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Evaluation of target volume margins for radiotherapy of prostate implanted with fiducial markers

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Abstract

The planning target volume (PTV) depends on the method of radiotherapy guidance. This study aimed to measure the systemic and random errors using an online marker matching and offline bone structure matching to estimate PTVmarker, PTVbone, or PTVlaser for treatment verification and radiotherapy guidance, especially in centers lacking radiotherapy fiducial markers (FMs). Thirty patients with localized prostate cancer who were treated with FM-based dose escalation protocol were included. The initial set-up was done with laser marks and daily megavoltage images were acquired. The systematic and random errors were calculated. PTVmarker, defined as the sum of maximum marker migration, and PTV calculated to compensate for the difference between online marker matching and offline analysis of marker matching. PTVmarker was added to estimated PTV from online marker matching to obtain PTVlaser. PTVskin marks migration, was calculated and deducted from PTVlaser to acquire PTVbone. The mean maximum marker migration was 2 ± 1.2 mm. The resultant values of PTVmarker were 2.7 ± 0.6 mm, 3.3 ± 1.1 mm, and 4.4 ± 2.2 mm, in the lateral (lat.), longitudinal (long) & vertical (vert.) directions, respectively, whereas values of PTVlaser were 13 ± 0.6 mm, 17.7 ± 1.1 mm, and 15.8 ± 2.2 mm, and PTVbone were 5.9 ± 0.6 mm, 8.6 ± 1.1 mm, 7.2 ± 2.2 mm, respectively, in the lat., long., and vert. directions. Our results show that PTV needed with FM-based image guidance ranged between 3 and 4 mm in the three cardinal directions, was 10 mm smaller than that required with laser skin marks guidance, and narrower by 5 mm compared to that obtained by offline bone structure image matching.

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References

  1. Huang SH, Catton C, Jezioranski J, Bayley A, Rose S, Rosewall T. The effect of changing technique, dose, and PTV margin on therapeutic ratio during prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2008;71(4):1057–64. https://www.ncbi.nlm.nih.gov/pubmed/18339487

    Article  Google Scholar 

  2. Ariyaratne H, Chesham H, Pettingell J, Alonzi R. Image-guided radiotherapy for prostate cancer with cone beam CT: dosimetric effects of imaging frequency and PTV margin. Radiother Oncol. 2016;121(1):103–8. https://www.ncbi.nlm.nih.gov/pubmed/27576431

    Article  Google Scholar 

  3. Gill SK, Reddy K, Campbell N, Chen C, Pearson D. Determination of optimal PTV margin for patients receiving CBCT-guided prostate IMRT: comparative analysis based on CBCT dose calculation with four different margins. J Appl Clin Med Phys. 2015;16(6):252–262. https://www.ncbi.nlm.nih.gov/pubmed/26699581

    Article  Google Scholar 

  4. Moseley DJ, White EA, Wiltshire KL, Rosewall T, Sharpe MB, Siewerdsen JH, et al. Comparison of localization performance with implanted fiducial markers and cone-beam computed tomography for on-line image-guided radiotherapy of the prostate. Int J Radiat Oncol Biol Phys. 2007;67(3):942–53. https://www.ncbi.nlm.nih.gov/pubmed/17293243

    Article  Google Scholar 

  5. Barney BM, Lee RJ, Handrahan D, Welsh KT, Cook JT, Sause WT. Image-guided radiotherapy (IGRT) for prostate cancer comparing kV imaging of fiducial markers with cone beam computed tomography (CBCT). Int J Radiat Oncol Biol Phys. 2011;80(1):301–5. https://www.ncbi.nlm.nih.gov/pubmed/20864274

    Article  Google Scholar 

  6. Skarsgard D, Cadman P, El-Gayed A, Pearcey R, Tai P, Pervez N, et al. Planning target volume margins for prostate radiotherapy using daily electronic portal imaging and implanted fiducial markers. Radiat Oncol. 2010;5:52. https://www.ncbi.nlm.nih.gov/pubmed/20537161

  7. O’Neill AGM, Jain S, Hounsell AR, O’Sullivan JM. Fiducial marker guided prostate radiotherapy: a review. Br J Radiol. 2016;89(1068):20160296. https://www.ncbi.nlm.nih.gov/pubmed/27585736

