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Sanei M, Ghaffari H, Ardekani MA, Mahdavi SR, Mofid B, Abdollahi H, Rostami A. Effectiveness of rectal displacement devices during prostate external-beam radiation therapy: A review. J Cancer Res Ther 2021; 17:303-310. [PMID: 34121672 DOI: 10.4103/jcrt.jcrt_841_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Dose-escalated prostate radiotherapy (RT) can improve treatment outcomes, but rectal toxicity is the main limiting factor for introducing dose-escalated RT. Pushing rectal wall away from the prostate reduces the volume of the rectum in high-dose region, which can decrease both short- and long-term rectal toxicities after RT. This review focuses on the literature using different rectal displacement devices such as endorectal balloons, tissue spacers, rectal retractor, and ProSpare during prostate External beam radiotherapy, with regard to dosimetric effects, clinical benefits, prostate motion, and postoperative RT setting.
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Affiliation(s)
- Mastaneh Sanei
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghaffari
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Afkhami Ardekani
- Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Radiologic Sciences and Medical Physics, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Aram Rostami
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences; Department of Medical Physics, Roshana Cancer Institute, Tehran, Iran
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Böckelmann F, Putz F, Kallis K, Lettmaier S, Fietkau R, Bert C. Adaptive radiotherapy and the dosimetric impact of inter- and intrafractional motion on the planning target volume for prostate cancer patients. Strahlenther Onkol 2020; 196:647-656. [PMID: 32157345 PMCID: PMC7305089 DOI: 10.1007/s00066-020-01596-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/03/2020] [Indexed: 12/25/2022]
Abstract
Purpose To investigate the dosimetric influence of daily interfractional (inter) setup errors and intrafractional (intra) target motion on the planning target volume (PTV) and the possibility of an offline adaptive radiotherapy (ART) method to correct larger patient positioning uncertainties in image-guided radiotherapy for prostate cancer (PCa). Materials and methods A CTV (clinical target volume)-to-PTV margin ranging from 15 mm in LR (left-right) and SI (superior-inferior) and 5–10 mm in AP (anterior-posterior) direction was applied to all patients. The dosimetric influence of this margin was retrospectively calculated by analysing systematic and random components of inter and intra errors of 31 consecutive intermediate- and high-risk localized PCa patients using daily cone beam computed tomography and kV/kV (kilo-Voltage) imaging. For each patient inter variation was assessed by observing the first 4 treatment days, which led to an offline ART-based treatment plan in case of larger variations. Results: Systematic inter uncertainties were larger (1.12 in LR, 2.28 in SI and 1.48 mm in AP) than intra systematic errors (0.44 in LR, 0.69 in SI and 0.80 mm in AP). Same findings for the random error in SI direction with 3.19 (inter) and 2.30 mm (intra), whereas in LR and AP results were alike with 1.89 (inter) and 1.91 mm (intra) and 2.10 (inter) and 2.27 mm (intra), respectively. The calculated margin revealed dimensions of 4–5 mm in LR, 8–9 mm in SI and 6–7 mm in AP direction. Treatment plans which had to be adapted showed smaller variations with 1.12 (LR) and 1.72 mm (SI) for Σ and 4.17 (LR) and 3.75 mm (SI) for σ compared to initial plans with 1.77 and 2.62 mm for Σ and 4.46 and 5.39 mm for σ in LR and SI, respectively. Conclusion The currently clinically used margin of 15 mm in LR and SI and 5–10 mm in AP direction includes inter and intra uncertainties. The results show that offline ART is feasible which becomes a necessity with further reductions in PTV margins. Electronic supplementary material The online version of this article (10.1007/s00066-020-01596-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Böckelmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Karoline Kallis
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
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Sterckx B, Steinseifer I, Wendling M. In vivo dosimetry with an electronic portal imaging device for prostate cancer radiotherapy with an endorectal balloon. Phys Imaging Radiat Oncol 2019; 12:7-9. [PMID: 33458288 PMCID: PMC7807678 DOI: 10.1016/j.phro.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
Electronic portal imaging device-based in vivo dosimetry with a commercial product was performed for 10 prostate cancer patients treated with an air-filled endorectal balloon. With the conventional in vivo method the verification results were outside of our clinical acceptance criteria for all patients. The in aqua vivo method, originally developed for lung cancer treatments, proved to be a practical solution to this problem. On average the percentage of points within γ agreement of 3% and 3 mm significantly improved from 90.9% ± 2.5% (1SD) for the conventional in vivo method to 99.0% ± 1.0% (1SD) for the in aqua vivo method.
