CBCT evaluation of inter- and intra-fraction motions during prostate stereotactic body radiotherapy: a technical note.
Cone-Beam Computed Tomography
Fiducial Markers
Humans
Hyaluronic Acid
/ administration & dosage
Male
Organs at Risk
/ diagnostic imaging
Patient Positioning
Prostate
/ diagnostic imaging
Prostatic Neoplasms
/ diagnostic imaging
Radiosurgery
Radiotherapy Dosage
Radiotherapy, Image-Guided
Radiotherapy, Intensity-Modulated
Treatment Outcome
Bladder
Cone beam CT, motion
Organs at risk
Prostate cancer
Radiotherapy
Rectum
Stereotactic body radiotherapy
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
19 Apr 2020
19 Apr 2020
Historique:
received:
28
11
2019
accepted:
08
04
2020
entrez:
21
4
2020
pubmed:
21
4
2020
medline:
20
1
2021
Statut:
epublish
Résumé
In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of recto-prostatic spacer implantation. The present study aimed at assessing the inter- and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT). Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs. Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter- and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter- and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement. Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc. NCT02361515, February 11th, 2015.
Sections du résumé
BACKGROUND
BACKGROUND
In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of recto-prostatic spacer implantation. The present study aimed at assessing the inter- and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT).
METHODS
METHODS
Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs.
RESULTS
RESULTS
Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter- and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter- and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement.
CONCLUSION
CONCLUSIONS
Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc.
TRIAL REGISTRATION
BACKGROUND
NCT02361515, February 11th, 2015.
Identifiants
pubmed: 32307017
doi: 10.1186/s13014-020-01534-2
pii: 10.1186/s13014-020-01534-2
pmc: PMC7168857
doi:
Substances chimiques
Hyaluronic Acid
9004-61-9
Banques de données
ClinicalTrials.gov
['NCT02361515']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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