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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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La radiothérapie externe guidée par l’imagerie dans le cancer de la prostate ; comment, quand et pourquoi ? Cancer Radiother 2018; 22:586-592. [DOI: 10.1016/j.canrad.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022]
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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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Bell LJ, Cox J, Eade T, Rinks M, Herschtal A, Kneebone A. Determining optimal planning target volume and image guidance policy for post-prostatectomy intensity modulated radiotherapy. Radiat Oncol 2015. [PMID: 26209446 PMCID: PMC4514953 DOI: 10.1186/s13014-015-0467-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited information available on the optimal Planning Target Volume (PTV) expansions and image guidance for post-prostatectomy intensity modulated radiotherapy (PP-IMRT). As the prostate bed does not move in a uniform manner, there is a rationale for anisotropic PTV margins with matching to soft tissue. The aim of this study is to find the combination of PTV expansion and image guidance policy for PP-IMRT that provides the best balance of target coverage whilst minimising dose to the organs at risk. METHODS The Cone Beam CT (CBCT) images (n = 377) of 40 patients who received PP-IMRT with daily online alignment to bony anatomy (BA) were reviewed. Six different PTV expansions were assessed: 3 published PTV expansions (0.5 cm uniform, 1 cm uniform, and 1 + 0.5 cm posterior) and 3 further anisotropic PTV expansions (Northern Sydney Cancer Centre (NSCC), van Herk, and smaller anisotropic). Each was assessed for size, bladder and rectum coverage and geographic miss. Each CBCT was rematched using a superior soft tissue (SST) and averaged soft tissue (AST) match. Potential geographic miss was assessed using all PTV expansions except the van Herk margin. RESULTS The 0.5 cm uniform expansion yielded the smallest PTV (median volume = 222.3 cc) and the 1 cm uniform expansion yielded the largest (361.7 cc). The Van Herk expansion includes the largest amount of bladder (28.0 %) and rectum (36.0 %) and the 0.5 cm uniform expansion the smallest (17.1 % bladder; 10.2 % rectum). The van Herk PTV expansion had the least geographic miss with BA matching (4.2 %) and the 0.5 cm uniform margin (28.4 %) the greatest. BA matching resulted in the highest geographic miss rate for all PTVs, followed by SST matching and AST matching. Changing from BA to an AST match decreases potential geographic miss by half to two thirds, depending on the PTV expansion, to <10 % for all PTV expansions. When using the smaller anisotropic PTV expansion, AST matching would reduce the geographic miss rate from 21.0 % with BA matching down to 5.6 %. CONCLUSIONS Our results suggest the optimal PTV expansion and image guidance policy for PP-IMRT is daily average soft tissue matching using CBCT scans with a small anisotropic PTV expansion of 0.5 cm in all directions apart from a 1 cm expansion in the anterior-posterior direction in the upper prostate bed. Care must be taken to ensure adequate training of Radiation Therapists to perform soft tissue matching with CBCT scans.
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Affiliation(s)
- Linda J Bell
- Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia. .,Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia.
| | - Jennifer Cox
- Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Thomas Eade
- Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Marianne Rinks
- Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Present address: Radiation Oncology, Shoalhaven Cancer Care Centre, Illawarra Shoalhaven Local Health District, Nowra, NSW, Australia
| | - Alan Herschtal
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Andrew Kneebone
- Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
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Bell LJ, Cox J, Eade T, Rinks M, Kneebone A. Prostate bed motion may cause geographic miss in post-prostatectomy image-guided intensity-modulated radiotherapy. J Med Imaging Radiat Oncol 2013; 57:725-32. [PMID: 24283563 DOI: 10.1111/1754-9485.12089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is little data to guide radiation oncologists on appropriate margin selection in the post-prostatectomy setting. The aim of this study was to quantify interfraction variation in motion of the prostate bed to determine these margins. METHODS The superior and inferior surgical clips in the prostate bed were tracked on pretreatment cone beam CT images (n = 377) for 40 patients who had received post-prostatectomy radiotherapy. Prostate bed motion was calculated for the upper and lower segments by measuring the position of surgical clips located close to midline relative to bony anatomy in the axial (translational) and sagittal (tilt) planes. The frequency of potential geographic misses was calculated for either 1 cm or 0.5 cm posterior planning target volume margins. RESULTS The mean magnitude of movement of the prostate bed in the anterior-posterior, superior-inferior and left-right planes, respectively, were as follows: upper portion, 0.50 cm, 0.28 cm, 0.10 cm; lower portion, 0.18 cm, 0.18 cm, 0.08 cm. The random and systematic errors, respectively, of the prostate bed motion in the anterior-posterior, superior-inferior and left-right planes, respectively, were as follows: upper portion, 0.47 cm and 0.50 cm, 0.28 cm and 0.27 cm, 0.11 cm and 0.11 cm; lower portion, 0.17 cm and 0.18 cm, 0.17 cm and 0.19 cm, 0.08 cm and 0.10 cm. Most geographic misses occurred in the upper prostate bed in the anterior-posterior plane. The median prostate bed tilt was 1.8° (range -23.4° to 42.3°). CONCLUSIONS Variability was seen in all planes for the movement of both surgical clips. The greatest movement occurred in the anterior-posterior plane in the upper prostate bed, which could cause geographic miss of treatment delivery. The variability in the movement of the superior and inferior clips indicates a prostate bed tilt that would be difficult to correct with standard online matching techniques. This creates a strong argument for using anisotropic planning target volume margins in post-prostatectomy radiotherapy.
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Affiliation(s)
- Linda J Bell
- Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, Australia; Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Cavalieri R, Gay HA, Liu J, Ferreira MC, Mota HC, Sibata CH, Allison RR. Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed. Radiat Oncol 2011; 6:142. [PMID: 22024279 PMCID: PMC3220642 DOI: 10.1186/1748-717x-6-142] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/24/2011] [Indexed: 11/14/2022] Open
Abstract
Background To evaluate the daily total error shift patterns on post-prostatectomy patients undergoing image guided radiotherapy (IGRT) with a diagnostic quality computer tomography (CT) on rails system. Methods A total of 17 consecutive post-prostatectomy patients receiving adjuvant or salvage IMRT using CT-on-rails IGRT were analyzed. The prostate bed's daily total error shifts were evaluated for a total of 661 CT scans. Results In the right-left, cranial-caudal, and posterior-anterior directions, 11.5%, 9.2%, and 6.5% of the 661 scans required no position adjustments; 75.3%, 66.1%, and 56.8% required a shift of 1 - 5 mm; 11.5%, 20.9%, and 31.2% required a shift of 6 - 10 mm; and 1.7%, 3.8%, and 5.5% required a shift of more than 10 mm, respectively. There was evidence of correlation between the x and y, x and z, and y and z axes in 3, 3, and 3 of 17 patients, respectively. Univariate (ANOVA) analysis showed that the total error pattern was random in the x, y, and z axis for 10, 5, and 2 of 17 patients, respectively, and systematic for the rest. Multivariate (MANOVA) analysis showed that the (x,y), (x,z), (y,z), and (x, y, z) total error pattern was random in 5, 1, 1, and 1 of 17 patients, respectively, and systematic for the rest. Conclusions The overall daily total error shift pattern for these 17 patients simulated with an empty bladder, and treated with CT on rails IGRT was predominantly systematic. Despite this, the temporal vector trends showed complex behaviors and unpredictable changes in magnitude and direction. These findings highlight the importance of using daily IGRT in post-prostatectomy patients.
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Affiliation(s)
- Ronaldo Cavalieri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
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