%0 Journal Article
%T Intensity modulated radiotherapy for high risk prostate cancer based on sentinel node SPECT imaging for target volume definition
%A Ute Ganswindt
%A Frank Paulsen
%A Stefan Corvin
%A Kai Eichhorn
%A Stefan Glocker
%A Ilse Hundt
%A Mattias Birkner
%A Markus Alber
%A Aristotelis Anastasiadis
%A Arnulf Stenzl
%A Roland Bares
%A Wilfried Budach
%A Michael Bamberg
%A Claus Belka
%J BMC Cancer
%D 2005
%I BioMed Central
%R 10.1186/1471-2407-5-91
%X Patients with high risk prostate cancer were included. Sentinel nodes (SN) were localised 1.5¨C3 hours after injection of 250 MBq 99mTc-Nanocoll using a double-headed gamma camera with an integrated X-Ray device. All sentinel node localisations were included into the pelvic clinical target volume (CTV). Dose prescriptions were 50.4 Gy (5 ¡Á 1.8 Gy / week) to the pelvis and 70.0 Gy (5 ¡Á 2.0 Gy / week) to the prostate including the base of seminal vesicles or whole seminal vesicles. Patients were treated with IMRT. Furthermore a theoretical comparison between IMRT and a three-dimensional conformal technique was performed.Since 08/2003 6 patients were treated with this protocol. All patients had detectable sentinel lymph nodes (total 29). 4 of 6 patients showed sentinel node localisations (total 10), that would not have been treated adequately with CT-based planning ('geographical miss') only. The most common localisation for a probable geographical miss was the perirectal area. The comparison between dose-volume-histograms of IMRT- and conventional CT-planning demonstrated clear superiority of IMRT when all sentinel lymph nodes were included. IMRT allowed a significantly better sparing of normal tissue and reduced volumes of small bowel, large bowel and rectum irradiated with critical doses. No gastrointestinal or genitourinary acute toxicity Grade 3 or 4 (RTOG) occurred.IMRT based on sentinel lymph node identification is feasible and reduces the probability of a geographical miss. Furthermore, IMRT allows a pronounced sparing of normal tissue irradiation. Thus, the chosen approach will help to increase the curative potential of radiotherapy in high risk prostate cancer patients.Treatment strategies for localised prostate cancer have to address issues of local control, prevention of distant spread and treatment of microscopic locoregional spread. It has been shown that local control is critically interrelated with the prevention of distant spread, since late metastases
%U http://www.biomedcentral.com/1471-2407/5/91