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Grierson E, Wilkinson D, Causer L, de Leon J. Evaluating the geometric and dosimetric impact of applying anisotropic CTV to PTV margins in image-guided post-prostatectomy radiation therapy. J Med Imaging Radiat Oncol 2023; 67:796-805. [PMID: 37454334 DOI: 10.1111/1754-9485.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Guidelines for clinical target volume (CTV) to planning target volume (PTV) margins in post-prostatectomy radiation therapy (PPRT) are varied and often not clearly defined. Assessment of appropriateness of margins is commonly measured on prevalence of geographic miss. METHODS Cone-beam CT (CBCT) images (n = 92) for 10 PPRT patients were incorporated to provide on-treatment information on the appropriateness of six different CTV expansion margins in terms of geographic miss and change in dose-volume statistics for CTV, rectum and bladder. Uniform margins included 10 mm, 5 mm, 10 mm + 5 mm posteriorly and 5 mm + 3 mm posteriorly. In addition, two anisotropic margins were evaluated by separating the superior and inferior portions of the CTV before expansion. Treatment plans were created for each PTV retrospectively. RESULTS The frequency of geographic miss was the smallest for the large uniform expansions but resulted in the highest organ-at-risk (OAR) doses. Geographic miss in the smaller uniform and anisotropic PTVs was more prevalent but commonly to a small volume < 1% of CTV. When averaged over all CBCT fractions, V95% dose for all CTV margins remained > 99%. The anisotropic expansions generated smaller irradiated target volumes and consequently saw up to 7.3% reduction in bladder dose when compared with similar uniform expansion margins. CONCLUSION Supplementing the incidence of geographic miss with dosimetric information on target coverage and OAR doses provides more informed assessment of the appropriateness of different CTV expansion margins. Our study extends the evaluation of anisotropic margins for PPRT.
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Affiliation(s)
- Emma Grierson
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - Dean Wilkinson
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lauren Causer
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - Jeremiah de Leon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
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Lim Joon D, Berlangieri A, Harris B, Tacey M, O'Meara R, Pitt B, Viotto A, Brown K, Schneider M, Lawrentschuk N, Sengupta S, Berry C, Jenkins T, Chao M, Wada M, Foroudi F, Khoo V. Exploratory models comparing ethiodized oil-glue and gold fiducials for bladder radiotherapy image-guidance. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 17:77-83. [PMID: 33898783 PMCID: PMC8058020 DOI: 10.1016/j.phro.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Background and purpose Image-guidance with fiducials has been shown to improve pelvic radiotherapy outcome. However, bladder fiducials using ethiodized oil (EO) alone can disperse widely, and gold causes Computed Tomography scan (CT) metal artifacts. The study's purpose was to investigate the ability to deliver EO-tissue glue fiducials and compare them to gold for bladder radiotherapy image guidance. Materials and methods A fluid-filled porcine bladder model was used to assess the ability to cystoscopically inject visible EO glue fiducials into the submucosa. We then transferred the bladders into a porcine pelvis for imaging and compared them to gold fiducials using CT, Cone Beam CT (CBCT), and kilovoltage (KV) planar views. A tissue-equivalent phantom was utilized to analyze the CT number Hounsfield Unit (HU) characteristics and artifacts of the glue and gold fiducials. Percentile ranges and normal tissue voxel percentages of the subsequent CT number voxel histogram from a 2 cm sphere surrounding the fiducial was used to characterize the artifact. Results We successfully delivered all EO glue fiducials into the porcine bladders as discrete fiducials. They were well seen on CT, CBCT, and KV imaging. The glue fiducials had lower CT number values, but less CT number spread of the voxel percentile ranges consistent with the diminished contrast and less artifact than gold. The glue fiducial types had similar CT number characteristics. Conclusion This study has shown that EO glue fiducials can be delivered with online visualization qualities comparable to gold fiducials without metal-related artifacts.
