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Effectiveness of rectal displacement devices in managing prostate motion: a systematic review. Strahlenther Onkol 2020; 197:97-115. [DOI: 10.1007/s00066-020-01633-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
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Ménard C, Pambrun JF, Kadoury S. The utilization of magnetic resonance imaging in the operating room. Brachytherapy 2017; 16:754-760. [PMID: 28139421 DOI: 10.1016/j.brachy.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022]
Abstract
Online image guidance in the operating room using ultrasound imaging led to the resurgence of prostate brachytherapy in the 1980s. Here we describe the evolution of integrating MRI technology in the brachytherapy suite or operating room. Given the complexity, cost, and inherent safety issues associated with MRI system integration, first steps focused on the computational integration of images rather than systems. This approach has broad appeal given minimal infrastructure costs and efficiencies comparable with standard care workflows. However, many concerns remain regarding accuracy of registration through the course of a brachytherapy procedure. In selected academic institutions, MRI systems have been integrated in or near the brachytherapy suite in varied configurations to improve the precision and quality of treatments. Navigation toolsets specifically adapted to prostate brachytherapy are in development and are reviewed.
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Affiliation(s)
- C Ménard
- University of Montréal Hospital Research Centre (CRCHUM), Montréal, QC, Canada; TECHNA Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Center, Toronto, ON, Canada.
| | - J-F Pambrun
- University of Montréal Hospital Research Centre (CRCHUM), Montréal, QC, Canada; École polytechnique de Montréal, Montréal, QC, Canada
| | - S Kadoury
- University of Montréal Hospital Research Centre (CRCHUM), Montréal, QC, Canada; École polytechnique de Montréal, Montréal, QC, Canada
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The effect of leg position on the dose distribution of intracavitary brachytherapy for cervical cancer: 3D computerised tomography plan evaluation and in vivo dosimetric study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s146039691600025x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurposeTo evaluate the impact of leg position on the dose distribution during intracavitary brachytherapy for cervical cancer.Patients and methodsThis prospective study was performed on 11 women with cervical cancer who underwent intracavitary brachytherapy. After insertion of the brachytherapy applicator, two sets of computed tomography slices were taken including pelvis, one with straight leg and one with leg flexion position with knee support. The dose (7 Gy) was prescribed to point A. The radiotherapy plan was run on the Plato Planning Software System V14·1 to get the dose distributions. Also, rectum and bladder doses were measured for both leg positions during the treatment. The doses and volumes of organs were compared via the Wilcoxon signed-rank test by using Statistical Package for the Social Sciences 11·5 statistical software.ResultsNo significant difference regarding the dose distributions and volumes of target, sigmoid and bladder due to leg position was observed, either on 3D planning or on in vivo dose measurements. However, there were significant differences for 25 and 50% isodose coverage of rectum in favour of straight leg position (p=0·026). There were no significant differences regarding maximum doses in any critical organ.ConclusionDifference in leg position caused only a small change in rectum dose distribution and did not cause any other change in either dose distributions or in vivo measured doses of both target and critical organs during cervical brachytherapy. Straight leg position appears better with regard to rectum dose.
