A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured.

Background: The prognosis of prostate cancer patients with lymph node metastases so small they can only be visualized by new imaging techniques as MR lymphography (MRL) is unknown. The purpose of this study was to investigate the prognosis of prostate cancer patients with non-enlarged metastatic lymph nodes on MRL and to identify a subgroup of MRL-positive patients who might be candidates for curative treatment.

Methods: The charts of 138 prostate cancer patients without enlarged lymph nodes on CT, in whom a pre-treatment MRL was performed were reviewed.

Individualized image-based lymph node irradiation for prostate cancer.

Controversy surrounds the benefit of whole pelvis radiotherapy (WPRT) over prostate-only radiotherapy (PORT) for intermediate-risk and high-risk patients with prostate cancer. In the PSA screening era, two large randomized trials as well as multiple retrospective studies comparing WPRT with PORT have been performed, albeit with contradictory results. Data regarding the use of WPRT in patients with biochemical recurrence after prostatectomy are scarce.

Magnetic resonance lymphography findings in patients with biochemical recurrence after prostatectomy and the relation with the Stephenson nomogram.

Purpose: To estimate the occurrence of positive lymph nodes on magnetic resonance lymphography (MRL) in patients with a prostate-specific antigen (PSA) recurrence after prostatectomy and to investigate the relation between score on the Stephenson nomogram and lymph node involvement on MRL.

Methods And Materials: Sixty-five candidates for salvage radiation therapy were referred for an MRL to determine their lymph node status. Clinical and histopathologic features were recorded.

Value of PET/CT and MR lymphography in treatment of prostate cancer patients with lymph node metastases.

Purpose: To determine the clinical value of two novel molecular imaging techniques: (11)C-choline positron emission tomography (PET)/computed tomography (CT) and ferumoxtran-10 enhanced magnetic resonance imaging (magnetic resonance lymphography [MRL]) for lymph node (LN) treatment in prostate cancer (PCa) patients. Therefore, we evaluated the ability of PET/CT and MRL to assess the number, size, and location of LN metastases in patients with primary or recurrent PCa.

Methods And Materials: A total of 29 patients underwent MRL and PET/CT for LN evaluation.

Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy.

Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT).

Methods And Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency.

An endorectal balloon reduces intrafraction prostate motion during radiotherapy.

Purpose: To investigate the effect of endorectal balloons (ERBs) on intrafraction and interfraction prostate motion during radiotherapy.

Methods And Materials: Thirty patients were treated with intensity-modulated radiotherapy, to a total dose of 80 Gy in 40 fractions. In 15 patients, a daily-inserted air-filled ERB was applied.

Reduction of treatment volume and radiation doses to surrounding tissues with intraprostatic gold markers in prostate cancer radiotherapy.

Background: High-precision radiotherapy with gold marker implantation is a standard technique for prostate cancer treatment. To provide insight into the beneficial effect of gold markers, the influence on treatment volume and radiation doses to healthy tissues was investigated.

Patients And Methods: Three consecutive treatment margins were constructed, for 10 patients with localized prostate cancer, to show the reduction of planning target volume (PTV): PTV 10 mm (no markers), PTV 7 mm (markers), and PTV 7/5 mm (markers and online correction).

Endorectal balloon reduces anorectal doses in post-prostatectomy intensity-modulated radiotherapy.

Background And Purpose: To investigate the effect of an endorectal balloon (ERB) on anal wall (Awall) and rectal wall (Rwall) doses in high-dose post-prostatectomy intensity-modulated radiotherapy (IMRT).

Materials And Methods: For 20 patients, referred for salvage IMRT after prostatectomy for prostate cancer, two planning CT-scans were performed: one with and one without an air-filled ERB. A planning target volume (PTV) was defined, using international guidelines.

Ferumoxtran-10 MR lymphography for target definition and follow-up in a patient undergoing image-guided, dose-escalated radiotherapy of lymph nodes upon PSA relapse.

Purpose: Evaluation of the lymph node situation in patients with prostate cancer is essential for effective radiotherapy. Using magnet resonance imaging (MRI) of the lymph nodes with ferumoxtran-10 (MR lymphography), it is possible to detect lymph node metastasis. We present our initial experience with ferumoxtran-10 MR lymphography as the basis for image-guided, dose-escalated lymph node radiotherapy and for early follow-up after radiotherapy.

Magnetic resonance lymphography-guided selective high-dose lymph node irradiation in prostate cancer.

Purpose: To demonstrate the feasibility of magnetic resonance lymphography (MRL) -guided delineation of a boost volume and an elective target volume for pelvic lymph node irradiation in patients with prostate cancer. The feasibility of irradiating these volumes with a high-dose boost to the MRL-positive lymph nodes in conjunction with irradiation of the prostate using intensity-modulated radiotherapy (IMRT) was also investigated.

Methods And Materials: In 4 prostate cancer patients with a high risk of lymph node involvement but no enlarged lymph nodes on CT and/or MRI, MRL detected pathological lymph nodes in the pelvis.

Differences in radiation dosimetry and anorectal function testing imply that anorectal symptoms may arise from different anatomic substrates.

Purpose: To explore the influence of functional changes and dosimetric parameters on specific incontinence-related anorectal complaints after prostate external beam radiotherapy and to estimate dose-effect relations for the anal wall and rectal wall.

