Conformal static field therapy for low volume low grade prostate cancer with rigid immobilization

The ability to improve existing standards of treating prostate cancer was investigated. To deliver a homogenous dose to the prostate with as little normal tissue margin as practical, seven patients with low volume carcinoma of the prostate were immobilized with alpha cradle body casts prior to using a CT-based 3D treatment planning system and beam's eye view (BEV) template. All patients had clinical Stage B-1 prostate cancer of favorable histologic differentiation (Gleason Score 2-5). A four field box technique was used, each beam having a single customized cerrobend block cut-out conforming to the exact contour of the prostate. To assess the accuracy of this process, daily port films were taken for 5 consecutive days and compared to a matched control group who were treated in a similar fashion, but were not casted. Dose volume histograms illustrate an average of 14% of bladder dose and 14% of rectal dose that can be eliminated using this technique when compared to field sizes and block placement in our previous technique. Daily setup variation was markedly improved using the cast, with a median daily variation of 1 mm as compared to 3 mm without the cast. The average range of movement for each of the seven casted patients was 3.3 mm as compared to 8 mm for the seven uncasted patients. Immobilization eliminated the worst 10% of all daily positioning errors. Using CT treatment planning with the patient casted and BEV allows for precise block placement with the prostate gland in its proper orientation during daily treatment. With improved immobilization and precise localization of the prostate gland, margins around the target can be made significantly smaller, and this may translate into a decrease in acute and/or late complications.