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Vanhanen A, Kapanen M. The effect of rectal retractor on intrafraction motion of the prostate. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/3/035021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Clemente S, Nigro R, Oliviero C, Marchioni C, Esposito M, Giglioli FR, Mancosu P, Marino C, Russo S, Stasi M, Strigari L, Veronese I, Landoni V. Role of the Technical Aspects of Hypofractionated Radiation Therapy Treatment of Prostate Cancer: A Review. Int J Radiat Oncol Biol Phys 2015; 91:182-95. [DOI: 10.1016/j.ijrobp.2014.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
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Uzel EK, Karaçam S, Eliçin O, Uzel O. Comparison of two different IMRT planning techniques in the treatment of nasopharyngeal carcinoma. Effect on parotid gland radiation doses. Strahlenther Onkol 2013; 189:552-8. [PMID: 23748231 DOI: 10.1007/s00066-013-0344-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the effect of two different intensity-modulated radiation therapy (IMRT) planning techniques on parotid gland doses in patients with nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS Radiotherapy for 10 NPC patients referred to the University of Istanbul Cerrahpasa Medical School was planned with arc- and static seven-field IMRT. The simultaneous integrated boost (SIB) technique was used to deliver 70 Gy (2.12 Gy per fraction) to the primary tumor and involved nodes; 60 Gy (1.81 Gy per fraction) to the entire nasopharynx and 54 Gy (1.63 Gy per fraction) to elective lymph nodes in 33 fractions. Plans also aimed to keep the mean parotid dose below 26 Gy and limit the maximum doses to the spinal cord and brain stem to 45 and 54 Gy, respectively. Mean parotid gland doses for the two planning techniques were compared using a paired t-test. Target coverage and dose inhomogeneity were evaluated by calculating conformity- (CI) and homogeneity index (HI) values. RESULTS Target coverage and dose homogeneity were identical and good for both planning techniques: CI = 1.05 ± 0.08 and 1.05 ± 0.08; HI = 1.08 ± 0.02 and 1.07 ± 0.01 for arc- and static field IMRT, respectively. Mean doses to contralateral parotid glands were 25.73 ± 4.27 and 27.73 ± 3.5 Gy(p = 0.008) for arc- and static field IMRT plans, respectively, whereas mean ipsilateral parotid doses were 30.65 ± 6.25 and 32.55 ± 5.93 Gy (non-significant p-value), respectively. Mean monitor units (MU) per fraction for the 10 patients were considerably lower for arc- than for static field treatments-540.5 ± 130.39 versus 1288.4 ± 197.28 (p < 0.001). CONCLUSION Normal tissues--particularly the parotid glands--are better spared with the arc technique in patients with NPC. MU and treatment times are considerably reduced in arc IMRT plans.
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Affiliation(s)
- E K Uzel
- Department of Radiation Oncology, Şişli Etfal Teaching and Research Hospital, 34303, Istanbul, Turkey.
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Dinkla AM, Pieters BR, Koedooder K, van Wieringen N, van der Laarse R, van der Grient JN, Rasch CR, Koning CC, Bel A. Improved tumour control probability with MRI-based prostate brachytherapy treatment planning. Acta Oncol 2013; 52:658-65. [PMID: 23282111 DOI: 10.3109/0284186x.2012.744875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Due to improved visibility on MRI, contouring of the prostate is improved compared to CT. The aim of this study was to quantify the benefits of using MRI for treatment planning as compared to CT-based planning for temporary implant prostate brachytherapy. MATERIAL AND METHODS CT and MRI image data of 13 patients were used to delineate the prostate and organs at risk (OARs) and to reconstruct the implanted catheters (typically 12). An experienced treatment planner created plans on the CT-based structure sets (CT-plan) and on the MRI-based structure sets (MRI-plan). Then, active dwell-positions and weights of the CT-plans were transferred to the MRI-based structure sets (CT-plan(MRI-contours)) and resulting dosimetric parameters and tumour control probabilities (TCPs) were studied. RESULTS For the CT-plan(MRI-contours) a statistically significant lower target coverage was detected: mean V100 was 95.1% as opposed to 98.3% for the original plans (p < 0.01). Planning on CT caused cold-spots that influence the TCP. MRI-based planning improved the TCPs by 6-10%, depending on the parameters of the radiobiological model used for TCP calculation. Basing the treatment plan on either CT- or MRI-delineations does not influence plan quality. CONCLUSION Evaluation of CT-based treatment planning by transferring the plan to MRI reveals underdosage of the prostate, especially at the base side. Planning on MRI can prevent cold-spots in the tumour and improves the TCP.
