Variant 4.
A 60-y-old man, asymptomatic in PSA screening program∗
| Treatment | Rating | Comments |
|---|---|---|
| Treatment planning | ||
| IMRT (nonarc) | 8 | Dosimetry may be improved by avoiding beams that pass through prostheses.124, 128, 129 |
| VMAT (arc-based IMRT) | 8 | Dosimetry may be improved by using more arcs.137 |
| IMRT (helical tomotherapy) | 7 | This procedure has been previously described.138 |
| Proton beam | 5 | This procedure reflects recognized controversy in the field. Use anterior-oriented beams139 or oblique beams.140 CT simulation with kV and MV CT images improves range of uncertainties for planning.141 |
| IGRT | ||
| Radiofrequency transponders | 7 | Hip implants have no meaningful effect on image guidance with this strategy.135 |
| 2D imaging with implanted fiducial markers | 7 | |
| MVCT/CBCT with fiducial markers | 7 | |
| Ultrasound | 7 | See reference134 |
| Simulation | ||
| CT simulation (kV CT) | 8 | Use a commercial algorithm to improve CT Hounsfield number accuracy and structure visualization.124, 125, 126 |
| Use MVCT to assist planning if available | 7 | This procedure may improve image resolution and permit calculation of electron density.131 |
| MRI simulation and fusion to CT | 8 | Bilateral hip implants are not a contraindication to CT/MRI simulation.133 |
| None | 3 | |
| RT fractionation | ||
| CFRT | 8 | This procedure is not a contraindication on previous protocol (ie, RTOG 940633). |
| HFRT | 6 | This procedure is not a contraindication on previous protocol (ie, RTOG 0415149). |
| SBRT | 6 | This procedure is not a contraindication on previous protocol (ie, RTOG 0938150). |
Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.
IGRT, image guidance radiation therapy; MVCT, megavoltage computed tomography; VMAT, volumetric modulated arc therapy. Other abbreviations as in Variants 1 and 3.
∗
PSA 5.2 ng/mL, prostate without palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient has bilateral hip implants.