External Beam RT for Prostate Cancer - ASTRO

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• Setup uncertainty ≤5mm • Distal margin = (0.035 x distal CTV radiological depth) + (3mm)* (3mm) • Proximal margin ~ 1cm • Smear ~0.9 0.9 cm (*<strong>Beam</strong> ( <strong>Beam</strong> range uncertainty)
• LM = setup uncertainty + penumbra p Lateral Margin • Setup uncertainty = 0.5cm • 225-250 225 250 MeV beam penumbra (95-50%) = 1.0-1.2cm • LM = 1.2-1.7 cm
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External Beam RT for Prostate Cance
Page 3 and 4:
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
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DVH Plan Evaluation: Clinical Const
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Sagittal g dose distribution
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VMAT for prostate • Similar to IM
Page 32 and 33:
VMAT
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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: Planning parameters • Right & lef
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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