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Comparison of Peripheral Zone and Central Gland Volume in Patients Undergoing Intensity-Modulated Radiotherapy

Zechmann, Christian M. MD; Simpfendörfer, Tobias MD; Giesel, Frederik L. MD, MBA; Zamecnik, Patrik MD; Thieke, Christian MD, PhD; Hielscher, Thomas Dipl Stat; Meinzer, Hans-Peter PhD; Delorme, Stefan MD

Journal of Computer Assisted Tomography: September/October 2010 - Volume 34 - Issue 5 - pp 739-745
doi: 10.1097/RCT.0b013e3181ebd14f
Abdominal Imaging

Background and Purpose: The shrinking effect of androgen deprivation therapy (ADT) and radiotherapy (RT) on prostate gland volume is a known clinical finding. Until now, it is not known which part of the prostate shrinks more. We examined patients with and without ADT undergoing intensity-modulated RT (IMRT) and performed 3-dimensional measurements of the peripheral zone (PZ) and central gland (CG) with magnetic resonance imaging (MRI).

Methods and Materials: Prostate gland volumes of PZ and CG between planning MRI and first available follow-up MRI were retrospectively determined in 44 patients with localized prostate carcinoma. A total of 24 patients had ADT with a median time interval of 5 months (range, 1.5-24 months). Median time interval between both MRI time points was 132 days (range, 104-224 days). Two observers performed PZ and CG delineation in consensus using planimetry. Volume changes over time were determined and compared.

Results: Patients who had ADT showed smaller prostate volume in the first MRI (mean [SD], 32 [16.7] mL), which was still present after IMRT (28.1 [16.7] mL). Patients who had no ADT started with 44.6 (16.9) mL and showed 37.5 (13.9) mL after IMRT. Shrinking effect in PZ was significantly larger than in CG for all patients (−18.3% vs −6.3%, P < 0.05).

Conclusions: Because, typically, most tumors are located in PZ and this area also shows the largest shrinkage effect after IMRT, this should be taken into account for planning purposes. Notably, there are only minor differences in the relative shrinking effects between patients with and without ADT, although they start with different volumes.

From the *Department of Radiology, German Cancer Research Center; †Department of Nuclear Medicine, University of Heidelberg; and ‡Division of Medical and Biological Informatics, §Department of Radiotherapy, and ∥Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany.

Received for publication March 16, 2010; accepted June 7, 2010.

Reprints: Christian M. Zechmann, MD, Im Neuenheimer Feld 400, Department of Nuclear Medicine, University Heidelberg, 69120 Heidelberg, Germany (e-mail:

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