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Affiliation(s)
- Daryl Lim Joon
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.,Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia
| | - Alexandra Berlangieri
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Benjamin Harris
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Mark Tacey
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Rachel O'Meara
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Brent Pitt
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Angela Viotto
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Kerryn Brown
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Michal Schneider
- Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia
| | - Nathan Lawrentschuk
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Shomik Sengupta
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Colleen Berry
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Trish Jenkins
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Michael Chao
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Morikatsu Wada
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Farshad Foroudi
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - Vincent Khoo
- Olivia Newton John Cancer Center, Radiation Oncology, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.,Monash University, Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Wellington Rd, Clayton, Victoria 3800, Australia.,Royal Marsden NHS Foundation Trust, 203 Fulham Rd, Chelsea, London SW3 6JJ, United Kingdom
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Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.Materials and methods:The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.Results:Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.Conclusion:In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.
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Elakshar S, Tsui JMG, Kucharczyk MJ, Tomic N, Fawaz ZS, Bahoric B, Papayanatos J, Chaddad A, Niazi T. Does Interfraction Cone Beam Computed Tomography Improve Target Localization in Prostate Bed Radiotherapy? Technol Cancer Res Treat 2019; 18:1533033819831962. [PMID: 30782085 PMCID: PMC6383090 DOI: 10.1177/1533033819831962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: In this prospective phase II study, we investigated whether cone beam computed
tomography scan was a superior method of image-guided radiotherapy relative to 2D
orthogonal kilovoltage images in the post-radical prostatectomy setting. Methods: A total of 419 treatment fractions were included in this analysis. The shifts required
to align the patient for each treatment were performed using 3D matching between cone
beam computed tomography scans and the corresponding computed tomography images used for
planning. This was compared with the shifts obtained from 2D orthogonal kilovoltage
images, matching with the corresponding digitally reconstructed radiographs. Patients
did not have fiducials inserted to assist with localization. Interfractional changes in
the bladder and rectal volumes were subsequently measured on the cone beam computed
tomography images for each fraction and compared to the shift differences between
orthogonal kilovoltage and cone beam computed tomography scans. The proportion of
treatment fractions with a shift difference exceeding the planning target volume of 7
mm, between orthogonal kilovoltage and cone beam computed tomography scans, was
calculated. Results: The mean vertical, lateral, and longitudinal shifts resulted from 2D match between
orthogonal kilovoltage images and corresponding digitally reconstructed radiographs were
0.353 cm (interquartile range: 0.1-0.5), 0.346 cm (interquartile range: 0.1-0.5), and
0.289 cm (interquartile range: 0.1-0.4), compared to 0.388 cm (interquartile range:
0.1-0.5), 0.342 cm (interquartile range: 0.1-0.5), and 0.291 cm (interquartile range:
0.1-0.4) obtained from 3D match between cone beam computed tomography and planning
computed tomography scan, respectively. Our results show a significant difference
between the kilovoltage and cone beam computed tomography shifts in the
anterior–posterior direction (P = .01). The proportion of treatment
fractions in which the differences in kilovoltage and cone beam computed tomography
shifts between exceeded the 7 mm planning target volume margin was 6%, 2%, and 3% in the
anterior–posterior, lateral, and superior–inferior directions, respectively. Conclusion: We prospectively demonstrated that the daily use of volumetric cone beam computed
tomography for treatment localization in post-radical prostatectomy patients
demonstrated an increased need for a shift in patient position. This suggests that in
post-radical prostatectomy patients the daily cone beam computed tomography imaging
improved localization of the prostate bed and may have prevented a limited number of
geographic misses, compared to daily kilovoltage imaging that was not assisted with
fiducials.
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Affiliation(s)
- Sara Elakshar
- 1 McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | - Nada Tomic
- 4 Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | | | - Ahmad Chaddad
- 2 McGill University Health Centre, Montreal, Quebec, Canada
| | - Tamim Niazi
- 1 McGill University, Jewish General Hospital, Montreal, Quebec, Canada
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Chao M, Ho H, Joon DL, Chan Y, Spencer S, Ng M, Wasiak J, Lawrentschuk N, McMillan K, Sengupta S, Tan A, Koufogiannis G, Cokelek M, Foroudi F, Khong TS, Bolton D. The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy. Radiat Oncol J 2019; 37:43-50. [PMID: 30947480 PMCID: PMC6453813 DOI: 10.3857/roj.2018.00556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. MATERIALS AND METHODS A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. RESULTS No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV70) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. CONCLUSION The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.