    Article  Google Scholar 

  8. Colleen AF, Lawton MD. 2019. https://www.rtog.org/CoreLab/ContouringAtlases.aspx. Accessed 16 Mar 2020

  9. Hammoud R, Patel SH, Pradhan D, Kim J, Guan H, Li S, et al. Examining margin reduction and its impact on dose distribution for prostate cancer patients undergoing daily cone-beam computed tomography. Int J Radiat Oncol Biol Phys. 2008;71(1):265–73. https://www.ncbi.nlm.nih.gov/pubmed/18406890

    Article  Google Scholar 

  10. Bentzen SM, Constine LS, Deasy JO, Eisbruch A, Jackson A, Marks LB, et al. Quantitative analyses of normal tissue effects in the clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S3–9.

    Article  Google Scholar 

  11. Vetterli D, Thalmann S, Behrensmeier F, Kemmerling L, Born EJ, Mini R, et al. Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode. Radiother Oncol. 2006;79(1):101–8. https://www.ncbi.nlm.nih.gov/pubmed/16621076

    Article  Google Scholar 

  12. The Royal college of Radiologist, Institute of Physics & Engineering in Medicine S& college of R. Deviation of systematic and random set up errors and relationship the CTV to the PTV margin. In: On target: ensuring geometric accuracy in radiotherapy. 2008. p. 29-30/76.

  13. van Herk M, Remeijer P, Rasch C, Lebesque JV. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47(4):1121–35. https://www.ncbi.nlm.nih.gov/pubmed/10863086

  14. https://www.rtog.org/ResearchAssociates/AdverseEventReporting/CooperativeGroupCommonToxicityCriteria.aspx. Accessed 16 Mar 2020

  15. Tiberi DA, Carrier JF, Beauchemin MC, Nguyen TV, Béliveau-Nadeau DTD. Impact of concurrent androgen deprivation on fiducial marker migration in external-beam radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84(1):e7.

    Article  Google Scholar 

  16. Delouya G, Carrier J-F, Béliveau-Nadeau D, Donath D, Taussky D. Migration of intraprostatic fiducial markers and its influence on the matching quality in external beam radiation therapy for prostate cancer. Radiother Oncol. 2010;96(1):43–7. https://www.ncbi.nlm.nih.gov/pubmed/20378191

    Article  Google Scholar 

  17. Cendales R, Torres F, Arbelaez J, Gaitan A, Vasquez J, Bobadilla I. Displacements of fiducial markers in patients with prostate cancer treated with image guided radiotherapy: A single-institution descriptive study. Reports Pract Oncol Radiother J Gt Cancer Cent Pozn Polish Soc Radiat Oncol. 2015;20(1):38–42. https://www.ncbi.nlm.nih.gov/pubmed/25535583

    Article  Google Scholar 

  18. Dehnad H, Nederveen AJ, van der Heide UA, van Moorselaar RJA, Hofman P, Lagendijk JJW. Clinical feasibility study for the use of implanted gold seeds in the prostate as reliable positioning markers during megavoltage irradiation. Radiother Oncol. 2003;67(3):295–302. https://www.ncbi.nlm.nih.gov/pubmed/12865177

    Article  Google Scholar 

  19. Meijer GJ, de Klerk J, Bzdusek K, van den Berg HA, Janssen R, Kaus MR, et al. What CTV-to-PTV margins should be applied for prostate irradiation? Four-dimensional quantitative assessment using model-based deformable image registration techniques. Int J Radiat Oncol Biol Phys. 2008;72(5):1416–25. https://www.ncbi.nlm.nih.gov/pubmed/18439767

    Article  Google Scholar 

  20. Johnston ML, Vial P, Wiltshire KL, Bell LJ, Blome S, Kerestes Z, et al. Daily online bony correction is required for prostate patients without fiducial markers or soft-tissue imaging. Clin Oncol (R Coll Radiol). 2011;23(7):454–9. https://www.ncbi.nlm.nih.gov/pubmed/21470835

    Article  CAS  Google Scholar 

  21. McNair HA, Hansen VN, Parker CC, Evans PM, Norman A, Miles E, et al. A comparison of the use of bony anatomy and internal markers for offline verification and an evaluation of the potential benefit of online and offline verification protocols for prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2008;71(1):41–50. https://www.ncbi.nlm.nih.gov/pubmed/17996391

