1
|
Shimomura A, Wu T, Rusu I, Kishan AU, Tree AC, Solanki AA, Liauw SL. Monitoring Intrafraction Motion of the Prostate During Radiation Therapy: Suggested Practice Points From a Focused Review. Pract Radiat Oncol 2024; 14:146-153. [PMID: 37875222 DOI: 10.1016/j.prro.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE External beam radiation therapy to the prostate is typically delivered after verification of prostatic position with image guidance. Prostate motion can occur during the delivery of each radiation treatment between the time of localization imaging and completion of treatment. The objective of this work is to review the literature on intrafraction motion (IFM) of the prostate during radiation therapy and offer clinical recommendations on management. METHODS AND MATERIALS A comprehensive literature review was conducted on prostate motion during prostate cancer radiation therapy. Information was organized around 3 key clinical questions, followed by an evidence-based recommendation. RESULTS IFM of the prostate during radiation therapy is typically ≤3 mm and is unlikely to compromise prostate dosimetry to a clinically meaningful degree for men treated in a relatively short treatment duration with planning target volume (PTV) margins of ≥3 to 5 mm. IFM of 5 mm or more has been observed in up to ∼10% of treatment fractions, with limited dosimetric effect related to the infrequency of occurrence and longer fractionation of therapy. IFM can be monitored in continuous or discontinuous fashion with a variety of imaging platforms. Correction of IFM may have the greatest value when tighter PTV margins are desired (such as with stereotactic body radiation therapy or intraprostatic nodule boosting), ultrahypofractionated courses, or when treatment time exceeds several minutes. CONCLUSIONS This focused review summarizes literature and provides practical recommendations regarding IFM in the treatment of prostate cancer with external beam radiation therapy.
Collapse
Affiliation(s)
- Aoi Shimomura
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Tianming Wu
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Iris Rusu
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois.
| |
Collapse
|
2
|
Hargrave C, Deegan T, Bednarz T, Poulsen M, Harden F, Mengersen K. An image‐guided radiotherapy decision support framework incorporating a Bayesian network and visualization tool. Med Phys 2018; 45:2884-2897. [DOI: 10.1002/mp.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 04/14/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Hunter Industrial Medicine Maitland 2320 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
| |
Collapse
|
3
|
Li M, Li GF, Hou XY, Gao H, Xu YG, Zhao T. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer. Chin Med J (Engl) 2017; 129:1447-54. [PMID: 27270540 PMCID: PMC4910368 DOI: 10.4103/0366-6999.183429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Image-guided radiation therapy (IGRT) is the preferred method for curative treatment of localized prostate cancer, which could improve disease outcome and reduce normal tissue toxicity reaction. IGRT using cone-beam computed tomography (CBCT) in combination with volumetric-modulated arc therapy (VMAT) potentially allows smaller treatment margins and dose escalation to the prostate. The aim of this study was to compare the difference of dosimetric diffusion in conventional IGRT using 7-field, step-and-shoot intensity-modulated radiation therapy (IMRT) and hypofractionated IGRT using VMAT for patients with localized prostate cancer. Methods: We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT (n = 12) or VMAT (n = 12) for prostate cancer between November 2013 and October 2015. Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator. Offline planning was performed using the daily treatment images registered with simulation computed tomography (CT) images. A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study. Dose distributions were recalculated on CBCT images registered with the planning CT scanner. Results: Compared with 7-field, step-and-shoot IMRT, VMAT plans resulted in improved planning target volume (PTV) D95% (7663.17 ± 69.57 cGy vs. 7789.17 ± 131.76 cGy, P < 0.001). VMAT reduced the rectal D25 (P < 0.001), D35 (P < 0.001), and D50 (P < 0.001), bladder V50 (P < 0.001), D25 (P = 0.002), D35 (P = 0.028), and D50 (P = 0.029). However, VMAT did not statistically significantly reduce the rectal V50, compared with 7-field, step-and-shoot IMRT (25.02 ± 5.54% vs. 27.43 ± 8.79%, P = 0.087). Conclusions: To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent normal tissues comparing to 7-field, step-and-shoot IMRT. Daily online image-guidance and better management of bladder and rectum could make a more precise treatment delivery.
