Quantifying dose perturbations in high-risk prostate radiotherapy due to translational and rotational motion of prostate and pelvic lymph nodes.
high‐risk prostate motion
intrafraction motion management
prostate cancer
real‐time dose reconstruction
Journal
Medical physics
ISSN: 2473-4209
Titre abrégé: Med Phys
Pays: United States
ID NLM: 0425746
Informations de publication
Date de publication:
06 Sep 2024
06 Sep 2024
Historique:
revised:
06
06
2024
received:
16
01
2024
accepted:
29
07
2024
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
6
9
2024
Statut:
aheadofprint
Résumé
Radiotherapy of the prostate and the pelvic lymph nodes (LN) is a part of the standard of care treatment for high-risk prostate cancer. The independent translational and rotational (i.e., six-degrees-of-freedom, [6DoF]) motion of the prostate and LN target during and between fractions can perturb the dose distribution. However, no standard dose reconstruction method accounting for differential 6DoF target motion is available. We present a framework for monitoring motion-induced dose perturbations for two independently moving target volumes in 6DoF. The framework was used to determine the dose perturbation for the prostate and the LN target caused by differential 6DoF motion for a cohort of high-risk prostate cancer patients. As a potential first step toward real-time dose-guided high-risk prostate radiotherapy, we furthermore investigated if the dose reconstruction was fast enough for real-time application for both targets. Twenty high-risk prostate cancer patients were treated with 3-arc volumetric modulated arc therapy (VMAT). Kilovoltage intrafraction monitoring (KIM) with triggered kilovoltage (kV) images acquired every 3 throughout 7-10 fractions per patient was used for retrospective 6DoF intrafraction prostate motion estimation. The 6DoF interfraction LN motion was determined from a pelvic bone match between the planning CT and a post-treatment cone beam CT (CBCT). Using the retrospectively extracted motion, real-time 6DoF motion-including dose reconstruction was simulated using the in-house developed software DoseTracker. A data stream with the 6DoF target positions and linac parameters was broadcasted at a 3-Hz frequency to DoseTracker. In a continuous loop, DoseTracker calculated the target dose increments including the specified motion and, for comparison, without motion. The motion-induced change in D Translational motion was largest in cranio-caudal (CC) direction (prostate: [-5.9, +8.4] mm; LN: [-9.9; +11.0] mm) and anterior-posterior (AP) direction (prostate:[-5.6; +6.9] mm; LN: [-9.6; +11.0] mm). The pitch was the largest rotation (prostate: [-22.5; +25.2] deg; LN: [-3.9; +5.5] deg). The prostate CTV ΔD Using the developed framework for dose perturbation monitoring, we found that the differential 6DoF target motion caused substantial dose perturbation for individual fractions, which largely averaged out after several fractions. The framework was shown to provide reliable dose calculations and a sufficiently high-dose reconstruction speed to be applicable in real-time.
Sections du résumé
BACKGROUND
BACKGROUND
Radiotherapy of the prostate and the pelvic lymph nodes (LN) is a part of the standard of care treatment for high-risk prostate cancer. The independent translational and rotational (i.e., six-degrees-of-freedom, [6DoF]) motion of the prostate and LN target during and between fractions can perturb the dose distribution. However, no standard dose reconstruction method accounting for differential 6DoF target motion is available.
PURPOSE
OBJECTIVE
We present a framework for monitoring motion-induced dose perturbations for two independently moving target volumes in 6DoF. The framework was used to determine the dose perturbation for the prostate and the LN target caused by differential 6DoF motion for a cohort of high-risk prostate cancer patients. As a potential first step toward real-time dose-guided high-risk prostate radiotherapy, we furthermore investigated if the dose reconstruction was fast enough for real-time application for both targets.
METHODS
METHODS
Twenty high-risk prostate cancer patients were treated with 3-arc volumetric modulated arc therapy (VMAT). Kilovoltage intrafraction monitoring (KIM) with triggered kilovoltage (kV) images acquired every 3 throughout 7-10 fractions per patient was used for retrospective 6DoF intrafraction prostate motion estimation. The 6DoF interfraction LN motion was determined from a pelvic bone match between the planning CT and a post-treatment cone beam CT (CBCT). Using the retrospectively extracted motion, real-time 6DoF motion-including dose reconstruction was simulated using the in-house developed software DoseTracker. A data stream with the 6DoF target positions and linac parameters was broadcasted at a 3-Hz frequency to DoseTracker. In a continuous loop, DoseTracker calculated the target dose increments including the specified motion and, for comparison, without motion. The motion-induced change in D
RESULTS
RESULTS
Translational motion was largest in cranio-caudal (CC) direction (prostate: [-5.9, +8.4] mm; LN: [-9.9; +11.0] mm) and anterior-posterior (AP) direction (prostate:[-5.6; +6.9] mm; LN: [-9.6; +11.0] mm). The pitch was the largest rotation (prostate: [-22.5; +25.2] deg; LN: [-3.9; +5.5] deg). The prostate CTV ΔD
CONCLUSION
CONCLUSIONS
Using the developed framework for dose perturbation monitoring, we found that the differential 6DoF target motion caused substantial dose perturbation for individual fractions, which largely averaged out after several fractions. The framework was shown to provide reliable dose calculations and a sufficiently high-dose reconstruction speed to be applicable in real-time.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.
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