: A careful examination of the foundation upon which the concept of the Dose-Volume Histogram (DVH) is built, and the implications of this set of parameters on the clinical application and interpretation of the DVH concept has not been conducted since the introduction of DVHs as a tool for the quantitative evaluation of treatment plans. The purpose of the work presented herein is to illustrate problems with current methods of implementing and interpreting DVHs when applied to hollow anatomic structures such as the bladder and rectum.
: A typical treatment plan for external beam irradiation of a patient with prostate cancer was chosen to provide a data set from which DVH curves for both the bladder and rectum were calculated. The two organs share the property of being shells with contents that are of no clinical importance. DVHs for both organs were computed using a solid model and using a shell model. Typical treatment plans for prostate cancer were used to generate DVH curves for both models. The Normal Tissue Complication Probability (NTCP) for these organs is discussed in this context.
: For an eight-field conformal treatment plan of the prostate, a bladder DVH curve generated using the shell model is higher than the corresponding curve generated using the solid model. The shell model also has a higher NTCP. A six-field conformal treatment plan slo results in a higher DVH curve for the shell model. A treatment plan consisting of bilateral 120-degree arcs, results in a higher DVH curve for the shell model, as well as a higher NTCP.
: The DVH concept currently used in evaluation of treatment plans is problematic because current practices of defining exactly what constitutes “bladder” and “rectum.” Commonly used methods of tracing the bladder and rectum imply use of a solid structure model for DVHs. In reality, these organs are shells and the critical structure associated with NTCP is obviously and indisputably the shell, as opposed to its contents. Treatment planning algorithms for DVH computation should thus be modified to utilize the shell model for these organs. 相似文献
Introduction Prostate volume involves a defined toxicity predictor in the radiation therapy of localized prostate cancer. Neoadjuvant hormone
therapy (nHT) can reduce prostate volume and, therefore, the planned volume. The objective of this study was to establish
if the value of nHT reduces the planned volume and if this reduction correlates with a reduction of the dose received in the
target organs.
Material and methods 28 patients diagnosed of localized prostate cancer and referred to our departments for radiation therapy with radical intention,
in the period ranging between April 2002 and October 2003, were included prospectively. The patients received nHT (triptorelin+flutamide)
for 2 months and adjuvant HT until completing 2 years in the high-risk cases. A transrectal ultrasound study was performed
in all patients, simulation CT and planning before the start of HT and after 2 months of treatment. The radiation therapy
was carried out with 6 or 18 MV LINAC photons, with a dose fractioning scheme of 5×180–200 cGy, a total dosage of 66–72 Gy
to prostate, 56 Gy to seminal vesicles and, in the high-risk cases, 46 Gy to pelvic lymph nodes.
Results The distribution according to risk group was: low risk 3.6%, intermediate risk 28.6% and high risk 67.9%. By transrectal ultrasound,
prostate volume on diagnosis was 50.65 cc pre HT and 38.97 cc post HT (p<0.001), which means a volume reduction of 24%. The
comparative analysis of the dose-volume histograms of the first versus the second CT shows a reduction in the planned volume
GTV1 (prostate) (81.33 cc vs 63.96 cc, p<0.05), PTV1 (prostate and margin) (197.51 cc vs 168.38 cc, p<0.001) and PTV2 (prostate,
vesicles and margin) (340.5 cc vs 307.26 cc, p<0.05), a reduction of the maximum dose in the seminal vesicles (70.2 versus
68.75 Gy, p<0.05), a reduction of the mean dose in the seminal vesicles (65.07 Gy versus 63.07 Gy, p<0.05), PTV2 (67.72 Gy
versus 66.9 Gy, p<0.01) and PTV3 (prostate, vesicles, pelvic lymph nodes and margin) (58.86 Gy versus 57.21 Gy, p<0.01), a
reduction of the D90 in the seminal vesicles (61.83 Gy versus 60.06 Gy, p<0.05) and PTV2 (61.04 Gy versus 59.45 Gy, p<0.05)
and a reduction of V60 of the rectum (32.45% versus 28.22%, p<0.05) and V60 of the bladder (41.78% versus 31.67%, p<0.005).
Conclusions Neoadjuvant hormone therapy reduces significantly prostate volume and as a result the planned volume and consequently the
rectal and bladder V60 can be significantly reduced. 相似文献