Collapse
Affiliation(s)
- Ming Li
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Gao-Feng Li
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Xiu-Yu Hou
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Hong Gao
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Yong-Gang Xu
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| | - Ting Zhao
- Department of Radiation Oncology, Beijing Hospital, Beijing 100730, China
| |
Collapse
|
4
|
Ramiandrisoa F, Duvergé L, Castelli J, Nguyen TD, Servagi-Vernat S, de Crevoisier R. [Clinical to planning target volume margins in prostate cancer radiotherapy]. Cancer Radiother 2016; 20:629-39. [PMID: 27614515 DOI: 10.1016/j.canrad.2016.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 02/03/2023]
Abstract
The knowledge of inter- and intrafraction motion and deformations of the intrapelvic target volumes (prostate, seminal vesicles, prostatectomy bed and lymph nodes) as well as the main organs at risk (bladder and rectum) allow to define rational clinical to planning target volume margins, depending on the different radiotherapy techniques and their uncertainties. In case of image-guided radiotherapy, prostate margins and seminal vesicles margins can be between 5 and 10mm. The margins around the prostatectomy bed vary from 10 to 15mm and those around the lymph node clinical target volume between 7 and 10mm. Stereotactic body radiotherapy allows lower margins, which are 3 to 5mm around the prostate. Image-guided and stereotactic body radiotherapy with adequate margins allow finally moderate or extreme hypofractionation.
Collapse
Affiliation(s)
- F Ramiandrisoa
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France.
| | - L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
| | - T D Nguyen
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - S Servagi-Vernat
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
| |
Collapse
|
5
|
Three-dimensional surface imaging for detection of intra-fraction setup variations during radiotherapy of pelvic tumors. Radiol Med 2016; 121:805-10. [PMID: 27300649 DOI: 10.1007/s11547-016-0659-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/30/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Surface-based image guided radiotherapy (IGRT) allows positioning and/or monitoring patients in 3 dimensions (3D), without the use of ionizing radiation. In this study, we report on intra-fraction motion measured by acquisition of multiple images of 3D body surfaces. MATERIALS AND METHODS Twenty-nine patients treated for pelvic tumors were enrolled. Setup variations (SV) through three consecutive body surfaces acquired by the optical IGRT system Align-RT (Vision-RT, London, UK) were analyzed before, during and at the end of treatment delivery. Displacements along the main axes (X, Y and Z) from initial (I) to mid-treatment (MT) and final (F) acquisitions were recorded. Time and direction of SV were assessed. RESULTS A total of 6272 images from 792 fractions of 29 patients were available. The main source of misalignment was between I and MT acquisition (p < 0.001). The dominant SV direction was the vertical one (Z axis), with mean SV of -1.20 ± 0.06 mm and -1.55 ± 0.06 mm for I-MT and I-F acquisitions, respectively. The Y mean components of SV were, respectively, -0.95 ± 0.10 mm and -1.0 ± 0.10 for I-MT and I-F acquisitions, while the X deviations were 0.07 ± 0.08 mm for I-MT and 0.26 ± 0.08 mm I-F. CONCLUSION Three-D surface imaging for patient setup monitoring highlighted remarkable mobility of patients during RT session, especially in the anterior-posterior direction (Z axis). The largest magnitude in patient movements occurred during the first part of delivery. These findings suggest that the initial setup control cannot not to be sufficient to guarantee treatment reproducibility, especially for long-lasting RT treatments.
