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Open Access 01-12-2012 | Research

Analysis of inter-fraction setup errors and organ motion by daily kilovoltage cone beam computed tomography in intensity modulated radiotherapy of prostate cancer

Authors: Marcella Palombarini, Stefano Mengoli, Paola Fantazzini, Cecilia Cadioli, Claudio Degli Esposti, Giovanni Piero Frezza

Published in: Radiation Oncology | Issue 1/2012

Abstract

Background

Intensity-modulated radiotherapy (IMRT) enables a better conformality to the target while sparing the surrounding normal tissues and potentially allows to increase the dose to the target, if this is precisely and accurately determined. The goal of this work is to determine inter-fraction setup errors and prostate motion in IMRT for localized prostate cancer, guided by daily kilovoltage cone beam computed tomography (kVCBCT).

Methods

Systematic and random components of the shifts were retrospectively evaluated by comparing two matching modalities (automatic bone and manual soft-tissue) between each of the 641 daily kVCBCTs (18 patients) and the planning kVCT. A simulated Adaptive Radiation Therapy (ART) protocol using the average of the first 5 kVCBCTs was tested by non-parametric bootstrapping procedure.

Results

Shifts were < 1 mm in left-right (LR) and in supero-inferior (SI) direction. In antero-posterior (AP) direction systematic prostate motion (2.7 ± 0.7 mm) gave the major contribution to the variability of results; the averages of the absolute total shifts were significantly larger in anterior (6.3 ± 0.2 mm) than in posterior (3.9 mm ± 0.2 mm) direction. The ART protocol would reduce margins in LR, SI and anterior but not in posterior direction.

Conclusions

The online soft-tissue correction based on daily kVCBCT during IMRT of prostate cancer is fast and efficient. The large random movements of prostate respect to bony anatomy, especially in the AP direction, where anisotropic margins are needed, suggest that daily kVCBCT is at the present time preferable for high dose and high gradients IMRT prostate treatments.

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Zelefsky MJ, Chan H, Hunt M, Yamada Y, Shippy AM, Amols H: Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol 2006, 176: 1415-1419. 10.1016/j.juro.2006.06.002CrossRefPubMed

Jereczek-Fossa BA, Orecchia R: Evidence-based radiation oncology: definitive, adjuvant and salvage radiotherapy for non-metastatic prostate cancer. Radiother Oncol 2007, 84: 194-215.CrossRef

Guckenberger M, Pohl F, Baier K, Meyer J, Vordermark D, Flentje M: Adverse effect of a distended rectum in intensity-modulated radiotherapy (IMRT) treatment planning of prostate cancer. Radiother Oncol 2006, 79: 59-63. 10.1016/j.radonc.2006.03.004CrossRefPubMed

Pinkawa M, Siluschek J, Gagel B, Demirel C, Asadpour B, Holy R, Eble MJ: Influence of the initial rectal distension on posterior margins in primary and postoperative radiotherapy for prostate cancer. Radiother Oncol 2006, 81: 284-290. 10.1016/j.radonc.2006.10.028CrossRefPubMed

Jaffray DA, Siewerdsen JH: Cone-beam computed tomography with flat-panel imager: initial performance characterization. Med Phys 2000, 27: 1311-1323. 10.1118/1.599009CrossRefPubMed

Ding GX, Duggan DM, Coffey CW: Accurate patient dosimetry of kilovoltage cone-beam CT in radiation therapy. Med Phys 2008, 35: 1135-1144. 10.1118/1.2839096CrossRefPubMed

Crook JM, Raymond Y, Salhani D, Yang H, Esche B: Prostate motion during standard radiotherapy as assessed by fiducial markers. Radiother Oncol 1995, 37: 35-42. 10.1016/0167-8140(95)01613-LCrossRefPubMed

Reddy NMS, Nori D, Sartin W, Maiorano S, Modena J, Mazur A, Osian A, Sood B, Ravi A, Sampath S, Lange CS: Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image-guided IMRT. Med Phys 2009, 36: 5604-5611. 10.1118/1.3260840CrossRefPubMed

Perks J, Turnbull H, Liu T, Purdy J, Valicenti R: Vector analysis of prostate patient setup with image-guided radiation therapy via kV cone beam computed tomography. Int J Radiat Oncol Biol Phys 2011, 79: 915-919. 10.1016/j.ijrobp.2010.04.008CrossRefPubMed

10.