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Affiliation(s)
- Bo Sterckx
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - Isabell Steinseifer
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - Markus Wendling
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
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Dubouloz A, Rouzaud M, Tsvang L, Verbakel W, Björkqvist M, Linthout N, Lencart J, Pérez-Moreno JM, Ozen Z, Escude L, Zilli T, Miralbell R. Urethra-sparing stereotactic body radiotherapy for prostate cancer: how much can the rectal wall dose be reduced with or without an endorectal balloon? Radiat Oncol 2018; 13:114. [PMID: 29921291 PMCID: PMC6008922 DOI: 10.1186/s13014-018-1059-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background This is a dosimetric comparative study intended to establish appropriate low-to-intermediate dose-constraints for the rectal wall (Rwall) in the context of a randomized phase-II trial on urethra-sparing stereotactic body radiotherapy (SBRT) for prostate cancer. The effect of plan optimization on low-to-intermediate Rwall dose and the potential benefit of an endorectal balloon (ERB) are investigated. Methods Ten prostate cancer patients, simulated with and without an ERB, were planned to receive 36.25Gy (7.25Gyx5) to the planning treatment volume (PTV) and 32.5Gy to the urethral planning risk volume (uPRV). Reference plans with and without the ERB, optimized with respect to PTV and uPRV coverage objectives and the organs at risk dose constraints, were further optimized using a standardized stepwise approach to push down dose constraints to the Rwall in the low to intermediate range in five sequential steps to obtain paired plans with and without ERB (Vm1 to Vm5). Homogeneity index for the PTV and the uPRV, and the Dice similarity coefficient (DSC) for the PTV were analyzed. Dosimetric parameters for Rwall including the median dose and the dose received by 10 to 60% of the Rwall, bladder wall (Bwall) and femoral heads (FHeads) were compared. The monitor units (MU) per plan were recorded. Results Vm4 reduced by half D30%, D40%, D50%, and Dmed for Rwall and decreased by a third D60% while HIPTV, HIuPRV and DSC remained stable with and without ERB compared to Vmref. HIPTV worsened at Vm5 both with and without ERB. No statistical differences were observed between paired plans on Rwall, Bwall except a higher D2% for Fheads with and without an ERB. Conclusions Further optimization to the Rwall in the context of urethra sparing prostate SBRT is feasible without compromising the dose homogeneity to the target. Independent of the use or not of an ERB, low-to-intermediate doses to the Rwall can be significantly reduced using a four-step sequential optimization approach.
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Affiliation(s)
- Angèle Dubouloz
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland. .,Radiation Oncology Department, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
| | - Michel Rouzaud
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Lev Tsvang
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel
| | - Wilko Verbakel
- Department of Radiation Oncology, VU medical center, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Mikko Björkqvist
- Department of Oncology and Radiotherapy, Turku University Hospital, PO Box 52, 20521, Turku, Finland.,Department of Medical Physics, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Nadine Linthout
- Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
| | - Joana Lencart
- Serviço de Radioterapia Externa, Instituto Portugues de Oncologia, Rua Dr Antonio Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Juan María Pérez-Moreno
- Servicio de Oncología Radioterápica, Centro Integral Oncológico "Clara Campal", Hospital Universitario Madrid Sanchinarro, C/ Oña 10, 28050, Madrid, Spain
| | - Zeynep Ozen
- Neolife Medical Center, Nisbetiye Mah. Yucel Sokak, No: 6 Besiktas, 34340, Istanbul, Turkey
| | - Lluís Escude
- Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
| | - Thomas Zilli
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Raymond Miralbell
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
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Streller T, Rusch U, Herraiz Lablanca MD, Minneken I, Najafi Y, Shrestha B, Oertel S, Riesterer O. The effect of endorectal balloon on anorectal dose during postoperative volumetric arc radiotherapy of prostate cancer. Radiother Oncol 2017; 123:454-8. [PMID: 28464996 DOI: 10.1016/j.radonc.2017.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the impact of endorectal balloon (ERB) on anorectal dose during postoperative VMAT of prostate cancer. METHODS In ten patients referred for salvage radiotherapy CTs were obtained without ERB and with air-filled ERB of 50ml and 100ml. CTs were repeated weekly (4-6 control CTs) and registered to the respective planning CT. For each planning CT, a VMAT plan was made with defined anorectal dose constraints and propagated on the respective control CTs. The dose volumes V40Gy, V60Gy and V65Gy of the rectal and anal wall (Rwall and Awall, respectively) and the ERB position were obtained from each plan. RESULTS In plans with ERB, the mean Rwall dose volumes V40Gy, V60Gy and V65Gy were higher by 8%, 5% and 2% (ERB 50ml) and 2%, 3% and 3% (ERB 100ml) in comparison to plans without ERB. The respective Awall dose volume differences were 2%, 0%, -1% (ERB 50ml), and -3%, -2%, -2% (ERB 100ml). The dose volume variability of the Rwall was comparable with and without ERB, but was slightly reduced by ERB for the Awall. The mean ERB position variability was >2mm in anterior-posterior and inferior-superior directions. CONCLUSION The use of ERB during post-operative VMAT has no advantages for anorectal dose.