Collapse
|
6
|
Li J, Tang XB, Zhang XZ, Zhang XW, Ge Y, Chen D, Chai L. Analysis of the setup errors of medical image registration-based cone-beam CT for lung cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:521-530. [PMID: 27061797 DOI: 10.3233/xst-160568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aimed to investigate the feasibility of efficiently using a rigid image registration (RIR) algorithm or a deformable image registration (DIR) algorithm to match medical images and evaluate the impact of setup errors on intensity modulated radiation therapy of lung cancer patients. METHODS Ten lung cancer patients were chosen randomly each day and were subjected to image-guided radiotherapy. The clinical registration between cone-beam computed tomography (CBCT) images and treatment planning system CT images was performed by applying both RIR and DIR; the clinical registration was evaluated on the basis of the contour index, including dice similarity coefficient, sensitivity, and positive predictive value; the optimal scheme of image registration was selected to ensure that the actual irradiation isocenter was consistent with the treatment planning isocenter. In each patient, the translational errors in the right-left (x), superior-inferior (y), and anterior-posterior (z) directions and the rotational errors in the u, υ, and w directions formed by the x, y, and z directions were calculated and analyzed daily in the whole course of treatment; margins were calculated according to this equation: M = 2.5∑+ 0.7δ. RESULTS The tumors and the surrounding soft tissues of the patients are shown more clearly in the CBCT images than in the CT images. DIR can be applied more efficiently than RIR to determine the morphological and positional changes in the organs shown in the images with the same or different modalities in the different period. The setup errors in translation in the x, y and z axes were 0.05±0.16, 0.09±0.32 and -0.02±0.13 cm, respectively; by contrast, the setup errors in rotation in u, υ and w directions were (0.41±0.64)°, (-0.08±0.57)° and (-0.03±0.62)°, respectively. The setup errors in the x, y and z axes of the patients indicated that the margins expansions were 0.82, 1.15 and 0.72 cm, respectively. CONCLUSION CBCT with DIR can measure and correct the setup errors online; as a result, setup errors in lung cancer treatments can be significantly reduced and the accuracy of radiotherapy can be enhanced.
Collapse
Affiliation(s)
- Jun Li
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Xiao-Bin Tang
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Xi-Zhi Zhang
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
| | - Xian-Wen Zhang
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, P. R. China
| | - Da Chen
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Lei Chai
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| |
Collapse
|
7
|
Law G, Leung R, Lee F, Luk H, Lee KC, Wong F, Wong M, Cheung S, Lee V, Mui WH, Chan M. Effectiveness of a Patient-Specific Immobilization and Positioning System to Limit Interfractional Translation and Rotation Setup Errors in Radiotherapy of Prostate Cancers. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijmpcero.2016.53020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Panje CM, Dal Pra A, Zilli T, R Zwahlen D, Papachristofilou A, Herrera FG, Matzinger O, Plasswilm L, Putora PM. Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice. Strahlenther Onkol 2015; 191:778-86. [PMID: 25986251 DOI: 10.1007/s00066-015-0849-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/22/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer. Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration. Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland. MATERIALS AND METHODS Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers. Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool. Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed. RESULTS The most commonly prescribed radiation dose was 78 Gy (range 70-80 Gy) across all risk groups. ADT was recommended for intermediate-risk patients for 6 months in over 80 % of the centers, and for high-risk patients for 2 or 3 years in over 90 % of centers. For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39 % in any clinical scenario. Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96 % of the centers. CONCLUSION Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer. In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines.
Collapse
Affiliation(s)
- Cédric M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Department of Radiation Oncology, Universitätsspital Zürich, Zurich, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital Bern, Bern, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Fernanda G Herrera
- Department of Radiation Oncology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Oscar Matzinger
- Department of Radiation Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Ludwig Plasswilm
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| |
Collapse
|
9
|
Hamamoto Y, Inata H, Sodeoka N, Nakayama S, Tsuruoka S, Takeda H, Manabe T, Mochizuki T, Umeda M. Observation of intrafraction prostate displacement through the course of conventionally fractionated radiotherapy for prostate cancer. Jpn J Radiol 2015; 33:187-93. [DOI: 10.1007/s11604-015-0396-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/21/2015] [Indexed: 11/28/2022]
|
10
|
Quantification of an external motion surrogate for quality assurance in lung cancer radiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:595430. [PMID: 25525599 PMCID: PMC4266763 DOI: 10.1155/2014/595430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/27/2014] [Accepted: 09/28/2014] [Indexed: 11/17/2022]
Abstract
The purpose of this work was to validate the stability of the end exhale position in deep expiration breath hold (DEBH) technique for quality assurance in stereotactic lung tumor radiation therapy. Furthermore, a motion analysis was performed for 20 patients to evaluate breathing periods and baseline drifts based on an external surrogate. This trajectory was detected using stereo infrared (IR) cameras and reflective body markers. The respiratory waveform showed large interpatient differences in the end exhale position during irradiation up to 18.8 mm compared to the global minimum. This position depends significantly on the tumor volume. Also the baseline drifts, which occur mostly in posterior direction, are affected by the tumor size. Breathing periods, which depend mostly on the patient age, were in a range between 2.4 s and 7.0 s. Fifteen out of 20 patients, who showed a reproducible end exhale position with a deviation of less than 5 mm, might benefit from DEBH due to smaller planning target volumes (PTV) compared to free breathing irradiation and hence sparing of healthy tissue. Patients with larger uncertainties should be treated with more complex motion compensation techniques.
