SU‐FF‐T‐99: Impact of Proper Bladder and Rectum Delineation in the Evaluation of the Effectiveness of IMRT in Prostate Cancer Radiotherapy

J. Xu, C. Buckey, Gregory P Swanson, Sotirios Stathakis, C. Esquivel, A. Gutiérrez, C. Shi, P. Mavroidis, Nikos Papanikolaou

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Purpose This study compares and evaluates different bladder and rectum delineation approaches using IMRT plans for prostate cases. A more comprehensive treatment plan evaluation can be performed using the biologically effective uniform dose (BEUD) together with the complication‐free tumor control probability (P+). Materials and Methods A single physician outlined the prostate planning target volume (PTV), rectum, bladder and femoral heads of 10 consecutive prostate patients. IMRT treatment plans were created with the Pinnacle treatment planning system (TPS). Two different bladder and rectum delineation approaches were examined. In the first approach the whole volume of bladder and rectum were delineated, whereas in the second approach, the delineation included only the volume of the organs lying in the range of 2 margins around the PTV. In the second case, the DVHs were normalized to their volume (2std normalized) and to the volume of the whole organ (2std relative to whole). Results At the optimum dose levels of the dose distributions using the whole volume of bladder and rectum, 2 std relative to the whole volume and 2 std normalized, respectively, the P+ is 67.7%, 51.2% and 32.7% for a BEUDPTV of 86.7 Gy, respectively. The respective total control probabilities, PB are 89.0%, 82.4% and 82.4% whereas the corresponding total complication probabilities, PI are 21.3%, 31.2% and 49.7%. More specifically, the response probabilities of the different tissues are 89.0%, 82.4% and 82.4% for the PTV, 0.0%, 0.0% and 0.01% for bladder and 21.3%, 31.2% and 49.7% for rectum. At the initially prescribed dose level (mean dose to the PTV = 79.4 Gy) the PI values become 6.7%, 12.4% and 27.8%. Conclusions The expected radiation induced bladder and rectum complications using different delineation approaches, should be estimated used appropriate dose‐response parameters, which should have been determined from studies of similar organ delineation methodology.

Original languageEnglish (US)
Pages (from-to)2542
Number of pages1
JournalMedical Physics
Issue number6
StatePublished - 2009


ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging

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