As the technology for external beam radiation has quickly evolved from multi-field forward planning technique to inversely planned intensity modulated radiotherapy, the ability to spare normal tissue targets has improved. Previous studies have investigated limiting radiation dose to the crura and penile bulb with promising results. However there has been minimal literature looking at radiation dose to the neurovascular bundles owing to its difficult localization on CT imaging and proximity to the prostate gland. Given this lack of literature we wanted to assess the feasibility of contouring the neurovascular bundle on MRI and generating radiation plans that limited the dose to this structure. In our current study, we used pelvic simulation CT scan and pelvic MRI registration to accurately delineate and contour the neurovascular bundles. Using this technique with volumetric modulated arc therapy we showed dosimetrically that the neurovascular bundles could receive limited radiation without increasing the dose delivered to the rectum, bladder, and femoral heads. Additionally, there remained adequate coverage of the prostate gland itself. Taken together, it appears to be dosimetrically viable to spare the neurovascular bundle in external beam radiation planning.
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Written by: Richard J. Cassidy, MD and Ashesh B. Jani, MD
Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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