PMID- 15378187
OWN - NLM
STAT- MEDLINE
DCOM- 20041028
LR  - 20191210
IS  - 0179-7158 (Print)
IS  - 0179-7158 (Linking)
VI  - 180
IP  - 9
DP  - 2004 Sep
TI  - Anatomic variations due to radical prostatectomy. Impact on target volume 
      definition and dose-volume parameters of rectum and bladder.
PG  - 563-72
AB  - BACKGROUND AND PURPOSE: A quantitative estimate of the impact of prostatectomy on 
      pelvic anatomy is unavailable, even if it would be an important prerequisite for 
      a precise definition of clinical target volume (CTV) in post-prostatectomy 
      radiotherapy. The purpose of this study was to investigate the impact of 
      prostatectomy on the definition of CTV, on the position of bladder and rectum and 
      their implications for three-dimensional conformal radiotherapy (3-D CRT). 
      PATIENTS AND METHODS: Six patients eligible for radical retropubic prostatectomy 
      were considered. Each patient underwent a planning CT between 1 week and 1 month 
      before surgery (CTpre), and then CT was repeated in the same positioning 1-2 
      months after surgery (CTpost). For each patient the CT(pre/post) scans were 
      matched; rectum, bladder and CTV were contoured on both CT scans for each patient 
      by one observer. Two different CTVs were contoured: CTV1: prostate + seminal 
      vesicles in CTpre; prostate + seminal vesicles surgical bed in CTpost; CTV2: 
      prostate in CTpre; prostate surgical bed in CT(post). After image registration, 
      the contours of rectum, bladder and CTV1/2 drawn on CTpost were transferred on 
      CTpre. The corresponding planning target volumes (PTVs) were generated, and for 
      each PTV, a conformal four field technique using 18-MV X-rays was planned. The 
      volumes of CTV1, CTV2, PTV1, PTV2, rectum and bladder pre- and post-surgery were 
      compared. Differences in 3-D position of these structures before and after 
      surgery were analyzed by beam's eye view (BEV) images. Pre- and post-surgery 
      dose-volume histograms (DVHs) of rectum and bladder were compared together with 
      the fraction of rectum/bladder receiving at least 95% of the ICRU dose (V95), the 
      treated volume (TV, body included in the 95% isodose) and the irradiated volume 
      (IV, body included in the 50% isodose). RESULTS: For both CTV1 and CTV2, the 
      volumes were significantly reduced after prostatectomy (average reduction around 
      30 cm3 for both; range 0-60 cm3). This reduction was mainly due to a more caudal 
      definition of the cranial edge of CTV after prostatectomy (average difference for 
      CTV2: 1.5 cm; range 0-2.5 cm). Concerning the bladder, a systematic posterior 
      shift of the bladder base (average: 1.5 cm) was found and was correlated with a 
      significant reduction of V95 for bladder (around 10 cm3; p = 0.03). V95 of the 
      rectum, TV and IV also resulted to be significantly lower after surgery. The 
      average reduction of V95 for the rectum was relatively small (2.5 cm3 of rectal 
      wall). CONCLUSION: The impact of prostatectomy on CTV definition is high. A 
      significant reduction of CTV, PTV, TV and IV may be expected after surgery with a 
      consequent reduction of the portions of rectum/bladder irradiated with adjuvant 
      radiotherapy.
FAU - Sanguineti, Giuseppe
AU  - Sanguineti G
AD  - Department of Radiation Oncology, University of Texas Medical Branch, Galveston, 
      Texas 77555-0711, USA. gisangui@utmb.edu
FAU - Castellone, Pietro
AU  - Castellone P
FAU - Foppiano, Franca
AU  - Foppiano F
FAU - Franzone, Paola
AU  - Franzone P
FAU - Marcenaro, Michela
AU  - Marcenaro M
FAU - Tognoni, Piero
AU  - Tognoni P
FAU - Bolognesi, Angelo
AU  - Bolognesi A
FAU - Ceresoli, Giovanni Luca
AU  - Ceresoli GL
FAU - Fiorino, Claudio
AU  - Fiorino C
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Validation Study
PL  - Germany
TA  - Strahlenther Onkol
JT  - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et 
      al]
JID - 8603469
SB  - IM
MH  - Aged
MH  - Body Burden
MH  - Humans
MH  - Imaging, Three-Dimensional/methods
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Organ Specificity
MH  - Pilot Projects
MH  - *Prostatectomy
MH  - Prostatic Neoplasms/diagnostic imaging/radiotherapy/*surgery
MH  - Radiation Injuries/prevention & control
MH  - Radiographic Image Interpretation, Computer-Assisted/*methods
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Radiotherapy, Conformal/adverse effects/methods
MH  - Rectum/*diagnostic imaging/radiation effects
MH  - Reproducibility of Results
MH  - Risk Assessment/methods
MH  - Salvage Therapy/methods
MH  - Sensitivity and Specificity
MH  - Tomography, X-Ray Computed/*methods
MH  - Urinary Bladder/*diagnostic imaging/radiation effects
EDAT- 2004/09/21 05:00
MHDA- 2004/10/29 09:00
CRDT- 2004/09/21 05:00
PHST- 2003/10/20 00:00 [received]
PHST- 2004/05/21 00:00 [accepted]
PHST- 2004/09/21 05:00 [pubmed]
PHST- 2004/10/29 09:00 [medline]
PHST- 2004/09/21 05:00 [entrez]
AID - 10.1007/s00066-004-1245-y [doi]
PST - ppublish
SO  - Strahlenther Onkol. 2004 Sep;180(9):563-72. doi: 10.1007/s00066-004-1245-y.