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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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Olivier J, Basson L, Puech P, Lacornerie T, Villers A, Wallet J, Lartigau E, Pasquier D. Stereotactic Re-irradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: Preliminary Results. Front Oncol 2019; 9:71. [PMID: 30828565 PMCID: PMC6384250 DOI: 10.3389/fonc.2019.00071] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/25/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives: To report the preliminary results of salvage re-irradiation in the prostatic bed after radical prostatectomy and salvage external beam radiation therapy (EBRT) using robotic stereotactic body radiation therapy (SBRT) with Cyberknife® for local recurrence of prostate cancer. Materials and Methods: Retrospective monocentric analysis was performed on patients treated with SBRT for isolated macroscopic recurrence in the prostatic bed. All patients had radical prostatectomy and salvage or adjuvant EBRT. Local recurrence was documented using magnetic resonance imaging (MRI) and positron emission tomography (PET). Biochemical recurrence was defined as 2 rises in prostate-specific antigen (PSA) of ≥ 0.2 ng/mL above nadir. Internal gold fiducials were used for the tracking of tumor motion during SBRT. The prescription dose was 36 Gy in 6 fractions for all patients. Toxicity was scored according to the CTCAE v4.0. Results: Between July 2011 and November 2017, 12 patients were treated with SBRT for prostatic bed recurrence with a median follow-up of 34.2 (range, 3.5–64.4) months. Isolated non-metastatic recurrence in the prostatic bed was seen at MRI and PET imaging. Two patients were treated with 6 months androgen deprivation therapy (ADT) concomitant with re-irradiation. The median planning target volume was 4.5 cm3 (range, 1.2–13.3). A PSA decrease after SBRT was found in 10 (83%) patients. The 1 and 2 years biochemical recurrence-free survival rates were 79 and 56%, respectively. Biochemical recurrence was observed for 6 patients (50%) after a median time of 18 (4-42) months. Toxicity showed: 3 patients (25%) with grade 1 cystitis and 1 patient (8%) with acute grade 2 proctitis at 4 months. One patient (13%) had grade 1 cystitis at 12 months. Conclusion: Re-irradiation for local recurrence in the prostatic bed using Cyberknife® after surgery and salvage or adjuvant EBRT is well-tolerated and associated with 2 years biochemical recurrence-free survival rates of 56%. Longer follow-up and larger series are necessary.
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Affiliation(s)
- Jonathan Olivier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,Department of Urology, CHU Lille, Lille, France
| | - Laurent Basson
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | | | | | - Jennifer Wallet
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL UMR CNRS 1189, Lille University, Villeneuve-d'Ascq, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL UMR CNRS 1189, Lille University, Villeneuve-d'Ascq, France
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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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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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Sá AC, Peres A, Pereira M, Coelho CM, Monsanto F, Macedo A, Lamas A. Evaluating deviations in prostatectomy patients treated with IMRT. Rep Pract Oncol Radiother 2016; 21:266-70. [DOI: 10.1016/j.rpor.2015.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022] Open
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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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Significance of image guidance to clinical outcomes for localized prostate cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:860639. [PMID: 25110701 PMCID: PMC4119732 DOI: 10.1155/2014/860639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/22/2014] [Indexed: 12/25/2022]
Abstract
Purpose. To compare toxicity profiles and biochemical tumor control outcomes between patients treated with image-guided intensity-modulated radiotherapy (IG-IMRT) and non-IGRT intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer. Materials and Methods. Between 2009 and 2012, 65 patients with localized prostate cancer were treated with IG-IMRT. This group of patients was retrospectively compared with a similar cohort of 62 patients who were treated between 2004 and 2009 with IMRT to the same dose without image guidance. Results. The median follow-up time was 4.8 years. The rectal volume receiving ≥40 and ≥70 Gy was significantly lower in the IG-IMRT group. Grade 2 and higher acute and late GI and GU toxicity rates were lower in IG-IMRT group, but there was no statistical difference. No significant improvement in biochemical control at 5 years was observed in two groups. In a Cox regression analysis identifying predictors for PSA relapse-free survival, only preradiotherapy PSA was significantly associated with biochemical control; IG-IMRT was not a statistically significant indicator. Conclusions. The use of image guidance in the radiation of prostate cancer at our institute did not show significant reduction in the rates of GI and GU toxicity and did not improve the biochemical control compared with IMRT.
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