Adaptive magnetic resonance-guided neurovascular-sparing radiotherapy for preservation of erectile function in prostate cancer patients
| Autor: | J. Hes, Eline N. de Groot-van Breugel, Jochem R.N. van der Voort van Zyp, Johannes C J de Boer, T. Willigenburg, Ruud C. Wortel, Helena M. Verkooijen, Frederik R. Teunissen, Harm H.E. van Melick |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment R895-920 Erectile function sparing Medical physics. Medical radiology. Nuclear medicine Prostate cancer Prostate medicine.artery medicine Erectile dysfunction Radiology Nuclear Medicine and imaging Original Research Article Internal pudendal artery Adverse effect RC254-282 Localized prostate cancer MR-Linac Radiation integumentary system medicine.diagnostic_test business.industry Neoplasms. Tumors. Oncology. Including cancer and carcinogens MRgRT Magnetic resonance imaging equipment and supplies Neurovascular bundle medicine.disease Radiation therapy medicine.anatomical_structure nervous system Neurovascular-sparing Radiology business human activities circulatory and respiratory physiology |
| Zdroj: | Physics and Imaging in Radiation Oncology Physics and Imaging in Radiation Oncology, Vol 20, Iss, Pp 5-10 (2021) |
| ISSN: | 2405-6316 |
| DOI: | 10.1016/j.phro.2021.09.002 |
| Popis: | Highlights • Magnetic resonance-guided radiotherapy enables visualization and dose adaptation of neurovascular structures. • Neurovascular-sparing magnetic resonance-guided radiotherapy hypothetically preserves erectile function. • Neurovascular-sparing 5×7.25 Gy magnetic resonance-guided radiotherapy for localized prostate cancer is feasible. • Extent of neurovascular bundle sparing largely depends on tumor location. Background and purpose Erectile dysfunction is a common adverse effect of external beam radiation therapy for localized prostate cancer (PCa), likely as a result of damage to neural and vascular tissue. Magnetic resonance-guided online adaptive radiotherapy (MRgRT) enables high-resolution MR imaging and paves the way for neurovascular-sparing approaches, potentially lowering erectile dysfunction after radiotherapy for PCa. The aim of this study was to assess the planning feasibility of neurovascular-sparing MRgRT for localized PCa. Materials and methods Twenty consecutive localized PCa patients, treated with standard 5×7.25 Gy MRgRT, were included. For these patients, neurovascular-sparing 5×7.25 Gy MRgRT plans were generated. Dose constraints for the neurovascular bundle (NVB), the internal pudendal artery (IPA), the corpus cavernosum (CC), and the penile bulb (PB) were established. Doses to regions of interest were compared between the neurovascular-sparing plans and the standard clinical pre-treatment plans. Results Neurovascular-sparing constraints for the CC, and PB were met in all 20 patients. For the IPA, constraints were met in 19 (95%) patients bilaterally and 1 (5%) patient unilaterally. Constraints for the NVB were met in 8 (40%) patients bilaterally, in 8 (40%) patients unilaterally, and were not met in 4 (20%) patients. NVB constraints were not met when gross tumor volume (GTV) was located dorsolaterally in the prostate. Dose to the NVB, IPA, and CC was significantly lower in the neurovascular-sparing plans. Conclusions Neurovascular-sparing MRgRT for localized PCa is feasible in the planning setting. The extent of NVB sparing largely depends on the patient’s GTV location in relation to the NVB. |
| Databáze: | OpenAIRE |
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