Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer

Nutting, Christopher M.; Convery, D.; Cosgrove, V.P.; Rowbottom, C.; Padhani, Anwar R.; Webb, Steve; Dearnaley, David P.

doi:10.1016/s0360-3016(00)00653-2

Cited by 216 publications

(84 citation statements)

References 28 publications

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“…IMRT has been shown to reduce normal tissue irradiation without sacrificing target coverage compared to conventional techniques 4 13 Attempting to treat large volumes within the pelvis benefits from the sparing capabilities of IMRT 4 . The small bowel is in close proximity to the pelvic nodes and the horse‐shoe shape of the nodes, as shown in Fig.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…It has been shown 4 that for prostate and pelvic node irradiation, reducing the number of beams from nine to five had no adverse effect on the planning target volume (PTV) coverage obtainable. It was also shown that the increase in volume of small bowel and colon irradiated to greater than 45 Gy was of the order of 2% when the number of fields was reduced from seven to five.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…Our experience with the Varian MLC and the experience from other centers (Memorial Sloane Kettering Cancer Center, New York, and Charite Hospital, Berlin) led us to decide to use dynamic delivery techniques for our first IMRT treatments. There are several excellent references discussing various individual aspects of IMRT which cover commissioning measurements, 1 , 2 planning techniques, 3 , 4 and treatment delivery quality assurance (QA) 5 8 Our intention in this paper is to provide a description of the procedures we undertook, from the commissioning of a commercially available inverse planning system (CadPlan/Helios, Varian Medical Systems, Palo Alto, CA), to routine treatment of prostate and pelvic nodes.…”

Section: Introductionmentioning

confidence: 99%

“…, 7 However, a general overview of some of the parameters required for the initiation of IMRT treatments will be described in order to explain our choice of both the Helios and MLC parameters. The rationale behind the use of IMRT for pelvic nodes and prostate treatment has already been described in detail, 4 and preliminary results from the RTOG trial 9413 suggest pelvic irradiation improves biochemical disease control compared with prostate radiotherapy alone 9 …”

Section: Introductionmentioning

confidence: 99%

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IMRT clinical implementation: Prostate and pelvic node irradiation using Helios and a 120‐leaf multileaf collimator

Clark

Mubata

Meehan

et al. 2002

J Applied Clin Med Phys

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Dynamic intensity modulated radiation therapy (IMRT) to treat prostate and pelvic nodes using the Varian 120‐leaf Millennium multileaf collimator (MLC) has been implemented in our clinic. This paper describes the procedures that have been undertaken to achieve this, including some of the commissioning aspects of Helios, verification of the dynamic dose delivery, and quality assurance (QA) of the dose delivered to the patient. Commissioning of Helios included measurements of transmission through the 120‐leaf MLC, which were found to be 1.7% for 6 mV and 1.8% for 10 MV. The rounded leaf edge effect, known as the dosimetric separation, was also determined using two independent methods. Values of 1.05 and 1.65 mm were obtained for 6 and 10 MV beams. Five test patients were planned for prostate and pelvic node irradiation to 70 and 50 Gy, respectively. Dose and fluence verification were carried out on specially designed phantoms and dose points in the prostate were measured to be within 2.0% (mean 0.9%, s.d. 0.6%) of the calculated dose and in the nodes within 3.0% (mean 1.6%, s.d. 1.1%). Following the results of this commissioning and implementation study, we have started to treat men with a target volume including the prostate and pelvic nodes using Helios optimized dynamic IMRT delivery in a dose escalation protocol.PACS number(s): 87.53.–j, 87.90.+y

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Section: Methods and Resultsmentioning

confidence: 99%

Section: Methods and Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

IMRT clinical implementation: Prostate and pelvic node irradiation using Helios and a 120‐leaf multileaf collimator

Clark

Mubata

Meehan

et al. 2002

J Applied Clin Med Phys

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“…However, given that late responding normal tissues are considered to have a low a/b ratio, the main concern of hypofractionated RT is late normal tissue toxicity. As reduction in the dose to critical normal tissues is obtainable with IMRT compared with 3D-CRT 15 , there has been recent interest in hypofractionated IMRT with various fractionation schedules for prostate cancer treatment. We report the results of a toxicity assessment after treating 22 prostate cancer patients with hypofractionated helical IMRT (total 75 Gy, 2.5 Gy/fraction).…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity

et al. 2011

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Purpose: To evaluate the toxicity of hypofractionated helical intensity-modulated radiotherapy (IMRT) for men with intermediate-and high-risk prostate cancer. Methods and Materials:A retrospective toxicity analysis was performed in 22 patients treated definitively with hypofractionated helical IMRT. The helical IMRT were designed to deliver 75 Gy in 2.5 Gy/fraction to the prostate gland, 63 Gy in 2.1 Gy/fraction to seminal vesicle, and 54 Gy in 1.8 Gy/fraction to pelvic lymph nodes. No patient received hormonal therapy. Toxicity was graded by the Radiation Therapy Oncology Group (RTOG) scales.Results: All patients tolerated the treatment well without treatment interruption, and there was no Grade 3 or more acute toxicity. With a median follow-up of 24.5 months, there was no Grade 3 or more late toxicity. The late Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity for total 22 patients were 9.1% and 18.2%, respectively, and the late Grade 1 GI and GU toxicity were 18.2% and 50%, respectively. Late GU toxicity was associated with greater bladder volume irradiated !70 Gy. Late GI toxicity did not correlate with any of the dosimetric parameters.Conclusions: This study demonstrate that hypofractionated helical IMRT with high biologic effective dose (BED) is well tolerated with favourable toxicity rate. If longer follow-up periods and larger cohorts confirm the favourable biochemical control rate and our favourable toxicity assessment results, the hypofractionated IMRT (total 75 Gy, 2.5 Gy/fraction) might be implemented in clinical field for treatment of prostate cancer.

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Intensity-Modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer

Sheets

Goldin²,

Meyer³

et al. 2012

JAMA

403

140

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Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer

Cited by 216 publications

References 28 publications

IMRT clinical implementation: Prostate and pelvic node irradiation using Helios and a 120‐leaf multileaf collimator

IMRT clinical implementation: Prostate and pelvic node irradiation using Helios and a 120‐leaf multileaf collimator

Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity

Intensity-Modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer

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