Dose distribution in 3-dimensional conformal radiotherapy for prostate cancer: comparison of femur doses for four treatment techniques
Authors: Karaçetin Didem , Çakır Aydın , Ağaoğlu Fulya , Çamlıca Hakan , Ergen Arzu , Dizdar Yavuz , Darendeliler Emin 
Published: February 2010

Purpose: Conformal radiotherapy of the prostate is an increasingly common technique in the treatment of prostate cancer. When using 3D conformal radiotherapy (CFRT) methods, it is desirable to protect the vital structures such as bladder, rectum, and femur. In this study, our aim was to compare the femur head doses resulting from co-planar beam arrangements in four-field (4F), five-field (5F), six-field (6F) and seven-field (7F) treatment plans, in a dose-escalated CFRT schedule.

Materials and Methods: From January 2005 to December 2006, at Istanbul University Medical Faculty of Radiation Oncology Clinic, a total of 22 patients with carcinoma of the prostate had been scanned using computed tomography (CT) (0.50 mm) in the supine position. During the CT scanning which used the Sim Pro (CMD–USA) programme, planned target volume (PTV), clinical target volume (CTV), and dose volumes received by the bladder, rectum and femur heads were recorded and dose–volume histogram (DVH) were created. The dose volume relating to prostate and seminal vesicles was termed CTV 1, and the dose volume relating to prostate alone was termed CTV 2. During the formation of PTV, into CTV 1, from the anterior-superior-inferior 8 mm, and from posterior 5 mm tolerance were taken into account. After volume determination is calculated using XiO (CMS-USA) 3D treatment planning computer, each patient 4F (45° – 25%, 135° – 25%, 225° – 25%, 315° – 25%), 5F (0° – 20%, 45° – 20%, 90° – 20%, 270° – 20%, 315° – 20%), 6F (45° – 20%, 90° – 10%, 135° 20%, 315° – 20%, 270° – 10%, 225° – 20%) and 7F (0° – 4%, 45° – 12.9%, 90° – 22.2%, 135° – 12.9%, 315° – 12.9%, 270° – 22.2%, 225° – 12.9%) was entered; 70 – 76 Gy was calculated to be given to prostate lodge. With the use of Siemes Oncor, 18 MV photons CFRT was applied. In DVH analysis, following were observed: V50, minimum and maximum doses for head of left femur and right femur total doses.

Results: Our statistical evaluation was made using SPSS software, and we found femur doses following; 4F V50 1030 cGy (minimum 58, maximum 1390), 5F V50 2425 cGy (minimum 540, maximum 3631), 6F V50 1769 cGy (minimum 1234, maximum 3912) and 7F V50 3230 cGy (minimum 2150, maximum 4137). In comparing different techniques, the greatest rectal sparing was achieved by the 5F plan. (Rectal: 5F V%25 = 59.90 ± 6.8 Gy, 4F V%25 = 62.30 ± 10.3 Gy, 6F V%25 = 69.36 ± 5.7 Gy, 7F V%25 = 61.32 ± 7.3 Gy). The greatest femoral head sparing was achieved by the 4F techniques. When paired samples t-test was made, we found considerable lower femur doses for 4F techniques (p = 0.05).

Conclusion: We concluded that, during radiotherapy to treat carcinoma of the prostate, the dose received by the rectum is the most important factor to consider, given the potential for late toxicity in this organ. However, while using lateral fields (90–270°) so as to protect the rectum, the doses received by the femur heads were observed to be higher. Especially in older patients, the critical doses of 52 Gy for TD5/5 and 65 Gy for TD 50/5 were observed to be not reached late toxicity for 4F, 5F, 6F and 7F.