Per Munck af Rosenschöld1, Neil B Desai2, Jung Hun Oh3, Aditya Apte3, Margie Hunt3, Abraham Kalikstein2, James Mechalakos3, Laura Happersett3, Joseph O Deasy3, Michael J Zelefsky4. 1. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA; Department of Radiation Oncology, Radiation Medicine Research Center, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark. 2. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA. 3. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA. 4. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA. Electronic address: zelefskm@mskcc.org.
Abstract
PURPOSE: To investigate the influence of treatment plan data and image guidance (IG) on positioning uncertainty during prostate cancer (PCa) radiotherapy (RT). METHODS: Body mass index (BMI), planning target volume (PTV), bladder volume (BV), and rectal cross section area (RCS) were collected for 267 consecutive PCa patients undergoing daily IGRT. Radiographic isocenter corrections to intra-prostatic fiducials for 12,490 treatment fractions were used to derive random (RE) and systematic (SE) inter-fraction uncertainties for the cardinal axes. These data were used to simulate RE and SE for weekly IG and Action Level (AL)-IG treatment protocols. RESULTS: SE and RE were 2-5 and 3-4mm in the cardinal axes, respectively, during simulation of no IG. Without IG, positive correlations (p<0.01) were noted for (1) anterior-posterior RE vs. RCS and BV and (2) cranio-caudal RE vs. RCS, BV and BMI. The RE increase was 3mm for the highest quartile of RCS, BV and BMI. Daily IGRT eliminated this relationship. 3D IG corrections of 1cm or more occured in 27% of treatment fractions and in 97% of patients. CONCLUSION: PCa patients with elevated pre-treatment BV, RCS and BMI have increased inter-fractionation positioning uncertainty and appear the primary candidates for daily IGRT.
PURPOSE: To investigate the influence of treatment plan data and image guidance (IG) on positioning uncertainty during prostate cancer (PCa) radiotherapy (RT). METHODS: Body mass index (BMI), planning target volume (PTV), bladder volume (BV), and rectal cross section area (RCS) were collected for 267 consecutive PCa patients undergoing daily IGRT. Radiographic isocenter corrections to intra-prostatic fiducials for 12,490 treatment fractions were used to derive random (RE) and systematic (SE) inter-fraction uncertainties for the cardinal axes. These data were used to simulate RE and SE for weekly IG and Action Level (AL)-IG treatment protocols. RESULTS: SE and RE were 2-5 and 3-4mm in the cardinal axes, respectively, during simulation of no IG. Without IG, positive correlations (p<0.01) were noted for (1) anterior-posterior RE vs. RCS and BV and (2) cranio-caudal RE vs. RCS, BV and BMI. The RE increase was 3mm for the highest quartile of RCS, BV and BMI. Daily IGRT eliminated this relationship. 3D IG corrections of 1cm or more occured in 27% of treatment fractions and in 97% of patients. CONCLUSION: PCa patients with elevated pre-treatment BV, RCS and BMI have increased inter-fractionation positioning uncertainty and appear the primary candidates for daily IGRT.
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