Radiotherapy Approaches for High-Risk Prostate Cancer with Elective Lymph Node Fields: A Comparative Analysis

Radiotherapy Approaches for High-Risk Prostate Cancer with Elective Lymph Node Fields: A Comparative Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiotherapy Approaches for High-Risk Prostate Cancer with Elective Lymph Node Fields: A Comparative Analysis Amanda Östensson, Josefine Grefve, Camilla Thellenberg-Karlsson, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6260892/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Radiotherapy for high-risk prostate cancer patients with elective pelvic fields require large target margins to account for independent target motion. However, these margins increase the exposure of healthy tissue. This study compares standard, sequential, and robust treatment planning strategies to evaluate plan performance with varying target margins and motion. Our aim is to identify the most effective method that allows for a reduction in target margins while maintaining adequate dose coverage, thereby reducing healthy tissue exposure. Methods: Nine high-risk prostate cancer patients, each with a planning CT and five CBCTs, were included in the analysis. Nominal treatment plans were created based on the planning CT, while simulated plans integrated CBCTs to generate six dose fractions using deformable image registration and dose warping techniques. All treatment planning strategies employed VMAT, with prescribed doses of 77 Gy to the prostate and 56 Gy to lymph nodes and seminal vesicles over 35 fractions. Deformable image registration utilised either gold fiducial markers or bone anatomy as reference points. Results: The sequential treatment planning strategy achieved the highest overall performance, demonstrating the best adherence to clinical objectives and scoring metrics, while the standard treatment plan strategy performed the worst. The simulated plans reflected similar trends, with slightly reduced performance compared to the nominal plans. Conclusion: The sequential planning approach provides superior sparing of healthy tissue and target coverage but may require increased treatment time. Robust planning demonstrates consistent performance and adaptability, fulfilling clinical goals efficiently, although its higher computational demands warrant further investigation into optimising its practical implementation. Radiotherapy Planning Elective Lymph Nodes Fields Treatment Planning Approaches Robust Treatment Planning Simulated Treatment Plans Prostate Cancer Full Text Additional Declarations Competing interest reported. We would like to disclose that Joakim Jonsson and Tufve Nyholm are part-owners of Hero Imaging AB, which produces the software used in this analysis. However, this does not influence the objectivity of our study. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6260892","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444080214,"identity":"9c1cde09-ca1a-4c31-b1b9-13283538240b","order_by":0,"name":"Amanda Östensson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYLACHmQOP/Fa2KAcyQaStRgcIKCaf9rhZw/e1DDIyc9vPvbwxx+bPOMb2WkSDH9scGqRuJ1mbjjnGIOxwTG2dGPetrRisxu52yQY29JwW3M7wUyah40hcQMbj5k0Y8PhxG1gLQ2HceqQv53+TZrnH0Pi/Db+b5I//hxO3DwDqIXhz3+cWgxu55hJ87YxJDYc42GT4GE7nLhBAqSFDXcgGN7OKZOc2ycB9EsaSG9a4owzbzdbJLYl49Qidzt9m8SbbzZy8s2HnwEdZpPY35678caHP3a4vQ8BEmj8BEIaRsEoGAWjYBTgBQCSPlF8Ro18FQAAAABJRU5ErkJggg==","orcid":"","institution":"Umeå University","correspondingAuthor":true,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Östensson","suffix":""},{"id":444080217,"identity":"ea3cbae7-87ea-4a25-a475-4138571f19cb","order_by":1,"name":"Josefine Grefve","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Josefine","middleName":"","lastName":"Grefve","suffix":""},{"id":444080218,"identity":"1242affc-5dcc-40a7-be09-0dcbc3426659","order_by":2,"name":"Camilla Thellenberg-Karlsson","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Camilla","middleName":"","lastName":"Thellenberg-Karlsson","suffix":""},{"id":444080219,"identity":"76c259c8-0c53-4cc7-83fd-696dce2a664d","order_by":3,"name":"Karin Söderkvist","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Karin","middleName":"","lastName":"Söderkvist","suffix":""},{"id":444080220,"identity":"a60eb13b-c04b-444f-990c-14af522a4a4f","order_by":4,"name":"Kristina Sandgren","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Kristina","middleName":"","lastName":"Sandgren","suffix":""},{"id":444080221,"identity":"2bb5672f-cfed-4d2e-afee-74a4bf5dfe72","order_by":5,"name":"Magnus Karlsson","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Magnus","middleName":"","lastName":"Karlsson","suffix":""},{"id":444080222,"identity":"dec5a9e7-9a19-4ec3-a412-bf15b8283a90","order_by":6,"name":"Tufve Nyholm","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Tufve","middleName":"","lastName":"Nyholm","suffix":""},{"id":444080223,"identity":"a364eea4-260b-4bef-8386-8d25ce54e7c5","order_by":7,"name":"Joakim Jonsson","email":"","orcid":"","institution":"Umeå University","correspondingAuthor":false,"prefix":"","firstName":"Joakim","middleName":"","lastName":"Jonsson","suffix":""}],"badges":[],"createdAt":"2025-03-19 11:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6260892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6260892/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81596534,"identity":"99d140e1-5d1a-4a2f-9060-24ae03be6150","added_by":"auto","created_at":"2025-04-29 02:46:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1863331,"visible":true,"origin":"","legend":"","description":"","filename":"RadiotherapyApproachesforHighRiskProstateCancerwithElectiveLymphNodeFieldsAComparativeAnalysis.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6260892/v1_covered_f324c315-5c9d-4230-971e-a6484d8ca7a7.pdf"}],"financialInterests":"Competing interest reported. 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However, these margins increase the exposure of healthy tissue. This study compares standard, sequential, and robust treatment planning strategies to evaluate plan performance with varying target margins and motion. Our aim is to identify the most effective method that allows for a reduction in target margins while maintaining adequate dose coverage, thereby reducing healthy tissue exposure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Nine high-risk prostate cancer patients, each with a planning CT and five CBCTs, were included in the analysis. Nominal treatment plans were created based on the planning CT, while simulated plans integrated CBCTs to generate six dose fractions using deformable image registration and dose warping techniques. All treatment planning strategies employed VMAT, with prescribed doses of 77 Gy to the prostate and 56 Gy to lymph nodes and seminal vesicles over 35 fractions. Deformable image registration utilised either gold fiducial markers or bone anatomy as reference points.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The sequential treatment planning strategy achieved the highest overall performance, demonstrating the best adherence to clinical objectives and scoring metrics, while the standard treatment plan strategy performed the worst. The simulated plans reflected similar trends, with slightly reduced performance compared to the nominal plans.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The sequential planning approach provides superior sparing of healthy tissue and target coverage but may require increased treatment time. Robust planning demonstrates consistent performance and adaptability, fulfilling clinical goals efficiently, although its higher computational demands warrant further investigation into optimising its practical implementation.\u003c/p\u003e","manuscriptTitle":"Radiotherapy Approaches for High-Risk Prostate Cancer with Elective Lymph Node Fields: A Comparative Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-18 06:35:38","doi":"10.21203/rs.3.rs-6260892/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0ed6aabc-ff4f-48a1-bf56-55442a040bf8","owner":[],"postedDate":"April 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T02:38:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-18 06:35:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6260892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6260892","identity":"rs-6260892","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}