Dustin Melancon

Planning Assignment (Prostate)

Target organ(s) or tissue being treated: prostate Prescription: Prostate cancer treatment using three-dimensional conformal radiation therapy (3D-CRT) with multiple fields. One fraction per day with a daily dose of 200 centigray (cGy) over 30 fractions. The target will receive a total dose of 6000 cGy with a source to axis distance (SAD) of 100 cm. Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below): Organ at risk Bladder Rectum Right femoral head Left femoral head Desired objective(s) Maximum dose of 6500 cGy Maximum dose of 6000 cGy Maximum dose of 6000 cGy Maximum dose of 6000 cGy Achieved objective(s) 4675.3 cGy 4065.3 cGy 4593.0 cGy 4656.9 cGy

Contour all critical structures on the dataset. Expand the prostate structure by 1cm in all directions and call it PTV. Place the isocenter in the center of the PTV. Create a single AP plan using the lowest photon energy in your clinic and 1.5cm margin around the PTV for blocking. From there, apply the following changes (one at a time) to see how the changes affect the plan (copy and paste plans or create separate trials for each change so you can look at all of them): Plan 1: Create a beam directly opposed to the original beam (PA) (assign 50/50 weighting to each beam) a. Where is the region of maximum dose (hot spot)? What is it? Maximum dose of 115% (6902.0 cGy) is posterior near anus. b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)? Rectum = 5890.8 cGy Bladder = 5880.3 cGy Right femoral head = 153.8 cGy Left femoral head = 166.8 cGy Plan 2: Increase the energy of both beams to the highest photon energy available. a. How did the isodose distribution change with the higher energy?

Dustin Melancon Increasing the energy of both beams to 18 MV increased the depth of isodose curves. The hot spot slightly changed from 115.0% (6902.0 cGy) to 105.2% (6311.3 cGy). Dose distribution shifted away from the skin to the patients midline. b. Did the doses to the rectum and bladder change? Yes, the rectum and bladder received slightly higher doses. Rectum = 5908.1 cGy Bladder = 5930.7 cGy c. If you change the weighting ratio, how does it affect the dose distribution? Changing the weighting ratio affected the dose distribution by giving higher dose to the field with more weight. Giving the AP field 50.3% weighting and the PA field 49.7% slightly lowered the hot spot to 105.0% (6299.3 cGy).

Plan 3: Add a Rt lateral field. Create a tighter blocked margin posteriorly along the rectum (try using 0.7cm vs. 1.5cm). Now, create an opposed beam, or a Lt. lateral. Assign even weights to all the beams (which should now be 4 beams) a. What is the biggest change you noticed with the isodose lines? Isodose lines were deeper and had a box-like shape around the PTV. b. What happened to the rectal, bladder and femoral head doses? Which structure received the biggest dose change? Why? Rectum = 4503.2 cGy Bladder = 5115.5 cGy Right femoral head = 3309.2 cGy Left femoral head = 3356.2 cGy Doses for rectum and bladder decreased, while the femoral heads had a significant increase in dose. This happened because the femoral heads are now getting radiation from the lateral fields. The hot spot lowered to 104.2% (6249.3 cGy). Plan 4: Adjust the weighting of the beams to try and achieve the best possible dose distribution.

Which treatment plan covers the target the best? What is the hot spot for that plan? The four-field technique provided the best target coverage with a hot spot of 103.3% (6197.3 cGy). Did you achieve the OR constraints as listed in the table on page 1? List them in the table. Yes, I achieved the organs at risk constraints. What did you learn from this planning assignment? The parallel-opposed treatment plan with only anterior and posterior fields gave excessive dose to normal tissues and critical organs above and below the tumor. The higher energy four-field technique reduced dose near the surface and normal tissue surrounding the tumor.

Dustin Melancon

What will you do differently next time? This clinical lab taught me optimal placement of beams for treating the prostate in 3DCRT. Ill be better prepared to ensure the target receives the prescription dose while limiting dose to critical structures. Ill also consider unequal weighting and using wedges to modify the beam.

Still curious? Try adding 2 more beams, so youll have 6 total beams on the plan (PA, RPO, RAO, AP, LAO, LPO). Assign even weighting to all 6 beams. a. Now what does the isodose distribution look like? Is it more or less conformal than a 4field plan? The isodose distribution is farther away from the surface and gives a lower hot spot of 102.6% (6153.2 cGy). It is less conformal than a four-field plan because of the evenly weighting six-field plan. I could achieve a more conformal plan with unequal beam weighting and wedges. b. What are the doses for the critical structures? Bladder = 5365.9 cGy Rectum = 5813.6 cGy Right femoral head = 709.2 cGy Left femoral head = 828.3 cGy c. What are the advantages to using this technique? Disadvantages? Advantages of this technique include a lower maximum dose and lower dose to the femoral heads. The disadvantage is that the bladder and rectum are receiving higher doses.