Dose-volume parameters comparison of organs at risk between the prone and supine positions in pelvic tumors using 3D-CRT

Abstract

Aims: Cancer is a major public health problem worldwide, the leading cause of death in developed countries. Radiotherapy is an important treatment for many malignancies. The main purpose of this study was to compare the two techniques of supine and prone in prostate and rectal cancers using DVH extraction parameters.

Methods and material: Clinical and dosimetry data of 41 rectal and prostate cancer patients were evaluated in both the supine and prone positions with belly board. Administered dose was daily 180 cGy. The four box fields in the first phase and two lateral fields in the second phase with 18 MV photon fields were used. Each patient underwent CT scan, at both the positions using a contrast agent with a full bladder.

Statistical analysis used: By using IBM SPSS software v23, all the data were described. The normal distribution of the data was performed using the KS sample statistical test. For data analysis, paired t test was used in the normal data and the Wilcoxon test was used in the non-normal data.

Results: In patients with rectal cancer, there is no change in the received minimum dose by organs at risk. A significant decrease in received maximum dose, except for the prostate organ, could be due to the spatial proximity of the two organs to each other. Also, the received average dose in the small intestine was significantly reduced (P = 0.005). But in other organs, the dose reduction was not significant. In patients with prostate cancer, there is no change in the received minimum dose by OARs, except for the bladder organ (P = 0.003). Except the bladder organs (P = 0.011), there is no significant decrease in the received average dose by OARs. The maximum dose of the OARs is significantly reduced, except for the colon where there was not much overlap in the PTV, in addition to receiving the dose in the range. There was no significant relationship between CI in the rectal field and UI in the prostate field (P > 0.05), but there was a significant relationship between CI in the prostate field and UI in the rectal field with change in patient position.

Conclusions: In the prone position, in both patients' groups, the OARs receive an optimal and better dose than the supine position, especially the small intestine organ in the rectal field and the bladder and rectum organs in the prostate field. However, it seems that this change in the position of rectal cancer patients is ineffective in reducing the dose of prostate and needs further investigation.