External Beam RT for Prostate Cancer - ASTRO

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Take home message Do not miss posterior aspect of prostate! >2/3 cancers arise in peripheral zone Si Simulate l t with ith empty t rectum t ( (e.g. enema) ) Thi d h f i i i l This decreases chances of missing posteriorly regardless of PTV
• Rectum • Bladder l dd • Femoral heads • CTV Defining Structures – Low risk = Prostate only – IInt risk ik= PProstate + prox SV – High risk = Prostate (+EPE) + SV (+/- nodes) • Use zoom • Use window and level • Use other planes of view (especially sag for apex)
Page 1 and 2: External Beam RT for Prostate Cance
Page 3 and 4: Learning Objectives • Understand
Page 5 and 6: 2010 AJCC Staging/Prognostic GROUPS
Page 7 and 8: Dose-escalation Dose escalation w/
Page 9 and 10: Systematic errors are clinically re
Page 11: • Impact of rectal distention may
Page 15 and 16: Urogenital diaghragm insertion into
Page 18 and 19: Rectum and Bladder • Want to cont
Page 20 and 21: IGRT PTV: VOLUMETRICALLY expand CTV
Page 22 and 23: 8 angles for virtually any anatomy
Page 24 and 25: OAR and Objectives External Ring 2
Page 26 and 27: DVH Plan Evaluation: Clinical Const
Page 28 and 29: Sagittal g dose distribution
Page 30 and 31: VMAT for prostate • Similar to IM
Page 32 and 33: VMAT
Page 34 and 35: Rails “in” in and patient cente
Page 36 and 37: K. Pulliam et al. Phy Med Biol 56 (
Page 38 and 39: Reducing PTV through IGRT (Image Gu
Page 40 and 41: Ultrasound is reasonably accurate.
Page 42 and 43: Fiducial markers
Page 44 and 45: Fiducials: MV vs vs. KV imaging •
Page 46 and 47: AP kV radiograph (>300 lb pt) Thank
Page 48 and 49: Alternative markers Ca ++ vs. Carbo
Page 50 and 51: • Better dose delivery => Better
Page 52 and 53: Intra-fraction Intra fraction varia
Page 54 and 55: Fiducials vs. MRI Maximum prostate
Page 56 and 57: Larger margin needed to cover SV’
Page 58: What we don’t like to see
Page 62 and 63:
May need to re-define “adequate
Page 65 and 66:
Is there a way to increase therapeu
Page 67 and 68:
Combined RT + HT • Intermediate r
Page 69 and 70:
Axial Sagittal Coronal Pre-HT volum
Page 71:
Decreasing “systematic” setup e
Page 74 and 75:
Range depends on radiologic path le
Page 76:
• Immobilization and reproducible
Page 79 and 80:
Fiducial marker Fiducial marker
Page 81 and 82:
All 3 large fiducials to 3000 HU No
Page 83 and 84:
Carbon-coated Carbon coated Zr0 on
Page 85 and 86:
Planning parameters • Right & lef
Page 87 and 88:
• LM = setup uncertainty + penumb
Page 89 and 90:
Rectal DVH V70=10%
Page 91:
Take home points • Higher radiati
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External Beam RT for Prostate Cancer - ASTRO

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