Penile bulb sparing in prostate cancer radiotherapy: Dose analysis of an in-house MRI system to improve contouring

Objective This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. Patients and methods A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT)...

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Published in:Strahlentherapie und Onkologie 2019-02, Vol.195 (2), p.153-163
Main Authors: Böckelmann, F., Hammon, M., Lettmaier, S., Fietkau, R., Bert, C., Putz, F.
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Language:English
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Medicine
Medicine & Public Health
Oncology
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Radiotherapy
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container_title Strahlentherapie und Onkologie
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Hammon, M.
Lettmaier, S.
Fietkau, R.
Bert, C.
Putz, F.
description Objective This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. Patients and methods A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm 3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. Results In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D mean ) and maximum (D max ) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p  
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Patients and methods A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm 3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. Results In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D mean ) and maximum (D max ) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p  &lt;0.05) than those of the CT-contoured PTV. For 6 patients, the estimated PB D max (seven-field IMRT and IBT) for the adapted PTV was &lt;70 Gy, whereas only 1 patient fulfilled this criterium with the CT-based PTV. Conclusion MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.</description><identifier>ISSN: 0179-7158</identifier><identifier>EISSN: 1439-099X</identifier><identifier>DOI: 10.1007/s00066-018-1377-0</identifier><identifier>PMID: 30315483</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Medicine ; Medicine &amp; Public Health ; Oncology ; Original Article ; Radiotherapy</subject><ispartof>Strahlentherapie und Onkologie, 2019-02, Vol.195 (2), p.153-163</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c296t-ff42bcd348dc4e4191e2792ed16b01ee972c6914cce861378df4287dbf33c26d3</cites><orcidid>0000-0002-8539-6600</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30315483$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Böckelmann, F.</creatorcontrib><creatorcontrib>Hammon, M.</creatorcontrib><creatorcontrib>Lettmaier, S.</creatorcontrib><creatorcontrib>Fietkau, R.</creatorcontrib><creatorcontrib>Bert, C.</creatorcontrib><creatorcontrib>Putz, F.</creatorcontrib><title>Penile bulb sparing in prostate cancer radiotherapy: Dose analysis of an in-house MRI system to improve contouring</title><title>Strahlentherapie und Onkologie</title><addtitle>Strahlenther Onkol</addtitle><addtitle>Strahlenther Onkol</addtitle><description>Objective This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. Patients and methods A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm 3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. Results In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D mean ) and maximum (D max ) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p  &lt;0.05) than those of the CT-contoured PTV. For 6 patients, the estimated PB D max (seven-field IMRT and IBT) for the adapted PTV was &lt;70 Gy, whereas only 1 patient fulfilled this criterium with the CT-based PTV. Conclusion MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.</description><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Radiotherapy</subject><issn>0179-7158</issn><issn>1439-099X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PwzAURS0EoqXwA1hQRhaDn-3a8YgqvqRKMIDEZjnOC6RKk2AnQ_89rlIYmd5y7tV9h5BLYDfAmL6NjDGlKIOcgtCasiMyBykMZcZ8HJM5A22ohmU-I2cxbhgDJY08JTPBBCxlLuZEvGJbN5gVY1NksXehbj-zus360MXBDZh513oMWXBl3Q1fGFy_OycnlWsiXhzugrw_3L-tnuj65fF5dbemnhs10KqSvPClkHnpJUowgFwbjiWoggGi0dwrA9J7zFXan5cpkOuyqITwXJViQa6n3jTme8Q42G0dPTaNa7Ebo-UAxvCl4DqhMKE-7Y4BK9uHeuvCzgKze1d2cmWTK7t3ZVnKXB3qx2KL5V_iV04C-ATEfq8Fg910Y2jTy_-0_gADwXOf</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Böckelmann, F.</creator><creator>Hammon, M.</creator><creator>Lettmaier, S.</creator><creator>Fietkau, R.</creator><creator>Bert, C.</creator><creator>Putz, F.</creator><general>Springer Berlin Heidelberg</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8539-6600</orcidid></search><sort><creationdate>20190201</creationdate><title>Penile bulb sparing in prostate cancer radiotherapy</title><author>Böckelmann, F. ; Hammon, M. ; Lettmaier, S. ; Fietkau, R. ; Bert, C. ; Putz, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c296t-ff42bcd348dc4e4191e2792ed16b01ee972c6914cce861378df4287dbf33c26d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Böckelmann, F.</creatorcontrib><creatorcontrib>Hammon, M.</creatorcontrib><creatorcontrib>Lettmaier, S.</creatorcontrib><creatorcontrib>Fietkau, R.</creatorcontrib><creatorcontrib>Bert, C.</creatorcontrib><creatorcontrib>Putz, F.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Strahlentherapie und Onkologie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Böckelmann, F.</au><au>Hammon, M.</au><au>Lettmaier, S.</au><au>Fietkau, R.</au><au>Bert, C.</au><au>Putz, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Penile bulb sparing in prostate cancer radiotherapy: Dose analysis of an in-house MRI system to improve contouring</atitle><jtitle>Strahlentherapie und Onkologie</jtitle><stitle>Strahlenther Onkol</stitle><addtitle>Strahlenther Onkol</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>195</volume><issue>2</issue><spage>153</spage><epage>163</epage><pages>153-163</pages><issn>0179-7158</issn><eissn>1439-099X</eissn><abstract>Objective This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions. Patients and methods A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm 3 air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin. Results In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D mean ) and maximum (D max ) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p  &lt;0.05) than those of the CT-contoured PTV. For 6 patients, the estimated PB D max (seven-field IMRT and IBT) for the adapted PTV was &lt;70 Gy, whereas only 1 patient fulfilled this criterium with the CT-based PTV. Conclusion MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30315483</pmid><doi>10.1007/s00066-018-1377-0</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-8539-6600</orcidid></addata></record>
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subjects Medicine
Medicine & Public Health
Oncology
Original Article
Radiotherapy
title Penile bulb sparing in prostate cancer radiotherapy: Dose analysis of an in-house MRI system to improve contouring
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