The magnetic resonance detected intraprostatic lesion in prostate cancer: planning and delivery of intensity-modulated radiotherapy
The magnetic resonance detected intraprostatic lesion in prostate cancer: planning and delivery of intensity-modulated radiotherapy
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DOI：
10.1016/j.radonc.2005.04.014
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发表时间：
2005-06-01
影响因子：
5.7
通讯作者：
De Neve, W
中科院分区：
文献类型：
--
作者：
De Meerleer, G;Villeirs, G;De Neve, W
背景与目的：前列腺癌放疗后局部复发多发生在肿瘤原发部位。剂量递增可减少局部复发率。调强放疗（IMIRT）可能有利于将最高剂量集中到前列腺内病变（GTVMRI）。因此，GTVMRI的可视化及其纳入计算机优化是必要的。材料与方法：对15例前列腺癌患者行IMIRT治疗。所有患者在直肠指检（DRE）中均有可触及的病变和/或PSA值为10.0 ng/ml。对前列腺进行t2加权MR检查，以检测GTVMRI，并将GTV的位置（MRI）与含瘤圆柱体的位置（活检）相关联。比较两种IMIRT方案：不包括GTVMRI的方案（IMRT-CONV）与将GTV（MRI）纳入方案优化的方案（IMRT-GTV(MRI)）。为了比较，我们将GTV（MRI）、CTV、PTV和直肠的物理和生物终点都考虑在内。在计划研究完成后，IMRT- gtvmri计划采用步进式IMRT进行临床传递。记录急性胃肠道（GI）和泌尿生殖系统（GU）毒性反应。结果：在所有病例中，GTV（MRI）的位置与含活检柱的肿瘤位置一致。GTVMRI距直肠前壁的平均和中位距离分别为3和2 mm（范围：0-12 mm）。对于GTVMRI，将其纳入优化导致所有物理端点的显着增加(P
Background and purpose: Local relapse after radiotherapy for prostate cancer mostly originates at the original tumor location. Dose escalation reduces local relapse rates. It may be of benefit to focus the highest dose to the intraprostatic lesion (GTVMRI) using intensity-modulated radiotherapy (IMIRT). Therefore, the visualization of the GTVMRI and its inclusion into computer optimization is mandatory.Materials and methods: Fifteen patients with prostatic adenocarcinoma were referred for IMIRT. All these patients had a palpable lesion on digital rectal examination (DRE) and/or a PSA > 10.0 ng/ml. A T2-weighted MR examination of the prostate was performed in order to detect a GTVMRI and correlate the location of the GTV(MRI) with the site of the tumour-containing cylinder (biopsy).Two IMIRT plans were compared: a plan without the inclusion of the GTVMRI (IMRT-CONV) versus a plan including the GTV(MRI) into the plan optimization (IMRT-GTV(MRI)). For comparison, both physical and biological endpoints of the GTV(MRI), CTV, PTV and rectum were taken into account.After the finalization of the planning study, the IMRT-GTVMRI plans were clinically delivered using step-and-shoot IMRT. Acute gastro-intestinal (GI) and genito-urinary (GU) toxicity were recorded.Results: In all cases, the location of the GTV(MRI) corresponded with the site of the tumor containing biopsy cylinder. The mean and median distance of the GTVMRI to the anterior rectal wall was 3 and 2 mm, respectively (range: 0-12 mm).For the GTVMRI, its inclusion in the optimization led to a significant increase of all physical endpoints (P