title: Evaluation of the optimal co-planar field arrangement for use in the boost phase of dose escalated conformal radiotherapy for localized prostate cancer.
abstract: The aim of this study was to determine the optimal co-planar beam arrangement from a variety of three-field (3F), four-field (4F) and six-field (6F) plans for the boost phase of a dose escalated conformal radiotherapy schedule. Three selected plans (3F 0 degrees, 90 degrees, 270 degrees plan, 4F 45 degrees, 90 degrees, 270 degrees, 315 degrees plan and 6F 40 degrees, 90 degrees, 115 degrees, 245 degrees, 270 degrees, 320 degrees plan) were compared with reference plans (3F 0 degrees, 120 degrees, 240 degrees plan, 4F 0 degrees, 90 degrees, 180 degrees, 270 degrees plan, 6F 55 degrees, 90 degrees, 125 degrees, 235 degrees, 270 degrees, 305 degrees plan and 6F 50 degrees, 90 degrees, 130 degrees, 230 degrees, 270 degrees, 310 degrees plan) in 10 patients. Doses of 64 Gy and 74 Gy were prescribed to the isocentre using 6 MV photons. The boost planning target volume comprised the prostate gland alone without a margin. Plans were compared by means of rectal volumes irradiated to >50% (V50), >80% (V80) and >90% (V90) of the prescribed dose. Irradiated volumes were also measured for the bladder (V90) and the femoral heads (V70). All optimal 3F, 4F and 6F plans gave lower irradiated rectal V80 and V90 levels than their corresponding reference plan. The 3F (0 degrees, 90 degrees, 270 degrees) plan consistently provided lower irradiated rectal levels at V50 to V90, with acceptable bladder and femoral head doses compared with the other plans in the study. When the 6F (50 degrees, 90 degrees, 130 degrees, 230 degrees, 270 degrees, 310 degrees) plan used at our institution for the boost phase was compared with the 3F (0 degrees, 90 degrees, 270 degrees) plan, the rectal V50 was reduced from 20.8+/-5.2%, to 12.6+/-5.1%, the rectal V80 was reduced from 8.7+/-2.9% to 6.5+/-3.1% and the rectal V90 was reduced from 5.5+/-2.1% to 3.9+/-2.0% (all p<0.001). The bladder V90 and the femoral heads V70 levels were equivalent. For the boost phase when escalating the dose from 64 Gy to 74 Gy, the co-planar plan that allowed optimal rectal sparing was a 3F beam arrangement using gantry angles of 0 degrees, 90 degrees and 270 degrees. This 3F plan provided improved rectal sparing compared with the 6F (50 degrees, 90 degrees, 130 degrees, 230 degrees, 270 degrees, 310 degrees) beam arrangement currently used at our institution, with equivalent and acceptable bladder and femoral head doses.
authors.affiliation: The Academic Unit of Radiotherapy & Oncology, The Institute of Cancer Research and The Royal Marsden NHS Trust, Sutton, Surrey, UK.
authors.forename: V S
authors.initials: VS
authors.lastname: Khoo
authors.forename: J L
authors.initials: JL
authors.lastname: Bedford
authors.forename: S
authors.initials: S
authors.lastname: Webb
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
mesh_terms: D000368:Aged; D005270:Femur Head / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000528:radiation effects