PURPOSE: We have tested a procedure of focal injection of the contrast medium Lipiodol as a fiducial marker for image-guided boost of the tumor in bladder cancer radiotherapy (RT). In this study, we have evaluated the feasibility and the safety of the method as well as the inter- and intra-fraction shift of the bladder tumor. MATERIALS AND METHODS: Five patients with muscle invasive urinary bladder cancer were included in the study. Lipiodol was injected during flexible cystoscopy into the submucosa of the bladder wall at the periphery of the tumor or the post resection tumor-bed. Cone-beam CT (CBCT) scans were acquired daily throughout the course of RT. RESULTS: Lipiodol demarcation of the bladder tumor was feasible and safe with only a minimum of side effects related to the procedure. The Lipiodol spots were visible on CT and CBCT scans for the duration of the RT course. More than half of all the treatment fractions required a geometric shift of 5 mm or more to match on the Lipiodol spots. The mean intra-fraction shift (3D) of the tumor was 3 mm, largest in the anterior-posterior and cranial-caudal directions. CONCLUSION: This study demonstrates that Lipiodol can be injected into the bladder mucosa and subsequently visualized on CT and CBCT as a fiducial marker. The relatively large inter-fraction shifts in the positions of Lipiodol spots compared to the intra-fraction movement indicates that image-guided RT based on radio-opaque markers is important for RT of the bladder cancer tumor.
PURPOSE: We have tested a procedure of focal injection of the contrast medium Lipiodol as a fiducial marker for image-guided boost of the tumor in bladder cancer radiotherapy (RT). In this study, we have evaluated the feasibility and the safety of the method as well as the inter- and intra-fraction shift of the bladder tumor. MATERIALS AND METHODS: Five patients with muscle invasive urinary bladder cancer were included in the study. Lipiodol was injected during flexible cystoscopy into the submucosa of the bladder wall at the periphery of the tumor or the post resection tumor-bed. Cone-beam CT (CBCT) scans were acquired daily throughout the course of RT. RESULTS:Lipiodol demarcation of the bladder tumor was feasible and safe with only a minimum of side effects related to the procedure. The Lipiodol spots were visible on CT and CBCT scans for the duration of the RT course. More than half of all the treatment fractions required a geometric shift of 5 mm or more to match on the Lipiodol spots. The mean intra-fraction shift (3D) of the tumor was 3 mm, largest in the anterior-posterior and cranial-caudal directions. CONCLUSION: This study demonstrates that Lipiodol can be injected into the bladder mucosa and subsequently visualized on CT and CBCT as a fiducial marker. The relatively large inter-fraction shifts in the positions of Lipiodol spots compared to the intra-fraction movement indicates that image-guided RT based on radio-opaque markers is important for RT of the bladder cancer tumor.
Authors: Adham Hijab; Boris Tocco; Ian Hanson; Hanneke Meijer; Christina Junker Nyborg; Anders Smedegaard Bertelsen; Robert Jan Smeenk; Gillian Smith; Jeff Michalski; Brian C Baumann; Shaista Hafeez Journal: Front Oncol Date: 2021-02-25 Impact factor: 6.244
Authors: Duncan den Boer; Mariska D den Hartogh; Alexis N T J Kotte; Jochem R N van der Voort van Zyp; Juus L Noteboom; Gijsbert H Bol; Thomas Willigenburg; Anita M Werensteijn-Honingh; Ina M Jürgenliemk-Schulz; Astrid L H M W van Lier; Petra S Kroon Journal: Phys Imaging Radiat Oncol Date: 2021-11-20
Authors: Matthew D Greer; Stephanie K Schaub; Stephen R Bowen; Jay J Liao; Kenneth Russell; Jonathan J Chen; Emily S Weg; Juergen Meyer; Tristan Alving; George R Schade; John L Gore; Sarah P Psutka; Robert B Montgomery; Michael Schweizer; Evan Y Yu; Petros Grivas; Jonathan L Wright; Jing Zeng Journal: Adv Radiat Oncol Date: 2021-11-21
Authors: Mischa de Ridder; Lara C Gerbrandy; Theo M de Reijke; Karel A Hinnen; Maarten C C M Hulshof Journal: Br J Radiol Date: 2020-06-01 Impact factor: 3.039
Authors: Maurice M Garcia; Alexander R Gottschalk; Jonathan Brajtbord; Badrinath R Konety; Maxwell V Meng; Mack Roach; Peter R Carroll Journal: PLoS One Date: 2014-03-03 Impact factor: 3.240