Comparison of biologically equivalent dose-volume parameters for the treatment of prostate cancer with concomitant boost IMRT versus IMRT combined with brachytherapy

Bradley R. Pieters, Jeroen B. van de Kamer, Yvonne R. J. van Herten, Niek van Wieringen, Greet M. D'Olieslager, Uulke A. van der Heide, Caro C. E. Koning

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Background and Purpose: The two main modalities to deliver high dose to the prostate and prevent high doses to neighboring organs are intensity modulated radiotherapy (IMRT) or external beam radiotherapy combined with brachytherapy. Because of the different biological effectiveness the physical dose distributions were converted to 3-dimensional linear quadratic dose at 2 Gy per fraction (EQD2). From the latter, cumulative EQD2-volume histograms were determined for comparison of the modalities. Material and methods: An IMRT plan was made on the contoured planning target volume (PTV1) and organs at risk (OAR) of 20 patients (IMRT-only). A dose of 70 Gy was prescribed on the PTV1 with a concomitant boost to a total of 76 Gy on a subvolume (PTV2). Also a 46 Gy IMRT plan was made combined with either a pulsed dose-rate (PDR) or a high dose-rate (HDR) brachytherapy boost. The EQD2 on the PTV1 of the combined IMRT-PDR and IMRT-HDR plans were made equivalent to the EQD2 of the 70 Gy IMRT-only plan. The α/β-ratio for prostate was set to 1.5 Gy and 10 Gy. For normal tissues an α/β-ratio of 3.0 Gy was taken. Several EQD2-volume histogram parameters were calculated for comparison and analyzed by two-way ANOVA. Results: The mean EQD2 to 95% of the prostate volume was slightly higher for the IMRT-only plan than for the brachytherapy modalities (P < 0.001), in contrast to the mean EQD2 to 50% of the prostate volume in which the opposite was the case (P < 0.001). Rectum and bladder doses for IMRT-only are significantly higher (P < 0.001). The urethra dose for IMRT-HDR was much higher than the other modalities only when the α/β-ratio for prostate was 10 Gy. Conclusion: Because of the high doses within an implant, the dose in 50% of the prostate volume is much higher with the brachytherapy modalities than IMRT-only which may have clinical consequences. With brachytherapy the doses to the OAR are lower or similar to IMRT-only. Dose escalation for prostate tumors is more easily achieved with brachytherapy than with IMRT alone. Therefore, brachytherapy might be the preferred modality to achieve further dose escalation. © 2008 Elsevier Ireland Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)46-52
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - 2008
Externally publishedYes

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