Collapse
|
11
|
Oehler C, Lang S, Dimmerling P, Bolesch C, Kloeck S, Tini A, Glanzmann C, Najafi Y, Studer G, Zwahlen DR. PTV margin definition in hypofractionated IGRT of localized prostate cancer using cone beam CT and orthogonal image pairs with fiducial markers. Radiat Oncol 2014; 9:229. [PMID: 25384898 PMCID: PMC4229608 DOI: 10.1186/s13014-014-0229-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 10/03/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate PTV margins for hypofractionated IGRT of prostate comparing kV/kV imaging or CBCT. PATIENTS AND METHODS Between 2009 and 2012, 20 patients with low- (LR), intermediate- (IR) and high-risk (HR) prostate cancer were treated with VMAT in supine position with fiducial markers (FM), endorectal balloon (ERB) and full bladder. CBCT's and kV/kV imaging were performed before and additional CBCT's after treatment assessing intra-fraction motion. CTVP for 5 patients with LR and CTVPSV for 5 patients with IR/HR prostate cancer were contoured independently by 3 radiation oncologists using MRI. The van Hark formula (PTV margin =2.5Σ +0.7σ) was applied to calculate PTV margins of prostate/seminal vesicles (P/PSV) using CBCT or FM. RESULTS 172 and 52 CBCTs before and after RT and 507 kV/kV images before RT were analysed. Differences between FM in CBCT or in planar kV image pairs were below 1 mm. Accounting for both random and systematic uncertainties anisotropic PTV margins were 5-8 mm for P (LR) and 6-11 mm for PSV (IR/HR). Random uncertainties like intra-fraction and inter-fraction (setup) uncertainties were of similar magnitude (0.9-1.4 mm). Largest uncertainty was introduced by CTV delineation (LR: 1-2 mm, IR/HR: 1.6-3.5 mm). Patient positioning using bone matching or ERB-matching resulted in larger PTV margins. CONCLUSIONS For IGRT CBCT or kV/kV-image pairs with FM are interchangeable in respect of accuracy. Especially for hypofractionated RT, PTV margins can be kept in the range of 5 mm or below if stringent daily IGRT, ideally including prostate tracking, is applied. MR-based CTV delineation optimization is recommended.
Collapse
Affiliation(s)
- Christoph Oehler
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. .,Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland.
| | - Stephanie Lang
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Peter Dimmerling
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Christian Bolesch
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Stephan Kloeck
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Alessandra Tini
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Yousef Najafi
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Daniel R Zwahlen
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. .,Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland.
| |
Collapse
|
12
|
Mayer A, Póti Z. [Novel irradiation techniques in the treatment of solid tumours. Radiotherapy for metastases]. Orv Hetil 2014; 155:283-90. [PMID: 24534876 DOI: 10.1556/oh.2014.29832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Novel developments in percutaneous radiotherapy, such as positron emission tomography/computed tomography, adaptive radiation planning, intensity modulation radiotherapy and intensity modulated arc therapy (RapidArc), as well as the newer generation of image control (cone-beam computed tomography) and image guided radiotherapy ensure increased dosages of planning target volume and clinical target volume of solid tumours without damaging surrounding tissues and providing maximal protection. By raising the dosages of planned target volume and clinical target volume, these novel technical developments have created new indications in the treatment of solid tumours. With the aid of the cone-beam computed tomography and image guided radiotherapy the organ metastasis (lung, liver, spinal cord) and the primary tumour can be treated safety and effectively. Hypofractionation, dose escalation and the use of stereotactic devices can probably decrease radiation damage. The authors review the most common forms of evidence-based fractionation schemes used in irradiation therapy.