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Affiliation(s)
- Michael Chao
- The Austin Hospital, Heidelberg, Australia.,Genesis Cancer Care Victoria, Melbourne, Australia
| | - Huong Ho
- Genesis Cancer Care Victoria, Melbourne, Australia
| | | | - Yee Chan
- The Austin Hospital, Heidelberg, Australia
| | | | - Michael Ng
- Genesis Cancer Care Victoria, Melbourne, Australia
| | | | | | | | | | - Alwin Tan
- The Bays Hospital, Mornington, Australia
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6
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Duncan C, Joon DL, Lawrentschuk N, Jenkins T, Schneider M, Khoo V, Chao M, Lawlor M, O'Meara R, Berry C, Viotto A, Brown K, Wada M, Foroudi F, Sengupta S. Fiducial markers: can the urologist do better? World J Urol 2018; 37:1281-1287. [PMID: 30288597 DOI: 10.1007/s00345-018-2515-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Radiotherapy to the bladder has a risk of toxicity to pelvic structures, which can be reduced by using fiducial markers for targeting. Injectable contrast offers an alternative marker to gold seeds, which may fall out or exacerbate scarring. Combining contrast agents with tissue glue can minimize dispersion through tissue, enhancing its utility. We evaluated combinations of contrast agents and tissue glue using porcine bladder, for feasibility and utility as fiducial markers to aid image-guided radiotherapy. METHODS Different contrast agents (Lipiodol ultra or Urografin) were combined with different tissue glues (Histoacryl, Tisseal or Glubran2). The mixtures were endoscopically injected into porcine bladder submucosa to identify the area of interest with multiple fiducial markers. The porcine bladders were imaged within a phantom porcine pelvis using standard radiation therapy imaging modalities. The feasibility as an injectable fiducial marker and visibility of each fiducial marker on imaging were scored as binary outcomes by two proceduralists and two radiation therapists, respectively. RESULTS Lipiodol-glue combinations were successfully administered as multiple fiducials that were evident on CT and CBCT. Lipiodol with Histoacryl or Glubran2 was visible on kV imaging. The Lipiodol Glubran2 combination was deemed subjectively easiest to use at delivery, and a better fiducial on KV imaging. CONCLUSION This study demonstrates the feasibility of mixing contrast medium Lipiodol with Histoacryl or Glubran2 tissue glue, which, injected endoscopically, provides discrete and visible fiducial markers to aid image-guided radiotherapy. Although promising, further study is required to assess the durability of these markers through a course of radiotherapy.
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Affiliation(s)
- Catriona Duncan
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia.,The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trish Jenkins
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | | | | | - Michael Chao
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Marita Lawlor
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Rachel O'Meara
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Colleen Berry
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Angela Viotto
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Kerryn Brown
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newtown-John Cancer Centre, Austin Health, Melbourne, VIC, Australia.,Olivia Newtown-John Cancer Research Institute, Austin Hospital, Melbourne, VIC, Australia
| | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia. .,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
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7
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Picardi C, Perret I, Miralbell R, Zilli T. Hypofractionated radiotherapy for prostate cancer in the postoperative setting: What is the evidence so far? Cancer Treat Rev 2018; 62:91-96. [DOI: 10.1016/j.ctrv.2017.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
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BioXmark for high-precision radiotherapy in an orthotopic pancreatic tumor mouse model : Experiences with a liquid fiducial marker. Strahlenther Onkol 2017; 193:1039-1047. [PMID: 28808749 DOI: 10.1007/s00066-017-1193-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/28/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE High-precision radiotherapy (RT) requires precise positioning, particularly with high single doses. Fiducial markers in combination with onboard imaging are excellent tools to support this. The purpose of this study is to establish a pancreatic cancer mouse model for high-precision image-guided RT (IGRT) using the liquid fiducial marker BioXmark (Nanovi, Kongens Lyngby, Denmark). METHODS In an animal-based cancer model, different volumes of BioXmark (10-50 µl), application forms, and imaging modalities-cone-beam computer tomography (CBCT) incorporated in either the Small Animal Radiation Research Platform (SARRP) or the small-animal micro-CT Scanner (SkyScan; Bruker, Brussels, Belgium)-as well as subsequent RT with the SARRP system were analyzed to derive recommendations for BioXmark. RESULTS Even small volumes (10 µl) of BioXmark could be detected by CBCT (SARRP and Skyscan). Larger volumes (50 µl) led to hardening artefacts. The position of BioXmark was monitored at least weekly by CBCT and was stable over 4 months. BioXmark was shown to be well tolerated; no changes in physical condition or toxic side effects were observed in comparison to control mice. BioXmark enabled an exact fusion with the original treatment plan with less hardening artefacts, and minimized the application of contrast agent for fractionated RT. CONCLUSION An orthotopic pancreatic tumor mouse model was established for high-precision IGRT using a fiducial marker. BioXmark was successfully tested and provides the perfect basis for improved imaging in high-precision RT. BioXmark enables a unique application method and optimal targeted precision in fractionated RT. Therefore, preclinical trials evaluating novel fractionation regimens and/or combination treatment with high-end RT can be performed.
