I have been able to learn a great deal of material through this course and my clinical experiences

at Froedtert Hospital. A specific case in which I encountered information not covered in DOS 531, was
that of a prostate cancer plan with nodal involvement treated using the departments Radixact
Tomotherapy technology. Tomotherapy was selected as it allows us to selectively target tumors in the
prostate gland and nodes with higher doses of radiation, while also reducing dose to surrounding
structures. This capability allows us to prevent GI and urinary side effects, while also minimizing on-table
time for the patient.1

This disease was determined to be high-risk due to nodal involvement and was to be treated
using a base plan of 5040 cGy in 28 fractions at 180cGy per day to the prostate and lymph node volume.
The base plan was followed by a boost to 2520cGy in 14 fractions at 180cGy per day to the prostate and
a 2 mm. margin. In this case, I specifically learned about the capabilities of TomoTherapy along with the
use of avoidance structures. These tools were used during treatment planning and allowed us to localize
dose to the regions of interest. The physician and dosimetrist contoured avoidance structures and OARs,
which were then transferred to the TPS. The TPS allowed us to set priorities to certain structures and
avoidances and automatically generated a plan that pulled dose in a manner that increased conformality
to the PTV while pulling dose away from the rectum, bladder, and small bowel. The avoidance structures
were weighted highly and drawn as a series of spheres that pushed dose deeper and tighter towards the
PTV and nodes. Figure 1 illustrates characteristic isodose distributions expected when using
Tomotherapy.

Figure 1. TomoTherapy Dose Distribution Prostate Cancer Treatment Plan

This plan was a great learning experience as it demonstrated that there are many techniques to
treat common cancer types. I was surprised to see level of achievable conformality and avoidance of
OARs. Advances such as the use of Tomothereapy are improving patient quality of life and specific to
prostate treatments, allow a decrease in urinary dysfunction and the ability to maintain baseline GI
function.2
1. Krause S. Radixact: More Precise Radiation Therapy for Cancer Patients. Radixact™ | Froedtert
Hospital | Milwaukee, Wis. https://www.froedtert.com/cancer/treatment/radiation/radixact.
Accessed February 21, 2018.
2. Pervez N, Krauze AV, Yee D, et al. Current Oncology.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364781/. Published June 2012. Accessed
February 21, 2018.
3. A Revolution in the Fight Against Cancer What TomoTherapy® Technology Means to You.
Accuray Precise, Innovative Tumor Treatments.
http://www.accuray.com/sites/default/files/Tomo_PatientEd_Brochure.pdf. Accessed February
20, 2018.