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Strahlentherapie und Onkologie

Published in:

01-07-2018 | Original Article

Shorter treatment times reduce the impact of intra-fractional motion

A real-time 4DUS study comparing VMAT vs. step-and-shoot IMRT for prostate cancer

Authors: Hendrik Ballhausen, Minglun Li, Ute Ganswindt, Claus Belka

Published in: Strahlentherapie und Onkologie | Issue 7/2018

Abstract

Purpose

To evaluate the impact of shorter treatment times on intra-fractional motion of the prostate during external beam radiotherapy.

Methods

53 h of intra-fractional motion of the prostate were recorded in real-time by 4D ultrasound (4DUS) during 720 fractions in 28 patients, 14 of which whom treated with step-and-shoot intensity-modulated radiotherapy (IMRT) and 14 of whom were treated with volumetric arc therapy (VMAT).

Results

The average VMAT fraction was recorded for 2 min 43 s and was substantially shorter than the average step-and-shoot IMRT fraction at 6 min 13 s. Average radial displacement of the prostate per fraction was substantially and significantly reduced from 1.31 ± 1.28 mm (n = 357 step-and-shoot IMRT fractions) to 0.96 ± 1.04 mm (n = 363 VMAT fractions), p = 0.00004. Radial, vertical, and longitudinal root-mean-square (r. m. s.) error per fraction was reduced from 1.55 to 1.12 mm (−28%, p < 0.0001), from 1.16 to 0.77 mm (−34%, p < 0.0001), and from 0.79 to 0.56 mm (−29%, p = 0.0002), respectively. Lateral intra-fractional motion was generally small and did not differ significantly. The prostate remained during 95% of fraction time within 4.55 mm of the isocenter in case of step-and-shoot IMRT and within 2.45 mm in case of VMAT. The variance of displacements increased linearly with time, and the rate was the same for both step-and-shoot IMRT and VMAT patients.

Conclusions

The position of the prostate changed less during shorter fractions, limiting fraction-average and end-of-fraction variance. This substantially and significantly reduced the impact of intra-fractional motion during shorter VMAT fractions as compared to longer step-and-shoot IMRT fractions.

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Title: Shorter treatment times reduce the impact of intra-fractional motion
A real-time 4DUS study comparing VMAT vs. step-and-shoot IMRT for prostate cancer
Authors: Hendrik Ballhausen
Minglun Li
Ute Ganswindt
Claus Belka
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 7/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1286-2

At a glance: The STEP trials

Springer Medicine

Shorter treatment times reduce the impact of intra-fractional motion

A real-time 4DUS study comparing VMAT vs. step-and-shoot IMRT for prostate cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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