Abstract
Purpose: The indications for the coverage of seminal vesicles (SV) in patients with clinically localized carcinoma of the prostate have been controversial. Our goal was to define subgroups of patients in whom coverage could be avoided, using pretreatment PSA and Gleason score. This is of particular interest in high-dose conformal radiotherapy, where irradiated volumes need to be significantly reduced, and in brachytherapy, where high risk patients would not be candidates for brachytherapy alone. Since the rectum is the major dose-limiting structure, we attempted to measure the extent of rectal sparing achieved by excluding the SV from external beam treatment fields. Material and Methods: We retrospectively studied the lateral X-ray simulation films of 43 consecutive patients treated with standard 4-field external beam radiotherapy for localized prostate cancer. After projecting the prostate and SV volumes on the lateral X-rays from planning CT scans, the rectal surface areas with and without SV coverage were measured, using a 1 cm margin around the target. In addition, the pathology reports of 389 consecutive patients with prostate carcinoma who were treated with radical prostatectomy alone between 1987 and 1993 were reviewed. Patients without preoperative PSA levels or biopsy Gleason scores, and patients who received neoadjuvant hormonal
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Citation Formats
Katcher, Jerald, Levin, Howard, Zippe, Craig, Klein, Eric, Tuason, Laurie, and Kupelian, Patrick.
Indications for seminal vesicle coverage in the treatment of clinically localized adenocarcinoma of the prostate with radiotherapy alone.
United States: N. p.,
1995.
Web.
doi:10.1016/0360-3016(95)97847-T.
Katcher, Jerald, Levin, Howard, Zippe, Craig, Klein, Eric, Tuason, Laurie, & Kupelian, Patrick.
Indications for seminal vesicle coverage in the treatment of clinically localized adenocarcinoma of the prostate with radiotherapy alone.
United States.
https://doi.org/10.1016/0360-3016(95)97847-T
Katcher, Jerald, Levin, Howard, Zippe, Craig, Klein, Eric, Tuason, Laurie, and Kupelian, Patrick.
1995.
"Indications for seminal vesicle coverage in the treatment of clinically localized adenocarcinoma of the prostate with radiotherapy alone."
United States.
https://doi.org/10.1016/0360-3016(95)97847-T.
@misc{etde_20420701,
title = {Indications for seminal vesicle coverage in the treatment of clinically localized adenocarcinoma of the prostate with radiotherapy alone}
author = {Katcher, Jerald, Levin, Howard, Zippe, Craig, Klein, Eric, Tuason, Laurie, and Kupelian, Patrick}
abstractNote = {Purpose: The indications for the coverage of seminal vesicles (SV) in patients with clinically localized carcinoma of the prostate have been controversial. Our goal was to define subgroups of patients in whom coverage could be avoided, using pretreatment PSA and Gleason score. This is of particular interest in high-dose conformal radiotherapy, where irradiated volumes need to be significantly reduced, and in brachytherapy, where high risk patients would not be candidates for brachytherapy alone. Since the rectum is the major dose-limiting structure, we attempted to measure the extent of rectal sparing achieved by excluding the SV from external beam treatment fields. Material and Methods: We retrospectively studied the lateral X-ray simulation films of 43 consecutive patients treated with standard 4-field external beam radiotherapy for localized prostate cancer. After projecting the prostate and SV volumes on the lateral X-rays from planning CT scans, the rectal surface areas with and without SV coverage were measured, using a 1 cm margin around the target. In addition, the pathology reports of 389 consecutive patients with prostate carcinoma who were treated with radical prostatectomy alone between 1987 and 1993 were reviewed. Patients without preoperative PSA levels or biopsy Gleason scores, and patients who received neoadjuvant hormonal therapy were excluded. Of the 345 remaining patients, only 3 had clinically stage T3 disease. Sixty-four (19%) had preoperative PSA levels {<=}4, 163 (47%) had PSA levels 4-10, 69 (20%) had PSA levels 10-20, and 49 (14%) had PSA levels >20. One hundred (29%) had a biopsy Gleason score {<=}5,155 (45%) had a score of 6,60 (17%) had a score of 7, and 30 (9%) had a score {>=}8. The incidence of SV involvement was 19% ((66(345))) for the entire group. The incidence of SV involvement was noted in different subgroups (Table). The usefulness of the empirical formula proposed by Diaz, i.e. calculated percentage of SV involvement PSA+(Gleason-6) x 10, defining high and low risk groups, was also tested. Results: The reduction in the total irradiated rectal areas to full doses, as determined on the lateral X-rays, ranged from 5% to 67% in individual patients, with a median of 44%. Using a cut-off of 15% as an acceptable level of risk of SV involvement, two low risk groups could be identified; all patients with PSA levels {<=}4, and patients with PSA 4-10 