Efficacy of hydrogel spacer compared with intensity-modulated radiotherapy for 3-dimensional conformal radiotherapy for prostate cancer

IF 1 4区医学 Q4 ONCOLOGY Medical Dosimetry Pub Date : 2025-09-01 Epub Date: 2025-02-01 DOI:10.1016/j.meddos.2025.01.005

Tetsukazu kiriyama RT , Akira Fukui MD , Hirohumi Ishikawa MD , Misako Doi RT , Yuki Nishimoto RT , Kenta Cyosei RT , Koji Kishimoto RT , Tanabe Yoshinori Ph.D.

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Abstract

One major adverse effect of prostate radiotherapy is associated with the rectum. The SpaceOAR system has been developed to address this problem, as it enables treatment planning with a reduced dose to the rectum. This study aimed to evaluate and compare the treatment plans between three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT) for prostate cancer using the SpaceOAR system. Thirty-five patients treated with prostate cancer radiation using the SpaceOAR system received a total radiation dose of 60 Gy/20 fractions. The dose constraints and robustness of the plan for VMAT and 3D-CRT were compared. For 3D-CRT, 6-field conformal method and 2-arc conformal method were created and compared in 3 treatment plans together with VMAT. The dose-constraint evaluation was performed using the planning target volume (PTV), rectum (mean dose), bladder (mean dose), and femoral head (mean dose).

One issue associated with prostate radiotherapy is the physiological movement of the target prostate gland, which reduces the accuracy of irradiation. The prostate moves several millimeters during irradiation due to physiological movements, and there are reports of a decrease in the PTV index due to this effect. This has a significant impact on the cure rate of prostate cancer. A comparative study of the 3 irradiation methods was conducted to investigate this issue. Each study item was analyzed using the Friedman test to determine the significance of the 3 irradiation methods.

Our analysis showed that the dose constraint was statistically significant for VMAT, but 3D-CRT was also sufficient in achieving dose constraints. The hydrogel spacer reduced the rectal dose and improved the dose-constrained fulfillment rate in VMAT and 3D-CRT.

In a study of prostate motion during irradiation, 3D-CRT, a robust plan, was superior in the PTV mean evaluation over VMAT, where the multileaf collimator moved in fine increments.

VMAT is currently the standard treatment for prostate cancer; however, with the introduction of the SpaceOAR system using hydrogel spacers, 3D-CRT may also be a viable option for prostate cancer treatment.

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水凝胶间隔剂与调强放疗在前列腺癌三维适形放疗中的疗效比较。

前列腺放射治疗的一个主要副作用与直肠有关。SpaceOAR系统就是为了解决这个问题而开发的，因为它可以减少直肠剂量的治疗计划。本研究旨在评估和比较使用SpaceOAR系统的前列腺癌三维适形放疗（3D-CRT）和体积调制电弧治疗（VMAT）的治疗方案。35名使用SpaceOAR系统接受前列腺癌放射治疗的患者接受的总放射剂量为60 Gy/20分。比较VMAT和3D-CRT方案的剂量约束和稳健性。对于3D-CRT，创建6视场适形法和2视场适形法，并与VMAT在3种治疗方案中进行比较。使用计划靶体积（PTV）、直肠（平均剂量）、膀胱（平均剂量）和股骨头（平均剂量）进行剂量约束评价。与前列腺放射治疗相关的一个问题是目标前列腺的生理运动，这降低了照射的准确性。由于生理运动，前列腺在照射期间移动了几毫米，有报道称PTV指数由于这种影响而下降。这对前列腺癌的治愈率有显著影响。为了探讨这一问题，我们对三种辐照方法进行了对比研究。采用Friedman检验对每个研究项目进行分析，以确定三种辐照方法的显著性。我们的分析表明，VMAT的剂量限制具有统计学意义，但3D-CRT也足以实现剂量限制。水凝胶间隔剂降低了直肠剂量，提高了VMAT和3D-CRT的剂量约束完成率。在一项放疗期间前列腺运动的研究中，3D-CRT，一个强大的计划，在PTV平均评估方面优于VMAT，其中多叶准直器以精细增量移动。VMAT目前是前列腺癌的标准治疗方法；然而，随着使用水凝胶隔离剂的SpaceOAR系统的引入，3D-CRT也可能成为前列腺癌治疗的可行选择。

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来源期刊

Medical Dosimetry 医学-核医学

CiteScore

2.40

自引率

0.00%

发文量

审稿时长

34 days

期刊介绍： Medical Dosimetry, the official journal of the American Association of Medical Dosimetrists, is the key source of information on new developments for the medical dosimetrist. Practical and comprehensive in coverage, the journal features original contributions and review articles by medical dosimetrists, oncologists, physicists, and radiation therapy technologists on clinical applications and techniques of external beam, interstitial, intracavitary and intraluminal irradiation in cancer management. Articles dealing primarily with physics will be reviewed by a specially appointed team of experts in the field.