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Case Study Outline

I. Abstract
II. Introduction
A. The role of adaptive radiation therapy as it pertains to patient-specific changes in daily
treatment of prostate cancer.
B. Importance of keeping the bladder and rectum volumes constant during the treatment of
prostate cancer.
C. Variations in daily delivered dose versus predicted dose from the initial CT scan due to
variations in bladder and rectum volumes.
D. Using MIM Software to compare delivered and desired dose distributions and to adapt
the treatment plan to account for variations.

III. Case Description


A. Patient Selection
1. Prospective and retrospective selection of patients was conducted for this
study.
2. Each patient selected was required to have a diagnosis of prostate cancer
with/without nodal involvement confirmed via biopsy.
3. Selected patients were simulated on a Siemens Emotion 16 CT Simulator or
Siemens Somatom Definition AS scanner, with full bladder and empty
rectum, following the clinics protocol.
B. Target Delineation
1. The planning target volume (PTV) as well as organs at risk (OR), specifically
bladder and rectum, were contoured on the CT dataset, and the plans were
created using Eclipse and Monaco treatment planning systems (TPS).
2. Patients were imaged daily using cone beam computed tomography (CBCT),
which was analyzed using MIM software for isodose distribution as well as
bladder and rectal volumes.
C. Treatment Planning
1. The treatment goals included uniform coverage of the PTV, while keeping the
dose to bladder and rectum as low as possible.
2. The prescription information for the selected patients is summarized in Table
1.
3. Desired dose to critical structures was not to exceed the guidelines from
Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC)
and the Radiation Therapy Oncology Group (RTOG).
4. Treatment techniques used were the volumetric arc therapy (VMAT) using
two-three full arcs and static intensity-modulated radiation therapy (IMRT)
using 9 beams.
D. Plan Analysis and Evaluation
1. Planning dose to the rectum, bladder and the PTV was compared to the actual
daily dose received; comparative figures for each patient are included.
2. The automated analysis of data was developed through MIM software, and the
analysis of dose received by the structures on daily basis was used to calculate
the projected cumulative dose.

IV. Conclusion

References

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prostate cancer radiotherapy using cone-beam computed tomography. Med Dos.
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http://dx.doi.org/10.1016/j.ijrobp.2011.06.1479.
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http://dx.doi.org/10.1016/j.ijrobp.2013.06.454.
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http://dx.doi.org/10.1016/j.ijrobp.2016.06.2300.
6. Pirozzi S, Piper J, Nelson A, Shen Z, Gardner S. Evaluation of deformable prostate cone
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Int J Radiat Oncol. 2013;87(2, Supplement):S719.
http://dx.doi.org/10.1016/j.ijrobp.2013.06.1904.
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