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Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning

BACKGROUND: Chemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological ma...

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Autores principales: Stromberger, Carmen, Kom, Yves, Kawgan-Kagan, Michael, Mensing, Tristan, Jahn, Ulrich, Schneider, Achim, Budach, Volker, Köhler, Christhardt, Marnitz, Simone
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904783/
https://www.ncbi.nlm.nih.gov/pubmed/20598136
http://dx.doi.org/10.1186/1748-717X-5-63
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author Stromberger, Carmen
Kom, Yves
Kawgan-Kagan, Michael
Mensing, Tristan
Jahn, Ulrich
Schneider, Achim
Budach, Volker
Köhler, Christhardt
Marnitz, Simone
author_facet Stromberger, Carmen
Kom, Yves
Kawgan-Kagan, Michael
Mensing, Tristan
Jahn, Ulrich
Schneider, Achim
Budach, Volker
Köhler, Christhardt
Marnitz, Simone
author_sort Stromberger, Carmen
collection PubMed
description BACKGROUND: Chemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological malignancies. Whether IMRT in prone (PP) or supine position (SP) might be beneficial for cervical cancer patients remains partially unanswered. METHODS: 10 patients on FIGO stage IB-III cervical cancer, 6 patients for definitive and 4 patients for adjuvant external beam pelvic RT, were planned in PP and SP using a 7-field IMRT technique. IMRT plans for PP and SP (mean dose, D(mean )50.4 Gy) were optimized in terms of PTV coverage (1(st )priority) and small bowel sparing (2(nd )priority). A comparison of DVH parameters for PTV, small bowel, bladder, and rectum was performed. RESULTS: The comparison showed a similar PTV coverage of 95% of the prescribed dose and for target conformity in IMRT plans (PP, SP). PTV, rectum and bladder volumes were comparable for PP and SP. Significantly larger volumes of small bowel were found in PP (436 cc, + 35%, p = 0.01). PP decreased the volume of small bowel at 20-50.4 Gy (p < 0.05) and increased the rectum volumes covered by doses from 10-40 Gy (p < 0.01), the V50.4 was < 5% in both treatment positions. Bladder sparing was significant better at 50.4 Gy (p = 0.03) for PP. CONCLUSION: In this dosimetric study, we demonstrated that pelvic IMRT in prone position for patients with cervical cancer seems to be beneficial in reducing small bowel volume at doses ≥20 Gy while providing similar target coverage and target conformity. The use of frequent image guidance with KV (kilovolt) or MV (megavolt) computertomography can reduce set-up deviations, and treatment in prone position can be done with a higher set-up accuracy. Clinical outcome studies are needed to affirm lower toxicity.
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spelling pubmed-29047832010-07-16 Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning Stromberger, Carmen Kom, Yves Kawgan-Kagan, Michael Mensing, Tristan Jahn, Ulrich Schneider, Achim Budach, Volker Köhler, Christhardt Marnitz, Simone Radiat Oncol Research BACKGROUND: Chemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological malignancies. Whether IMRT in prone (PP) or supine position (SP) might be beneficial for cervical cancer patients remains partially unanswered. METHODS: 10 patients on FIGO stage IB-III cervical cancer, 6 patients for definitive and 4 patients for adjuvant external beam pelvic RT, were planned in PP and SP using a 7-field IMRT technique. IMRT plans for PP and SP (mean dose, D(mean )50.4 Gy) were optimized in terms of PTV coverage (1(st )priority) and small bowel sparing (2(nd )priority). A comparison of DVH parameters for PTV, small bowel, bladder, and rectum was performed. RESULTS: The comparison showed a similar PTV coverage of 95% of the prescribed dose and for target conformity in IMRT plans (PP, SP). PTV, rectum and bladder volumes were comparable for PP and SP. Significantly larger volumes of small bowel were found in PP (436 cc, + 35%, p = 0.01). PP decreased the volume of small bowel at 20-50.4 Gy (p < 0.05) and increased the rectum volumes covered by doses from 10-40 Gy (p < 0.01), the V50.4 was < 5% in both treatment positions. Bladder sparing was significant better at 50.4 Gy (p = 0.03) for PP. CONCLUSION: In this dosimetric study, we demonstrated that pelvic IMRT in prone position for patients with cervical cancer seems to be beneficial in reducing small bowel volume at doses ≥20 Gy while providing similar target coverage and target conformity. The use of frequent image guidance with KV (kilovolt) or MV (megavolt) computertomography can reduce set-up deviations, and treatment in prone position can be done with a higher set-up accuracy. Clinical outcome studies are needed to affirm lower toxicity. BioMed Central 2010-07-02 /pmc/articles/PMC2904783/ /pubmed/20598136 http://dx.doi.org/10.1186/1748-717X-5-63 Text en Copyright ©2010 Stromberger et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Stromberger, Carmen
Kom, Yves
Kawgan-Kagan, Michael
Mensing, Tristan
Jahn, Ulrich
Schneider, Achim
Budach, Volker
Köhler, Christhardt
Marnitz, Simone
Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title_full Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title_fullStr Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title_full_unstemmed Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title_short Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning
title_sort intensity-modulated radiotherapy in patients with cervical cancer. an intra-individual comparison of prone and supine positioning
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904783/
https://www.ncbi.nlm.nih.gov/pubmed/20598136
http://dx.doi.org/10.1186/1748-717X-5-63
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