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Chin S, Aherne NJ, Last A, Assareh H, Shakespeare TP. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines. J Med Imaging Radiat Oncol 2017. [PMID: 28623847 DOI: 10.1111/1754-9485.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. METHODS Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. RESULTS Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. CONCLUSIONS Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT.
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Affiliation(s)
- Stephen Chin
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Hassan Assareh
- Department of Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
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10
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Abuodeh YA, Naghavi AO, Juan TH, Ma Z, Wilder RB. Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses. Int Braz J Urol 2017; 43:628-637. [PMID: 28379660 PMCID: PMC5557437 DOI: 10.1590/s1677-5538.ibju.2016.0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant” setting starting within 4 months of radical prostatectomy for adverse features; and “salvage” setting for a PSA≥0.2ng/mL. Materials and Methods Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively. Results Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively). Conclusions There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.
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Affiliation(s)
- Yazan A Abuodeh
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Tzu-Hua Juan
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Zhenjun Ma
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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11
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Vilotte F, Antoine M, Bobin M, Latorzeff I, Supiot S, Richaud P, Thomas L, Leduc N, Guérif S, Iriondo-Alberdi J, de Crevoisier R, Sargos P. Post-Prostatectomy Image-Guided Radiotherapy: The Invisible Target Concept. Front Oncol 2017; 7:34. [PMID: 28337425 PMCID: PMC5343009 DOI: 10.3389/fonc.2017.00034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022] Open
Abstract
In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.
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Affiliation(s)
- Florent Vilotte
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Mickael Antoine
- Department of Medical Physics, Institut Bergonié , Bordeaux Cedex , France
| | - Maxime Bobin
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD, Clinique Pasteur , Toulouse , France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest René Gauducheau , Nantes , France
| | - Pierre Richaud
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Laurence Thomas
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Nicolas Leduc
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
| | - Stephane Guérif
- Department of Radiotherapy, CHU de Poitier , Poitiers , France
| | | | | | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié , Bordeaux Cedex , France
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Fourie N, Ali OA, Rae WID. Development and verification of a time delivery model for prostate intensity modulated radiotherapy using a Siemens® Artiste™ 160 Multi-leaf Collimator Linac. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:51-56. [DOI: 10.1007/s13246-016-0518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022]
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Prostate bed target interfractional motion using RTOG consensus definitions and daily CT on rails : Does target motion differ between superior and inferior portions of the clinical target volume? Strahlenther Onkol 2016; 193:38-45. [PMID: 27909738 DOI: 10.1007/s00066-016-1077-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Using high-quality CT-on-rails imaging, the daily motion of the prostate bed clinical target volume (PB-CTV) based on consensus Radiation Therapy Oncology Group (RTOG) definitions (instead of surgical clips/fiducials) was studied. It was assessed whether PB motion in the superior portion of PB-CTV (SUP-CTV) differed from the inferior PB-CTV (INF-CTV). PATIENTS AND METHODS Eight pT2-3bN0-1M0 patients underwent postprostatectomy intensity-modulated radiotherapy, totaling 300 fractions. INF-CTV and SUP-CTV were defined as PB-CTV located inferior and superior to the superior border of the pubic symphysis, respectively. Daily pretreatment CT-on-rails images were compared to the planning CT in the left-right (LR), superoinferior (SI), and