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Related Concept Videos

Imaging Studies III: Computed Tomography01:27

Imaging Studies III: Computed Tomography

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DefinitionComputed Tomography (CT) of the genitourinary (GU) tract is a non-invasive imaging modality that utilizes X-rays and computer processing to generate detailed cross-sectional images of the urinary system, encompassing the kidneys, ureters, bladder, and adjacent structures such as the adrenal glands.PurposeCT scans of the GU tract serve several diagnostic and therapeutic purposes, including:Diagnosis of Urinary Tract Diseases: Detects kidney stones, tumors, cysts, and congenital...
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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Comparing CTVs for permanent prostate brachytherapy.

C A Oton1, L Blanco, L F Oton

  • 1Department of Radiation Oncology, University of La Laguna Tenerife, Santa Cruz de Tenerife, Spain, caoton@gmail.com.

Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
|October 30, 2014
PubMed
Summary
This summary is machine-generated.

The risk of prostate cancer spreading outside the prostate gland (extraprostatic extension) is high, necessitating a 3 mm clinical target volume (CTV) margin. Planning for this expanded CTV in low dose rate brachytherapy is feasible and dosimetrically sound.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Current guidelines for clinical target volume (CTV) delineation in prostate cancer low dose rate (LDR) brachytherapy vary, with the American Brachytherapy Society (ABS) recommending CTV = prostate and the European Society for Radiotherapy and Oncology (ESTRO) advocating for CTV = prostate + 3 mm excluding the rectum.
  • Significant debate exists among authors regarding the optimal CTV definition for LDR brachytherapy.

Purpose of the Study:

  • To evaluate the appropriateness of existing CTV recommendations for prostate cancer LDR brachytherapy.
  • To assess the feasibility and dosimetric impact of applying seed distributions to different CTV definitions, specifically an expanded CTV with a 3 mm margin.

Main Methods:

  • A retrospective analysis of 98 patients treated with Iodine-125 (125I) seeds (145 Gy) with an initial CTV = prostate was performed.
  • The risk of extraprostatic extension (EPE) was assessed for each patient. The adequacy of the original treatment plan for an expanded CTV (prostate + 3 mm) was evaluated, and new plans with seed distributions were generated for this expanded CTV.
  • Dosimetric comparisons were conducted between the original and newly generated plans.

Main Results:

  • The mean risk of EPE was found to be 28.46%, indicating a substantial likelihood of tumor extension beyond the prostate.
  • Applying the original treatment plan to the expanded CTV (prostate + 3 mm) resulted in unsatisfactory dosimetry.
  • New treatment plans with optimized seed distributions were successfully generated for all 98 patients, meeting all dosimetric specifications for the expanded CTV.

Conclusions:

  • The high observed risk of EPE supports the necessity of incorporating a 3 mm margin around the prostate for the CTV in all cases.
  • The ESTRO-recommended CTV (prostate + 3 mm excluding the rectum) is feasible for LDR brachytherapy and allows for planning that better accounts for the probable extent of prostate cancer.
  • This approach optimizes treatment planning to encompass the most likely spread of the tumor, potentially improving treatment outcomes.