Rectal dose-volume differences using proton radiotherapy and a rectal balloon or water alone for the treatment of prostate cancer

Purpose: To describe dose-volume values with the use of water alone vs. a rectal balloon (RB) for the treatment of prostate cancer with proton therapy. Materials and Methods: We analyzed 30 proton plans for 15 patients who underwent CT and MRI scans with an RB or water alone. Simulation was performed with a modified MRI endorectal coil and an RB with 100 mL of water or water alone. Doses of 78-82 gray equivalents were prescribed to the planning target volume. The two groups were compared for three structures: rectum, rectal wall (RW), and rectal wall 7 cm (RW7) at the level of the planning target volume. Results: Rectum and RW volumes radiated to low, intermediate, and high doses were small: rectum V10, 33.7%; V50, 17.3%; and V70, 10.2%; RW V10, 32.4%; V50, 20.4%; and V70, 14.6%. The RB effectively increased the rectal volume for all cases (139.8 +/- 44.9 mL vs. 217.7 +/- 32.2 mL (p < 0.001). The RB also decreased the volume of the rectum radiated to doses V10-V65 (p <= 0.05); RW for V10-V50; and RW7 for V10-V35. An absolute rectum V50 improvement > 5% was seen for the RB in 5 of 15 cases, for a benefit of 9.2% +/- 2.3% compared with 2.4% 1.3% for the remaining 10 cases (p < 0.001). Similar benefit was seen for the rectal wall. No benefit was seen for doses >= 70 gray equivalents for the rectum, RW, or RW7. No benefit of <= 1% was seen with an RB in 46% for the rectum V70 and in 40% for the rectal wall V70. Conclusions: Rectum and rectal wall doses with proton radiation were low whether using water or an RB. Selected patients will have a small but significant advantage with an RB; however, water alone was well tolerated and will be an alternative for most patients. (c) 2007 Elsevier Inc.