External Beam RT for Prostate Cancer - ASTRO

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MDACC EBRT recommendations • Low risk Prostate only 78 Gy PTV (>80 Gy CTV) • Intermediate risk Prostate & “Proximal” Proximal SV 6 mo HT for select pts (≥ 2 mos TAB then leuprolide) • High risk & T3 Prostate & most of SV (Select pts LN) 2 years HT
Decreasing “systematic” setup error from simulation to treatment is over half the battle • At simulation: Goal is reproducible anatomy – Comfortable position (a relaxed patient is a stable patient) – Empty rectum (allows use of tighter posterior margin) – Do not overfill bladder – Consider possible CT “table sag” • During treatment: Be proactive – Educate patients about bladder and rectal filling (give feedback) – IGRT primarily for translational rather than rotational shifts – Examine large variations
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External Beam RT for Prostate Cance
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Learning Objectives • Understand
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2010 AJCC Staging/Prognostic GROUPS
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Dose-escalation Dose escalation w/
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Systematic errors are clinically re
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• Impact of rectal distention may
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• Rectum • Bladder l dd • Fem
Page 15 and 16:
Urogenital diaghragm insertion into
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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: Axial Sagittal Coronal Pre-HT volum
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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