Optimized coverage of high-risk adjuvant lymph node areas in prostate cancer using a sentinel node-based, intensity-modulated radiation therapy technique

Journal Article · Thu Feb 01 04:00:00 EST 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.08.082· OSTI ID:20944672

Ganswindt, Ute ^[1]; Paulsen, Frank ^[1]; Corvin, Stefan ^[2]; Hundt, Ilse ^[3]; Alber, Markus ^[4]; Frey, Bettina C ^[4]; Stenzl, Arnulf ^[2]; Bares, Roland ^[3]; Bamberg, Michael ^[1]; Belka, Claus ^[1]

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1. Department of Radiation Oncology, University of Tuebingen, Tuebingen (Germany)
2. Department of Urology, University of Tuebingen, Tuebingen (Germany)
3. Department of Nuclear Medicine, University of Tuebingen, Tuebingen (Germany)
4. Department of Radiation Oncology, Biomedical Physics, University of Tuebingen, Tuebingen (Germany)

Purpose: Irradiation of adjuvant lymph nodes in high-risk prostate cancer was shown to be associated with improved rates of biochemical nonevidence of disease in the Radiation Therapy Oncology Group trial (RTOG 94-13). To account for the highly individual lymphatic drainage pattern we tested an intensity-modulated radiation therapy (IMRT) approach based on the determination of pelvic sentinel lymph nodes (SN). Methods and Materials: Patients with a risk of more than 15% lymph node involvement were included. For treatment planning, SN localizations were included into the pelvic clinical target volume. Dose prescriptions were 50.4 Gy to the adjuvant area and 70.0 Gy to the prostate. All treatment plans were generated using equivalent uniform dose (EUD)-based optimization algorithms and Monte Carlo dose calculations and compared with 3D conventional plans. Results: A total of 25 patients were treated and 142 SN were detectable (mean: n = 5.7; range, 0-13). Most SN were found in the external iliac (35%), the internal iliac (18.3%), and the iliac commune (11.3%) regions. Using a standard CT-based planning target volume, relevant SN would have been missed in 19 of 25 patients, mostly in the presacral/perirectal area (22 SN in 12 patients). The comparison of conventional 3D plans with the respective IMRT plans revealed a clear superiority of the IMRT plans. No gastrointestinal or genitourinary acute toxicity Grade 3 or 4 (RTOG criteria) occurred. Conclusions: Distributions of SN are highly variable. Data for SN derived from single photon emission computed tomography are easily integrated into an IMRT-based treatment strategy. By using SN data the probability of a geographic miss is reduced. The use of IMRT allows sparing of normal tissue irradiation.

• OSTI ID: 20944672
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 67; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ALGORITHMS
CARCINOMAS
HEALTH HAZARDS
IRRADIATION
LYMPH NODES
MONTE CARLO METHOD
OPTIMIZATION
PATIENTS
PLANNING
PROSTATE
RADIATION DOSES
RADIOTHERAPY
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
TOXICITY