Radiotherapy planning and delivery
tumor, prostate
SEMINAL VESICLES, TUMOR, PROSTATE, URETHRA
A biodegradable spacer (BioProtect BalloonDuring the planning scans and treatment, precautions were taken to reduce prostate motion. Patients were instructed to maintain a low-fiber diet beginning 5 days before the planning scans and continuing until the completion of treatment to decrease intestinal gas. They were required to take a moderate laxative 48 h before to the planned MRI and CT scan. If necessary, enemas were performed 1 h before the acquisition of the planning scans and before each treatment session as needed to reduce rectal volume. Patients were also encouraged to drink 200 ml of water 1 h before the scans, after voiding completely. The lead investigators of the trial (FH & JB) draw and/or supervised the anatomical contours of the prostate, DIN, seminal vesicles, and OARs, which were then reviewed by a panel of board-certified radiation oncologists. The DIN and the urethra were identified as the region of interest in the MRI by a radiologist (J-YM). To generate the planned target volume, the prostate was uniformly expanded by 3 mm (PTVp).The DIN was contoured as the gross tumor volume (GTV) and expanded by 3 mm to create a PTVDose-volume histogram goals and details of RT planning were published elsewhere (HERE PLEASE INCLUDE THE FOLLOWING CITATION doi: 10.1016/j.ijrobp.2018.09.023 Herrera F.G et al THIS CAN BE INCLUDED MANUALLY AS NEW REF 47. Briefly, Dose-volume histogram goals for the rectum were maximum dose to to 0.1 cmWhenever possible, patients had to be treated with CyberKnife. However, Tomotherapy (Accuray Inc, Sunnyvale, CA) or VMAT (Elekta Synergy Stockholm, Sweden) were allowed in case of impossibilities to treat with CyberKnife (To improve patient comfort, all patients were treated in the supine treatment position with a knee cushion.