Variant 7.
A 60-y-old man, asymptomatic in PSA screening program∗
| Treatment | Rating | Comments |
|---|---|---|
| Simulation | ||
| Immobilization of pannus (eg, tape or cover sheet) | 7 | There may be considerable variability. |
| Treatment planning | Limiting beam angles can be considered. For low-risk patients, one can consider weight loss prior to starting treatment. | |
| IMRT (nonarc) | 8 | |
| IMRT (arc) | 8 | One can consider limiting arcs. |
| Proton beam | 6 | Beam angles for proton beam therapy must be carefully considered because of limitations in proton beam path length. |
| IGRT | ||
| Electromagnetic transponders | 4 | Obesity may obscure reading of transponders. In borderline cases, the transponders may be used as fiducial markers if the signal cannot be obtained. |
| Daily CBCT with fiducial markers | 8 | |
| Daily CBCT without fiducial markers | 7 | |
| Daily planar imaging with fiducial markers | 7 | |
| Daily ultrasound imaging | 5 |
Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.
Abbreviations as in Variants 1 and 4.
∗
PSA 5.2 ng/mL, prostate with palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient is obese, with pannus extending into radiation field.