sentinel node was slightly better with IMXT (D98% 5 57.3 ± 5.1 Gy) when compared with VMAT (D98% 5 56.2 ± 4.1 Gy). The irradiation of rectal, bladder, small bowel, and femoral heads volumes was significantly reduced with IMPT when compared to IMXT and VMAT. NTCPs rates for rectal and bladder ≥ grade-3 late toxicity were better with IMPT (0.4 ± 0.0% and 0.0 ± 0.0%) compared with IMXT (4.6 ± 3.3% and 1.4 ± 1.1%), and VMAT (4.5 ± 4.0% and 1.6 ± 1.6%), respectively. Acceptable dose-volume distributions and low rectal and urinary NTCPs were estimated to geometrically complex pelvic volumes such as the ones proposed in this study using IMXT, VMAT and IMPT. IMPT succeeded, however, to propose the best physical and biological treatment plans compared to both X-ray derived plans.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Linfonodos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Revista: Technol Cancer Res Treat Assunto da revista: NEOPLASIAS / TERAPEUTICA Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Suíça

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Linfonodos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Revista: Technol Cancer Res Treat Assunto da revista: NEOPLASIAS / TERAPEUTICA Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Suíça