anteroposterior (AP) directions. Two parameters were defined: "total PB-CTV motion" represented total shifts from skin tattoos to RTOG-defined anatomic areas; "PB-CTV target motion" (performed for both SUP-CTV and INF-CTV) represented shifts from bone to RTOG-defined anatomic areas (i. e., subtracting shifts from skin tattoos to bone). RESULTS Mean (± standard deviation, SD) total PB-CTV motion was -1.5 (± 6.0), 1.3 (± 4.5), and 3.7 (± 5.7) mm in LR, SI, and AP directions, respectively. Mean (± SD) PB-CTV target motion was 0.2 (±1.4), 0.3 (±2.4), and 0 (±3.1) mm in the LR, SI, and AP directions, respectively. Mean (± SD) INF-CTV target motion was 0.1 (± 2.8), 0.5 (± 2.2), and 0.2 (± 2.5) mm, and SUP-CTV target motion was 0.3 (± 1.8), 0.5 (± 2.3), and 0 (± 5.0) mm in LR, SI, and AP directions, respectively. No statistically significant differences between INF-CTV and SUP-CTV motion were present in any direction. CONCLUSION There are no statistically apparent motion differences between SUP-CTV and INF-CTV. Current uniform planning target volume (PTV) margins are adequate to cover both portions of the CTV.
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Shakir SI, Udrescu C, Enachescu C, Rouviere O, Arion S, Caraivan I, Chapet O. Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences. Phys Med 2016; 32:1422-1427. [PMID: 27810195 DOI: 10.1016/j.ejmp.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE The objective of the study was to verify the stability of gold markers in the prostatic bed (PB) during salvage radiotherapy. MATERIAL AND METHODS Seven patients, diagnosed with a macroscopic nodule visible on MRI, underwent targeted MRI-guided biopsies. Three gold markers were implanted into the PB close to the relapsing nodule for CT/MRI fusion. A dose of 60Gy was delivered using IMRT to the PB followed by a dose escalation up to 72Gy to the macroscopic nodule. Daily anterior and left-lateral kV-images were acquired for repositioning. The coordinates of the center of each marker were measured on the two kV-images. The distance variations (Dvar) of the markers in the first session and the subsequent ones were compared. RESULTS No marker was lost during treatment. The average distance between markers was 7.8mm. The average Dvar was 0.8mm, in absolute value. A total of 380/528 (72%) Dvar were ⩽1mm. A Dvar greater than 2mm was observed in 5.7% of measurements, with a maximum value of 4.8mm. CONCLUSIONS Despite the absence of the prostate, the implantation of gold markers in the PB remains feasible, with Dvar often less than 2mm, and could be used to develop new approaches of salvage focal radiotherapy on the macroscopic relapse after prostatectomy.
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Affiliation(s)
- Shakir I Shakir
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Corina Udrescu
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France; Department of Medical Physics, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Benite, France
| | - Ciprian Enachescu
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Olivier Rouviere
- Department of Urological Radiology, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Simona Arion
- Department of Urological Radiology, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Ionela Caraivan
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - Olivier Chapet
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite, France.
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Prostate cancer treated with image-guided helical TomoTherapy® and image-guided LINAC-IMRT. Strahlenther Onkol 2016; 192:223-31. [DOI: 10.1007/s00066-015-0935-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
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Murray JR, McNair HA, Dearnaley DP. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care? Cancer Manag Res 2015; 7:331-44. [PMID: 26635484 PMCID: PMC4646477 DOI: 10.2147/cmar.s51955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.
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Affiliation(s)
- Julia R Murray
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Helen A McNair
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David P Dearnaley
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
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Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy. Strahlenther Onkol 2015; 191:801-9. [DOI: 10.1007/s00066-015-0872-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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