and Gleason {<=}6. These constituted 53% ((184(345))) of all patients. Overall, the low-risk patients had a 6.5% ((12(184))) incidence of SV involvement versus 34% ((54(161))) for the high risk patients (p=<.001). Using the empiric formula proposed by Diaz, 221 (64%) patients were in the low risk group (calculated incidence {<=}13%), and 124 (36%) in the high risk group (calculated incidence >13%). The low risk group had an actuarial 9% incidence of SV involvement versus 37% for the high risk group (p=<0.001). Conclusion: Exclusion of the SV from the treatment field can result in significant reduction (40-50%) in the volume of irradiated rectum. Our data confirm that pretreatment PSA levels and Gleason scores can be effectively used to define subgroups of patients in whom irradiation of the SV can be avoided. We propose exclusion of the SV from the treatment field in all patients with PSA levels {<=}4, and patients with PSA levels 4-10 and a Gleason score {<=}6. We confirmed the usefulness of the formula proposed by Diaz as an alternate method to estimate SV involvement.}
doi = {10.1016/0360-3016(95)97847-T}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}
title = {Indications for seminal vesicle coverage in the treatment of clinically localized adenocarcinoma of the prostate with radiotherapy alone}
author = {Katcher, Jerald, Levin, Howard, Zippe, Craig, Klein, Eric, Tuason, Laurie, and Kupelian, Patrick}
abstractNote = {Purpose: The indications for the coverage of seminal vesicles (SV) in patients with clinically localized carcinoma of the prostate have been controversial. Our goal was to define subgroups of patients in whom coverage could be avoided, using pretreatment PSA and Gleason score. This is of particular interest in high-dose conformal radiotherapy, where irradiated volumes need to be significantly reduced, and in brachytherapy, where high risk patients would not be candidates for brachytherapy alone. Since the rectum is the major dose-limiting structure, we attempted to measure the extent of rectal sparing achieved by excluding the SV from external beam treatment fields. Material and Methods: We retrospectively studied the lateral X-ray simulation films of 43 consecutive patients treated with standard 4-field external beam radiotherapy for localized prostate cancer. After projecting the prostate and SV volumes on the lateral X-rays from planning CT scans, the rectal surface areas with and without SV coverage were measured, using a 1 cm margin around the target. In addition, the pathology reports of 389 consecutive patients with prostate carcinoma who were treated with radical prostatectomy alone between 1987 and 1993 were reviewed. Patients without preoperative PSA levels or biopsy Gleason scores, and patients who received neoadjuvant hormonal therapy were excluded. Of the 345 remaining patients, only 3 had clinically stage T3 disease. Sixty-four (19%) had preoperative PSA levels {<=}4, 163 (47%) had PSA levels 4-10, 69 (20%) had PSA levels 10-20, and 49 (14%) had PSA levels >20. One hundred (29%) had a biopsy Gleason score {<=}5,155 (45%) had a score of 6,60 (17%) had a score of 7, and 30 (9%) had a score {>=}8. The incidence of SV involvement was 19% ((66(345))) for the entire group. The incidence of SV involvement was noted in different subgroups (Table). The usefulness of the empirical formula proposed by Diaz, i.e. calculated percentage of SV involvement PSA+(Gleason-6) x 10, defining high and low risk groups, was also tested. Results: The reduction in the total irradiated rectal areas to full doses, as determined on the lateral X-rays, ranged from 5% to 67% in individual patients, with a median of 44%. Using a cut-off of 15% as an acceptable level of risk of SV involvement, two low risk groups could be identified; all patients with PSA levels {<=}4, and patients with PSA 4-10 and Gleason {<=}6. These constituted 53% ((184(345))) of all patients. Overall, the low-risk patients had a 6.5% ((12(184))) incidence of SV involvement versus 34% ((54(161))) for the high risk patients (p=<.001). Using the empiric formula proposed by Diaz, 221 (64%) patients were in the low risk group (calculated incidence {<=}13%), and 124 (36%) in the high risk group (calculated incidence >13%). The low risk group had an actuarial 9% incidence of SV involvement versus 37% for the high risk group (p=<0.001). Conclusion: Exclusion of the SV from the treatment field can result in significant reduction (40-50%) in the volume of irradiated rectum. Our data confirm that pretreatment PSA levels and Gleason scores can be effectively used to define subgroups of patients in whom irradiation of the SV can be avoided. We propose exclusion of the SV from the treatment field in all patients with PSA levels {<=}4, and patients with PSA levels 4-10 and a Gleason score {<=}6. We confirmed the usefulness of the formula proposed by Diaz as an alternate method to estimate SV involvement.}
doi = {10.1016/0360-3016(95)97847-T}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}