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Volume 18, Number 4, 2013

Volumetric modulated arc therapy for prostate cancer patients with hip prosthesis

Ramachandran Prabhakar, Milind Kumar,  Suja Cheruliyil, Silpa Jayakumar, Satheesan Balasubramanian, Jim Cramb


Aim: To study the use of RapidArc techniques in the treatment of prostate cancer patients
with hip prosthesis.
Background: An important aspect of treatment planning is to achieve dose homogeneity
inside the planning target volume (PTV). Especially for those patients presenting with hip
prosthesis, it becomes a challenging task to achieve dose uniformity inside the PTV.
Materials and methods: Five prostate patients presenting with hip prosthesis who had undergone radical radiotherapy were selected for this study. Depending on the composition of
prosthesis, a predefined set of Hounsfield values were assigned to each study set. RapidArc
plans were generated on an Eclipse treatment planning system. Two arcs that include
clockwise and counter-clockwise arcs were used in all these cases. To avoid beams passing
through the prosthesis, a simple structure was defined around it with 1 cm margin and a
strict dose constraint applied to the block during VMAT optimization.
Results: The mean D2/D98 ratio of PTV for all the patients was 1.06 ± 0.01. The mean percentage rectum volume receiving 50 Gy, 60 Gy, 70 Gy and 75 Gy for all the patients were 33.1 ± 5.9, 21.7 ± 5.5, 13.8 ± 4.4 and 9.5 ± 3.0, respectively.
Conclusions: This study shows that using a double arc RapidArc technique is a simple and
effective treatment method of treating prostate cancer in patients presenting with a hip
prosthesis. The definition of a beam avoidance structure encompassing the prosthesis and
applying strict dose constraints to it reduces the beam contribution to the prosthesis

Signature: Rep Pract Oncol Radiother, 2013; 18(4) : 209-213

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