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Preservation of organs related to future sexual function during prostate stereotactic body radiotherapy: feasibility analysis through a re-optimization process

      ABSTRACT

      Preserving the quality of life and sexual function of patients with a localized prostate cancer remains a challenge for physicians and a major issue for patients. The present study aimed at demonstrating the feasibility of a dosimetric preservation of the sexual organs during prostate stereotactic radiotherapy planning. Patients from a single centre were retrospectively included in the RPAH-2 trial and randomized in Arm B if they presented with either a low- or intermediate- risk prostate cancer. A 37.5Gy in 5 fractions stereotactic body radiotherapy was delivered on the prostate gland. The corpus cavernosum, penile bulb and internal pudental arteries were retrospectively delineated before a re-optimization process. During this process, RPAH-2 trial dose constraints were respected on Gross Tumor Volume (GTV), Planning Target Volume and usual organs at risk. Pre-defined dose setting delivered to corpus cavernosum, penile bulb and internal pudental arteries were collected and compared before and after the re-optimization process. Nine patients were included in the study. A decrease of the median of each investigated dose setting (except D90% for corpus cavernosum) was reported after the re-optimization for corpus cavernosum, penile bulb and internal pudental arteries. Our study demonstrated the feasibility of a dosimetric preservation of structures considered as relevant to preserve sexual function after prostate stereotactic radiotherapy.

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      References

        • Mottet N.
        • Bergh R.C.N.
        • van den; Briers E.
        • et al.
        EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent.
        Eur Urol. 2021; 79: 243-262https://doi.org/10.1016/j.eururo.2020.09.042
        • Park B.H.
        • Jeon H.G.
        • Jeong B.C.
        • et al.
        Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy.
        J Urol. 2014; 192: 82-88https://doi.org/10.1016/j.juro.2014.01.005
        • Wang X.
        • Wu Y.
        • Guo J.
        • et al.
        Intrafascial nerve-sparing radical prostatectomy improves patients’ postoperative continence recovery and erectile function: A pooled analysis based on available literatures.
        Medicine (Baltimore). 2018; 97: e11297https://doi.org/10.1097/MD.0000000000011297
        • Coughlin G.D.
        • Yaxley J.W.
        • Chambers S.K.
        • et al.
        Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study.
        Lancet Oncol. 2018; 19: 1051-1060https://doi.org/10.1016/S1470-2045(18)30357-7
        • Mulhall J.
        • Ahmed A.
        • Parker M.
        • et al.
        The hemodynamics of erectile dysfunction following external beam radiation for prostate cancer.
        J Sex Med. 2005; 2: 432-437https://doi.org/10.1111/j.1743-6109.2005.20362.x
        • McLaughlin P.W.
        • Narayana V.
        • Meirovitz A.
        • et al.
        Vessel-sparing prostate radiotherapy: dose limitation to critical erectile vascular structures (internal pudendal artery and corpus cavernosum) defined by MRI.
        Int J Radiat Oncol Biol Phys. 2005; 61: 20-31https://doi.org/10.1016/j.ijrobp.2004.04.070
        • Mahmood J.
        • Shamah A.A.
        • Creed T.M.
        • et al.
        Radiation-induced erectile dysfunction: recent advances and future directions.
        Adv Radiat Oncol. 2016; 1: 161-169https://doi.org/10.1016/j.adro.2016.05.003
        • Gaither T.W.
        • Awad M.A.
        • Osterberg E.C.
        • et al.
        The natural history of erectile dysfunction after prostatic radiotherapy: a systematic review and meta-analysis.
        J Sex Med. 2017; 14: 1071-1078https://doi.org/10.1016/j.jsxm.2017.07.010
        • Zelefsky M.J.
        • Eid J.F.
        Elucidating the etiology of erectile dysfunction after definitive therapy for prostatic cancer.
        Int J Radiat Oncol Biol Phys. 1998; 40: 129-133https://doi.org/10.1016/s0360-3016(97)00554-3
        • Widmark A.
        • Gunnlaugsson A.
        • Beckman L.
        • et al.
        Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial.
        Lancet. 2019; 394: 385-395https://doi.org/10.1016/S0140-6736(19)31131-6
        • Brand D.H.
        • Tree A.C.
        • Ostler P.
        • et al.
        Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial.
        Lancet Oncol. 2019; 20: 1531-1543https://doi.org/10.1016/S1470-2045(19)30569-8
        • Yoon W.
        • Kim J.K.
        • Jeong Y.Y.
        • et al.
        Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced CT.
        Radiographics. 2004; 24 (discussion 1605-1606): 1591-1605https://doi.org/10.1148/rg.246045028
        • Rosen R.C.
        • Cappelleri J.C.
        • Smith M.D.
        • et al.
        Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.
        Int J Impot Res. 1999; 11: 319-326https://doi.org/10.1038/sj.ijir.3900472
        • van der Wielen G.J.
        • Mulhall J.P.
        • Incrocci L.
        Erectile dysfunction after radiotherapy for prostate cancer and radiation dose to the penile structures: a critical review.
        Radiother Oncol. 2007; 84: 107-113https://doi.org/10.1016/j.radonc.2007.07.018