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Affiliation(s)
- Anna M. Dinkla
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Bradley R. Pieters
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Kees Koedooder
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Niek van Wieringen
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Rob van der Laarse
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | | | - Coen R. Rasch
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Caro C. Koning
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Centre,
Amsterdam, the Netherlands
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Mutanga TF, de Boer HC, Rajan V, Dirkx ML, Incrocci L, Heijmen BJ. Day-to-Day Reproducibility of Prostate Intrafraction Motion Assessed by Multiple kV and MV Imaging of Implanted Markers During Treatment. Int J Radiat Oncol Biol Phys 2012; 83:400-7. [DOI: 10.1016/j.ijrobp.2011.05.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/04/2011] [Accepted: 05/22/2011] [Indexed: 11/28/2022]
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Wu J, Ruan D, Cho B, Sawant A, Petersen J, Newell LJ, Cattell H, Keall PJ. Electromagnetic detection and real-time DMLC adaptation to target rotation during radiotherapy. Int J Radiat Oncol Biol Phys 2011; 82:e545-53. [PMID: 22014957 DOI: 10.1016/j.ijrobp.2011.06.1958] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 05/10/2011] [Accepted: 06/01/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE Intrafraction rotation of more than 45° and 25° has been observed for lung and prostate tumors, respectively. Such rotation is not routinely adapted to during current radiotherapy, which may compromise tumor dose coverage. The aim of the study was to investigate the geometric and dosimetric performance of an electromagnetically guided real-time dynamic multileaf collimator (DMLC) tracking system to adapt to intrafractional tumor rotation. MATERIALS/METHODS Target rotation was provided by changing the treatment couch angle. The target rotation was measured by a research Calypso system integrated with a real-time DMLC tracking system employed on a Varian linac. The geometric beam-target rotational alignment difference was measured using electronic portal images. The dosimetric accuracy was quantified using a two-dimensional ion chamber array. For each beam, the following five delivery modes were tested: 1) nonrotated target (reference); 2) fixed rotated target with tracking; 3) fixed rotated target without tracking; 4) actively rotating target with tracking; and 5) actively rotating target without tracking. Dosimetric performance of the latter four modes was measured and compared to the reference dose distribution using a 3 mm/3% γ-test. RESULTS Geometrically, the beam-target rotational alignment difference was 0.3° ± 0.6° for fixed rotation and 0.3° ± 1.3° for active rotation. Dosimetrically, the average failure rate for the γ-test for a fixed rotated target was 11% with tracking and 36% without tracking. The average failure rate for an actively rotating target was 9% with tracking and 35% without tracking. CONCLUSIONS For the first time, real-time target rotation has been accurately detected and adapted to during radiation delivery via DMLC tracking. The beam-target rotational alignment difference was mostly within 1°. Dose distributions to fixed and actively rotating targets with DMLC tracking were significantly superior to those without tracking.
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Affiliation(s)
- Junqing Wu
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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McJury M, O'Neill A, Lawson M, McGrath C, Grey A, Page W, O'Sullivan JM. Assessing the image quality of pelvic MR images acquired with a flat couch for radiotherapy treatment planning. Br J Radiol 2011; 84:750-5. [PMID: 21750138 DOI: 10.1259/bjr/27295679] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To improve the integration of MRI with radiotherapy treatment planning, our department fabricated a flat couch top for our MR scanner. Setting up using this couch top meant that the patients were physically higher up in the scanner and, posteriorly, a gap was introduced between the patient and radiofrequency coil. METHODS Phantom measurements were performed to assess the quantitative impact on image quality. A phantom was set up with and without the flat couch insert in place, and measurements of image uniformity and signal to noise were made. To assess clinical impact, six patients with pelvic cancer were recruited and scanned on both couch types. The image quality of pairs of scans was assessed by two consultant radiologists. RESULTS The use of the flat couch insert led to a drop in image signal to noise of approximately 14%. Uniformity in the anteroposterior direction was affected the most, with little change in right-to-left and feet-to-head directions. All six patients were successfully scanned on the flat couch, although one patient had to be positioned with their arms by their sides. The image quality scores showed no statistically significant change between scans with and without the flat couch in place. CONCLUSION Although the quantitative performance of the coil is affected by the integration of a flat couch top, there is no discernible deterioration of diagnostic image quality, as assessed by two consultant radiologists. Although the flat couch insert moved patients higher in the bore of the scanner, all patients in the study were successfully scanned.
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Affiliation(s)
- M McJury
- Radiotherapy Physics Department, Northern Ireland Cancer Centre, Belfast, Northern Ireland, UK.
