Top

Published in:

01-09-2017 | Original Article

Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy

Comparison of gold marker-based registrations with native MVCT

Authors: Peter Wust, MD, Marc Joswig, MD, Reinhold Graf, MD, Dirk Böhmer, MD, Marcus Beck, Thomasz Barelkowski, Volker Budach, MD, Pirus Ghadjar, MD

Published in: Strahlentherapie und Onkologie | Issue 9/2017

Abstract

Introduction

For high-dose radiation therapy (RT) of prostate cancer, image-guided (IGRT) and intensity-modulated RT (IMRT) approaches are standard. Less is known regarding comparisons of different IGRT techniques and the resulting residual errors, as well as regarding their influences on dose distributions.

Patients and methods

A total of 58 patients who received tomotherapy-based RT up to 84 Gy for high-risk prostate cancer underwent IGRT based either on daily megavoltage CT (MVCT) alone (n = 43) or the additional use of gold markers (n = 15) under routine conditions. Planned Adaptive (Accuray Inc., Madison, WI, USA) software was used for elaborated offline analysis to quantify residual interfractional prostate positioning errors, along with systematic and random errors and the resulting safety margins after both IGRT approaches. Dosimetric parameters for clinical target volume (CTV) coverage and exposition of organs at risk (OAR) were also analyzed and compared. Interfractional as well as intrafractional displacements were determined.

Results

Particularly in the vertical direction, residual interfractional positioning errors were reduced using the gold marker-based approach, but dosimetric differences were moderate and the clinical relevance relatively small. Intrafractional prostate motion proved to be quite high, with displacements of 1–3 mm; however, these did not result in additional dosimetric impairments.

Conclusion

Residual interfractional positioning errors were reduced using gold marker-based IGRT; however, this resulted in only slightly different final dose distributions. Therefore, daily MVCT-based IGRT without markers might be a valid alternative.

Viani GA, Stefano EJ, Afonso SL (2009) Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 74(5):1405–1418CrossRefPubMed

Zietman AL, DeSilvio ML, Slater JD, Rossi CJ, Miller DW, Adams JA, Shipley WU (2005) Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 294(10):1233–1239CrossRefPubMed

Frenzel T, Kruell A (2015) The use of IMRT in Germany. Strahlenther Onkol 191(11):821–826CrossRefPubMed

Ghadjar P, Gwerder N, Manser P, Vock J, Madlung A, Mini R, Aebersold DM (2010) High-dose (80 Gy) intensity-modulated radiation therapy with daily image-guidance as primary treatment for localized prostate cancer. Strahlenther Onkol 186(12):687–692CrossRefPubMed

Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X, Carver B, Coleman J, Lovelock M, Hunt M (2012) Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Physics 84(1):125–129CrossRef

Kupelian PA, Langen KM, Willoughby TR, Zeidan OA, Meeks SL (2008) Image-guided radiotherapy for localized prostate cancer: treating a moving target. Semin Radiat Oncol 18(1):58–66CrossRefPubMed

Ghadjar P, Gwerder N, Madlung A, Behrensmeier F, Thalmann GN, Mini R, Aebersold DM (2009) Use of gold markers for setup in image-guided fractionated high-dose-rate brachytherapy as a monotherapy for prostate cancer. Strahlenther Onkol 185(11):731–735CrossRefPubMed

Rudat V, Nour A, Hammoud M, Alaradi A, Mohammed A (2016) Image-guided intensity-modulated radiotherapy of prostate cancer. Strahlenther Onkol 192(2):109–117CrossRefPubMed

Drozdz S, Schwedas M, Salz H, Foller S, Wendt TG (2016) Prostate cancer treated with image-guided helical TomoTherapy® and image-guided LINAC-IMRT. Strahlenther Onkol 192(4):223–231CrossRefPubMed

10.

Graf R, Boehmer D, Nadobny J, Budach V, Wust P (2012) Appropriate patient instructions can reduce prostate motion. Radiat Oncol 7(1):1CrossRef

11.

Van Herk M (2004) Errors and margins in radiotherapy. Semin Radiat Oncol 14(1):52–64CrossRefPubMed

12.

Moseley DJ, White EA, Wiltshire KL, Rosewall T, Sharpe MB, Siewerdsen JH, Bissonnette JP, Gospodarowicz M, Warde P, Catton CN, Jaffray DA (2007) Comparison of localization performance with implanted fiducial markers and cone-beam computed tomography for on-line image-guided radiotherapy of the prostate. International Journal of Radiation Oncology* Biology. Physics (College Park Md) 67(3):942–953

13.

