Potential improvements in the therapeutic ratio of prostate cancer irradiation: dose escalation of pathologically identified tumour nodules using intensity modulated radiotherapy
C M Nutting, MD, MRCP, FRCR
1
C M Corbishley, FRCPath
3
B Sanchez-Nieto, PhD, MIPEM
2
V P Cosgrove, PhD
2
S Webb, DSc, FInstP, FIPEM
2 and
D P Dearnaley, MD, FRCP, FRCR
1
1Department of Radiotherapy and 2Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, SM2 5PT and 3Department of Histopathology, St Georges' Hospital, Blackshaw Road, Tooting, London, UK
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Figure 1. An algorithm showing the study design. IMRT, intensity modulated radiotherapy; TCP, tumour control probability; NTCP, normal tissue complication probability.
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Figure 2. Generation of prostate maps. (a) Gross prostatectomy specimen showing a tumour in the peripheral zone. (b, c) Typical prostate maps. The microscopic areas of tumour were marked on the cover slip of each slide using a fine marker pen.
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Figure 3. The position of intraprostatic tumour nodules for each of the six patients. The planning target volume is red, the DIPTN is orange and the NDIPTN is blue.
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Figure 4. Dose distributions for (a) prostate only, (b)intraprostatic tumour nodule (IPTN) boost and (c) dominant IPTN boost techniques.
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Figure 5. Dose–volume histograms for (a) prostate only, (b) intraprostatic tumour nodule (IPTN) boost and (c) dominant IPTN boost techniques.
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Copyright © 2002 by the British Institute of Radiology.
) and the intraprostatic tumour nodule (IPTN) (
) of one patient corresponding to irradiation of the prostate to 70 Gy and dose escalation of the IPTN to 90 Gy. (b) Tumour control probability (
TCP) histogram corresponding to the DVH above (
/ß=10 Gy).