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27 August 2008
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Rectal dose constraints for whole pelvic prostate cancer radiotherapy developed
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MedWire News: US scientists have developed a set of rectal dose constraints for patients with clinically localized prostate cancer having definitive whole pelvic radiotherapy that allows for volumetric assessment of the dose-volume.
Rectal dose constraints based on threshold toxicity have been reported by several institutions. However, these have led to a range of confusing dose-volume histogram recommendations, say Linda Chan, from the University of California in San Francisco, and colleagues.
To develop a set of standardized constraints for patients undergoing whole pelvic radiotherapy for prostate cancer, the team performed a literature review of eight studies identified from the PubMed database examining dose-volume histogram data. In all cases, the studies involved intensity-modulated radiotherapy.
The studies, all but one of which contained specific recommendations for rectal toxicity, involved a total of 2867 patients, the team notes in the International Journal of Radiation Oncology • Biology • Physics.
Generating a continuous, proposed rectal dose-constraint curve, the team found that intensity-modulated radiotherapy met the curve and was able to achieve reduced doses to the rectum of 30% to 40%.
In addition, the data indicated that 50% of patients treated according to the curve had no bowel toxicity, while 33% reported Grade 1 toxicity, and 17% reported Grade 2 toxicity. Furthermore, there was no Grade 3-4 acute rectal toxicity.
The team concludes: "This report provides a proposed rectal dose-constraint curve that can be used for the development and evaluation of treatment plans. Additional research is needed to validate this dose-volume constraint threshold as a proposed class solution across institutions."
Int J Radiation Oncology Biol Phys 2008; 72: 69-77
http://dx.doi.org/10.1016/j.ijrobp.2007.12.045
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