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Jeang EH, Min S, Cho KH, Hwang UJ, Choi SH, Kwak J, Jeong JH, Kim H, Lee SB, Shin D, Park J, Kim JY, Kim DY, Lim YK. Two-dimensional in vivo rectal dosimetry using an endorectal balloon with unfoldable radiochromic film during prostate cancer radiotherapy. Radiother Oncol 2016; 120:327-32. [PMID: 27222297 DOI: 10.1016/j.radonc.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The present study aims to investigate the feasibility of two-dimensional (2D) in vivo rectal dosimetry using an endorectal balloon for the radiotherapy of prostate cancer. MATERIALS AND METHODS The endorectal balloon was equipped with an unfoldable radiochromic film. The film was unrolled as the balloon was inflated, and rolled as it was deflated. Its mechanical and imaging properties were tested, and the dosimetric effectiveness was evaluated in clinical photon and proton beams. RESULTS The size of the endorectal balloon including the film was linearly proportional to the volume of water filled in the balloon, and its position could be identified by X-ray radiography. The loss of dose information due to film cutting was within ±1mm from the cutting line. Applying linear interpolation on cut film, the gamma passing rate was more than 95% for 2%/2mm criteria. The measured dose profiles agreed with the plan within 3% and 4% for the photon and proton beams, respectively. A dose-volume histogram of the anterior rectal wall could be obtained from the measured dose distribution in the balloon, which also agreed well with the plan. CONCLUSIONS 2D in vivo rectal dosimetry is feasible using the endorectal balloon with a radiochromic film in the radiotherapy of prostate cancer.
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Affiliation(s)
- Eun Hee Jeang
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Soonki Min
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Kwan Ho Cho
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Ui-Jung Hwang
- Department of Radiation Oncology, National Medical Center, Seoul, Republic of Korea
| | - Sang Hyoun Choi
- Department of Radiation Oncology, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Hwi Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Haksoo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Se Byeong Lee
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Dongho Shin
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Jeonghoon Park
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Dae Yong Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea.
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Wang KK, Vapiwala N, Bui V, Deville C, Plastaras JP, Bar-Ad V, Tochner Z, Both S. The impact of stool and gas volume on intrafraction prostate motion in patients undergoing radiotherapy with daily endorectal balloon. Radiother Oncol 2014; 112:89-94. [PMID: 25023042 DOI: 10.1016/j.radonc.2014.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 04/24/2014] [Accepted: 05/31/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to quantify the impact of rectal stool/gas volumes on intrafraction prostate motion for patients undergoing prostate radiotherapy with daily endorectal balloon (ERB). METHODS Total and anterior stool/gas rectal volumes were quantified in 30 patients treated with daily ERB. Real-time intrafraction prostate motion from 494 treatment sessions, at most 6 min in length, was evaluated using Calypso(®) tracking system. RESULTS The deviation of prostate intrafraction motion distribution was a function of stool/gas volume, especially when stool/gas is located in the anterior part of the rectum. Compared to patients with small anterior stool/gas volumes (<10 cm(3)), those with large volume (10-60 cm(3)) had a twofold increase in 3D prostate motion and interquartile data range within the 6th minute of treatment time. The 10% of the overall CBCT session where large anterior rectal volumes were observed demonstrated larger percentage of time at displacement greater than our proposed internal margin 3 mm. CONCLUSION Volume and location of stool/gas can directly impact the ERB's intrafraction immobilization ability. Although our patient preparation protocol and the 100 cm(3) daily ERB effectively stabilized prostate motion for 90% of the fractions, a larger-sized ERB may improve prostate fixation for patients with greater and/or variable daily rectal volume.
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Jameson MG, De Leon J, Windsor AA, Cloak K, Keats S, Dowling JA, Chandra SS, Vial P, Sidhom M, Holloway L, Metcalfe P. Endorectal balloons in the post prostatectomy setting: do gains in stability lead to more predictable dosimetry? Radiother Oncol 2013; 109:493-7. [PMID: 24044793 DOI: 10.1016/j.radonc.2013.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To perform a comparative study assessing potential benefits of endorectal-balloons (ERB) in post-prostatectomy patients. METHOD AND MATERIALS Ten retrospective post-prostatectomy patients treated without ERB and ten prospective patients treated with the ERB in situ were recruited. All patients received IMRT and IGRT using kilovoltage cone-beam computed tomography (kVCBCT). kVCBCT datasets were registered to the planning dataset, recontoured and the original plan recalculated on the kVCBCTs to recreate anatomical conditions during treatment. The imaging, structure and dose data were imported into in-house software for the assessment of geometric variation and cumulative equivalent uniform dose (EUD) in the two groups. RESULTS The difference in location (ΔCOV) for the bladder between planning and each CBCT was similar for each group. The range of mean ΔCOV for the rectum was 0.15-0.58 cm and 0.15-0.59 cm for the non-ERB and ERB groups. For superior-CTV and inferior-CTV the difference between planned and delivered D95% (mean ± SD) for the non-ERB group was 2.1 ± 6.0 Gy and -0.04 ± 0.20 Gy. While for the ERB group the difference in D95% was 8.7 ± 12.6 Gy and 0.003 ± 0.104 Gy. CONCLUSIONS The use of ERBs in the post-prostatectomy setting did improve geometric reproducibility of the target and surrounding normal tissues, however no improvement in dosimetric stability was observed for the margins employed.
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Affiliation(s)
- Michael G Jameson
- Liverpool and Macarthur Cancer Therapy Centres, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia; Ingham Institute, Australia.
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