Collapse
Affiliation(s)
- Arpád Mayer
- Uzsoki utcai Kórház Fővárosi Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145
| | - Zsuzsa Póti
- Uzsoki utcai Kórház Fővárosi Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145
| |
Collapse
|
13
|
Sveistrup J, af Rosenschöld PM, Deasy JO, Oh JH, Pommer T, Petersen PM, Engelholm SA. Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance. Radiat Oncol 2014; 9:44. [PMID: 24495815 PMCID: PMC3922544 DOI: 10.1186/1748-717x-9-44] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). METHODS A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1-2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5-7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. RESULTS The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p < 0.001). For GU toxicity the numbers were 41.8% and 29.7%, respectively (p = 0.011). On multivariate analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p < 0.001, HR = 11.59 [CI: 6.67-20.14]). 3DCRT was also associated with an increased risk of developing GU toxicity compared to IG-IMRT.The 3-year actuarial biochemical progression-free survival probability was 86.0% for 3DCRT and 90.3% for IG-IMRT (p = 0.386). On multivariate analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT. CONCLUSION The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction.
Collapse
Affiliation(s)
- Joen Sveistrup
- Department of Radiation Oncology, Section 3994, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
| | | | | | | | | | | | | |
Collapse
|
14
|
Cramer AK, Haile AG, Ognjenovic S, Doshi TS, Reilly WM, Rubinstein KE, Nabavizadeh N, Nguyen T, Meng LZ, Fuss M, Tanyi JA, Hung AY. Real-time prostate motion assessment: image-guidance and the temporal dependence of intra-fraction motion. BMC MEDICAL PHYSICS 2013; 13:4. [PMID: 24059584 PMCID: PMC3849088 DOI: 10.1186/1756-6649-13-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 09/09/2013] [Indexed: 12/25/2022]
Abstract
Background The rapid adoption of image-guidance in prostate intensity-modulated radiotherapy (IMRT) results in longer treatment times, which may result in larger intrafraction motion, thereby negating the advantage of image-guidance. This study aims to qualify and quantify the contribution of image-guidance to the temporal dependence of intrafraction motion during prostate IMRT. Methods One-hundred and forty-three patients who underwent conventional IMRT (n=67) or intensity-modulated arc therapy (IMAT/RapidArc, n=76) for localized prostate cancer were evaluated. Intrafraction motion assessment was based on continuous RL (lateral), SI (longitudinal), and AP (vertical) positional detection of electromagnetic transponders at 10 Hz. Daily motion amplitudes were reported as session mean, median, and root-mean-square (RMS) displacements. Temporal effect was evaluated by categorizing treatment sessions into 4 different classes: IMRTc (transponder only localization), IMRTcc (transponder + CBCT localization), IMATc (transponder only localization), or IMATcc (transponder + CBCT localization). Results Mean/median session times were 4.15/3.99 min (IMATc), 12.74/12.19 min (IMATcc), 5.99/5.77 min (IMRTc), and 12.98/12.39 min (IMRTcc), with significant pair-wise difference (p<0.0001) between all category combinations except for IMRTcc vs. IMATcc (p>0.05). Median intrafraction motion difference between CBCT and non-CBCT categories strongly correlated with time for RMS (t-value=17.29; p<0.0001), SI (t-value=−4.25; p<0.0001), and AP (t-value=2.76; p<0.0066), with a weak correlation for RL (t-value=1.67; p=0.0971). Treatment time reduction with non-CBCT treatment categories showed reductions in the observed intrafraction motion: systematic error (Σ)<0.6 mm and random error (σ)<1.2 mm compared with ≤0.8 mm and <1.6 mm, respectively, for CBCT-involved treatment categories. Conclusions For treatment durations >4-6 minutes, and without any intrafraction motion mitigation protocol in place, patient repositioning is recommended, with at least the acquisition of the lateral component of an orthogonal image pair in the absence of volumetric imaging.
Collapse
Affiliation(s)
- Avilash K Cramer
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|