N Hardcastle, PhD; A Davies, BAppSc; K Foo, BSc, MBBS (Hons.), FRANZCR; A Miller, BMed, BSc, GradDipEd, FRANZCR; PE Metcalfe, PhD.
Rectal dose reduction with IMRT for prostate radiotherapy
Version of Record online: 9 JUN 2010
© 2010 The Authors. Journal compilation © 2010 The Royal Australian and New Zealand College of Radiologists
Journal of Medical Imaging and Radiation Oncology
Volume 54, Issue 3, pages 235–248, June 2010
How to Cite
Hardcastle, N., Davies, A., Foo, K., Miller, A. and Metcalfe, P. (2010), Rectal dose reduction with IMRT for prostate radiotherapy. Journal of Medical Imaging and Radiation Oncology, 54: 235–248. doi: 10.1111/j.1754-9485.2010.02164.x
Conflicts of interest: None.
- Issue online: 9 JUN 2010
- Version of Record online: 9 JUN 2010
- Submitted 4 June 2009; accepted 10 February 2010.
- seminal vesicles IMRT;
Dose escalation in radiation therapy has led to increased control rates with some clinical trial evidence that rectal toxicity may be reduced when using intensity-modulated radiotherapy (IMRT) over 3D conformal radiotherapy (3DCRT) for dose-escalated prostate radiotherapy. However, IMRT for prostate patients is not yet standard in many Australian radiation oncology centres. This study investigates dosimetric changes that can be observed between IMRT and 3DCRT in prostate radiotherapy. Fifteen patients were selected for analysis. Two target definitions were investigated – prostate-only and prostate plus seminal vesicles (p + SVs). A five-field 3DCRT and seven-field IMRT plan were created for each patient and target definition. The planning target volume coverage was matched for both plans. Doses to the rectum, bladder and femoral heads were compared using dose volume histograms. The rectal normal tissue complication probabilities (NTCPs) were calculated and compared for the 3DCRT and IMRT plans. The delivery efficiency was investigated. The IMRT plans resulted in reductions in the V25, V50, V60, V70 and V75 Gy values for both the prostate-only and p + SVs targets. Rectal NTCP was reduced with IMRT for three different sets of model parameters. The reductions in rectal dose and NTCP were much larger for the p + SVs target. Delivery of IMRT plans was less efficient than for 3DCRT plans. IMRT resulted in superior plans based on dosimetric and biological endpoints. The dosimetric gains with IMRT were greater for the more complex p + SVs target. The gains made came at the cost of decreased delivery efficiency.