Methods And Materials: Sixty patients, irradiated for localized prostate cancer, underwent anorectal manometry and barostat measurements to evaluate anal pressures, rectal capacity, and rectal sensory functions. In addition, 30 untreated men were analyzed as a control group.

Is there a role for endorectal balloons in prostate radiotherapy? A systematic review.

Background And Purpose: Endorectal balloons (ERBs) are being used in prostate radiotherapy for prostate immobilization and rectal wall (Rwall) sparing. Some of their aspects, however, have been questioned, like patient's tolerance and their value in modern high-precision radiotherapy. This paper gives an overview of published data concerning ERB application in prostate radiotherapy.

Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy.

Background And Purpose: To investigate the anal wall (Awall) sparing effect of an endorectal balloon (ERB) in 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer.

Materials And Methods: In 24 patients with localized prostate carcinoma, two planning CT-scans were performed: with and without ERB. A prostate planning target volume (PTV) was defined, and the Awall was delineated, using two different methods.

Off-line setup corrections only marginally reduce the number of on-line corrections for prostate radiotherapy using implanted gold markers.

Purpose: To evaluate the efficiency of combining on-line and off-line corrections for the positioning of patients receiving external beam radiotherapy for prostate cancer.

Materials And Methods: Daily portal images were acquired during the treatment of 102 patients to verify and correct the position of the prostatic gland using implanted gold markers. In addition to an existing off-line procedure, on-line corrections were applied in the anterior-posterior (AP) direction only, to limit the increase in daily workload.

Offering a treatment choice in the irradiation of prostate cancer leads to better informed and more active patients, without harm to well-being.

Purpose: To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose.

Methods And Materials: A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice.

Doctors' and patients' preferences for participation and treatment in curative prostate cancer radiotherapy.

Purpose: Physicians hold opinions about unvoiced patient preferences, so-called substitute preferences. We studied whether doctors can predict preferences of patients supported with a decision aid.

Methods: A total of 150 patients with prostate cancer facing radiotherapy were included.

Prostate and lymph node proton magnetic resonance (MR) spectroscopic imaging with external array coils at 3 T to detect recurrent prostate cancer after radiation therapy.

In a patient suspected of having recurrent prostate cancer after radiation therapy, we demonstrate the feasibility of noninvasive proton magnetic resonance spectroscopic (1H-MRS) imaging of the prostate and a lymph node at 3 T using a matrix of external surface coils. Written informed consent was obtained from the patient. With 1H-MRS imaging, high choline with low citrate signal was observed in the prostate, and in the lymph node a signal of choline-containing compounds was identified.

Reduced late rectal mucosal changes after prostate three-dimensional conformal radiotherapy with endorectal balloon as observed in repeated endoscopy.

Purpose: The aim of this study was to investigate prospectively the rectal wall (Rwall) spatial dose distribution, toxicity, and mucosal changes after prostate cancer radiotherapy with or without an endorectal balloon (ERB).

Methods And Materials: A total of 24 patients with ERB and 24 without ERB (No-ERB) were treated with three-dimensional conformal radiotherapy (3D-CRT) to a dose of 67.5 Gy.

Bladder filling variation during radiation treatment of prostate cancer: can the use of a bladder ultrasound scanner and biofeedback optimize bladder filling?

Purpose: To investigate the use of a bladder ultrasound scanner in achieving a better reproducible bladder filling during irradiation of pelvic tumors, specifically prostate cancer.

Methods And Materials: First, the accuracy of the bladder ultrasound scanner relative to computed tomography was validated in a group of 26 patients. Next, daily bladder volume variation was evaluated in a group of 18 patients.

Rectal wall sparing effect of three different endorectal balloons in 3D conformal and IMRT prostate radiotherapy.

Purpose: To investigate the dosimetric consequences and rectal wall (Rwall) sparing effect of three different endorectal balloons (ERBs) for three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for prostate cancer.

Methods And Materials: In 20 patients, 4 planning computed tomography scans were made: 1 without ERB and 3 with ERB1, ERB2, or ERB3 inserted. Two different planning target volumes were defined: prostate only, and prostate plus seminal vesicles.

The effect of an endorectal balloon and off-line correction on the interfraction systematic and random prostate position variations: a comparative study.

Purpose: To investigate the effect of an endorectal balloon (ERB) and an off-line correction protocol on the day-to-day, interfraction prostate gland motion, in patients receiving external beam radiotherapy for prostate cancer.

Methods And Materials: In 22 patients, irradiated with an ERB in situ (ERB group) and in 30 patients without an ERB (No-ERB group), prostate displacements were measured daily in three orthogonal directions with portal images. Implanted gold markers and an off-line electronic portal imaging correction protocol were used for prostate position verification and correction.

Set-up improvement in head and neck radiotherapy using a 3D off-line EPID-based correction protocol and a customised head and neck support.

Purpose: First, to investigate the set-up improvement resulting from the introduction of a customised head and neck (HN) support system in combination with a technologist-driven off-line correction protocol in HN radiotherapy. Second, to define margins for planning target volume definition, accounting for systematic and random set-up uncertainties.

Methods And Materials: In 63 patients 498 treatment fractions were evaluated to develop and implement a 3D shrinking action level correction protocol.