    Article  Google Scholar 

  22. Law G, Leung R, Lee F, Luk H, Lee KC, Wong F, et al. Effectiveness of a Patient-Specific Immobilization and Positioning System to Limit Interfractional Translation and Rotation Setup Errors in Radiotherapy of Prostate Cancers. Int J Med Physics, Clin Eng Radiat Oncol. 2016;05(03):184–95. https://www.scirp.org/journal/doi.aspx? 10.4236/ijmpcero.2016.53020

    Article  Google Scholar 

  23. Kaiser A, Schultheiss TE, Wong JYC, Smith DD, Han C, Vora NL, et al. Pitch, roll, and yaw variations in patient positioning. Int J Radiat Oncol Biol Phys. 2006;66(3):949–55. https://www.ncbi.nlm.nih.gov/pubmed/16949765

    Article  Google Scholar 

  24. Adamczyk M, Piotrowski T, Adamiak E. Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients. Reports Pract Oncol Radiother J Gt Cancer Cent Pozn Polish Soc Radiat Oncol. 2012;17(2):104–9. https://www.ncbi.nlm.nih.gov/pubmed/24377008

    Article  Google Scholar 

  25. Salas Buzón M del C, Gutiérrez Bayard L, Lagares-Franco C, de Ingunza Barón L. Image-guided radiotherapy using MV for prostate cancer: a correlation analysis between electronic portal imaging with Fiducial markers and cone beam CT. J Adv Radiol Med Imaging. 2016;1(1):1–10.

  26. Dzierma Y, Beyhs M, Palm J, Niewald M, Bell K, Nuesken F, et al. Set-up errors and planning margins in planar and CBCT image-guided radiotherapy using three different imaging systems: a clinical study for prostate and head-and-neck cancer. Phys Med. 2015;31(8):1055–9. https://doi.org/10.1016/j.ejmp.2015.09.002.

    Article  PubMed  Google Scholar 

  27. van Haaren PMA, Bel A, Hofman P, van Vulpen M, Kotte ANTJ, van der Heide UA. Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients. Radiother Oncol. 2009;90(3):291–8. https://www.ncbi.nlm.nih.gov/pubmed/19195732

  28. Hatton JA, Greer PB, Tang C, Wright P, Capp A, Gupta S, et al. Does the planning dose-volume histogram represent treatment doses in image-guided prostate radiation therapy? Assessment with cone-beam computerised tomography scans. Radiother Oncol. 2011;98(2):162–8. https://www.ncbi.nlm.nih.gov/pubmed/21295873

    Article  Google Scholar 

  29. Kupelian PA, Langen KM, Zeidan OA, Meeks SL, Willoughby TR, Wagner TH, et al. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66(3):876–82. https://www.ncbi.nlm.nih.gov/pubmed/17011460

    Article  Google Scholar 

  30. Schild MH, Schild SE, Wong WW, Vora SA, Keole SR, Vargas CE, et al. A prospective trial of intensity modulated radiation therapy (IMRT) incorporating a simultaneous integrated boost for prostate cancer: long-term outcomes compared with standard image guided IMRT. Int J Radiat Oncol Biol Phys. 2017;97(5):1021–5.

    Article  Google Scholar 

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Acknowledgements

I want to acknowledge Dr. Samy El Serafy (Head of palliative care unit NEMROCK) & Dr. Ekram Hamed (Head of intervention radiology-NCI) for the great helps and generous supports to that work.

Funding

Kasr Al-Ainy School of Oncology Grant.

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Authors and Affiliations

  1. Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, 11562, Egypt

    Radwa Fawzy, Raafat Abdel-Malek & Ahmed Seleem

  2. Department of Dosimetry and Imaging, Radiotherapy Physics, NHS Trust, United Lincolnshire Hospitals, England, UK

    Mohamed Metwaly

  3. Department of Diagnostic and Intervention Radiology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt

    Omar Abdelaziz

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  1. Radwa Fawzy
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Correspondence to Radwa Fawzy.

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Fawzy, R., Abdel-Malek, R., Metwaly, M. et al. Evaluation of target volume margins for radiotherapy of prostate implanted with fiducial markers. Radiol Phys Technol 13, 152–159 (2020). https://doi.org/10.1007/s12194-020-00563-6

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