Bylund KC, Bayouth JE, Smith MC, Hass AC, Bhatia SK, Buatti JM: Analysis of interfraction prostate motion using megavoltage cone beam computed tomography. Int J Radiat Oncol Biol Phys 2008, 72: 949-956. 10.1016/j.ijrobp.2008.07.002CrossRefPubMed

11.

Fiorino C, Di Muzio N, Broggi S, Cozzarini C, Maggiulli E, Alongi F, Valdagni R, Fazio F, Calandrino R: Evidence of limited motion of the prostate by carefully empting the rectum as assessed by daily MVCT image guidance with helical tomotherapy. Int J Radiat Oncol Biol Phys 2008, 71: 611-617. 10.1016/j.ijrobp.2008.01.048CrossRefPubMed

12.

Shah AP, Kupelian PA, Willoughby TR, Langen KM, Meeks SL: An evaluation of intrafraction motion of the prostate in the prone and supine positions using electromagnetic tracking. Radiother Oncol 2011, 99: 37-43. 10.1016/j.radonc.2011.02.012CrossRefPubMed

13.

Crawford ED: Use of algorithms as determinants for individual patient decision making: National Comprehensive Cancer Network versus artificial neural networks. Urology 2003, 62: 13-19. 10.1016/j.urology.2003.10.008CrossRefPubMed

14.

Borgefors G: Hierarchical chamfer matching: a parametric edge matching algorithm. IEEE Transactions Pattern Analysis and Machine Intelligency 1998,10(6):849-865.CrossRef

15.

Shapiro SS, Wilk MB: An analysis of variance test for normality (complete samples). Biometrika 1965,52(3-4):591-611. 10.1093/biomet/52.3-4.591CrossRef

16.

Efron B: Bootstrap methods: another look to the Jackknife. Ann Statist 1979, 7: 1-26. 10.1214/aos/1176344552CrossRef

17.

Stasi M, Munoz F, Fiorino C, Pasquino M, Baiotto B, Marini P, Malinverni G, Valdagni R, Gabriele P: Emptying the rectum before treatment delivery limits the variations of rectal dose-volume parameters during 3D-CRT of prostate cancer. Radiother Oncol 2006, 80: 363-370. 10.1016/j.radonc.2006.08.007CrossRefPubMed

18.

Wang CW, Chong FC, Lai MK, Pu YS, Wu JK, Cheng JC: Set-up errors due to endorectal balloon positioning in intensity modulated radiation therapy for prostate cancer. Radiother Oncol 2007, 84: 177-184. 10.1016/j.radonc.2007.06.009CrossRefPubMed

19.

Hoogeman MS, van Herk M, de Bois J, Lebesque JV: Strategies to reduce the systematic error due to tumor and rectum motion in radiotherapy of prostate cancer. Radiother Oncol 2005, 74: 177-185. 10.1016/j.radonc.2004.12.010CrossRefPubMed

20.

Baum C, Birkner M, Alber M, Paulsen F, Nüsslin F: Dosimetric consequences of the application of off-line setup error correction protocols and a hull-volume definition strategy for intensity modulated radiotherapy of prostate cancer. Radiother Oncol 2005, 76: 35-42.CrossRefPubMed

21.

Nijkamp J, Pos FJ, Nuver TT, de Jong R, Remeijer P, Sonke JJ, Lebesque JV: Adaptive radiotherapy for prostate cancer using kilovoltage cone-beam computed tomography: first clinical results. Int J Radiat Oncol Biol Phys 2008, 70: 75-82. 10.1016/j.ijrobp.2007.05.046CrossRefPubMed

Title: Analysis of inter-fraction setup errors and organ motion by daily kilovoltage cone beam computed tomography in intensity modulated radiotherapy of prostate cancer
Authors: Marcella Palombarini
Stefano Mengoli
Paola Fantazzini
Cecilia Cadioli
Claudio Degli Esposti
Giovanni Piero Frezza
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-56

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of inter-fraction setup errors and organ motion by daily kilovoltage cone beam computed tomography in intensity modulated radiotherapy of prostate cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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