Dependence of the safe rectum dose on the CTV–PTV margin size and treatment technique

Abstract

Background

Late rectal injury is a common side effect of external beam radiotherapy for prostate cancer.

Aim

The aim of this study was to evaluate what total dose may be safely delivered for prostate patients for 3DCRT and IMRT techniques and the CTV–PTV margin.

Materials and methods

3DCRT and IMRT plans were prepared for 12 patients. For each patient PTV was defined with CTV–PTV margins of 0.4, 0.6, …, 1.0[[ce:hsp sp="0.25"/]]cm, and total doses of 70, 72, …, 80[[ce:hsp sp="0.25"/]]Gy, with 2[[ce:hsp sp="0.25"/]]Gy dose fraction. NTCP values for the rectum were calculated using the Lyman model. Both techniques were compared in terms of population mean DVH.

Results

Significantly smaller NTCPs for IMRT were obtained. For both techniques diminishing the margin CTV–PTV of 2[[ce:hsp sp="0.25"/]]mm leads to decreasing the NTCP of about 0.03. For total dose of 80[[ce:hsp sp="0.25"/]]Gy the NTCP was smaller than 10% for the 4[[ce:hsp sp="0.25"/]]mm margin only. The QUANTEC dose volume constraints were more frequently fulfilled for the IMRT technique than for the 3DCRT technique.

Conclusions

The IMRT technique is safer for prostate patients than the 3DCRT. If very high total doses are applied the CTV–PTV margin of 0.4[[ce:hsp sp="0.25"/]]cm and the IMRT technique should be used. If the CTV–PTV margin of 0.6[[ce:hsp sp="0.25"/]]cm is applied, the NTCP is smaller than 10% for the 3DCRT and IMRT techniques for the total doses smaller than 74[[ce:hsp sp="0.25"/]]Gy and 78[[ce:hsp sp="0.25"/]]Gy, respectively.