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Vieillot S, Fenoglietto P, Aillères N, Hay MH, Dubois JB, Azria D. Cancer de la prostate. Cancer Radiother 2010; 14 Suppl 1:S161-73. [DOI: 10.1016/s1278-3218(10)70020-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Vieillot S, Fenoglietto P, Ailleres N, Hay MH, Dubois JB, Azria D. Radiothérapie postopératoire du cancer de la prostate. Cancer Radiother 2010; 14 Suppl 1:S174-81. [DOI: 10.1016/s1278-3218(10)70021-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stereographic Targeting in Prostate Radiotherapy: Speed and Precision by Daily Automatic Positioning Corrections Using Kilovoltage/Megavoltage Image Pairs. Int J Radiat Oncol Biol Phys 2008; 71:1074-83. [DOI: 10.1016/j.ijrobp.2007.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 11/16/2007] [Accepted: 11/16/2007] [Indexed: 11/20/2022]
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Abstract
In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential.
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Affiliation(s)
- Clare Tempany
- Department of Radiology, Brigham & Women's Hospital, Boston, MA 02115, USA.
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Boehmer D, Maingon P, Poortmans P, Baron MH, Miralbell R, Remouchamps V, Scrase C, Bossi A, Bolla M. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol 2006; 79:259-69. [PMID: 16797094 DOI: 10.1016/j.radonc.2006.05.012] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 05/15/2006] [Accepted: 05/23/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSES The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. PATIENTS AND METHODS Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. RESULTS Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. CONCLUSIONS On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer.
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Affiliation(s)
- Dirk Boehmer
- Klinik f. Strahlentherapie, Universitätsmedizin Berlin, Charité Campus Mitte, Germany.
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Keros L, Bernier V, Aletti P, Marchesi V, Wolf D, Noel A. Qualitative estimation of pelvic organ interactions and their consequences on prostate motion: Study on a deceased person. Med Phys 2006; 33:1902-10. [PMID: 16872097 DOI: 10.1118/1.2198190] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In an attempt to have better targeting of the prostate during radiotherapy it is necessary to understand the mechanical interactions between bladder, rectum, and prostate and estimate their consequences on prostate motion. For this, the volumes of bladder, rectum, and lungs were modified concomitantly on a deceased person. A CT acquisition was performed for each of these different pelvic configurations (36 acquisitions). An increase in the volume of the bladder or lungs induces a compression of tissues of the pelvic area from its supero-anterior (S-A) to infero-posterior (I-P) side. Conversely, an increase of rectum volume induces a compression from the I-P to the S-A side of the pelvic region. These compressive actions can be added or subtracted from each other, depending on their amplitudes and directions. Prostate motion occurs when a movement of the rectum is observed (this movement depends, itself, on lungs and bladder volume). The maximum movement of prostate is 9 mm considering maximal bladder or rectal action, and 11 mm considering maximum lung action. In some other cases, opposition of compressive effects can lead to stasis of the prostate. Based on the volumes of bladder, rectum, and lungs, it is possible to qualitatively estimate the movement of organs of the pelvic area. The best way to reduce prostate movement is to recommend the patient to have an empty rectum, with either full bladder and/or full lungs.
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Affiliation(s)
- Laurent Keros
- Département de physique Médicale, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
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Byrne TE. A review of prostate motion with considerations for the treatment of prostate cancer. Med Dosim 2005; 30:155-61. [PMID: 16112467 DOI: 10.1016/j.meddos.2005.03.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 03/30/2005] [Indexed: 11/19/2022]
Abstract
The motion of the prostate gland can influence the efficacy of radiation therapy. This article examines the literature concerning prostate gland motion with considerations for the treatment of cancer. The objectives of this review include providing radiation oncologists, medical physicists, and dosimetrists with data to assist in determining the best treatment adaptation for individual patients. The prostate gland is not a static structure, but rather a dynamic structure and this should be a consideration in the treatment protocol. The treatment planning personnel must add a margin to the clinical treatment volume (CTV) radiation field to account for prostate motion and patient setup errors resulting in a planning treatment volume (PTV). The movement of the prostate in a radiation field with a small margin to protect the anterior rectum may allow the posterior aspect of the gland to escape the prescribed dose. Thus, an understanding of potential prostate movements in radiation therapy is critical to achieve tumor control and minimize radiation complications in patients.
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Affiliation(s)
- Thomas E Byrne
- Department of Radiation Oncology, Thompson Cancer Survival Center, Knoxville, TN 37916, USA
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