Mayyas E, Chetty IJ, Chetvertkov M, Wen N, Neicu T, Nurushev T, Ren L, Lu M, Stricker H, Pradhan D, Movsas B (2013) Evaluation of multiple image-based modalities for image-guided radiation therapy (IGRT) of prostate carcinoma: a prospective study. Med Phys 40(4):041707CrossRefPubMed

14.

ICRU (2010) Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). J ICRU 10(1):83

15.

Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 70(2):301–311CrossRefPubMed

16.

Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Burman CM, Hunt M, Wolfe T, Venkatraman ES, Jackson A, Skwarchuk M (2000) Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 55(3):241–249CrossRefPubMed

17.

Alicikus ZA, Yamada Y, Zhang Z, Pei X, Hunt M, Kollmeier M, Cox B, Zelefsky MJ (2011) Ten-year outcomes of high-dose, intensity‐modulated radiotherapy for localized prostate cancer. Cancer 117(7):1429–1437CrossRefPubMed

18.

Bortfeld T, Webb S (2008) Single-arc IMRT? Phys Med Biol 54(1):N9CrossRefPubMed

19.

Li JS, Lin MH, Buyyounouski MK, Horwitz EM, Ma CM (2013) Reduction of prostate intrafractional motion from shortening the treatment time. Phys Med Biol 58(14):4921–4932CrossRefPubMedPubMedCentral

20.

Cramer AK, Haile AG, Ognjenovic S, Doshi TS, Reilly WM, Rubinstein KE, Nabavizadeh N, Nguyen T, Meng LZ, Fuss M, Tanyi JA (2013) Real-time prostate motion assessment: image-guidance and the temporal dependence of intra-fraction motion. BMC Med Physics 13(1):1CrossRef

21.

Langen KM, Lu W, Willoughby TR, Chauhan B, Meeks SL, Kupelian PA, Olivera G (2009) Dosimetric effect of prostate motion during helical tomotherapy. Int J Radiat Oncol Biol Physics 74(4):1134–1142CrossRef

22.

Adamson J, Wu Q, Yan D (2011) Dosimetric effect of intrafraction motion and residual setup error for hypofractionated prostate intensity-modulated radiotherapy with online cone beam computed tomography image guidance. Int J Radiat Oncol Biol Physics 80(2):453–461CrossRef

23.

Ghilezan MJ, Jaffray DA, Siewerdsen JH, Van Herk M, Shetty A, Sharpe MB, Jafri SZ, Vicini FA, Matter RC, Brabbins DS, Martinez AA (2005) Prostate gland motion assessed with cine-magnetic resonance imaging (cine-MRI). Int J Radiat Oncol Biol Physics 62(2):406–417CrossRef

24.

Nijkamp J, Pos FJ, Nuver TT, De Jong R, Remeijer P, Sonke JJ, Lebesque JV (2008) Adaptive radiotherapy for prostate cancer using kilovoltage cone-beam computed tomography: first clinical results. Int J Radiat Oncol Biol Physics 70(1):75–82CrossRef

25.

Engels B, Soete G, Verellen D, Storme G (2009) Conformal arc radiotherapy for prostate cancer: increased biochemical failure in patients with distended rectum on the planning computed tomogram despite image guidance by implanted markers. Int J Radiat Oncol Biol Physics 74(2):388–391CrossRef

26.

Engels B, Soete G, Gevaert T, Storme G, Michielsen D, De Ridder M (2014) Impact of planning target volume margins and rectal distention on biochemical failure in image-guided radiotherapy of prostate cancer. Radiother Oncol 111(1):106–109CrossRefPubMed

Title: Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy
Comparison of gold marker-based registrations with native MVCT
Authors: Peter Wust, MD
Marc Joswig, MD
Reinhold Graf, MD
Dirk Böhmer, MD
Marcus Beck
Thomasz Barelkowski
Volker Budach, MD
Pirus Ghadjar, MD
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 9/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1141-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy

Comparison of gold marker-based registrations with native MVCT

Abstract

Introduction

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2017

Radiotherapie verstärkt Wirkung von PD-1-Checkpoint-Inhibitoren

Hyperfractionated accelerated radiation therapy plus cetuximab plus cisplatin chemotherapy in locally advanced inoperable squamous cell carcinoma of the head and neck

Defining biochemical recurrence after radical prostatectomy and timing of early salvage radiotherapy

125I brachytherapy in younger prostate cancer patients

Optimales Fraktionierungsschema und Zeitintervall zwischen Radiotherapie und Operation beim Rektumkarzinom

Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy