Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
ROSE PROSTATE SBRT.pptx
1. PROSTATE SBRT
ROSE CASE
RADIATION ONCOLOGY SIMULATION TO EXECUTION
DR KANHU CHARAN PATRO
MD,DNB(RADIATION ONCOLOGY),MBA,FICRO,FAROI,PDCR,CEPC
HOD,RADIATION ONCOLOGY
Mahatma Gandhi Cancer Hospital And Research Institute, Visakhapatnam
drkcpatro@gmail.com /M+91-9160470564
2. General history
• 66 , male
• No co morbidity
• h/o BHP
• On regular f/up
• p/w urinary retention
• Needed catheterization
• Evaluated
3. SHORT HISTORY
• 66 year old male
• No comorbidities
• Presented with Lower Urinary Tract symptoms
(LUTS) – Obstructive symptoms: acute retention
of urine since 4 months in jan 2022
• BPH for 3 years
• PSA: 36 ng/dl
• Biopsy: Adenocarcinoma
• Gleason score: 3+4 (7), Gleason group: 2, core:
4/8 positive
4. MRI PELVIS PRE HT
• CEMRI pelvis: Prostate volume: 78.5cc.
• Well defined T2W Hypointense 3*1cm lesion at peripheral
zone at right side; at apical region and few hypointense
lesions in right half of the prostate.
• Rt peripheral zone hypo intense area
• Restricted diffusion
• Abnormal contrast enhancement
• Lower signal in ADC
• No seminal vesicle involvement
• Rt External iliac node
• Hypertrophy of glandular zone and transitional zone – BPH
7. TUMOR BOARD
• 6 months of Neoadjuvant Hormonal therapy
followed by EBRT then Adjuvant Hormonal
therapy
8. POST HT MRI
• Prostate volume: 64cc
• T2W Hyperintense lesion with peripheral hypo
intensity at posterolateral aspect peripheral
zone – reduced in size
12. RADIATION TUMOR BOARD
• SBRT based on PRIME protocol
• 36.25Gy in 5# to the prostate
• 25Gy in 5# to the nodal region
• Alternate days treatment over 2 weeks
• Morning treatment
32. TARGET DELINEATION
• CTV P: according to ESTRO ACROP guidelines
• CTV N:
– Contoured by giving a radial margin of 5 to 7mm around
the common iliac, external iliac, internal iliac, presacral and
the obturator vessels and editing from muscles and bones
– Cranial extent of CTV nodes: at the level of L5–S1 vertebra
– Caudal extent: at the level obturator nodes
• Seminal vesicle: 1.5cm when no involvement; entire SV
if involved
• PTV P & PTV N:
– 5mm to the CTV P (including SV) and CTV N.
39. SEPARATING FROM BLADDER BASE
• Distinction between the base of the
prostate and the bladder lumen . Also,
protrusion of the prostate into the bladder
due to benign prostate hypertrophy can be
considered.
• We therefore recommend the routine use
of contrast on planning-CT, unless contra-
indicated.
• CT and MRI based. Protrusion of prostatic
hyperplasia into the bladder base can be
easily visualized on T2-weighted MRI and
adds to a correct delineation of the prostate
especially when no contrast is administered
prior to CT
• DELAYED PHASE CT-10 min
51. Identification of
vas deferens and
exclusion
The yellow arrows indicate the deferens
ducts
The deferent duct, consisting of a thin tubular structure
that can be recognized cranial and medial to each SV,
should not be included in this delineation
54. DELINEATING URETHRA
The lower part of the urethra, where it can
be excluded from the clinical target
volume
Whenever visible, the urethra should be excluded from the apex, creating
a butterfly shaped structure, except in cases where the urethra cannot be
discriminated from the apex or when urethral involvement is suspected
104. ACKNOWLEDGMENTS
DOCTORS
• DR P S BHATTACHARYA
• DR C R KUNDU
• DR V K REDDY
• DR MJR
PHYSICISTS
• MR A C PRABU
• MR A SRINU
• DR ANIL KUMAR
• MR BHOOPATI
• MR KARUNAKARAN
TECHNOLOGIST TEAM