External Beam RT for Prostate Cancer - ASTRO

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• Immobilization and reproducible setup is important <strong>for</strong> protons just like IM<strong>RT</strong> • Reproduce radiologic path length • “Pro-active” target localization
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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
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Urogenital diaghragm insertion into
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Rectum and Bladder • Want to cont
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IGRT PTV: VOLUMETRICALLY expand CTV
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8 angles for virtually any anatomy
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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 78 and 79: Rectal balloon Sagittal and Coronal
Page 80 and 81: Newhauser et al: Dose Perturbations
Page 82 and 83: Ca ++ Ca vs vs. Carbon Carbon-coate
Page 84 and 85: Fusion at simulation between scan 1
Page 86 and 87: • Setup uncertainty ≤5mm • Di
Page 88 and 89: Two opposed lateral beams
Page 90 and 91: Patient alignment at PTC-H • Dail
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External Beam RT for Prostate Cancer - ASTRO

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