- 作者：Charlotte L. Brouwer ; MSc&lowast ; ; c.l.brouwer@umcg.nl ; Esther M. Wiesendanger ; MD&lowast ; ; Peter C. van der Hulst ; MSc&lowast ; ; Gustaaf W. van Imhoff ; MD ; PhD&dagger ; ; Johannes A. Langendijk ; MD ; PhD&lowast ; ; Max Beijert ; MD&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2013
- 出版时间：1 February, 2013
- 年：2013
- 卷：85
- 期：2
- 页码：298-308
- 全文大小：729 K
We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D95 % scrotal dose of at least 85 % of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95 % of the prescribed dose, with lowest maximum dose.
Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage.