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[Expected benefit of lymph node and seminal vesical dissection to decrease high-risk prostate cancer radiotherapy]
J Colliaux1, L Kharchi2, S Vincendeau3
1Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France.
Reducing the target volume in prostate cancer intensity-modulated radiotherapy, after lymph node and seminal vesicle dissection, significantly lowers rectal and bladder doses. This approach decreases the risk of digestive toxicity, improving patient outcomes.
Area of Science:
- Radiation Oncology
- Urologic Oncology
- Medical Physics
Background:
- Prostate cancer treatment often involves intensity-modulated radiotherapy (IMRT).
- Pelvic lymph node and seminal vesicle dissection are surgical procedures preceding radiotherapy.
- Optimizing target volume in IMRT is crucial for minimizing toxicity.
Purpose of the Study:
- To evaluate the dosimetric benefits of reducing the target volume in prostate cancer IMRT.
- To assess the impact of including seminal vesicles and lymph nodes on target volume.
- To quantify the reduction in radiation dose to organs at risk with smaller target volumes.
Main Methods:
- Retrospective analysis of 25 high-risk prostate cancer patients treated with surgery followed by IMRT.
- Simulation of four treatment planning scenarios with varying target volumes: prostate-seminal vesicles-lymph nodes, prostate-lymph nodes, prostate-seminal vesicles, and prostate only.
- Dose-volume histograms and risk of late toxicity were analyzed for each plan.
Main Results:
- Including seminal vesicles and lymph nodes increased the target volume by factors of 1.6 and 6.5, respectively.
- Reducing the target volume from prostate-seminal vesicles-lymph nodes to prostate only decreased rectal mean dose from 49Gy to 36Gy.
- This reduction also decreased the risk of late rectal bleeding (4.4% to 2.4%) and bladder wall mean dose (51Gy to 35Gy).
- Excluding lymph nodes reduced the absolute risk of diarrhea by 11%.
Conclusions:
- Pelvic lymph node and seminal vesicle dissection prior to prostate cancer IMRT allows for target volume reduction.
- This strategy leads to a moderate decrease in the risk of digestive toxicity.
- Optimizing target volumes in IMRT can improve treatment tolerance and patient outcomes.
