TY - JOUR
T1 - Adaptive magnetic resonance-guided neurovascular-sparing radiotherapy for preservation of erectile function in prostate cancer patients
AU - Teunissen, Frederik R
AU - Wortel, Ruud C
AU - Hes, Jochem
AU - Willigenburg, Thomas
AU - de Groot-van Breugel, Eline N
AU - de Boer, Johannes C J
AU - van Melick, Harm H E
AU - Verkooijen, Helena M
AU - van der Voort van Zyp, Jochem R N
N1 - Funding Information:
This research has been partly funded by ZonMW IMDI/LSH-TKI Foundation (The Hague, The Netherlands, project number 104006004 ), Elekta AB (Stockholm, Sweden), and Philips Medical Systems (Best, The Netherlands). The funding sources had no involvement in the design of the study, the collection, analysis, and interpretation of the data, nor in the writing and decision to submit the article for publication.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/10
Y1 - 2021/10
N2 - Background and purpose: Erectile dysfunction is a common adverse effect of external beam radiation therapy for localized prostate cancer (PCa), likely as a result of damage to neural and vascular tissue. Magnetic resonance-guided online adaptive radiotherapy (MRgRT) enables high-resolution MR imaging and paves the way for neurovascular-sparing approaches, potentially lowering erectile dysfunction after radiotherapy for PCa. The aim of this study was to assess the planning feasibility of neurovascular-sparing MRgRT for localized PCa.Materials and methods: Twenty consecutive localized PCa patients, treated with standard 5×7.25 Gy MRgRT, were included. For these patients, neurovascular-sparing 5×7.25 Gy MRgRT plans were generated. Dose constraints for the neurovascular bundle (NVB), the internal pudendal artery (IPA), the corpus cavernosum (CC), and the penile bulb (PB) were established. Doses to regions of interest were compared between the neurovascular-sparing plans and the standard clinical pre-treatment plans.Results: Neurovascular-sparing constraints for the CC, and PB were met in all 20 patients. For the IPA, constraints were met in 19 (95%) patients bilaterally and 1 (5%) patient unilaterally. Constraints for the NVB were met in 8 (40%) patients bilaterally, in 8 (40%) patients unilaterally, and were not met in 4 (20%) patients. NVB constraints were not met when gross tumor volume (GTV) was located dorsolaterally in the prostate. Dose to the NVB, IPA, and CC was significantly lower in the neurovascular-sparing plans.Conclusions: Neurovascular-sparing MRgRT for localized PCa is feasible in the planning setting. The extent of NVB sparing largely depends on the patient's GTV location in relation to the NVB.
AB - Background and purpose: Erectile dysfunction is a common adverse effect of external beam radiation therapy for localized prostate cancer (PCa), likely as a result of damage to neural and vascular tissue. Magnetic resonance-guided online adaptive radiotherapy (MRgRT) enables high-resolution MR imaging and paves the way for neurovascular-sparing approaches, potentially lowering erectile dysfunction after radiotherapy for PCa. The aim of this study was to assess the planning feasibility of neurovascular-sparing MRgRT for localized PCa.Materials and methods: Twenty consecutive localized PCa patients, treated with standard 5×7.25 Gy MRgRT, were included. For these patients, neurovascular-sparing 5×7.25 Gy MRgRT plans were generated. Dose constraints for the neurovascular bundle (NVB), the internal pudendal artery (IPA), the corpus cavernosum (CC), and the penile bulb (PB) were established. Doses to regions of interest were compared between the neurovascular-sparing plans and the standard clinical pre-treatment plans.Results: Neurovascular-sparing constraints for the CC, and PB were met in all 20 patients. For the IPA, constraints were met in 19 (95%) patients bilaterally and 1 (5%) patient unilaterally. Constraints for the NVB were met in 8 (40%) patients bilaterally, in 8 (40%) patients unilaterally, and were not met in 4 (20%) patients. NVB constraints were not met when gross tumor volume (GTV) was located dorsolaterally in the prostate. Dose to the NVB, IPA, and CC was significantly lower in the neurovascular-sparing plans.Conclusions: Neurovascular-sparing MRgRT for localized PCa is feasible in the planning setting. The extent of NVB sparing largely depends on the patient's GTV location in relation to the NVB.
KW - Erectile dysfunction
KW - Erectile function sparing
KW - Localized prostate cancer
KW - MR-Linac
KW - MRgRT
KW - Neurovascular-sparing
UR - https://www.scopus.com/pages/publications/85122813536
U2 - 10.1016/j.phro.2021.09.002
DO - 10.1016/j.phro.2021.09.002
M3 - Article
C2 - 34604553
SN - 2405-6316
VL - 20
SP - 5
EP - 10
JO - Physics and Imaging in Radiation Oncology
JF - Physics and Imaging in Radiation Oncology
ER -